Applications of nanotechnology in the field of physical therapy

1. Applications of
Nanotechnology in
the Field of
Physical Therapy
BY:
Mohamed Samir El-Asaly
PT, CKTP
Under supervision
Prof. Dr. Mohamed Abd Elhakeem

2. AFFECTING
PROSTHETICS AT
THE NANO SCALE

3. Prosthetics
 Physical 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.

5. Prosthetics
The major causes of amputation are:
1.peripheral vascular disease
2.Trauma
3. malignancy
4.congenital deficiency

6. Prosthetics
 In 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.

7. Prosthetics
 Men 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.

8. Prosthetics
 Physical therapists are key
members of the
rehabilitation team, working
with prosthetists, physicians,
occupational therapists, and
others to foster the patient’s
welfare.
 For individuals with LE
amputation, physical
therapists have the major
role in assisting the person
to regain function.

9. Prosthetics
 Historic 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.

10. Prosthetics
 Today, 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,
Syme’s, 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.

11. Types of Prosthetics
1. PARTIAL FOOT AND SYME’S
PROSTHESES
2. TRANSTIBIAL PROSTHESES
3. TRANSFEMORAL PROSTHESES
4. Knee Disarticulation Prostheses
5. Hip Disarticulation Prostheses
6. BILATERAL PROSTHESES

12. Component of
Prosthetics
 Foot-Ankle Assemblies
 Nonarticulated Feet
 Solid Ankle Cushion
Heel (SACH)
 Stationary Attachment
Flexible Endoskeleton
(SAFE) foot
 Articulated Feet
Single-Axis Feet
Multiple-Axis Feet

13. Component of
Prosthetics
 Rotators and Shock
Absorbers
 Shank
Exoskeletal Shank
Endoskeletal Shank
 Socket
 Lined Socket
 Unlined Socket

14. Donning

15. Major Problems in
prosthetics
 Prosthetic 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.

16. 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.

17. AFFECTING PROSTHETICS
AT THE NANO SCALE
 To enhance design by
allowing prosthetics to
become:
1. More biocompatible.
2. Hygienic.
3. Lighter.

18. AFFECTING PROSTHETICS
AT THE NANO SCALE
 The 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.

19. 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.

20. 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.

21. Nanotechnology
Powder in Prosthetics
 One 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.

22. Nanotechnology
Powder in Prosthetics
 At 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.

23. Nanotechnology
Powder in Prosthetics
 When bonded to a material’s 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 product’s moisture resistant
capabilities.

24. Nanotechnology
Powder in Prosthetics
 Together 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.

25. Nanotechnology
Powder in Prosthetics
 This 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.

26. Nanotechnology
Powder in Prosthetics
 The 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.

27. Nanotechnology
Powder in Prosthetics
 The 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.

28. Carbon Nanotube and
Prosthetics
 Research 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.

29. Carbon Nanotube and
Prosthetics
 In 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.

30. CNT and Mechanoreceptors
in Prosthetics

31. Nano-Silver Particles
and Prosthetics
 The 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.

32. Nano-Silver Particles
and Prosthetics
 In 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.

33. Carbon Nano
Tubes and
Artificial
Muscles

34. CNT and Artificial
Muscles
 Researchers 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.

35. CNT and Artificial
Muscles
 A 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
nanotubes
 It 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.

36. CNT and Artificial
Muscles

37. CNT and Artificial
Muscles
 Although 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.

38. A biodegradable tri-
component graft for
anterior cruciate
ligament
reconstruction

39. Stability of knee

40. Function of ACL
Primary (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.

41. Risk Factor to ACL tear
 High-risk sports: football,
baseball, soccer, skiing, and
basketball
 Sex: F > M
 Femoral notch stenosis: < 0.2
 Footwear

42. Clinical picture
 Non-contact injury:
1. Often occurs while changing direction or
landing from a jump.
2. "popping" noise.
3. Within a few hours, a large hemarthrosis
develops.
4. Pain, swelling, and instability or giving way of
the knee.
5. Unable to return to play.

43. Clinical picture
 Contact and high-
energy traumatic
injuries:
Often are associated
with other ligamentous
and meniscal injuries.
Terrible Triad !!

44. ACL Reconstruction
Grafting can be from :
1. Patellar tendon (Gold Standard
Method)
2. Hamstring tendons
3. Quadriceps tendon.
4. Allograft
 The 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.

45. ACL Reconstruction

46. A biodegradable tri-component graft
for anterior cruciate ligament
reconstruction
 Bone–patellar tendon–bone (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.

47. A biodegradable tri-component graft
for anterior cruciate ligament
reconstruction
 In 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:
1. Porous poly(1,8-octanediol-co-citric acid).
2. Hydroxyapatite nanocomposites (POC–
HA).
3. Poly(L-lactide) (PLL) braids
 All regions of the tri-component graft were
porous and the tensile properties were in
the range of the native ACL.

48. A biodegradable tri-component graft
for anterior cruciate ligament
reconstruction
 When 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.

49. Nanotechnology and
Transcutaneous
Electrical Nerve
Stimulation

50. TENS
 Transcutaneous Electrical Nerve
Stimulation (TENS) is a therapy
that uses low-voltage electrical
current for pain relief.
 It’s used to relieve pain for several
different types of illnesses and
conditions.

51. TENS
 They 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.

52. Pain Gait Theory

53. Nanotechnology
application in TENS
 A 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.

54. Nanotechnology
application in TENS
 The device is small and is
strapped onto the back of the
patient’s 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 didn’t reveal
the nanotechnology secretes
that is used in Quell