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Fulltext Development and evaluation of new coupling system for lower limb prostheses with acoustic alarm system

Eshraghi A, Osman NA, Gholizadeh H, Ahmadian J, Rahmati B, Abas WA

Sci Rep, 2013;3:2270.
PMID: 23881340 DOI: 10.1038/srep02270

Individuals with lower limb amputation need a secure suspension system for their prosthetic devices. A new coupling system was developed that is capable of suspending the prosthesis. The system's safety is ensured through an acoustic alarm system. This article explains how the system works and provides an in vivo evaluation of the device with regard to pistoning during walking. The system was designed to be used with silicone liners and is based on the requirements of prosthetic suspension systems. Mechanical testing was performed using a universal testing machine. The pistoning during walking was measured using a motion analysis system. The new coupling device produced significantly less pistoning compared to a common suspension system (pin/lock). The safety alarm system would buzz if the suspension was going to fail. The new coupling system could securely suspend the prostheses in transtibial amputees and produced less vertical movement than the pin/lock system.
Fulltext Interface pressure in transtibial socket during ascent and descent on stairs and its effect on patient satisfaction

Ali S, Abu Osman NA, Eshraghi A, Gholizadeh H, Abd Razak NA, Wan Abas WA

Clin Biomech (Bristol, Avon), 2013 Nov-Dec;28(9-10):994-9.
PMID: 24161521 DOI: 10.1016/j.clinbiomech.2013.09.004

Transtibial amputees encounter stairs and steps during their daily activities. The excessive pressure between residual limb/socket may reduce the walking capability of transtibial prosthetic users during ascent and descent on stairs. The purposes of the research were to evaluate the interface pressure between Dermo (shuttle lock) and Seal-In X5 (prosthetic valve) interface systems during stair ascent and descent, and to determine their satisfaction effects on users.
Fulltext Influence of functional knee bracing on the isokinetic and functional tests of anterior cruciate ligament deficient patients

Mortaza N, Abu Osman NA, Jamshidi AA, Razjouyan J

PLoS One, 2013;8(5):e64308.
PMID: 23717593 DOI: 10.1371/journal.pone.0064308

Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in Anterior cruciate ligament(ACL)-injured patients. However, many athletes might refrain from wearing the braces because of the fear of performance hindrance in the playing field. The aim of this study was to examine the effect of three functional knee brace/sleeves upon the isokinetic and functional performance of ACL-deficient and healthy subjects. Six anterior cruciate ligament deficient (29.0 ± 5.3 yrs., 175.2 ± 5.4 cm, and 73.0 ± 10.0 kg) and six healthy male subjects (27.2 ± 3.7 yrs., 176.4 ± 6.4 cm, and 70.3 ± 6.9 kg) were selected. The effect of a custom-made functional knee brace, and two neoprene knee sleeves, one with four metal supports and one without support were examined via the use of isokinetic and functional tests in four sets (non-braced,wearing functional knee brace,and wearing the sleeves). Cross-over hop and single leg vertical jump test were performed and jump height, and hop distance were recorded. Peak torque to body weight ratio and average power in two isokinetic velocities(60°.s(-1),180°.s(-1)) were recorded and the brace/sleeves effect was calculated as the changes in peak torque measured in the brace/sleeves conditions, expressed as a percentage of peak torque measured in non-braced condition. Frequency content of the isokinetic torque-time curves was also analyzed. Wilcoxon signed rank test was used to compare the measured values in four test conditions within each control and ACL-deficient group,and Mann-Whitney U test was used for the comparison between the two groups. No significant differences in peak torque, average power, torque-time curve frequency content, vertical-jump and hop measurements were found within the experimental and the non-braced conditions (p>0.05). Although the examined functional knee brace/sleeves had no significant effect on the knee muscle performance, there have been some enhancement regarding the extension peak torques and power generating capacity of the ACL-deficient subjects that could be helpful in reducing the bilateral asymmetry in these patients.
Fulltext Numerical investigation of the effect of cannula placement on thrombosis

Ong C, Dokos S, Chan B, Lim E, Al Abed A, Bin Abu Osman NA, et al.

Theor Biol Med Model, 2013;10:35.
PMID: 23680359 DOI: 10.1186/1742-4682-10-35

Despite the rapid advancement of left ventricular assist devices (LVADs), adverse events leading to deaths have been frequently reported in patients implanted with LVADs, including bleeding, infection, thromboembolism, neurological dysfunction and hemolysis. Cannulation forms an important component with regards to thrombus formation in assisted patients by varying the intraventricular flow distribution in the left ventricle (LV). To investigate the correlation between LVAD cannula placement and potential for thrombus formation, detailed analysis of the intraventricular flow field was carried out in the present study using a two way fluid structure interaction (FSI), axisymmetric model of a passive LV incorporating an inflow cannula. Three different cannula placements were simulated, with device insertion near the LV apex, penetrating one-fourth and mid-way into the LV long axis. The risk of thrombus formation is assessed by analyzing the intraventricular vorticity distribution and its associated vortex intensity, amount of stagnation flow in the ventricle as well as the level of wall shear stress. Our results show that the one-fourth placement of the cannula into the LV achieves the best performance in reducing the risk of thrombus formation. Compared to cannula placement near the apex, higher vortex intensity is achieved at the one-fourth placement, thus increasing wash out of platelets at the ventricular wall. One-fourth LV penetration produced negligible stagnation flow region near the apical wall region, helping to reduce platelet deposition on the surface of the cannula and the ventricular wall.
Fulltext The validity and reliability of motion analysis in patellar tendon reflex assessment

Tham LK, Abu Osman NA, Wan Abas WA, Lim KS

PLoS One, 2013;8(2):e55702.
PMID: 23409022 DOI: 10.1371/journal.pone.0055702

The deep tendon reflex assessments that are essential to the accurate diagnosis of neurological or neuromuscular disorders are conducted subjectively in clinical neurology. Our aim was to assess deep tendon reflexes objectively with a new reflex quantification method.
Transtibial prosthesis suspension systems: systematic review of literature

Gholizadeh H, Abu Osman NA, Eshraghi A, Ali S, Razak NA

Clin Biomech (Bristol, Avon), 2014 Jan;29(1):87-97.
PMID: 24315710 DOI: 10.1016/j.clinbiomech.2013.10.013

Today a number of prosthetic suspension systems are available for transtibial amputees. Consideration of an appropriate suspension system can ensure that amputee's functional needs are satisfied. The higher the insight to suspension systems, the easier would be the selection for prosthetists. This review attempted to find scientific evidence pertaining to various transtibial suspension systems to provide selection criteria for clinicians.
Mechanical and physical properties of calcium silicate/alumina composite for biomedical engineering applications

Shirazi FS, Mehrali M, Oshkour AA, Metselaar HS, Kadri NA, Abu Osman NA

J Mech Behav Biomed Mater, 2014 Feb;30:168-75.
PMID: 24316872 DOI: 10.1016/j.jmbbm.2013.10.024

The focus of this study is to investigate the effect of Al2O3 on α-calcium silicate (α-CaSiO3) ceramic. α-CaSiO3 was synthesized from CaO and SiO2 using mechanochemical method followed by calcinations at 1000°C. α-CaSiO3 and alumina were grinded using ball mill to create mixtures, containing 0-50w% of Al2O3 loadings. The powders were uniaxially pressed and followed by cold isostatic pressing (CIP) in order to achieve greater uniformity of compaction and to increase the shape capability. Afterward, the compaction was sintered in a resistive element furnace at both 1150°C and 1250°C with a 5h holding time. It was found that alumina reacted with α-CaSiO3 and formed alumina-rich calcium aluminates after sintering. An addition of 15wt% of Al2O3 powder at 1250°C were found to improve the hardness and fracture toughness of the calcium silicate. It was also observed that the average grain sizes of α-CaSiO3 /Al2O3 composite were maintained 500-700nm after sintering process.
Effect of exercise and gait retraining on knee adduction moment in people with knee osteoarthritis

Khalaj N, Abu Osman NA, Mokhtar AH, Mehdikhani M, Wan Abas WA

Proc Inst Mech Eng H, 2014 Feb;228(2):190-9.
PMID: 24458100 DOI: 10.1177/0954411914521155

The knee adduction moment represents the medial knee joint load, and greater value is associated with higher load. In people with knee osteoarthritis, it is important to apply proper treatment with the least side effects to reduce knee adduction moment and, consequently, reduce medial knee joint load. This reduction may slow the progression of knee osteoarthritis. The research team performed a literature search of electronic databases. The search keywords were as follows: knee osteoarthritis, knee adduction moment, exercise program, exercise therapy, gait retraining, gait modification and knee joint loading. In total, 12 studies were selected, according to the selection criteria. Findings from previous studies illustrated that exercise and gait retraining programs could alter knee adduction moment in people with knee osteoarthritis. These treatments are noninvasive and nonpharmacological which so far have no or few side effects, as well as being low cost. The results of this review revealed that gait retraining programs were helpful in reducing the knee adduction moment. In contrast, not all the exercise programs were beneficial in reducing knee adduction moment. Future studies are needed to indicate best clinical exercise and gait retraining programs, which are most effective in reducing knee adduction moment in people with knee osteoarthritis.
Study design: systematic review
Fulltext Balance control in lower extremity amputees during quiet standing: a systematic review

Ku PX, Abu Osman NA, Wan Abas WA

Gait Posture, 2014 Feb;39(2):672-82.
PMID: 24331296 DOI: 10.1016/j.gaitpost.2013.07.006

Postural control has been widely evaluated for the normal population and different groups over the past 20 years. Numerous studies have investigated postural control in quiet standing posture among amputees. However, a comprehensive analysis is lacking on the possible contributing factors to balance. The present systematic review highlights the current findings on variables that contribute to balance instability for lower extremity amputees. The search strategy was performed on PubMed, Web of Science, Medline, Scopus, and CINAHL and then followed by additional manual searching via reference lists in the reviewed articles. The quality of the articles was evaluated using a methodological quality assessment tool. This review included and evaluated a total of 23 full-text articles. Despite the inconsistencies in the methodological design of the studies, all articles scored above the acceptable level in terms of quality. A majority of the studies revealed that lower extremity amputees have increased postural sway in the standing posture. Asymmetry in body weight, which is mainly distributed in the non-amputated leg, was described. Aside from the centre of pressure in postural control, sensory inputs may be a related topic for investigation in view of evidence on their contribution, particularly visual input. Other balance-related factors, such as stump length and patients' confidence level, were also neglected. Further research requires examination on the potential factors that affect postural control as the information of standing postural is still limited.
Effects of surface coating on reducing friction and wear of orthopaedic implants

Ching HA, Choudhury D, Nine MJ, Abu Osman NA

Sci Technol Adv Mater, 2014 Feb;15(1):014402.
PMID: 27877638

Coatings such as diamond-like carbon (DLC) and titanium nitride (TiN) are employed in joint implants due to their excellent tribological properties. Recently, graphite-like carbon (GLC) and tantalum (Ta) have been proven to have good potential as coating as they possess mechanical properties similar to bones-high hardness and high flexibility. The purpose of this systematic literature review is to summarize the coating techniques of these four materials in order to compare their mechanical properties and tribological outcomes. Eighteen studies published between January 2000 and February 2013 have met the inclusion criteria for this review. Details of their fabrication parameters, material and mechanical properties along with the tribological outcomes, such as friction and wear rate, were identified and are presented in a systematic way. Although experiment conditions varied, we conclude that Ta has the lowest wear rate compared to DLC, GLC and TiN because it has a lower wear rate with high contact pressure as well as higher hardness to elasticity ratio. However, a further tribology test is needed in an environment which replicates artificial joints to confirm the acceptability of these findings.
Facile synthesis of calcium silicate hydrate using sodium dodecyl sulfate as a surfactant assisted by ultrasonic irradiation

Mehrali M, Seyed Shirazi SF, Baradaran S, Mehrali M, Metselaar HS, Kadri NA, et al.

Ultrason Sonochem, 2014 Mar;21(2):735-42.
PMID: 24120175 DOI: 10.1016/j.ultsonch.2013.08.012

Calcium silicate hydrate (CSH) consisting of nanosheets has been successfully synthesized assisted by a tip ultrasonic irradiation (UI) method using calcium nitrate (Ca(NO3)·4H2O), sodium silicate (Na2SiO3·9H2O) and sodium dodecyl sulfate (SDS) in water. Systematic studies found that reaction time of ultrasonic irradiation and concentrations of surfactant (SDS) in the system were important factors to control the crystallite size and morphologies. The products were characterized by X-ray power diffraction (XRD), field emission scanning electron microscopy (FESEM) and Fourier transform infrared spectrometry (FTIR). The size-strain plot (SSP) method was used to study the individual contributions of crystallite sizes and lattice strain on the peak broadening of the CSH. These characterization techniques revealed the successful formation of a crystalline phase with an average crystallite size of about 13 nm and nanosheet morphology at a reaction time of 10 min UI with 0.2 g SDS in solvent which were found to be optimum time and concentrations of SDS for the synthesis of CSH powders.
Extracellular matrix integrity affects the mechanical behaviour of in-situ chondrocytes under compression

Moo EK, Han SK, Federico S, Sibole SC, Jinha A, Abu Osman NA, et al.

J Biomech, 2014 Mar 21;47(5):1004-13.
PMID: 24480705 DOI: 10.1016/j.jbiomech.2014.01.003

Cartilage lesions change the microenvironment of cells and may accelerate cartilage degradation through catabolic responses from chondrocytes. In this study, we investigated the effects of structural integrity of the extracellular matrix (ECM) on chondrocytes by comparing the mechanics of cells surrounded by an intact ECM with cells close to a cartilage lesion using experimental and numerical methods. Experimentally, 15% nominal compression was applied to bovine cartilage tissues using a light-transmissible compression system. Target cells in the intact ECM and near lesions were imaged by dual-photon microscopy. Changes in cell morphology (N(cell)=32 for both ECM conditions) were quantified. A two-scale (tissue level and cell level) Finite Element (FE) model was also developed. A 15% nominal compression was applied to a non-linear, biphasic tissue model with the corresponding cell level models studied at different radial locations from the centre of the sample in the transient phase and at steady state. We studied the Green-Lagrange strains in the tissue and cells. Experimental and theoretical results indicated that cells near lesions deform less axially than chondrocytes in the intact ECM at steady state. However, cells near lesions experienced large tensile strains in the principal height direction, which are likely associated with non-uniform tissue radial bulging. Previous experiments showed that tensile strains of high magnitude cause an up-regulation of digestive enzyme gene expressions. Therefore, we propose that cartilage degradation near tissue lesions may be due to the large tensile strains in the principal height direction applied to cells, thus leading to an up-regulation of catabolic factors.
Synthesis, mechanical properties, and in vitro biocompatibility with osteoblasts of calcium silicate-reduced graphene oxide composites

Mehrali M, Moghaddam E, Shirazi SF, Baradaran S, Mehrali M, Latibari ST, et al.

ACS Appl Mater Interfaces, 2014 Mar 26;6(6):3947-62.
PMID: 24588873 DOI: 10.1021/am500845x

Calcium silicate (CaSiO3, CS) ceramics are promising bioactive materials for bone tissue engineering, particularly for bone repair. However, the low toughness of CS limits its application in load-bearing conditions. Recent findings indicating the promising biocompatibility of graphene imply that graphene can be used as an additive to improve the mechanical properties of composites. Here, we report a simple method for the synthesis of calcium silicate/reduced graphene oxide (CS/rGO) composites using a hydrothermal approach followed by hot isostatic pressing (HIP). Adding rGO to pure CS increased the hardness of the material by ∼40%, the elastic modulus by ∼52%, and the fracture toughness by ∼123%. Different toughening mechanisms were observed including crack bridging, crack branching, crack deflection, and rGO pull-out, thus increasing the resistance to crack propagation and leading to a considerable improvement in the fracture toughness of the composites. The formation of bone-like apatite on a range of CS/rGO composites with rGO weight percentages ranging from 0 to 1.5 has been investigated in simulated body fluid (SBF). The presence of a bone-like apatite layer on the composite surface after soaking in SBF was demonstrated by X-ray diffraction (XRD) and field emission scanning electron microscopy (FESEM). The biocompatibility of the CS/rGO composites was characterized using methyl thiazole tetrazolium (MTT) assays in vitro. The cell adhesion results showed that human osteoblast cells (hFOB) can adhere to and develop on the CS/rGO composites. In addition, the proliferation rate and alkaline phosphatase (ALP) activity of cells on the CS/rGO composites were improved compared with the pure CS ceramics. These results suggest that calcium silicate/reduced graphene oxide composites are promising materials for biomedical applications.
Intrarater test-retest reliability of static and dynamic stability indexes measurement using the Biodex Stability System during unilateral stance

Arifin N, Abu Osman NA, Wan Abas WA

J Appl Biomech, 2014 Apr;30(2):300-4.
PMID: 23878204 DOI: 10.1123/jab.2013-0130

The measurements of postural balance often involve measurement error, which affects the analysis and interpretation of the outcomes. In most of the existing clinical rehabilitation research, the ability to produce reliable measures is a prerequisite for an accurate assessment of an intervention after a period of time. Although clinical balance assessment has been performed in previous study, none has determined the intrarater test-retest reliability of static and dynamic stability indexes during dominant single stance. In this study, one rater examined 20 healthy university students (female=12, male=8) in two sessions separated by 7 day intervals. Three stability indexes--the overall stability index (OSI), anterior/posterior stability index (APSI), and medial/ lateral stability index (MLSI) in static and dynamic conditions--were measured during single dominant stance. Intraclass correlation coefficient (ICC), standard error measurement (SEM) and 95% confidence interval (95% CI) were calculated. Test-retest ICCs for OSI, APSI, and MLSI were 0.85, 0.78, and 0.84 during static condition and were 0.77, 0.77, and 0.65 during dynamic condition, respectively. We concluded that the postural stability assessment using Biodex stability system demonstrates good-to-excellent test-retest reliability over a 1 week time interval.
Fulltext Development and performance of a new prosthesis system using ultrasonic sensor for wrist movements: a preliminary study

Abd Razak NA, Abu Osman NA, Gholizadeh H, Ali S

Biomed Eng Online, 2014 Apr 23;13:49.
PMID: 24755242 DOI: 10.1186/1475-925X-13-49

BACKGROUND: The design and performance of a new development prosthesis system known as biomechatronics wrist prosthesis is presented in this paper. The prosthesis system was implemented by replacing the Bowden tension cable of body powered prosthesis system using two ultrasonic sensors, two servo motors and microcontroller inside the prosthesis hand for transradial user.
METHODS: The system components and hand prototypes involve the anthropometry, CAD design and prototyping, biomechatronics engineering together with the prosthetics. The modeler construction of the system develop allows the ultrasonic sensors that are placed on the shoulder to generate the wrist movement of the prosthesis. The kinematics of wrist movement, which are the pronation/supination and flexion/extension were tested using the motion analysis and general motion of human hand were compared. The study also evaluated the require degree of detection for the input of the ultrasonic sensor to generate the wrist movements.
RESULTS: The values collected by the vicon motion analysis for biomechatronics prosthesis system were reliable to do the common tasks in daily life. The degree of the head needed to bend to give the full input wave was about 45°-55° of rotation or about 14 cm-16 cm. The biomechatronics wrist prosthesis gave higher degree of rotation to do the daily tasks but did not achieve the maximum degree of rotation.
CONCLUSION: The new development of using sensor and actuator in generating the wrist movements will be interesting for used list in medicine, robotics technology, rehabilitations, prosthetics and orthotics.
Satisfaction and problems experienced with wrist movements: comparison between a common body-powered prosthesis and a new biomechatronics prosthesis

Abd Razak NA, Abu Osman NA, Kamyab M, Wan Abas WA, Gholizadeh H

Am J Phys Med Rehabil, 2014 May;93(5):437-44.
PMID: 24429510 DOI: 10.1097/PHM.0b013e3182a51fc2

This report compares wrist supination and pronation and flexion and extension movements with the common body-powered prosthesis and a new biomechatronics prosthesis with regard to patient satisfaction and problems experienced with the prosthesis. Fifteen subjects with traumatic transradial amputation who used both prosthetic systems participated in this study. Each subject completed two questionnaires to evaluate their satisfaction and problems experienced with the two prosthetic systems. Satisfaction and problems with the prosthetic's wrist movements were analyzed in terms of the following: supination and pronation; flexion and extension; appearance; sweating; wounds; pain; irritation; pistoning; smell; sound; durability; and the abilities to open a door, hold a cup, and pick up or place objects. This study revealed that the respondents were more satisfied with the biomechatronics wrist prosthesis with regard to supination and pronation, flexion and extension, pain, and the ability to open a door. However, satisfaction with the prosthesis showed no significant differences in terms of sweating, wounds, irritation, pistoning, smell, sound, and durability. The abilities to hold a cup and pick up or place an object were significantly better with the body-powered prosthesis. The results of the survey suggest that satisfaction and problems with wrist movements in persons with transradial amputation can be improved with a biomechatronics wrist prosthesis compared with the common body-powered prosthesis.
Is metal nanofluid reliable as heat carrier?

Nine MJ, Chung H, Tanshen MR, Osman NA, Jeong H

J Hazard Mater, 2014 May 30;273:183-91.
PMID: 24735805 DOI: 10.1016/j.jhazmat.2014.03.055

A pre- and post experimental analysis of copper-water and silver-water nanofluids are conducted to investigate minimal changes in quality of nanofluids before and after an effective heat transfer. A single loop oscillating heat pipe (OHP) having inner diameter of 2.4mm is charged with aforementioned nanofluids at 60% filling ratio for end to end heat transfer. Post experimental analysis of both nanofluids raises questions to the physical, chemical and thermal stability of such suspension for hazardless uses in the field of heat transfer. The color, deposition, dispersibility, propensity to be oxidized, disintegration, agglomeration and thermal conductivity of metal nanofluids are found to be strictly affected by heat transfer process and vice versa. Such degradation in quality of basic properties of metal nanofluids implies its challenges in practical application even for short-term heat transfer operations at oxidative environment as nano-sized metal particles are chemically more unstable than its bulk material. The use of the solid/liquid suspension containing metal nanoparticles in any heat exchanger as heat carrier might be detrimental to the whole system.
Fulltext Design and development of potential tissue engineering scaffolds from structurally different longitudinal parts of a bovine-femur

Pramanik S, Pingguan-Murphy B, Cho J, Abu Osman NA

Sci Rep, 2014 Jul 28;4:5843.
PMID: 25068570 DOI: 10.1038/srep05843

The complex architecture of the cortical part of the bovine-femur was examined to develop potential tissue engineering (TE) scaffolds. Weight-change and X-ray diffraction (XRD) results show that significant phase transformation and morphology conversion of the bone occur at 500-750°C and 750-900°C, respectively. Another breakthrough finding was achieved by determining a sintering condition for the nucleation of hydroxyapatite crystal from bovine bone via XRD technique. Scanning electron microscopy results of morphological growth suggests that the concentration of polymer fibrils increases (or decreases, in case of apatite crystals) from the distal to proximal end of the femur. Energy-dispersive analysis of X-ray, Fourier transform infrared, micro-computer tomography, and mechanical studies of the actual composition also strongly support our microscopic results and firmly indicate the functionally graded material properties of bovine-femur. Bones sintered at 900 and 1000°C show potential properties for soft and hard TE applications, respectively.
New method for the isolation of endothelial cells from large vessels

Ataollahi F, Pingguan-Murphy B, Moradi A, Wan Abas WA, Chua KH, Abu Osman NA

Cytotherapy, 2014 Aug;16(8):1145-52.
PMID: 24831838 DOI: 10.1016/j.jcyt.2014.01.010

Numerous protocols for the isolation of bovine aortic endothelial cells have been described in the previous literature. However, these protocols prevent researchers from obtaining the pure population of endothelial cells. Thus, this study aimed to develop a new and economical method for the isolation of pure endothelial cells by introducing a new strategy to the enzymatic digestion method proposed by previous researchers.
Treatment stability of Milwaukee brace in idiopathic hyperkyphosis

Mehdikhani M, Behtash H, Ganjavian MS, Abu Osman NA, Khalaj N

Prosthet Orthot Int, 2014 Aug;38(4):316-20.
PMID: 23950552 DOI: 10.1177/0309364613499063

The Milwaukee brace is an efficient method for correcting hyperkyphosis before skeletal maturity. However, loss of correction in long-term follow-up is inevitable.

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