Matthew Fagan | PubMed Health

PubMed2006

The Philadelphia Episiotomy Intervention Study.

OBJECTIVE: To lower the episiotomy rate through physician education and documentation of indication when episiotomy was performed. STUDY DESIGN: The intervention consisted of an evidence-based lecture recommending limited usage of episiotomy and requesting documentation of any episiotomy's indication. Data 3 months prior to the intervention were compared to those of the year following. Adjusted comparisons of episiotomy rates were completed using multivariate logistic regression models. RESULTS: For all vaginal deliveries, there was a 17% decrease in the rate of episiotomy, from 46.9% to 38.8%. For spontaneous vaginal deliveries, there was a 25% decrease in the episiotomy rate, from 40.8% to 30.8%. The most common indications for episiotomy reported were routine/elective, 41.0%; vacuum, 18.6%; forceps, 16.4%; and nonreassuring fetal heart tracing, 10.9%. CONCLUSION: Episiotomy rates may be effectively reduced through physician education and documentation of procedure indication.

Adult↗

PubMed2005

Perceptual limits for a robotic rehabilitation environment using visual feedback distortion.

Imperceptible visual distortion, in the form of a disguised progression of performance goals, may be a helpful addition to rehabilitation after stroke and other brain injuries. This paper describes work that has been done to lay the groundwork for testing this hypothesis. We have constructed and validated an experimental environment that provides controllable visual distortion and allows precise force and position measurements. To estimate the amount of visual distortion that should be imperceptible, we measured the limits for force and distance/position perception in our rehabilitation environment for young and elderly unimpaired subjects and for a single traumatic brain injury (TBI) patient. We found the Just Noticeable Difference (JND) for produced force to be 19.7% (0.296 N) and the JND for movement distance/finger position to be 13.0% (3.99 mm) for young subjects (ages 18-35). For elderly subjects (ages 61-80), the JND for force was measured to be 31.0% (0.619 N) and the JND for distance/po'sition was 16.1% (5.01 mm). JNDs of 46.0% (0.920 N) and 45.0% (14.8 mm) were found for the motor-impaired individual. In addition, a subject's rating of effort was found to be profoundly influenced by visual feedback concerning the force magnitude. Even when this feedback was distorted, it accounted for 99% of the variance of the effort rating. These results indicate that substantial visual distortions should be imperceptible to the subject, and that visual feedback can be used to influence the subject's perceived experience in our robotic environment. This means that we should be able to use imperceptible visual distortion to alter a patient's perception of therapeutic exercise in a robotic environment.

Adolescent↗