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- Publisher
- de Gruyter
- Copyright
- ©2016 Walter de Gruyter GmbH, Berlin/Boston
- ISSN
- 1896-530X
- eISSN
- 1896-530X
- DOI
- 10.1515/bams-2016-0021
- Publisher site
- See Article on Publisher Site
Abstract
IntroductionUntil recently, successive generations of young orthopedists gained the much needed experience in operating rooms under the supervision of their older colleagues. Currently, the development of orthopedics has meant that resident physicians, within a much shorter period of time, must acquire the knowledge and skills that their older colleagues gained over years, learning as they operated on patients. As a result, alternative teaching methods such as training on simulators and computer simulations are becoming more desirable in the training of residents physicians, as well as improvement of skills of senior staff in the event of implementation, for example, of new surgical techniques. Traditional and hitherto effective training model in medicine is based on the principle of “master-apprentice” and consists in learning on patients according to the old rule “see, do, teach the next”. Changing the existing rules of organization of work in hospitals causes rupture of ties between the trainers and the trainees. To better face this situation, it is necessary to introduce a new model of education. A lot has been written in scientific literature about the paradigm shift in the education of orthopedic surgeons that takes into account integration of new technologies into professional education. Training on simulators would then be a requirement. Use of simulation in medicine as well as aviation is set to be the norm. The idea is to raise the level of patient safety as much as possible and to learn to work in teams and communication with the patient, thanks to skills gained in this way. In the prepared study, focus was laid on citing examples of devices, computer programs, and electronic materials used in e-learning related to issue of simulation in orthopedics. Review of prevailing state of knowledge in this field and its arrangement was the key to the preparation of this article. In line with this, the authors started from the general definition of simulation and simulator in order to further present issues associated with it through examples, detailing the understanding of ideas.The concept simulation originates from the Latin word simulatio meaning “make-believe”. In the medical context, in different sources, understanding of this concept has been expanded, and so one author writes that “simulation is a technique of learning medical procedures in conditions similar to the real” [1], in another, “simulation is a training and method of education based on feedback, during which the learner practices under conditions as close to the natural as possible” [2]. In each case, the definition of simulation boils down to understanding this concept as an approximation of reconstruction of phenomenon or behavior of a given object using a model. Currently, a large spectrum of issues from various fields of science, ranging from mathematical modeling, through simulations using technological achievements, ending in simulation of behaviors, is to be found under the concept of simulation. The concept of simulator (lat. simulator meaning “follower”) is inherently connected with simulations in medical field. This term is used to describe an equipment that allows for reconstruction of cause of real processes under artificial conditions. Simulations and simulators are presented in two respects in the terms of the phenomena discussed in the text of the chapter:Techniques – it is here that we talk of a device imitating another device (imitator), artificially reproducing characteristics of a particular object or dynamics of specific processes. The concept of simulation in the technical aspect, hence, is synonymous with a concrete device, i.e. simulator.Computer science – when the talk is about a computer program that reproduces operation of certain devices or dynamics of specific processes. It is closely associated with the concept of computer simulation, that is, the study of behavior of real objects on the basis of actions of computer programs simulating this behavior.Simulations and simulators in medicine and related sciences are used for the following purposes:test (conducted under laboratory conditions)training (incorporated into school, universities syllabus)diagnostic and therapeutic (within the hospital, clinics, private medical practice)The below-presented study on medical applications, orthopedic, and rehabilitation simulations presents selected examples based on the above-proposed division.Research (laboratory) simulatorsMany research institutes and commercial companies are taking on research/simulation designed to test all kinds of prostheses and stabilizers. With their help, one can acquire information on the strength, durability, and mechanical properties of tested constituent elements. Results of such studies are important both from the perspective of medicine and from that of different sports. For simulation purposes, specialized equipment with dedicated software is being built.One example of such model has been developed by MTS 370.02 Bionix. Axial and axial-torsional tabletop model is ideal for testing dynamic properties of a wide variety of different biomedical materials and components (Figure 1) [3]. The axial model is designed to perform accurate, reproducible tests on fatigue life, mechanics of fracture, stretching, bending, and compressing of biomaterials. Axial-torsion is extremely useful in carrying out research on durability and wear of such components as knee joints, hip, or spinal implants and conducting studies on simple as well as very complex kinematic interconnection of the skeleton and other orthopedic structures. In collaboration with the Mayo Clinic and Johns Hopkins University, MTS developed the Bionix Kinematics Knee Simulator, used to mirror ideal working conditions of the knee joint.Figure 1:Laboratory device for conducting simulation and studies of dynamic properties of a wide range of biomedical materials and components [3].A similar type of device to simulate the structure of the spine and other parts of the human skeleton (Figure 2) [3], including the ankle joint and foot, has also been developed.Figure 2:A device for simulating the working of the knee joint [3].Specialized anatomical models and phantoms are produced for the purposes of laboratory tests. One such example is the phantom developed in 2008 by Honda Motor in order to analyze human body skeleton [4]. The phantom was developed for crash tests. Thanks to this type of testing, we were able to learn about the strength of the human body, while damages observed during tests help generate visual images of the forces acting on human skeleton (Figure 3). The main objective of the project was to reduce the number of injuries (to lower, lumbar-sacral spine, and upper leg) arising frequently as a result of collisions of SUV cars or minivan with pedestrians. In designing the dummy, focus was to, as accurately as possible, reconstruct the structure of these parts of the body; as a result, a more precise assessment of existing fractures was attained. Knowledge of pedestrian injuries is complemented by data on injuries of lower leg and knee ligament rupture.Figure 3:Honda third-generation pedestrian phantom dubbed POLAR III [4].Such studies began in 1998. Honda was the first company in the world to develop a phantom simulating the kinematics of the human body during collision with a car. The purpose of the unit was to identify those parts of the car body that constituted the highest danger to the safety of pedestrians and then work out technologies to reduce the risk of head injuries.In 2000, the next step consisting of developing the second-generation pedestrian dummy, known as POLAR II, was made. It significantly improved simulation of the kinematics of the human body during a collision with a car; thanks to built-in measuring instruments, it was possible to determine the level of risk of serious injury of up to eight parts of the body, including the head and neck. In addition, the company has developed its own simulations used to carry out these tests. In phantom POLAR III, focus was laid on the lower back and upper legs, which are particularly vulnerable to injuries in case of collision of a pedestrian with large cars (e.g. SUV, minivan). Accuracy of the measurements was improved by modernizing the relevant parts of the device. On the other hand, the use of modern materials and change of shape of the phantom facilitated a better reproduction of the characteristics of the human body. Thanks to modern phantoms, Honda has actively joined in studies aimed at minimizing pedestrian injury caused by a collision with a car.Training (educational) simulatorsMany of the simulation equipment available on the market have been developed with training of students and raising the qualifications of medical staff in mind. Development of this type of equipment in recent years has been very dynamic. Year after year, new proposals of simulators with ever more innovative technical solutions appear. However, it should be noted that the first medical simulator was built in Norway in the 1950s. It was made by artists and was modeled on a drowned person. Currently, apart from Norway, the most developed market for simulators is the United States, Japan, United Kingdom, and Germany [1]. Among the orthopedic simulators, one can find simple phantom models used for training manual skills, as well as complex systems in which advanced electronics and IT technology control its function. With simple models, one can practice, for example, venepunture using mannequins that simulate neurological reflexes. Some of them are even used to mimic surgical operation. Mannequins have recorded voice, have active eye-pupils, and react to given medicine. There are also others who have been implanted with an artificial part of the human body, for example, simulators of older patients with, for example, implanted hip prosthetic. Regardless of the degree of complexity, simulators make it possible to better understand the pathological phenomena of the functioning of the human body; in addition, by offering the opportunity to exercise new techniques multiple times, they help optimize actions, for example, of a surgeon (including manner and duration), bringing them almost to perfection. In each case, an orthopedic surgeon, on the grounds of the work on the simulators, has an opportunity to train skills needed in a later clinical work without any negative consequences for a real patient.Anatomical models and phantomsModels that faithfully reproduce the real anatomical-physiological objects constitute one of the basic elements that offer an orthopedic surgeon an opportunity to train and retrain certain skills. Models of cartilage, bone, and muscle system constitute an impressive group of these models. One of these skeletons manufactured by 3B Scientific is a flexible skeleton that makes it possible to understand the normal and pathological range of motion in the human joints (Figure 4A). Another skeleton model allows one to know the function and location of skeletal muscle attachments. Through deformation of given section of the skeleton, one can trace the pressure exerted on vessels and nerves during maximal and pathological movements (Figure 4B) [5].Figure 4:Left: flexible human skeleton for analysis of normal and pathological ranges of motion (Fred A15 3B Scientific); right: flexible skeletal with muscle attachments (Sam A13).Injury mannequins with different sets of simulated wounds are among phantoms mimicking medical disorders, on which medical students can effectively learn (Figure 5).Figure 5:Hurt Trauma dummy (Manufacturer: LAERDAL).It is a multifunctional mannequin combining the functions of a dummy used for practising first aid skills, immobilization, dressing of wounds, and intubation. The kit includes three replaceable heads, i.e. for teaching intubation using different tools, for intubation injury, and for practising skills of dressing face and skull injuries. The kit includes a variety of injury modules, including a replaceable module for gunshot wound to the chest.Yet other examples of collections that allow for efficient acquisition of knowledge and, in a sense, experience in the field of orthopedics and rehabilitation are learning using modern models of bones in three-dimensional (3D), which faithfully reflect human bone in terms of form and quality (Figure 6). They contain cortex and spongy tissue found in long bones. Moreover, they have very good mechanical properties – similar to the physiological human bones.Figure 6:Model of human bone.Orthopedic surgeon may cut models, e.g. femur, tibia, pelvis, etc., and install systems for stabilizing fractures or train surgical techniques of correction of deformities, which may significantly contribute to improvement of necessary dexterity of a surgeon during surgery actually carried out on real live tissues.Three-dimensional printers technology presents enormous opportunities in the development of orthopedic surgery. Image of bone deformation for individual and specific case digitally reproduced using 3D Computed Tomography technology, that is, MRI – 3D, may be reconstructed in real space, thanks to the possibility of printing 3D model in a 1:1 scale. Now, after obtaining real model of the deformed section of the bone skeleton, it is possible to plan corrective surgery using real correction carried out on a model of surgically cut bone fragments with their stabilization of used implants. With 3D technology, one can faithfully reproduce reality and lay out anatomical details. For example, it is possible to print specific parts of the body in the form of lumps. This allows the doctor not only to see them but also to touch them. This technique provides answers as to whether a planned, theoretical way of operating is technically feasible and, most importantly, whether used implants will lead to their stable fixation (without the need for additional external immobilization). Use of 3D printing in the field of orthopedic and dental care is very rapidly expanding. In orthopedics, in maxillofacial surgery and plastic surgery, this technology is used to print implant bone substitutes used in accident victims, by filling cavities in bone tissue. Three-dimensional printers can also be used to create models to help in reconstruction procedures (alloplastic 3D reconstruction of the skeleton of the face), e.g. in the case of a face transplant, in which, for the first time in Poland, a team of doctors at the Reconstructive Surgery and Vascular Oncology Centre in Gliwice carried out on a 33-year-old patient. Implementation of open-work plaster for fractures of limbs hold high hopes in this area. A special type of lightweight but durable “plaster” is used for this purpose. It seems that soon 3D printing technology that provides possibility of spatial reproduction of whole bone as an organ with bone substitute biomaterial called “Polish artificial bone” will merge. Work began in 2004 at the Academy of Mining and Metallurgy in Krakow. Now researchers from AGH University of Science and Technology and Medical University of Lublin are working together on this project. In all likelihood, the biological properties of the new chitosan-based composites will be used in medicine for production of bone substitute composite [6].Surgical operations simulatorsIn recent years, products of companies offering medical simulators that reflect anatomical areas of the body, on which it is possible to simulate surgical operations, thanks to implementing of engineering and electronic techniques, have been entering the market with growing momentum. Among them, one can find simulators facilitating training of different surgical procedures in the field of orthopedics. One such simulator is a simulator that allows for carrying out arthroscopy (Figure 7) [7].Figure 7:A set stimulating arthroscopic surgery (SimbionixArtro).Manipulators coupled with actuators help mimic resistance of the tissues and anatomical components of the knee in a manner similar to the real tissues. Trainee doctor or medical student has a feeling of working on real soft tissues and bone, depending on the task (program) entered into a computer simulator. He can perform routine diagnostic arthroscopy of the knee joint and surgical arthroscopy (simulated surgical operation of reconstruction of meniscus, of reconstruction of cruciate ligaments, etc.). One working on a simulator has the ability to “perform surgery” on the knee joint with simultaneous observation of own movements on a computer screen, allowing him to practice visual-motor coordination before proceeding to surgery under real hospital conditions.Arthroscopic techniques can also be trained based on augmented reality technology where camera image with superimposed 3D graphics generated in real time is used. In one of the works, the issue of how the use of augmented reality technology can teach medical students arthroscopy has been presented in a very interesting way [8]. Instruction/animation that shows step-by-step basis of what to do and how to correctly carry out a procedure appears on a computer screen.What is extremely valuable is that while working on these types of simulators (device or computer program), students or specializing physicians have the opportunity to repeatedly retrain accurate diagnosis and perform complex surgical procedures within damaged joints, experiencing a close approximation of the real effects of their conduct with simultaneous minus any eventual adverse consequences for the real patient. Accordingly, they enable virtual tracking of own activities and also have the ability of the so-called telementoring, that is, remote control carried out on an ongoing basis by the learner [9], [10]. Medical simulators, therefore, allow one to not only practice known surgical techniques but also provide the opportunity to practice new techniques, which until now had been impossible in real space on anatomical preparations of the so-called cadavers.Simulator of limitations of the human bodyAn example of simulator imitating limitations of movements occurring in the elderly is set of equipment mounted on different parts of the body of a healthy individual (student) developed by one of the companies. When properly prepared and mounted, they simulate the sensations of old age (Figure 8) [11].Figure 8:Simulator of old age [11].It provides the student with an opportunity to get acquainted with limitations resulting from the aging of the human body. Limiters on the joints, weights, stabilizing agents, tampons on the ears, and eye apparatus restrict freedom of the one exercising, causing them to start feeling like a person at of advanced age.Diagnostic and therapeutic simulatorsSciences provide ever new solutions used not only in medical science but also directly in medical practice. Devices using simulation techniques are used in various areas of medicine.Tele RobotsA significant part of simulators used in diagnosis and treatment of patients constitute device robots on the basis of which it is possible to perform surgery at a distance. Their state of development, mainly due to rapid development of tele robotics and increasingly better data transfer speed and quality, has made it possible to remotely carry out surgical procedures with the help of robots imitating the movements of the surgeon [10]. In 1992, the first commercial robot, Robodoc, was used in carrying out hip replacement surgery. With its help, (drilled) canal of the femur was developed, attaining 95% accuracy while the classic instrumental method gave results worse by 20% [12]. The next-generation robots were developed and, along with improvement of quality of data transfer, provided more satisfactory results. This allowed them to control arms, voice, and movement of manipulators. One of the best robots used in medicine is the da Vinci System and its modification ZEUS (Figure 9).Figure 9:The Da Vinci system [13].Thanks to an operation control panel, with the aid of special glasses, a doctor carrying out an operation sees a 3D image. Feelings are received by operating console, while enforcement actions are transmitted to the robot through manipulators. Robot has extraordinary operational precision, significantly exceeding the movements of a doctor surgeon. This is facilitated by a well-developed robot structure, with arms and precise mechanical wrists that carry out operator’s commands, performing surgical operation.Devices for diagnosing and correcting postureSimulation methods are increasingly being used in the medical practice. They often help enhance diagnosis based on processing of images obtained from devices for imaging techniques, i.e. X-ray, CT, and MRI. In orthopedics, one of the most modern simulation techniques used in medical practice is a non-invasive, safe for the patient and staff, alternative for X-ray test, a combination of latest optical and digital data processing techniques [14]. It is a non-contact, highly accurate measurement and analysis of patient’s back and spine as well as differences in the length of the legs. Test is carried out very quickly because data transfer to the PC is almost instantaneous, while the precision of the measurements promotes selection of best possible treatment for a particular patient. Technically, measurements are carried out using a projector that emits measurement lines on the surface of the back and a video camera that sends images to a computer. Measurement technology at the level of data analysis enables accurate simulation of correction of posture (difference in leg lengths, curvature of the spine, pelvis positions, etc.) (Figure 10).Figure 10:Left: a three-dimensional analysis of the spine; right: dynamic analysis of gait [14].With this approach, it is possible to schedule personalized therapy. Because the test is noninvasive and completely safe for the patient, it can be repeated several times throughout the duration of therapy. Comparison progresses in treatment can be done by comparing images of the specific therapies carried out. Systems used to analyze defects in the feet and gait are another example of implementation of knowledge of simulation and data processing. Some of these measurement techniques are for static tests; others, for dynamic tests. One such system is a system that allows visualization of the ground’s reaction force on the feet during a walk (Figure 10). Pressure values are determined by dynamic pressure on a platform with pressure sensors. Erroneous and wrong measurements are minimized, thanks to high-resolution sensors in the platform and accurate data processing algorithms [14].Exoskeletons supporting gait and posturalA device called exoskeleton represents the unquestionable achievement with regard to a model replicating real movements of the human body, particularly the skeleton. It is a kind of external skeleton that was developed for military use (to increase the potential of a soldier) but can successfully be used in orthopedics and rehabilitation (Figure 11).Figure 11:Example of exoskeleton [15].In view of a special design and appropriate software, exoskeleton can perfectly simulate movements of the human body (e.g. the extremities). In moving the upper limbs, a patient forces synchronized movement of relevant elements of the mechanical design that constitute support for the lower limbs limp. The developed device, although it still has some drawbacks in its everyday use, is a huge benefit to the health and mobility of wheelchair users [16], [17]. It affords people with disabilities an opportunity to stand on their own feet and even move in a fluid manner. Polish scientists, too, have recorded major achievements in the construction of exoskeletons. EgzoEMG robot, a robot equipped with EMG technology, has been developed in Silesian University of Technology. The main target of the exoskeleton is as a “helper” physiotherapist, but it also provides diagnostic opportunities, allowing for assessment of muscle strength, electrical activity in a patient’s muscles, and measurement of range of motion. Data analysis makes it possible to assess a patient’s condition and then prepare for him appropriate program settings, according to doctor’s prescription. This creates an opportunity for active rehabilitation – using electrical activity appearing in the muscles of even weak patients [18].ConclusionAtomization of knowledge associated with the exponentially increasing knowledge of reality means that currently, doctors have more and more pieces of knowledge and practical skills to assimilate within a limited time. In the interim, development of technical sciences causes an increase in new technologies applied in medicine, necessitating a young student of medicine to possess ability to use not only the traditionally used surgical equipment but also increasingly innovative surgical instruments. For future orthopedic surgeons and physiotherapists, all these mean that all kinds of methods aimed at improving educational process will have to be incorporated into medical students’ educational pathways. Equipment allowing students to carry out various types of simulation are already being implemented in many places in the world in respected medical centers. In the meanwhile, work on new challenges of simulation in medicine is underway at various levels in a number of scientific and commercial institutions. This makes for a big challenge, especially given the that fact that it is connected with interdisciplinary activities, requiring cooperation of doctors, engineers, and IT specialists. Only coordinated efforts are likely to lead to success – enrichment of science and education from further proposals from results of simulation and simulators [19], [20], [21]. The introduction of advanced simulation techniques for training of pilots caused a significant drop in the incidences and aircraft accidents; in addition, it became an impetus for introduction of similar methods in the training of doctors. Simulators imitating the behavior of a patient built on the basis of computerized robotic mannequins (with the processes taking place in the human body) offer great opportunities leading to a clinical proficiency without the risk of causing complications to a real patient. Thanks to simulators, medical staff members are afforded the opportunity to exercise under a realistic albeit safe conditions, which undoubtedly will contribute to solid preparation of medical doctors for clinical work.Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.Research funding: This work was financially supported by UJCM – Monika Piwowar, Collegium Medicum grant system K/ZDS/006364.Employment or leadership: None declared.Honorarium: None declared.Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.References1.Prawie jak na operacji. 2014. W Lublinie będą ćwiczyć na symulatorach. Available at: http://www.dziennikwschodni.pl/apps/pbcs.dll/article?AID=/20140330/MAGAZYN/140329559. Accessed: 2 Jan 2015.Prawie jak na operacji2014W Lublinie będą ćwiczyć na symulatorach. Available at: http://www.dziennikwschodni.pl/apps/pbcs.dll/article?AID=/20140330/MAGAZYN/140329559Accessed: 2 Jan 20152.Centrum Symulacji Medycznych, II Klinika Anestezjologii i Intensywnej Terapii WUM. 2016. Available at: http://csm.wum.edu.pl/.Centrum Symulacji Medycznych, II Klinika Anestezjologii i Intensywnej Terapii WUM2016Available at: http://csm.wum.edu.pl/3.Protezy, stabilizatory, obuwie. 2016. Available at: http://www.elhys.com.pl/protezy__stabilizatory.html.Protezy, stabilizatory, obuwie2016Available at: http://www.elhys.com.pl/protezy__stabilizatory.html4.Fantom Polar III. 2016. Available at: http://world.honda.com/news/2008/4080918POLAR-III/.Fantom Polar III2016Available at: http://world.honda.com/news/2008/4080918POLAR-III/5.3bscientific. 2016. Available at: http://www.3bscientific.com/.3bscientific2016Available at: http://www.3bscientific.com/6.Przekora A, Ginalska G. Biological properties of novel chitosan-based composites for medical application as bone substitute. Cent Eur J Biol 2014;9:634–41. Available at: http://link.springer.com/10.2478/s11535-014-0297-y. Accessed: 2 Jan 2015.PrzekoraAGinalskaGBiological properties of novel chitosan-based composites for medical application as bone substituteCent Eur J Biol2014963441Available at: http://link.springer.com/10.2478/s11535-014-0297-yAccessed: 2 Jan 20157.Arthro-mentor. 2016. Available at: http://simbionix.com/simulators/arthro-mentor/.Arthro-mentor2016Available at: http://simbionix.com/simulators/arthro-mentor/8.Atesok K, Mabrey JD, Jazrawi LM, Egol KA. Surgical simulation in orthopaedic skills training. J Am Acad Orthop Surg 2012;20:410–22. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22751160. Accessed: 19 Dec 2014.AtesokKMabreyJDJazrawiLMEgolKASurgical simulation in orthopaedic skills trainingJ Am Acad Orthop Surg20122041022Available at: http://www.ncbi.nlm.nih.gov/pubmed/22751160Accessed: 19 Dec 20149.Noszczyk B. Chirurgia Bliska Przyszłości. Pol Przegl Chir 2004;32:409–14.NoszczykBChirurgia Bliska PrzyszłościPol Przegl Chir2004324091410.Grunwald T, Krummel T, Sherman R. Advanced technologies in plastic surgery: how new innovations can improve our training and practice. Plast Reconstr Surg 2004;114:1556–67. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15509950. Accessed: 30 Dec 2014.GrunwaldTKrummelTShermanRAdvanced technologies in plastic surgery: how new innovations can improve our training and practicePlast Reconstr Surg2004114155667Available at: http://www.ncbi.nlm.nih.gov/pubmed/15509950Accessed: 30 Dec 201411.Old-Age-Simulator. 2016. Available at: http://www.excusememe.com/article/1085/Old-Age-Simulator.Old-Age-Simulator2016Available at: http://www.excusememe.com/article/1085/Old-Age-Simulator12.Noszczyk B. Chirurgia bliższej przyszłości. Pol Przegl Chir 1995;30:444–9.NoszczykBChirurgia bliższej przyszłościPol Przegl Chir199530444913.da Vinci Surgery. 2016. Available at: http://www.davincisurgery.com/.da Vinci Surgery2016Available at: http://www.davincisurgery.com/14.Diers. 2016. Available at: http://www.mediprofit.pl.Diers2016Available at: http://www.mediprofit.pl15.Exoskeleton Simulation on LOPEZ. 2012. Available at: https://www.youtube.com/watch?v=QlfW1nK9fcE.Exoskeleton Simulation on LOPEZ2012Available at: https://www.youtube.com/watch?v=QlfW1nK9fcE16.Wolff J, Parker C, Borisoff J, Mortenson W Ben, Mattie J. A survey of stakeholder perspectives on exoskeleton technology. J Neuroeng Rehabil 2014;11:169. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25523497. Accessed: 21 Dec 2014.WolffJParkerCBorisoffJMortensonW BenMattieJA survey of stakeholder perspectives on exoskeleton technologyJ Neuroeng Rehabil201411169Available at: http://www.ncbi.nlm.nih.gov/pubmed/25523497Accessed: 21 Dec 201417.Jarrassé N, Proietti T, Crocher V, Robertson J, Sahbani A, Morel G, et al. Robotic exoskeletons: a perspective for the rehabilitation of arm coordination in stroke patients. Front Hum Neurosci 2014;8:947. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4249450&tool=pmcentrez&rend ertype=abstract. Accessed: 27 Dec 2014.JarrasséNProiettiTCrocherVRobertsonJSahbaniAMorelGRobotic exoskeletons: a perspective for the rehabilitation of arm coordination in stroke patientsFront Hum Neurosci20148947Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4249450&tool=pmcentrez&rend ertype=abstractAccessed: 27 Dec 201418.Rehabilitacja jak lot sterowcem. 2014. Available at: http://www.mp.pl/treningzdrowotny/aktualnosci/100063,rehabilitacja-jak-lot-sterowcem.Rehabilitacja jak lot sterowcem2014Available at: http://www.mp.pl/treningzdrowotny/aktualnosci/100063,rehabilitacja-jak-lot-sterowcem19.Society for Simulation in Healthcare. 2016. Available at: http://www.ssih.org/.Society for Simulation in Healthcare2016Available at: http://www.ssih.org/20.Society in Europe for Simulation applied to Medicine. 2016. Available at: http://www.sesam-web.org/.Society in Europe for Simulation applied to Medicine2016Available at: http://www.sesam-web.org/21.Doughty CB, Kessler DO, Zuckerbraun NS, Stone KP, Reid JR, Kennedy CS, Nypaver MM, Auerbach MA. Simulation in Pediatric Emergency Medicine Fellowships. Pediatrics. 2015;136:e152–8. DOI: 10.1542/peds.2014-4158. PubMed PMID: 26055850.DoughtyCBKesslerDOZuckerbraunNSStoneKPReidJRKennedyCSNypaverMMAuerbachMASimulation in Pediatric Emergency Medicine FellowshipsPediatrics2015136e152810.1542/peds.2014-4158PubMed PMID: 26055850
Journal
Bio-Algorithms and Med-Systems – de Gruyter
Published: Dec 1, 2016