Applications of Nanotechnology in the Field of Physical Therapy

Applications of Nanotechnology in the Field of Physical TherapyBY:Mohamed Samir El-AsalyPT, CKTPUnder supervisionProf. Dr. Mohamed Abd Elhakeem

AFFECTING PROSTHETICS AT THE NANO SCALE

ProstheticsPhysical therapists are concerned with the care of individuals with lower- and upper-limb amputations.

Patients are often fitted with a prosthesis to replace the absent part of the leg or arm.

In the broadest sense, prostheses also include dentures, titanium femoral heads, and plastic heart valves.

ProstheticsThe major causes of amputation are:peripheral vascular diseaseTrauma malignancy congenital deficiency

ProstheticsIn the United States, vascular disease accounts for most leg amputations, particularly among patients with diabetes.

Individuals older than 60 constitute the largest group of people with amputation.

Trauma is responsible for the majority of amputations in younger adults and adolescents.

ProstheticsMen are more likely to sustain amputation because of trauma and vascular disease.

Bone and soft tissue tumors are sometimes treated by amputation, with adolescence the period of peak incidence.

Congenital deficiency refers to the absence or abnormality of a limb evident at birth.

ProstheticsPhysical therapists are key members of the rehabilitation team, working with prosthetists, physicians, occupational therapists, and others to foster the patients welfare.

For individuals with LE amputation, physical therapists have the major role in assisting the person to regain function.

ProstheticsHistoric records confirm that the concept of replacing a missing limb is very old. A forked stick that formed a peg leg to support a transtibial (below-knee) amputation limb was known in antiquity.

ProstheticsToday, most individuals with LE amputation are provided with a prosthesis because function with one LE is very different from maneuvering with two. The principal LE prostheses are partial foot, Symes, transtibial, and transfemoral, as well as knee and hip disarticulation. The physical therapist should be familiar with their characteristics and maintenance, as well as the rehabilitation of patients fitted with these devices.

Types of ProstheticsPARTIAL FOOT AND SYMES PROSTHESESTRANSTIBIAL PROSTHESESTRANSFEMORAL PROSTHESESKnee Disarticulation ProsthesesHip Disarticulation ProsthesesBILATERAL PROSTHESES

Component of ProstheticsFoot-Ankle AssembliesNonarticulated FeetSolid Ankle Cushion Heel (SACH)Stationary Attachment Flexible Endoskeleton (SAFE) footArticulated FeetSingle-Axis FeetMultiple-Axis Feet

Component of ProstheticsRotators and Shock AbsorbersShankExoskeletal ShankEndoskeletal ShankSocketLined SocketUnlined Socket

Donning

Major Problems in prostheticsProsthetic socks may be worn to make your prosthesis more comfortable and to help protect your skin.Change the socks daily or more often if required.The residual limb sweating.Infection of the residual limb.

AFFECTING PROSTHETICS AT THE NANO SCALE

Martin Bionics is collaborating with the Oak Ridge National Laboratory (ORNL), to develop a prosthetics and orthotics coating based on newly developed nanotechnologies.

AFFECTING PROSTHETICS AT THE NANO SCALE To enhance design by allowing prosthetics to become:

More biocompatible.Hygienic.Lighter.

AFFECTING PROSTHETICS AT THE NANO SCALEThe ability to alter these characteristics is highly limited by the material properties available for use. Until recent advances in nanotechnologies, material properties were limited in their capabilities; however, the incorporation of nanotechnology stands to vastly improve these products.

AFFECTING PROSTHETICS AT THE NANO SCALE These nanotechnologies will provide the prosthetics and orthotics industry a resolution to outstanding issues experienced by users.

Many amputees complain that excessive local perspiration negatively affects the interface between the limb and the socket or suspension system, and evaporative mechanisms are severely limited by the low moisture permeability of most modern socket systems.

AFFECTING PROSTHETICS AT THE NANO SCALE Unfortunately for amputees, in vivo studies have shown that slightly moist skin generates more friction than either dry skin or very wet skin.Offering prosthetic and orthotic users interface materials with nanotechnology that provides greater hygiene, ease of cleaning, enhanced donning abilities, and reduced heat and moisture buildup will provide a heightened quality of life for these prosthetics users.

Nanotechnology Powder in ProstheticsOne such technology that is currently under development through the collaborative relationship between Martin Bionics and Oak Ridge National Labs is a superhydrophobic nanotechnology powder, which is hoped to enhance the hygienic environment of the prosthetic or orthotic against the body.

Nanotechnology Powder in ProstheticsAt a microscopic and sub levels, material surfaces are typically uneven, and show inconsistencies along the surface. This allows biological particles to be caught in small groves and adhere to the surface, effecting hygiene.This nanotechnology powder, when applied, forms a layer of nano-scale structures that are packed tightly together across this uneven surface.

Nanotechnology Powder in ProstheticsWhen bonded to a materials surface the powder creates a protective barrier above the actual surface. Because of the small distance between the nano-structures, particles of water, dirt and other molecules will sit on the top of this layer of nano-scale material. In addition to this physical barrier there is a chemical component of the powder that provides a super-slick coating and acts to enhance the products moisture resistant capabilities.

Nanotechnology Powder in ProstheticsTogether these components do not allow for adhesion or penetration to the material surface itself, and result in a surface that is super-water-repellent. In addition to this characteristic, other foreign particles unable to interact with the surface are easily swept away with water. This results in an enhanced cleaning effect on the surface.

Nanotechnology Powder in ProstheticsThis superhydrophobic powder is applicable to many surfaces of prosthetic and orthotic interface components used within the industry. An example of the benefits of this technology can be shown in prosthetic liners.While these liners have drastically improved overall prosthetic comfort, limitations persist, including hygiene issues such as sweat and odor build-up, donning difficulty for some patients, and difficulty in cleaning.

Nanotechnology Powder in ProstheticsThe application of the superhydrophobic powder would cause sweat and odor absorption to be eliminated, providing a more hygienic environment for the sensitive residual limb, cleaning the material will be less time constraining with nearly instantaneous drying of the material, and the powders ultra slick surface will ease donning.

Nanotechnology Powder in ProstheticsThe superhydrophobic nanotechnology is a self-bonding water repellant application powder designed for use as an aftermarket product on current orthotics, and prosthetic liners, suspension sleeves, cosmetic coverings and sockets. Later prosthetic products such as gel liners and suspension sleeves will soon be manufactured with the superhydrophobic powder incorporated in them.

Carbon Nanotube and ProstheticsResearch groups at ORNL are currently in the process of refining carbon nanotube technology. These structures are made of carbon atoms bonded together in a circular helix pattern of adjustable lengths. The results of this bonding are very durable string like nano-structures. Due to their carbon element, one of the strongest natural substances, and the strong bonds, these formations are difficult to break. When embedded into materials, such as the silicone used in the prosthetics industry, these structures lend their strength to the material resulting in a more durable product.

Carbon Nanotube and ProstheticsIn addition to obvious benefits of stronger materials, longer lasting components or thinner more life like cosmesis, carbon nanotubes allow for coloration of the material, thus possibly eliminating or reducing the need for dyes in the cosmesis. Nanotubes light absorption bands are diameter dependent and can be changed through tuning of nanotubes production conditions.

CNT and Mechanoreceptors in Prosthetics

Nano-Silver Particles and ProstheticsThe implementation of nano-scale silver particles into the textile products used in prosthetics is expected to improve the hygiene of the interface environment. Silver, long known for its antibacterial properties, is able to reduce the growth and spread of many types of microscopic organisms resulting in a reduced chance of infection.It is also these organisms that are responsible for the odor that is often associated with many prosthetic products.

Nano-Silver Particles and ProstheticsIn this application the silver is ground into nano-scale sized particles and embedded in textile products.This can be done for any cloth material and proves to be quite durably and long lasting. Though currently limited to cloth, early tests have proven successful with subjects able to wear articles of clothing for a week at a time with no odor. This process could be applied to the socks placed over a residual limb, or any textile component to achieve a more hygienic environment for the sensitive limb tissue.

Carbon Nano Tubes and Artificial Muscles

CNT and Artificial MusclesResearchers for decades have been developing polymers and other materials they hope to someday use to create artificial muscles that, when given an electrical charge, mimic the real thing more cheaply and effectively than the hydraulic systems and electric motors used today.

CNT and Artificial MusclesA group of scientists at the University of Texas at Dallas NanoTech Institute reports in Science that they have demonstrated a fundamentally new type of artificial muscle, consisting almost exclusively of carbon nanotubesIt can operate at extreme low temperatures that would cause other artificial muscles systems to freeze and at very high temperatures that would cause other muscle systems to decompose.

CNT and Artificial Muscles

CNT and Artificial MusclesAlthough artificial muscles generally operate on the same principal as animal muscles, the carbon nanotube artificial muscle is not likely to be used in prosthetic limbs or to replace tissue. "The high voltages used for actuation eliminate the possibility of tissue replacement," Baughman says, adding that prosthetic limbs do not need the rapid response rate or ability to endure extreme temperatures that the new material possesses.

A biodegradable tri-component graft for anterior cruciate ligament reconstruction

Stability of knee

Function of ACLPrimary (85%) restraint to limit anterior translation of the tibia.Secondary restraint to tibial rotation and varus/valgus angulation at full extension.The average tensile strength for the ACL is 2160 N.

Risk Factor to ACL tearHigh-risk sports: football, baseball, soccer, skiing, and basketballSex: F > M Femoral notch stenosis: < 0.2Footwear

Clinical pictureNon-contact injury:Often occurs while changing direction or landing from a jump."popping" noise.Within a few hours, a large hemarthrosis develops.Pain, swelling, and instability or giving way of the knee.Unable to return to play.

Clinical pictureContact and high-energy traumatic injuries:

Often are associated with other ligamentous and meniscal injuries.Terrible Triad !!

ACL ReconstructionGrafting can be from :Patellar tendon (Gold Standard Method)Hamstring tendonsQuadriceps tendon. AllograftThe expected long-term success rate of ACL reconstruction is between 75-95%.Failure Rate is 8%, which may be attributed to: recurrent instability, graft failure, or arthrofibrosis.

ACL Reconstruction

A biodegradable tri-component graft for anterior cruciate ligament reconstructionBonepatellar tendonbone (BPTB) autografts are the gold standard for anterior cruciate ligament (ACL) reconstruction because the bony ends allow for superior healing and anchoring through bone to-bone regeneration.However, the disadvantages of BPTB grafts include donor site morbidity and patellar rupture.

A biodegradable tri-component graft for anterior cruciate ligament reconstructionIn order to incorporate bone-to-bone healing without the risks associated with harvesting autogenous tissue, a biodegradable and synthetic tri-component graft was fabricated, consisting of:Porous poly(1,8-octanediol-co-citric acid).Hydroxyapatite nanocomposites (POCHA).Poly(L-lactide) (PLL) braidsAll regions of the tri-component graft were porous and the tensile properties were in the range of the native ACL.

A biodegradable tri-component graft for anterior cruciate ligament reconstructionWhen these novel grafts were used to reconstruct the ACL of rabbits, all animals after 6 weeks were weight-bearing and showed good functionality.Histological assessment confirmed tissue infiltration throughout the entire scaffold and tissue ingrowth and interlocking within the bone tunnels, which is favourable for graft fixation. In conclusion, this study suggests that a tri-component, biodegradable graft is a promising strategy to regenerate tissue types necessary for ACL tissue engineering, and provides a basis for developing an off-the-shelf graft for ACL repair.

Nanotechnology and Transcutaneous Electrical Nerve Stimulation

TENSTranscutaneous Electrical Nerve Stimulation (TENS) is a therapy that uses low-voltage electrical current for pain relief.Its used to relieve pain for several different types of illnesses and conditions.

TENSThey use it most often to treat muscle, joint, or bone problems that occur with illnesses such as osteoarthritis or fibromyalgia, or for conditions such as low back pain, neck pain, tendinitis, or bursitis. People have also used TENS to treat sudden (acute) pain, such as labor pain, and long-lasting (chronic) pain, such as cancer pain.

Pain Gait Theory

Nanotechnology application in TENSA physiotherapist can use Quell which is a non-invasive neurostimulation technology that provides pain relief in conditions such as degenerative knee conditions, sciatica, fibromyalgia and chronic pain.

It provides a transcutaneous electrical nerve stimulation application to the area of pain.

Nanotechnology application in TENSThe device is small and is strapped onto the back of the patients calf. Once the device is on the calf it sends electrical pulses to the nerves that signal the brain to release pain relieving opioids.The manufactures didnt reveal the nanotechnology secretes that is used in Quell