Orthopedic News

By Shailesh Kumar Singh, Sr. Physiotherapist AIIMS New Delhi

Physiotherapy is thought to be a supportive mode of treatment whereas according to the definition given by WHO, DCPT, and Healthcare Profession Act, “It is an INDEPENDENT PROFESSION in which a physiotherapist practices by undertaking comprehensive examination and appropriate investigation, provides treatment and advice to any person with movement or functional dysfunction, malfunction, disability, and pain from trauma and disease, using modalities, exercises, mobilization, manipulations, for prevention, screening, diagnosis, and treatment.

Despite the definition given by these reputed institutions, there is still a lack of awareness about the different treatment approaches that a therapist uses to treat a patient not only among the common public but also among the health stakeholders therefore physiotherapists receive a referral with already written treatment including only machines and basic exercise which is been in practice for more than 70 years now and making the gap between conventional physiotherapy and advance physiotherapy deeper.

Physiotherapy had been started with more reliance on machines and thereby offering only diplomas earlier but with the passing of time the bachelor’s degree has been started and later on looking into the role of physiotherapy in specialized areas masters in different fields viz; MPT in Neuro, ortho, obs and gynae, sports, pediatrics, oncology, etc have been started like we have different MDs after MBBS. Ph.D. is also now being offered in physiotherapy as the research in the field has shown accelerated growth.

We need to understand that the equipment which is been used in physiotherapy is only to give temporary relief but not to provide a permanent solution for the primary complaint which is possible only with a bottom-up approach that means assessing the patient thoroughly and then planning the treatment accordingly.

A physiotherapist uses his extra ear that means his hands for the assessment of the patient includes not only the history of the primary complaint but also looking deep into the local structures giving that symptom while keeping in mind the far-off structures that could be the contributing factors for the problem thereby reaching to the root cause of primary complaint rather than a superficial treatment of just the symptoms.

After the assessment comes the role of evidence-based treatment for the condition which includes the re-alignment of the joints, and bones, manual releases for the tight fascia and muscles, realign scar tissues that can get in the way of your body’s full range of motion, manual lymph drainage, etc using manual therapy, osteopathy, dry needling, Kinesio tape, cupping therapy. etc with the individualized exercise program which ultimately leads to chucking out the root cause of the primary problem which is giving those superficial symptoms and thereby providing the patients a permanent solution to their problem and reduce their need to visit the physiotherapy clinic again and again for the same problem that frequently happens with the use of only physiotherapy machines rather than wholesome approach.

For Example: A patient comes in with pain in the back radiating to the right lower limb. so the conventional approach for the case would be using diathermy, ultrasound locally, and IFT for pain relief along with traction giving the patient symptomatic relief rather on the other hand, in the advanced physiotherapy approach, the physiotherapist will assess the patient for the root cause of the symptoms .he will take a detailed history and later on a detailed assessment by looking into the posture of the patient is in because of the pain, the gait pattern, muscles in spasms, muscles which are short with trigger points, the mobility of the spine not only the lumbar spine but the spine as a whole with the areas of hypomobility and hypermobility, alignment of the nearby joints like sacroiliac joints, hip joints, pelvic bones, fascial restrictions, breathing pattern, abdominal viscera movement, etc to reach into a clinical diagnosis and thence start with the individualized treatment protocol.

So physiotherapy is already been shifted from mere dependence on the equipment with a blinded approach to a more scientific approach using novel techniques making it a full-fledged system in itself. This treatment approach is time taking so the patient should understand the need for the same, should be compliant and vigilant to what is happening to their system and what should be done to help them come out of their suffering permanently. So in the end a small request to the patient” Don’t let your body be fooled by masking your symptoms rather love it to the fullest by giving it the gift of the right treatment”

When things get too much, we usually hear the advice to “take a burden off,” but when it comes to bone care, the reverse can be helpful. Japanese researchers have discovered several crucial mechanisms for how physical tension triggers bone growth.
In a study that was published in the journal “Cell Reports,” researchers from the National Cerebral and Cardiovascular Center Research Institute demonstrated how load influences the production of the peptide osteocrin (OSTN), which increases when stress is applied and reduces when it is decreased. Exercise loads build bones and skeletal muscles, avoiding bone and muscle atrophy. Maintaining bone and muscle strength is crucial for continuing to engage in physical activity.

Long bones like the femur and tibia grow through a very intricate process that is influenced by both genetics and environmental elements like exercise and gravity.

“Not much is known about how mechanical force initiates biochemical signals to control bone growth,” says lead author of the study Haruko Watanabe-Takano. “We investigated how load is related to the metabolic balance adjustment of bone maintenance.”

Osteoblasts, which form bone, and osteoclasts, which break it down, function in harmony to maintain bone, which is assumed to be created in response to load requirement. The group specifically looked at OSTN, an osteoblast-produced peptide, and its expression in mice. Both the control of bone development and athletic endurance depend on OSTN.
The area where the load was applied and in bones like the tibia, radius, and ulna were where the researchers discovered that OSTN was highly expressed.

Furthermore, they demonstrated that the periosteal osteoblasts in these bones secreted OSTN. The periosteum, a membrane that covers the outside of bones except where long bones connect, plays a role in bone creation and remodelling, particularly during growth.

“We also found that OSTN expression decreased when load was reduced, and was increased by load stimulation,” says Watanabe-Takano. “Moreover, when we genetically engineered mice lacking OSTN, we found that they had reduced bone mass compared with normal mice and lacked load-induced recovery of bone mass after prolonged load reduction. Thus, we concluded that OSTN makes bone in response to stimulation by load, promoting bone formation.”

The scientists discovered that OSTN raises levels of another peptide termed C natriuretic peptide, which in turn stimulates bone-forming osteoblasts to proliferate, mature, and develop into functional cells. Given that prolonged bed rest is known to limit bone production, the findings of this study will be helpful in promoting bone preservation in bedridden patients as well as in the prevention and management of frailty syndrome. Future studies will build on these results to discover further mechanisms, such as how periosteal cells detect load stimulation.

According to a new opinion article published in the Lancet Diabetes & Endocrinology, osteoporosis screening and therapy lags behind other illnesses, resulting in severe morbidity, mortality, and economic consequences.

Over the last 30 years, there has been considerable development in the capacity to identify osteoporosis, a condition that weakens bones and can impair mobility, cause pain, and increase mortality that was formerly thought to be an unavoidable result of ageing.

Unfortunately, despite that progress, the use of dual-energy x-ray absorptiometry (DXA) and fracture risk assessments – tests that can accurately diagnose osteoporosis and determine the likelihood of having a hip or other bone fracture, has been on the decline. According to the perspective, the use of DXA in women 65 years and older has dropped to 11.3% in 2014, down from 13.2% from five years earlier. The decline coincided with a 70% reduction in Medicare reimbursements for office-based scans.

Titled ‘Osteoporosis in the USA: prevention and unmet needs’, the review highlighted that many at-risk patients are not advised to take preventive medications, and may be unduly frightened to take them. Failures in primary prevention of osteoporosis are compounded by inadequate post-fracture follow-up care. The review noted that following a fracture, patients are not being treated with effective medications, which contrasts with the treatment of patients after a heart attack. Of patients who had an acute myocardial infarction (AMI), 96% received standard-of-care medication while only 30% of women 66 years or older received standard-of-care medication to treat osteoporosis in the 12 months after their fracture.

“Furthermore, studies have shown significantly lower screening with bone density scans and treatment in non-Hispanic Black women, with estimates of a disparity in comparison to non-Hispanic White women as high as 20%. This disparity is also present in post-fracture diagnosis and treatment,” said co-author Douglas P. Kiel, M.D., M.P.H., Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Professor of Medicine, Harvard Medical School.

“Our review underscored some myths regarding osteoporosis patients. Osteoporosis is thought to affect non-Hispanic White and Asian women, and that may be why screening, prevention and post-fracture treatment of non-Hispanic Black women is so much lower,” he added.

According to the perspective, the reduction of Medicare reimbursement for DXA also has disenfranchised rural communities. “Understanding the impact of access to osteoporosis screening and treatment will help the country reduce disparities in care,” Dr. Kiel added. “Major holes remain in the how the U.S. serves patients with this important age-related chronic disease, and it’s clear we need to address the disparity of and access to standard-of-care.”

Another difficult element is that there is now no obvious solution for primary osteoporosis prevention. Estrogen has been widely utilised in younger postmenopausal women with osteoporosis risk factors, but a Women’s Health Initiative research highlighted questions about its long-term safety, leaving a vacuum in treatment choices.

In individuals with rheumatoid arthritis, who are at an increased risk for the illness, medicines often administered to patients to reduce joint inflammation may also reduce the risk of cardiovascular disease.

The study, titled, ‘Reducing cardiovascular risk with immunomodulators: a randomised active comparator trial among patients with rheumatoid arthritis’, was published in the journal Annals of Rheumatic Diseases. “The reassuring message is that as your joints are improving with RA treatments, so too is your risk for cardiovascular disease,” says Joan Bathon, MD, a co-leader of the study and professor of medicine and director of the division of rheumatology at Columbia University Vagelos College of Physicians and Surgeons.

Immunomodulators, or anti-inflammatory medications, have been demonstrated in recent clinical studies to considerably lower heart attacks, strokes, and other cardiovascular events in persons with cardiovascular disease. However, it remained unclear if these medications, which increase heart disease risk by 50% compared to the general population in adults with rheumatoid arthritis, have a similar impact on these patients.

Rheumatoid arthritis is a chronic autoimmune and inflammatory disease that causes painful joint swelling and affects more than 1.3 million individuals in the United States. Inflammation is known to cause atherosclerosis and contribute to heart disease, which may account for the higher prevalence of heart disease in rheumatoid arthritis sufferers.

Patients with moderate to severe rheumatoid arthritis should first consider methotrexate, although most RA patients eventually start on a tumour necrosis factor inhibitor (TNFi) or triple therapy (methotrexate plus sulfasalazine and hydroxychloroquine).

In a recent study, conducted by Brigham and Women’s Hospital and Columbia University researchers, 115 adults with moderate to severe rheumatoid arthritis who had not responded to methotrexate treatment were randomised to triple therapy or to add a TNFi, either adalimumab (Humira) or etanercept (Enbrel).
Both groups saw comparable reductions in arterial inflammation, a risk factor for heart disease, and RA disease activity after six months.

“We were surprised to see that both of these powerful anti-inflammatory treatment strategies reduced heart disease risk in patients with rheumatoid arthritis,” Bathon says. “Doctors still need to pay attention to the usual heart disease risk factors, such as high cholesterol, high blood pressure, and obesity. But since inflammation–a key feature of RA–elevates cardiovascular risk even further, reducing inflammation by treating the arthritis is a novel mechanism to reduce heart disease risk in these patients.”

According to recent research, women can lower their chance of developing a hip fracture by increasing their protein intake and regularly consuming tea or coffee. According to research conducted by food experts at the University of Leeds in the UK, women’s risk of hip fracture decreased by 14% on average with every additional 25g of protein consumed daily. They also unexpectedly found that each additional cup of tea or coffee they consumed was associated with a 4% decrease in risk.

The preventive advantages were stronger for women who were underweight, with a 25g/day increase in protein cutting their risk by 45%, the researchers reported in the journal Clinical Nutrition.

For those who follow a plant-based diet, the protein can come from beans, nuts, or legumes. It can also come from meat, dairy products, or eggs. A steak or piece of salmon, together with three to four eggs, would each offer about 25g of protein. 17g of protein would be present in 100g of tofu.

A hip fracture occurred in little over 3% of the research group’s female participants.
An extensive observational analysis of more than 26,000 women served as the foundation for the inquiry, “Foods, nutrients, and hip fracture risk: A prospective study of middle-aged women.”

The researchers were able to pinpoint correlations between dietary elements and health since this was an observational study. They were unable to distinguish clear cause from clear effect.

The study’s principal investigator, James Webster, a doctorate researcher at Leeds’ School of Food Science and Nutrition, stated: “Hip fracture has tremendous consequences to people and society throughout the world.
Hip fracture frequently causes the onset of various chronic conditions, loss of independence, and early mortality. The NHS in the UK spends between £2 and $3 billion annually.

“Diet is a factor that people can modify to protect themselves by maintaining healthy bones and muscles. This study is one of the first to investigate relationships between food and nutrient intakes and risk of hip fracture, with hip fractures accurately identified through hospital records.
“The results highlight which aspects of diet may be useful tools in reducing hip fracture risk in women, with evidence of links between higher protein, tea and coffee intakes and a reduced risk.”

Proteins are the fundamental building blocks of life and are essential for maintaining healthy cells, tissues, and muscles as well as strong bones.
Some nutritional experts consider the 0.8g per kilogramme of bodyweight daily protein recommendation in the UK to be excessively low. According to the study, persons who consume more protein had a lower risk of hip fracture. However, very high protein consumption, defined as more than 2 to 3 g of protein per kg of body weight per day, might have detrimental consequences on health. These extremely high protein intake levels could not be investigated by the research.

“In the UK, most individuals eat an acceptable quantity of protein, but specific groups, such as vegetarians or vegans, need to verify that their protein intakes are high enough for optimal health,” said Professor Janet Cade, who directs Leeds’ Nutritional Epidemiology Group and oversaw the study.

Why risk reductions for overweight women may be larger

Reduced bone mineral density and muscle mass may be more prevalent in underweight women. By aiding in the establishment or restoration of bone and muscle health, increasing intakes of a number of foods and minerals, particularly protein, may help lower the risk of hip fracture more in underweight women than in healthy or overweight women. The researchers point out that more study is necessary to corroborate this conclusion.

Tea and coffee both contain biologically active compounds called polyphenols and phytoestrogens which may help to maintain bone health.
Professor Cade added: “This is an interesting finding given that tea and coffee are the UK’s favourite drinks. We still need to know more about how these drinks could affect bone health but it might be through promoting the amount of calcium present in our bones.”

A novel method has been created to allow bone regeneration to repair big bone defects using a specific hydrogel. Following successful animal model studies, the researchers want to proceed to clinical trials.

The groundbreaking study was conducted by experts from TAU’s Maurice and Gabriela Goldschleger School of Dental Medicine, led by Prof. Lihi Adler-Abramovich and Dr. Michal Halperin-Sternfeld, in collaboration with Prof. Itzhak Binderman, Dr. Rachel Sarig, Dr. Moran Aviv, and researchers from the University of Michigan in Ann Arbor.

The paper was published in the Journal of Clinical Periodontology. Prof. Adler-Abramovich: “Small bone defects, such as fractures, heal spontaneously, with the body restoring the lost bone tissue. The problem begins with large bone defects. In many cases, when substantial bone loss results from tumor resection (removal by surgery), physical trauma, tooth extraction, gum disease or inflammation around dental implants, the bone is unable to renew itself. In the current study, we developed a hydrogel that mimics the natural substances in the extracellular matrix of bones, stimulating bone growth and reactivating the immune system to accelerate the healing process.”

The researchers explain that the extracellular matrix is the substance surrounding our cells, providing them with structural support. Every type of tissue in our body has a specific extracellular matrix consisting of suitable substances with the right mechanical properties. The new hydrogel has a fibrillary structure that mimics that of the extracellular matrix of the natural bone. Furthermore, it is rigid, thus enabling the patient’s cells to differentiate into bone-forming cells.

“As can be expected, the extracellular matrix of our bones is quite rigid,” says Prof. Adler-Abramovich. “In our study, we produced a hydrogel that mimics this specific matrix in both chemical and physical properties. At the nanometric level, the cell can attach itself to the gel, gaining structural support and receiving relevant mechanical signals from the fibers. At first, to test these properties, we grew cells in a 3D model of the gel. Then we examined the impact of the hydrogel on model animals with large bone defects that could not heal spontaneously. We monitored them for two months with various methods, including Micro C.T. To our delight, the bone defects were fully corrected through regeneration, with the bones regaining their original thickness, and generating new blood vessels.”

According to Prof. Adler-Abramovich, the innovative gel has extensive clinical applications in both orthopedic and dental medicine: “When we lose teeth due to extensive damage or bacterial infections, the standard treatment is dental implants. Implants, however, must be anchored in a sufficient amount of bone, and when bone loss is too substantial, physicians implant additional bone from a healthy part of the body — a complex medical procedure. Another option is adding bone substitutes from either human or animal sources, but these might generate an immune response. I hope that in the future the hydrogel we have developed will enable faster, safer, and simpler bone restoration.”

An anthropological study revealed that childbearing permanently affects the bones of females in hitherto unknown ways. Its discovery, based on primatological study, sheds new light on how childbirth may permanently affect the body.

The findings of the study were published in the journal PLOS ONE. “Our findings provide additional evidence of the profound impact that reproduction has on the female organism, further demonstrating that the skeleton is not a static organ, but a dynamic one that changes with life events,” explains Paola Cerrito, who led the research as a doctoral student in NYU’s Department of Anthropology and College of Dentistry.

Specifically, the researchers found that calcium, magnesium, and phosphorus concentrations are lower in females who have experienced reproduction. These changes are linked to giving birth itself and to lactation.

However, they caution that while other clinical studies show calcium and phosphorus are necessary for optimal bone strength, the new findings do not address overall health implications for either primates or humans. Rather, they say, the work illuminates the dynamic nature of our bones.

“A bone is not a static and dead portion of the skeleton,” notes NYU anthropologist Shara Bailey, one of the study’s authors. “It continuously adjusts and responds to physiological processes.”

The other authors of the study, which appears in the journal PLOS ONE, are Timothy Bromage, a professor in NYU College of Dentistry, Bin Hu, an adjunct professor at NYU College of Dentistry, Justin Goldstein, a doctoral candidate at Texas State University, and Rachel Kalisher, a doctoral candidate at Brown University.

It’s been long-established that menopause can have an effect on females’ bones. Less clear is how preceding life-cycle events, such as reproduction, can influence skeletal composition. To address this, the researchers studied the primary lamellar bone–the main type of bone in a mature skeleton. This aspect of the skeleton is an ideal part of the body to examine because it changes over time and leaves biological markers of these changes, allowing scientists to monitor alterations during the life span.
In the researchers examined the growth rate of lamellar bone in the femora, or thigh bones, of both female and male primates who had lived at the Sabana Seca Field Station in Puerto Rico and died of natural causes. Veterinarians at the field station had monitored and recorded information on these primates’ health and reproductive history, allowing the researchers to match bone-composition changes to life events with notable precision.

Cerrito and her colleagues used electron microscopy and energy-dispersive X-ray analysis–commonly deployed methods to gauge the chemical composition of tissue samples–to calculate changes in concentrations of calcium, phosphorus, oxygen, magnesium, and sodium in the primates’ bones.

Their results showed different concentrations of some of these elements in females who gave birth compared males as well as females who did not give birth. Specifically, in females who gave birth, calcium and phosphorus were lower in bone formed during reproductive events. Moreover, there was a significant decline in magnesium concentration during these primates’ breastfeeding of infants.

“Our research shows that even before the cessation of fertility the skeleton responds dynamically to changes in reproductive status,” says Cerrito, now a research fellow at ETH Zurich. “Moreover, these findings reaffirm the significant impact giving birth has on a female organism–quite simply, evidence of reproduction is ‘written in the bones’ for life.”

According to a recent study done by scientists at the University of Hong Kong, osteoporotic hip fracture, which is already a dangerous and devastating condition for senior men and women throughout the world, is set to deteriorate as the population ages and gets more frail. According to the study, men and adults over the age of 85 are especially vulnerable to osteoporosis and fractures, highlighting the need for more research, prevention, and treatment.

Associate Professor Ching-lung Cheung of the University of Hong Kong’s Department of Pharmacology and Pharmacy presented the findings today at the annual conference of the American Society of Bone and Mineral Research in Austin, Texas.

The study examined data from 19 countries for individuals aged 50 and over who sustained hip fractures between 2005 and 2018. It was revealed that an overall increase in the number of hip fractures was predicted in 18 of the 19 nations studied. Hip fracture rates were forecasted for 2030 and 2050 using World Bank population estimates.

Hip fracture rates are expected to more than double globally by 2050, with males having a greater proportionate rise than women.

The study identified many probable explanations of the gender discrepancy. Although the frequency of hip fractures dropped in the majority of countries throughout the study period, the amount of the reduction was lower in men. Men are living longer lives as a result of advancements in healthcare, personal cleanliness, food, and other areas. According to the United Nations, the average life expectancy for males would be over 75 years by 2050, which coincides to the age range where this study discovered a significant risk of hip fracture.

As a result, researchers estimate an increase in the number of men who are at high risk of hip fracture.

Similarly, osteoporosis in males has long gone undetected and untreated, according to Dr. Cheung. Our research also found that males are 30% to 67% less likely than women to take anti-osteoporosis medications following a hip fracture, he said. As a result, more emphasis should be made on the prevention and treatment of men’s hip fractures.

Previous research on the occurrence of hip fractures relied on dated data from various study approaches and historical periods. This study looked at the most recent secular trends in hip fracture incidence, mortality, and post-fracture pharmacological therapy in 19 different countries.

To deliver comparable data across all sites, a standard protocol and data model were used. The annual incidence of hip fracture, death, and rates of pharmacological therapy within a year were computed using age- and sex-standardized data.

The researchers discovered significant variation among the 19 countries they looked at using descriptive analyses of patient-level healthcare data.

Hip fracture incidence was calculated to be 180 per 100,000 people overall, controlling for age and sex (Women 236; Men 118). However, the average annual change in the incidence of hip fractures ranged from -2.8% to +2.1%. The countries with the largest reductions in fractures were Hong Kong (2.4%), Singapore (2.8%), and Denmark (2.8%).

The Netherlands (+2.1%) and South Korea (+1.2%) saw the largest gains. One-year all-cause mortality ranged from 14.4% to 28.3%, while mortality trends ranged from 5.3% to +18.4% annually, with Australia (5.3%), the Netherlands (4.6%), and Singapore (4.3%) recording the highest declines. 11.5% to 50.3% of hip fracture patients took an anti-osteoporosis drug within a year of the fracture, with yearly trends ranging from 9.6% to +12.7% and dropping in 6 of 15 locations.

Further in-depth investigation is needed to determine the causes of the observed variation among nations, according to co-author and research assistant professor Chor Wing Sing. Better osteoporosis therapy and post-fracture care, according to the expert, may be the cause of some countries’ relatively large hip fracture decreases. Better fall-prevention initiatives and more precise clinical care standards undoubtedly contributed to the improvement.

A rise in bone mineral density, or BMD, as a result of people’s increased awareness of bone health, according to Dr. Sing, may also have been helpful. She referenced a study from Hong Kong, where there had been one of the highest decreases in hip fractures, which shown that women over 50 had started getting more active and undertaking more weight-bearing activity, which had led to a considerable long-term increase in BMD.

Impact of ageing on hip fractures

The main takeaway from the new study, according to its authors, is that the impact of the ageing population cannot be completely offset by the decrease in hip fractures that has occurred in many nations in recent years. Hip fractures are anticipated to become more common. However, post-fracture care is still insufficient in many nations.

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While post-fracture care in this demographic is typically conservative, the incidence of hip fracture in those over 85 (the “oldest old”) continues to be more than double that of other age groups.

A stronger and more coordinated effort by healthcare professionals, patients, and caregivers will be necessary to prevent hip fractures, bridge the treatment gap, and improve post-fracture care, particularly in males and the elderly. There is an urgent need for this all around the world.

Anterior cruciate ligament (ACL) damage, a type of knee injury that most frequently happens during sports, is becoming increasingly common in kids and teens, claims a research. Surgery should be carried out as soon as feasible for adolescents and young adults with ACL injuries when it is recommended. However, there is a twofold increase in the likelihood of delayed surgery for kids and teens whose parents don’t understand English.

The journal Clinical Orthopaedics and Related Research published the study’s results. ACL rips hurt and may become permanently disabled if left untreated.

Most surgeons agree that surgery should be carried out within a month or two of the accident if it is necessary, which is typically the case with young athletes. Longer delays might cause more serious, permanent knee injury.

Sports medicine expert Neeraj M. Patel, MD, MPH, MBS, and colleagues examined 543 young patients who underwent ACL surgery at the Ann and Robert H. Lurie Children’s Hospital in Chicago. 16 was the average patient age, and both boys and girls were evenly represented. The authors analysed the timing of surgical procedures between 113 patients whose preferred language was not English and 430 patients whose families spoke Spanish at home (more than 90% of these patients’ families spoke Spanish at home).

The patients with parents who spoke a language other than English were twice as likely to have surgery more than 90 days after the accident, the researchers discovered. Even if the researchers took into consideration the patients’ insurance status, this disparity was still seen.

Orthopedic surgery departments are urged by Dr. Patel and his colleagues to offer more equal care to kids and teens whose parents speak a language other than English. Some of the tactics they advise are:

* Increasing the number of multilingual medical professionals,

* Making arrangements for improved interpreter availability,

* By making health information readily available in the local community’s native tongues,

* Collaborating with primary care physicians, community groups, and schools to promote awareness of ACL injuries, speed up diagnosis, and

* Teaching medical staff members how to make sure that families are aware of the suggestions for managing an ACL injury and are actively involved in the choice of whether to have surgery.

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The authors state that “institutions should build a culture of care that is attentive to and ready for persons whose preferred language is not English.” This should entail asking questions to and interacting with such families to learn more about their particular healthcare requirements, prejudices they deal with, and hurdles to care.

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An international research team has successfully recovered muscular mobility in a model of paralysed mice using organic neurons. Prof. Tae-Woo Lee (Department of Materials Science and Engineering, Seoul National University, Republic of Korea) and Prof. Zhenan Bao headed the team (Department of Chemical Engineering, Stanford University, US).

The outcome was published in the prestigious international journal “Nature Biomedical Engineering.” The nerves are easily harmed by a variety of factors, including physical injury, genetic factors, secondary problems, and ageing. The nerves are crucial for life activities and also have a substantial impact on quality of life. Additionally, some or all of their body functions are permanently lost due to poor bio-signaling because once nerves are injured, they are difficult to rebuild.

The traumatic account of a celebrity’s spinal cord injury occasionally makes the news. Despite the dramatic advances in medicine and biology, the medical problem of nerve injury, which has existed since the dawn of humanity, has remained a mystery to science, and there doesn’t appear to be any clear solution in the near future.

Damaged nerves have been treated in a variety of ways, including surgical procedures and drugs, but it is still nearly difficult to restore damaged or degraded nerve functioning.

Functional Electrical Stimulation (FES), a technique used often in clinical practise for the rehabilitation of patients with neurological impairment, uses computer-controlled signals. This involves applying electrical stimulation to muscles that are no longer arbitrary controlled in neuropathy patients in order to trigger muscle contraction, resulting in functionally effective motions in the biological body while being constrained in a particular space.

These conventional approaches, however, have drawbacks that make them unsuitable for patients to use on a long-term basis in their daily lives. This is because they use sophisticated digital circuits and computers for signal processing to stimulate muscles, which uses a lot of energy and has poor biocompatibility.

By using a stretchable, low-power organic nanowire neurormorphic device that mimics the structure and functionality of real nerve fibres, the research team was able to control the movement of mice’s legs solely with artificial nerves, eliminating the need for a complicated and large external computer. The stretchy artificial nerve comprises of a hydrogel electrode for signal transmission to the leg muscles, an organic artificial synapse that mimics a biological synapse, and a strain sensor that models a proprioceptor that senses muscle movements.

Because the researchers controlled the mouse legs’ movement and the force with which their muscles contract in line with the frequency of the action potentials conveyed to it, the artificial synapse performs smoother and more lifelike leg motions than the standard FES.

Furthermore, the artificial proprioceptor monitors the mouse’s leg movement and delivers real-time feedback to the artificial synapse to reduce muscle injury from excessive leg movement.

A paralysed mouse was taught to kick the ball, walk, and run on the treadmill by the researchers. Furthermore, by taking samples of recorded signals from the motor cortex of moving animals and manipulating the legs of mice through artificial synapses, the study team demonstrated the potential use of artificial nerves in the future for voluntary movement.

The neuromorphic technology, which is gaining interest as a next-generation computer device by simulating the behaviour of a biological neural network, has a new application feasibility that was discovered by the researchers. The researchers showed that the neuromorphic field would be utilised in other sectors, including biomedical engineering and biotechnology, in addition to computers.

According to Prof. Tae-Woo Lee, “Neural injury is still seen as a major scientific challenge from the past to the present despite the amazing medical breakthroughs, and without a fresh discovery, it will still be a difficult problem to overcome in the future. The study’s relevance is best summed up by the phrase, “This research provides a fresh advance in overcoming nerve damage in an engineering method using neuromorphic technology, not in a biomedical way. “An engineering approach to overcoming nerve damage will provide a new road to improve the quality of life for those suffering from linked diseases and disorders,” the author further stated.

Prof. Zhenan Bao highlighted the study’s potential, noting that it “has offered a cornerstone for patient-friendly, more realistically useable wearable neural prosthetics, away from the existing form factor” through the development of flexible artificial nerves for patients with injured nerves. This gave rise to hopes that “The underlying technology of the stretchy artificial nerve may be used to numerous medical wearable technologies,” as she put it.

The study team stated a wish to continue the work with therapeutic applications beyond primates and animals such as mice in the future. This suggests that new techniques and therapies for human nerve damage, including as spinal cord injury, peripheral nerve damage, and neurological impairments such as Lou Gehrig’s, Parkinson’s, and Huntington’s disease, may be available.