面向术后康复的人体皮肤形变研究

面向术后康复的人体皮肤形变研究 Quantification of skin deformation with motion-analysis technique: optimizing postoperative rehabilitation trainings aSchool of Biological Science and Engineering, Beihang University of slow wound healing after surgery. Therefore, the measurement of mechanical effects of common RT and Abstract daily activities on key positions of human body plays a significant role in scientific PR plan. Estimating the mechanical impact of common Measurement of skin deformation is a good way to exercises on surgical sites plays an important role in characterize the mechanical effects. At present, skin scientific rehabilitation training. The kinematic loads on deformation measurements are mainly based on surgical sites were simulated by measuring the skin ultrasound. Deep and transverse information of deformation of 7 healthy volunteers with a motion [7]. subcutaneous tissue is obtained by imaging registrationcapture system. According to the skin deformation However, image resolution of ultrasound is too low to measurement, all 13 actions were divided into 3 levels, fulfill the requirement of accurate measurement. Imaging which is consistent with our daily experience. The results errors exist even in the high performance ultrasound showed significant differences between each level. [8]images .Recently, a novel method to measure skin Therefore, our classification is reasonable and able to deformation is raising based on the motion capture provide a scientific guide for gradual exercise and daily [9]system. Mahmud et al set a rectangular grid on activities in different postoperative rehabilitation (PR) forearm, and captured the movement of skin by tracing phases. Besides, an advice on rehabilitation training markers. They also validated the system and verified that exercise for various surgical sites was given according to it’s possible to measure skin deformation of large areas. the experimental data. Our results provide a theoretical According to recent researches, walk (gait) is a gold basis for scientific rehabilitation plan, which can [10]standard for kinematic analysis of lower limbs and accelerate the physiological and psychological also a most common RT exercise. However, no unified recoveries, optimizing the effect of rehabilitation. standard of RT or daily activities has been developed for Keywords: postoperative rehabilitation, surgical site， [11] upper limbs. Namdari et al chose 10 tasks from the skin deformation, measurement [12]functional assessment section of the ASES and PSS [13]. But their validity and comprehensiveness were not fully accepted. It is necessary to develop a scientific 1. Introduction action protocol which can fully reflect RT and daily activities. The large mechanical wound caused by operations The aim of this study is to simulate the kinematic restrains activities of patients, which leads to stiffness of loads on surgical sites during common RT and daily [1, 2]joint as well as muscular atrophy or adhesion, and activities by measuring the skin deformation of healthy [3, 4]also lowers life quality . Rehabilitation training (RT) volunteers. Our study may provide data support for not only helps recover somatic function, but also making scientific and personalized RT plans after contributes to overcoming psychological problems after various surgeries. [5, 6]operations . Currently, RTs are basically based on experience of clinicians or pain feelings of patients, 2. Method lacking of quantitative and scientific kinematic analysis. Simple and subjective standard may lead to a 2.1. Participants conservative treatment which will slow down muscle and joint function recovery; while unreasonable RT will The data were obtained from 7 healthy Asian male result in slow-healing wound. The pain caused by large volunteers with a mean age of 43.2?2 years old. The range of motion (ROM) will result in fear of RTs in exclusion criteria were previous surgery, trauma or injury patients. In fact, mechanical stress is an important factor of any joint. All the volunteers were all right-handed. ICVRV2011 Before the procedure, every subject signed a written measureable all over the experimental space. The sample informed consent form, followed by some trainings to frequency was set as 50Hz. Since the volunteer could make sure they behave standard enough as we expected. finish all tasks normally, the deformation at the neck- Table 1 Mean (SD) characteristics of the back-waist was firstly measured beginning with the subjects standard anatomical position. Every action was repeated Characteristics Mean ? SD Range 3 times. Then the chest-abdomen skin deformation was Age(y) 43.2?2 39~46 measured. Height(m) 1.681?0.02 1.651~1.725 Weight(Kg) 81.00?17.2 55.00~117.50 2BMI (kg/m) 28.56?5.7 19.43~39.55 2.2. Scheme and Procedure Infrared markers were placed to measure the skin deformation of neck-back-waist and chest-abdomen, respectively in twice tests. A rectangular marker con,guration with 20 markers (2 cm apart) was applied to the skin of chest. Sternoclavicular joint was selected as the feature point at chest. Another rectangular marker Figure 1, Marker arrangement con,guration with 12 markers (2 cm apart) was applied to left abdomen, with a feature point 9 cm below and 4 cm left to the xiphoid process. Then a similar 2.3. Data processing con,guration with 41 markers (2 cm apart) was applied to neck-back-waist with vertebras as the identifications. According to surgery options, marker 6, 7, 10，11, Furthermore, to distinguish actions, markers were also 14, 15, 33, 36 of CA and marker 7, 10, 20, 22, 26, 32, 35, placed on head and arms where the ROM was large 36, 37, 40, 43, 44, 45 of neck-back-waist are the key (Figure 1). points we focused on. The displacement percent of key In this study, 13 most common tasks in RT and daily point and its 4 neighborhoods are calculated as their activities were chosen to measure skin deformation on vertical and horizontal deformation; that is various areas. The tasks were shown in Table 2. d= (U-I)/I; V= (S+ I)/2; H= (R+ L)/2; Dd dDd dTable 2 Tasks (abbreviation) Where, d is displacement, U is ultimate distance, I is The daily activities or initial distance; V and H are vertical and horizontal DDNO. Action rehabilitation training simulated deformation, S, I, R, L are superior, inferior , right d dddWash the middle of one's 01 Bend arms touching back (BAB) back/unhook one's own bra and left displacement of the key point Place hand behind one’s head 02 comb one's hair The kinematic data were analyzed with SPSS (HBH) 03 Hand to contralateral shoulder (HTS) Dress shirt software, version 19.0 (SPSS, Chicago, IL, USA). Arm reach task (forward & lateral) Repeated-measures one-way analysis of variance was 04 Exercise the shoulder (ART) adduction and abduction used. The results showed no significant difference 05 Arms Circumduction (AC) between individual trials (P =0.971). Therefore, the mean 06 Body bend (forward-reverse) (BBF) value for the 3 trials of every action was used. The tasks 07 Body bend (lateral) (BBL) Exercise spine & waist muscles were divided into several groups based on the results; T-08 Body twist (BT) test was used to find out whether there was a significant 09 Head nod (HN) Exercise the cervical vertebra difference between each group. and neck muscles 10 Head rotate (HR) 11 Walk (WK) Exercise hip joint and muscles Active straight leg raise (forward, 3(Results 12 。。45Lateral, 90Lateral) (SLR) 13 Composite activities (Taichi) (TCH) Exercise the whole body The vertical and horizontal skin deformation during each action was shown in Table 3.The 13 tasks were Three 3-cameras Optotrak Certus Motion Capture classified into 3 levels according to skin deformation Systems (NDI Corporation, Ontario, Canada, resolution: magnitude (shown in table 4), large (>10%), medium (3-0.01 mm, 3D accuracy: 0.1 mm) were placed at the 10%), small (<3%), the larger one was selected when the vertices of a equilateral triangle (5m between each vertical and horizontal skin deformation were not the camera) to ensure the movement of subjects was 11.95?12.35?same. The skin deformation had a significant difference 06 2.63?0.20 1.49?0.46 4.63?0.56 2.07 2.24 between each level, p<0.05 10.41?11.71?12.61?07 4.57?0.44 1.63?0.22 1.26 2.31 2.36 The actions of HBH, ART, AC, BBF and TCH caused 15.68?08 3.07?0.28 0.72?0.11 2.58?0.11 1.31?0.25 a large vertical skin deformation on chest, which was 0.95 09 0.33?0.08 0.66?0.10 9.80?0.48 1.94?0.12 0.34?0.02 significantly larger than the horizontal one (p<0.05). But 10.77?during the actions of BAB and HTS, medium skin 10 0.69?0.07 0.37?0.09 2.87?0.23 0.25?0.03 0.17 deformation was occurred horizontally (the vertical 11 0.95?0.08 1.26?0.11 0.19?0.04 3.54?0.35 5.82?1.42 deformation was significantly smaller, p<0.05). Other 12 0.67?0.02 5.10?0.71 0.24?0.05 4.13?0.64 5.75?0.80 actions had small effect on chest. The actions that caused 13.49?13.74?10.87?11.95?12.48?13 0.73 0.83 0.99 2.03 2.26 a large skin deformation on abdomen were BBF (with a Table 4 Classification of tasks larger skin deformation vertically), BBL, BT, TCH level (larger horizontally); the actions which led to a medium Small Medium Large site skin deformation were ART, AC, SLR (larger HBH, ART, AC, Chest BBL, BT, HN, HR, WK, SLR BAB, HTS BBF, TCH horizontally), WK (larger vertically); others affected little AbdomeART, AC, WK, BBF, BBL, BT, BAB, HBH, HTS, HN, HR on abdomen. n SLR TCH BAB, HBH, HTS, ART, BBF, Only the action AC (larger vertically) led to a medium Neck AC HN, HR, TCH BBL, BT, WK, SLR BAB, HBH, AC, BBF, BBL, skin deformation on neck; while there were large skin Back HTS, HN, HR, WK ART, SLR BT, TCH deformations when conducting the actions of HN, TCH BAB, HBH, HTS,ART, AC, HN, BBF, BBL, BT, Waist WK, SLR HR TCH and HR; little effect was brought on neck by other actions. The actions AC (larger vertically), BBF, BBL (larger 4. Discussion horizontally), BT and TCH had a great impact on back; the actions BAB, HBH (larger vertically), ART (larger Clinically, RT was usually conducted based on horizontally) and SLR were in a group with medium skin doctors’ experience or the pain feelings of patients. It is deformation on back; the others had small effects. On necessary to plan RT in a more quantitative and scientific waist, the actions BBF (larger vertically), BBL, BT way. All 13 tasks in this research were most common (larger horizontally) and TCH led to a large skin actions in RTs or daily activities. The kinematic loads on deformation; while only a medium skin deformation were surgical sites during RT and daily activities were causes by WK and SLR with other actions little effect. simulated by measuring the skin deformation of healthy Table 3 Skin deformation of surgery areas (%) Vertical deformation Taskvolunteers. For each surgical site, the horizontal and s Chest Abdomen Neck Back Waist vertical skin deformations were different during most 01 8.50?1.95 2.34?0.62 0.62?0.10 4.76?1.15 0.69?0.13 actions, some of which had even significant differences. 12.97?02 2.25?0.48 0.95?0.17 8.60?0.54 0.66?0.19 1.47 Since a large deformation in one direction would cause 03 8.84?1.83 2.55?0.53 1.07?0.12 1.07?0.13 1.07?0.14 slow wound healing during specific actions, the 10.86?04 2.94?0.17 2.03?0.22 4.48?0.62 0.85?0.39 deformation was calculated in two directions to prevent 1.10 12.83?10.81?the mistake caused by averaging. For example, action 05 2.67?0.48 3.54?0.29 2.40?0.34 1.85 1.98 BBF led to a large vertical deformation at abdomen, 11.73?13.74?06 0.93?0.21 1.62?0.24 1.45?0.35 1.01 0.83 signi,cantly different from the horizontal one. Hence, the 12.92?07 7.92?1.03 1.12?0.07 2.29?0.74 1.15?0.26 patients with a horizontal wound at abdomen should be 1.25 10.80?10.43?careful when performing such actions, which might 08 1.97?0.09 5.53?0.77 1.42?0.21 2.25 2.26 prevent wound healing; vice versa. 09 0.35?0.03 0.51?0.04 1.53?1.08 0.42?0.08 0.24?0.04 Post rehabilitation is usually divided into 3 phases, 10.25?10 0.82?1.56 0.44?0.03 2.52?0.19 0.30?0.06 0.24 early phase (1-7 days after surgery), middle phase (2-5 11 1.06?0.15 5.91?0.24 0.22?0.01 2.36?0.23 6.33?1.82 weeks after surgery), and later phase (6-12 weeks after [14]12 0.72?0.08 8.42?1.00 0.17?0.03 3.32?0.26 8.71?1.24 surgery) . Generally, middle phase would be the 11.98?10.32?11.15?12.42?critical period of physiological and psychological 13 1.49?0.26 1.28 1.12 1.02 2.29 recovery from surgery. Formal and systematic RTs Horizontal deformation Tasks Chest Abdomen Neck Back Waist should be conducted no later than middle phase. 01 4.99?1.67 0.90?0.14 0.58?0.02 1.67?0.31 0.40?0.04 Meanwhile, trainings in early PR phase would lay a 02 5.23?0.75 0.95?0.16 1.67?0.58 1.90?0.27 0.39?0.06 foundation for the whole rehabilitation. All 13 actions 03 5.17?0.92 1.07?0.11 2.55?0.54 2.55?0.55 2.55?0.56 were divided into 3 levels, between which the skin 04 5.07?0.64 6.42?1.03 0.74?0.09 8.42?1.46 1.35?0.67 deformation differs significantly. Besides, the 05 6.69?0.89 5.07?0.54 1.38?0.02 2.58?0.11 1.11?0.19 classification result was consistent with our daily experience. Therefore, the classification was reasonable and could be a scientific basis for the planning of RT and performed gradually according to the classification, from daily activities during each PR phase. Clinically, actions small level to large level over the PR phases. The like ART, AC and TCH were widely used in RT after advisable and gradual RT plans conforming to our thoracic operations. However, the result of our research suggestion may accelerate wound healing as well as showed that the motions led to a large skin deformation physiological and psychological recovery. on the surgical site. It might affect wound healing that performing such actions too much or too early. Acknowledgment Furthermore, current research revealed that muscle and Thanks and for their help in this experiment. joint functions recovered better by repetitive motions in [14]small range than short motions of large ranges . References Actually, because of the large ROM, the amount of exercises like ART, AC and TCH has to be decreased to [1]Wu Yaqun, Xu XInbo. Breast tumor. Hubei publishers of even only twice 20-minutes every day during early PR science and technology, Wuhan, 2002, 118-120. [15]phase to prevent too much negative influences . 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