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Resistance Is Fruitful: 'Smart' Brace Retrains Injured Joints
NY Times ^ | October 7, 2004 | ANNE EISENBERG

Posted on 10/07/2004 10:17:13 PM PDT by neverdem

WHAT'S NEXT

In mint condition, the knee is a biomechanical marvel, an intricately linked interaction of bones, ligaments, tendons and cartilage that produces smooth, stable motion.

But as professional athletes and weekend exercisers know only too well, the knee is also a classic weak spot, vulnerable to damage and slow to heal. Strengthening it after injury or surgery may require hours on the bulky machines of a hospital or gym.

Now a mechanical engineer at Northeastern University has devised a small portable device that people may be able to strap onto their knees to rehabilitate them as they walk around doing daily chores.

The device is an adaptation of a standard off-the-shelf knee brace. Constantinos Mavroidis, an associate professor of mechanical and industrial engineering at the university, and his students added small, tightly sealed containers to either side of the brace at the knee.

They filled the containers with sets of small plates and a special "smart" fluid that changes from liquid to gel when it is zapped by electricity.

When a computer-controlled voltage is sent to the plates, an electric field is created and the fluid within instantly grows viscous. As the knee flexes and the plates rotate relative to one another, resistance is created.

The device imitates the job of the large machines used for training, exercise and rehabilitation in a gym. But instead of increasing the resistance with heavy blocks or bars, scientists can control the brace by changing the voltage.

"It's basically a weight-lifting machine that you can slap on your leg," said Jason Nikitczuk, a graduate student in mechanical engineering who worked with Dr. Mavroidis on the project. "You can adjust how much weight you are applying, just like you change weights on a machine."

The device cannot yet be bought off the shelf; it exists only as a research prototype in Dr. Mavroidis's laboratory.

He hopes, though, that it will eventually be manufactured, and is now in discussion with Spaulding Rehabilitation Hospital in Boston to explore clinical trials of the device.

Joel Stein, chief medical officer at the hospital, said that devices like the one developed by Dr. Mavroidis and his group that use smart or electro-rheological fluids were promising rehabilitative tools. "The appeal of this technology is that it allows them to vary the force that the brace exerts during the gait cycle or other activities," he said.

Conventional braces, called orthotics, typically are not programmable. "They are mechanical, and don't easily vary the forces over a range of activities," he said. But Dr. Mavroidis's prototype can be programmed to produce different levels of resistance for walking, for example, and stair climbing.

"This could be a nice portable way to put an exercise machine on a patient instead of going to a gym," Dr. Stein said.

Dr. Mavroidis said that the next generation of his device would provide not only controllable resistance, but also the power to push the joint itself. This might be useful, for instance, for a patient who is recovering mobility after a stroke. "The device will be able to move the joint, just like a physical therapist does manually now," he said.

Work on developing the actuators for the prototype has been financed by the National Science Foundation.

The apparatus is expected to operate using a relatively lightweight battery. The resistance can be varied in several ways. "We can use a control knob that a person rotates to select resistance," Dr. Mavroidis said, "or there can be a software program that a physical therapist uses to individualize treatment with patients."

Dr. Mavroidis said he had chosen the knee for the first device, but that similar principles could be applied to a brace for the elbow. The machines he hopes to produce one day will probably cost roughly $2,000, he said.

Brian Weinberg, a graduate mechanical engineering student at Northeastern, did much of the design work for the device, integrating the plates and fluids in their sealed containers onto the existing brace. "As soon as it worked well," he said, "we took it apart and started improving the design and control for the next generation of the device."

Paolo Bonato, director of the Motion Analysis Laboratory at Spaulding Rehabilitation Hospital, is a member of the team that is looking into clinical testing of the brace. Dr. Bonato is an assistant professor in the department of physical medicine and rehabilitation at Harvard Medical School.

One of the advantages of the technology is its quick response time, Dr. Bonato said. The liquid can turn to a gel in a millisecond or two. "The electro-rheological fluids provide good feedback," he said, "so that you could potentially adjust the properties of an artificial joint or orthotic according to the task you are performing."

Dr. Bonato expects the technology to be most promising as an exercise aid. "If they design it as wearable," he said, "you can continuously exercise in daily activities," as opposed to doing rehabilitation only at a hospital or gym.

Dr. Bonato said that a number of researchers were pursuing programmable rehabilitative devices. "It's exciting, what's happening in orthotics and prosthetics," he said. But these devices won't be on the market for a while. "It will probably be at least five years before we move from prototypes to actual products," he said.

Dr. Mavroidis hopes that his invention may one day find use far from earthbound exercise rooms. Long trips in space cause significant loss in the bone and muscle mass of astronauts, he said. But a device like his might be worn by the astronauts during their daily activities to strengthen their legs.

"I think it might work to prevent the effects of weightlessness," he said.

E-mail: Eisenberg@nytimes.com


TOPICS: Culture/Society; Extended News; Government; News/Current Events; US: District of Columbia; US: Massachusetts
KEYWORDS: health; healthcare; medicine; medicinehealth; northeasternuniv; nsf

1 posted on 10/07/2004 10:17:13 PM PDT by neverdem
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To: fourdeuce82d; El Gato; JudyB1938; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; LadyDoc; ...

FReepmail me if you want on or off my health and science ping list.


2 posted on 10/07/2004 10:18:59 PM PDT by neverdem (Xin loi min oi)
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To: neverdem

very cool.


3 posted on 10/07/2004 10:21:13 PM PDT by flashbunny
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To: neverdem

That sounds interesting, but I'll have to wait till I see an article in a reputable publication.


4 posted on 10/07/2004 10:22:37 PM PDT by Paleo Conservative (Hey! Hey! Ho! Ho! Dan Rather's got to go!)
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To: Paleo Conservative

I don't know if that's going to happen, but CBS news is going to have a segment on it...


5 posted on 10/07/2004 11:18:01 PM PDT by Gil4
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To: neverdem
But as professional athletes and weekend exercisers know only too well, the knee is also a classic weak spot, vulnerable to damage and slow to heal. Strengthening it after injury or surgery may require hours on the bulky machines of a hospital or gym.

Not all exercises involving the knees are actually good for your knees. In particular knee extension machines put incredible stress on the knee joints. A lot of my knee problems cleared up after I was advised to stop doing these exercises.

6 posted on 10/07/2004 11:36:30 PM PDT by wideminded
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To: wideminded
Sure would be nice if this was something out now. I'm having major knee surgery next month and am dreading the physical therapy after. Yuck...
7 posted on 10/07/2004 11:41:59 PM PDT by codyjacksmom (Attention All Girlie-men...Please don't forget your foo foo's on the way out the door.)
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To: codyjacksmom
A doctor suggested I have surgery on both knees to remove bone chips, etc. I decided to think it over. Then I read that a major study of this surgery had just been completed. It found that the people who had had the surgery were no better off than a control group who postponed the surgery. The article also stated that orthopedic doctors were have a hard time accepting the results of the study because this type of procedure provides a major part of their income.

I have tried some other ways of improving the health of my knees and they feel a lot better than when I went to the doctor. Obviously there are many situations when people really do need surgery.

8 posted on 10/08/2004 12:00:43 AM PDT by wideminded
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To: wideminded
Mine is one of the hopeless cases. Doing physical therapy for 3 months and not helping. I'm a very double-jointed type person, so all my joints and ligaments are very loose. My kneecap keeps dislocating to the outside edge of my leg and the PT has not brought it back anywhere near the correct position. Everything needs to be manually tightened and straightened, including a bone that doesn't line up properly. Not looking forward to it, but also don't want to go through that experience again with the ambulance and ER stuff. That was a nightmare in itself. LOL
9 posted on 10/08/2004 12:08:32 AM PDT by codyjacksmom (Attention All Girlie-men...Please don't forget your foo foo's on the way out the door.)
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To: Paleo Conservative
That sounds interesting, but I'll have to wait till I see an article in a reputable publication.

Here's a google. This phenomenon has been around since the late 1980s apparently, at least.

10 posted on 10/08/2004 12:13:01 AM PDT by neverdem (Xin loi min oi)
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To: codyjacksmom

Best of luck to you.


11 posted on 10/08/2004 12:25:00 AM PDT by wideminded
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To: wideminded
Thanks...and keep up the good work you are doing with yours. It's worth all the effort. :-)
12 posted on 10/08/2004 12:26:56 AM PDT by codyjacksmom (Attention All Girlie-men...Please don't forget your foo foo's on the way out the door.)
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To: codyjacksmom

Ouch. Deepest wishes for a quick recovery.


13 posted on 10/08/2004 12:52:44 AM PDT by rmlew (Copperheads and Peaceniks beware! Sedition is a crime.)
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To: rmlew
Thank you. I'm sure it will be. Of course, maybe I can milk it a little extra so I will have more uninterrupted FReeping time! LOL
14 posted on 10/08/2004 12:55:45 AM PDT by codyjacksmom (Attention All Girlie-men...Please don't forget your foo foo's on the way out the door.)
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