Randomized controlled trial of a good practice approach to treatment of childhood obesity in Malaysia: Malaysian childhood obesity treatment trial (MASCOT)

Context. Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world. Aim. To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia. Methods. Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days). Results. The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p < 0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group. Conclusions. Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes

PROBLEM BASED LEARNING IN MANAGEMENT AND CLINICAL ENGINEERING COURSE

This paper addressed student perceptions and opinion of the problem based learning method, as well as the empirically collected data on students' learning outcomes on a Biomedical Engineering course, i.e. Management and Clinical Engineering. Pure lecture delivery with absence of practical intervention was deemed insufficient to provide appropriate means to achieve the course objectives. Therefore, a Mock Company assignment was introduced in this course as a problem based learning application aimed to aid the achievement of the program outcome while improving the attainment of the course objectives. The students were divided into groups to form individual mock company. Each mock company formed their organization post for each member, and came up with a business plan for a new project to be presented for fund approval by the panels, made up of the course instructors and invited lecturers from the clinical engineering industry and hospital practitioners. The company discussion progress and performance were monitored by the instructors through the formal university e- learning platform throughout the semester with occasional response and suggestions. The panels identified the expected lack of business and management knowledge but this was counteracted by the reasonably successful business plan produced independently by all companies’ At the end of the semester, through questionnaires, 69.6% of the 56 students agreed that this mock company assignment was useful in achieving the course objectives and should be conducted in the following years. Students who performed weakly in this assignment also demonstrated lower performance in all evaluations including by traditional means (p = 0.01), although there were no direct associations amongst the problem-based and the traditional evaluations (r <0.66). The students’ responses also reflected their readiness to perform more independent learning approaches, despite them expressing the lack of clear scope and guideline, which is the nature of a problem-based learning experience

In-socket sensory system with an adaptive neuro-based fuzzy inference system for active transfemoral prosthetic legs

An in-socket sensory system enables the monitoring of transfemoral amputee movement for a microprocessor-controlled prosthetic leg. User movement recognition from an in-socket sensor allows a powered prosthetic leg to actively mimic healthy ambulation, thereby reducing an amputee's metabolic energy consumption. This study established an adaptive neurofuzzy inference system (ANFIS)-based control input framework from an in-socket sensor signal for gait phase classification to derive user intention as read by in-socket sensor arrays. Particular gait phase recognition was mapped with the cadence and torque control output of a knee joint actuator. The control input framework was validated with 30 experimental gait samples of the in-socket sensory signal of a transfemoral amputee walking at fluctuating speeds of 0 to 2 km · h- 1. The physical simulation of the controller presented a realistic simulation of the actuated knee joint in terms of a knee mechanism with 95% to 99% accuracy of knee cadence and 80% to 90% accuracy of torque compared with those of normal gait. The ANFIS system successfully detected the seven gait phases based on the amputee's in-socket sensor signals and assigned accurate knee joint torque and cadence values as output. © 2018 SPIE and IS&T

Health related quality of life of obese adolescents in Kuwait

Obesity impairs health related quality of life (HRQL) in adolescents, but most evidence in this area has mostly come from western societies. We wanted to test the hypothesis that obesity impairs HRQL in Kuwaiti adolescents, and to test for differences in HRQL assessed by self-report and parent-proxy report. In 500 Kuwaiti 10-14 year olds HRQL was assessed using the Peds QL (TM) with both adolescent self-reports (n = 500) and parent-proxy reports (n = 374). Obesity was not significantly associated with HRQL in regression analysis. In a paired comparison of 98 pairs of obese adolescents vs. 98 healthy weight peers, impairment of HRQL reached significance only for physical score (95% CI = -1.5, -9.4), not for psychosocial score or total score. In a paired comparison of parent-proxy vs. self-reports for the obese adolescents, total score (95% CI = -4.9, -10.9), physical score (95% CI = -3.2, -11.0), and psychosocial score (95% CI = -4.2, -10.8) were all significantly lower in the parent reports. Obesity is not associated with marked impairment of HRQL in adolescents in Kuwait, in contrast to studies in western societies. This may reflect cultural differences in attitudes towards obesity

Mechanomyographic Parameter Extraction Methods: An Appraisal for Clinical Applications

The research conducted in the last three decades has collectively demonstrated that the skeletal muscle performance can be alternatively assessed by mechanomyographic signal (MMG) parameters. Indices of muscle performance, not limited to force, power, work, endurance and the related physiological processes underlying muscle activities during contraction have been evaluated in the light of the signal features. As a non-stationary signal that reflects several distinctive patterns of muscle actions, the illustrations obtained from the literature support the reliability of MMG in the analysis of muscles under voluntary and stimulus evoked contractions. An appraisal of the standard practice including the measurement theories of the methods used to extract parameters of the signal is vital to the application of the signal during experimental and clinical practices, especially in areas where electromyograms are contraindicated or have limited application. As we highlight the underpinning technical guidelines and domains where each method is well-suited, the limitations of the methods are also presented to position the state of the art in MMG parameters extraction, thus providing the theoretical framework for improvement on the current practices to widen the opportunity for new insights and discoveries. Since the signal modality has not been widely deployed due partly to the limited information extractable from the signals when compared with other classical techniques used to assess muscle performance, this survey is particularly relevant to the projected future of MMG applications in the realm of musculoskeletal assessments and in the real time detection of muscle activity

Sensory systems in micro-processor controlled prosthetic leg: a review

Micro-processor controlled prosthetic legs (MPCPL) offer better functionality than conventional prosthetic legs as they use actuators to replace missing joint function. This potentially reduces the user's metabolic energy consumption and normal walking gait can be mimicked as closely as possible. However, MPCPL require a good control system to perform efficiently, and one of the essential components is the system of sensors. The sensory system must satisfy two important criteria; the practicality in donning and doffing the prosthesis, i.e. the process of putting on and taking off the prosthesis by the amputee user, and the quality in the information provided. In this paper, a comprehensive review was conducted on studies related to the state of the art of sensory system adopted in MPCPL. The publications were searched using four electronics databases within the last 13 years. A total of 31 papers were reviewed. The articles were classified into three main categories: prosthetic-device oriented, user's-biological-input oriented and neuro-mechanical fusion sensory system. Types of sensors used and their application to the prosthetic system were analyzed. This review indicates that the sensors technology reported in the literature still does not fulfil the criteria of an efficient sensory system. Hence, a sensory system that eases the don and doff process of the prosthesis, yet informative in terms of providing enough useful data to effectively control the prosthesis, is needed for a successful MPCPL

The Relationship Between Authoritative Parenting Style, Oral Sensory Processing, and Eating Behaviour Related to Picky Eaters among Toddlers in Klang Valley, Malaysia

This study aimed to examine the relationship between authoritative parenting style, oral sensory processing, and eating behaviour related to picky eaters among children aged 3 to 5 years. A cross-sectional study was conducted with 99 mother/father-child dyads from several Klang Valley nurseries and kindergartens. Online survey data collection, including the Child Eating Behaviour Questionnaire (CEBQ), the Child Sensory Profile 2 Questionnaire (CSP-2) (Oral Domain), the Parental Style Dimension Questionnaire (PSDQ), and a demographic questionnaire. Appointment-based collection of anthropometric measurements (weight and height) was conducted. Pearson correlation was used to determine the relationship between eating behaviour (picky eaters), oral sensory processing, and authoritative parenting scores, independent t-test to determine nutrition status and eating behaviour, and chi-square test to examine picky eater status and oral sensory processing classification. Results show that the prevalence of picky eaters is 45.5%. Picky eaters scored low in food responsiveness and food enjoyment but high in satiety response and slowness in eating. There was only an association between picky eating behaviour and oral sensory processing (r=0.22, p=0.003), but no correlation between these indicators and authoritative parenting styles (p>0.05). No significant difference was found in nutrition status between non-picky eaters and picky eaters (p>0.05). According to this study, nearly one out of two children is a picky eater, which is defined by less enjoyment of food, less responsiveness to food, eating slowly, and feeling full quickly. This research is likely to aid in the development of more targeted intervention programmes for picky eaters

Electrical stimulator with mechanomyography-based real-time monitoring, muscle fatigue detection, and safety shut-off: a pilot study

Functional electrical stimulation (FES) has been used to produce force-related activities on the paralyzed muscle among spinal cord injury (SCI) individuals. Early muscle fatigue is an issue in all FES applications. If not properly monitored, overstimulation can occur, which can lead to muscle damage. A real-Time mechanomyography (MMG)-based FES system was implemented on the quadriceps muscles of three individuals with SCI to generate an isometric force on both legs. Three threshold drop levels of MMG-root mean square (MMG-RMS) feature (thr50, thr60, and thr70; representing 50%, 60%, and 70% drop from initial MMG-RMS values, respectively) were used to terminate the stimulation session. The mean stimulation time increased when the MMG-RMS drop threshold increased (thr50: 22.7 s, thr60: 25.7 s, and thr70: 27.3 s), indicating longer sessions when lower performance drop was allowed. Moreover, at thr70, the torque dropped below 50% from the initial value in 14 trials, more than at thr50 and thr60. This is a clear indication of muscle fatigue detection using the MMG-RMS value. The stimulation time at thr70 was significantly longer (p = 0.013) than that at thr50. The results demonstrated that a real-Time MMG-based FES monitoring system has the potential to prevent the onset of critical muscle fatigue in individuals with SCI in prolonged FES sessions

Muscle size and strength benefits of functional electrical stimulation-evoked cycling dosage in spinal cord injury: a narrative review

Loss of sensory motor function is one of the main causes of physical and activity limitations among individual with spinal cord injury (SCI). SCI may lead to muscle paralysis, weakness and disused muscle atrophy. Evidences have shown electrical stimulation and strengthening exercise might improve lower limb muscle strength and size among individual with SCI. Functional electrical stimulation (FES) evoked cycling is one of the methods that can elicit leg muscle contractions in order to produce a cycling motion and promote the integrity of the involved muscles. Therefore, this review is to synthesize the scientific literature regarding the effects of multiple dosages of FES-evoked lower limb cycling on muscle properties. A systematic literature search from 1946 to 2016 was performed. From over 1,139 articles retrieved from the database, about 31 potentially relevant articles were retained for possible inclusion. However, only 10 articles out of 31 articles fulfilled the inclusion criteria. Although the available evidence is compelling, there is insufficient quantity and quality evidence to draw conclusions regarding the specific parameter of FES-CE that may optimally increase muscle strength, mass, and circumference. However, it can be safely concluded that an effective training session would spend for 45-60 min, 3 times a week for at least 4 weeks to see changes in muscle size and strength