Journal of Rehabilitation and Assistive Technologies Engineering最新文献

Air cell cushions are widely used in wheelchair seating and medical support surfaces to reduce interface pressure and prevent pressure injuries. Their effectiveness depends on maintaining proper internal air pressure, which can fluctuate with environmental changes such as temperature and atmospheric pressure. These fluctuations pose a risk in clinical and transport settings where cushions may be exposed to extreme conditions. This study examines the behavior of air cell cushions made from silicone, polyurethane, and TPU-coated fabric under different environmental conditions. Using a proportional-integral-derivative (PID) control algorithm, we regulated the internal air-cell pressure to remain constant under changing temperature (15-35 °C) and atmospheric pressure (101-75 kPa) conditions. Results indicate that the cushion material significantly influences pressure stability, with TPU-coated fabric being the most sensitive to environmental changes. Applying the closed-loop control algorithm, it is possible to maintain the set pressure within ±0.05 kPa regardless of the cushion material, loading conditions, and environmental variations.

The ability to grasp objects has a significant impact on the independence of individuals following a stroke, a spinal cord injury, or for those who are living with amyotrophic lateral sclerosis. In most cases, physical rehabilitation is not sufficient to regain the hand function necessary for day-to-day life. Hand orthoses capable of providing grasping assistance in activities of daily living are therefore crucial to a more independent lifestyle. However, most available options struggle to offer an acceptable balance between cost, size, weight and functionality, resulting in limited use in practice. This article presents a low-cost, 3D-printed hand orthosis that relies solely on mechanical elements to aid in finger flexion. An underactuated, flexible design for the fingers with nylon strips as spring blades was used to achieve a design that costs only 27% of the price of comparable commercially available options, as well as being very lightweight and easily customizable. It was also demonstrated that rigid thumb supports allowed the orthosis to be used in the majority of daily grasping tasks. Finally, the use of the proposed mechanism was shown to be able to provide up to 4 N of flexion assistance to the finger when using a medium wrap grip.

Background: The global prevalence of dementia is increasing, necessitating effective non-pharmacological interventions due to the limitations and side effects of pharmacological treatments. Digital health interventions, including Virtual Reality (VR), offer promising alternatives. This study assessed the feasibility, safety, and potential side effects of interactive computer-generated VR (CGVR) for individuals with dementia (IwD), focusing on reaction tests of varying complexity.

Methods: In the feasibility study recruited 32 participants with mild to moderate dementia, assessed by the Mini-Mental-State-Examination (MMSE). Participants underwent a single CGVR session involving virtual reaction wall tasks of varying difficulty. Pre- and post-exposure assessments, alongside feedback forms, evaluated cognitive and motor functions, mood, anxiety, and balance (paired t-test).

Results: Of the 32 participants, 29 completed the study (9% drop-out). Observational data indicated high levels of engagement and enjoyment. No adverse effects on cognitive or motor functions were observed, with slight non-significant improvements across most parameters. MMSE scores correlated significantly with task feasibility and reaction/motor times, highlighting the influence of cognitive status on performance.

Conclusions: CGVR demonstrated high feasibility and acceptability among IwD, with no adverse effects and potential to enhance cognitive and motor skills. Further research is required to explore long-term efficacy and optimize therapeutic applications.

Background: Anti-gravity exosuits supporting hip and knee extension have emerged for overground training. This study investigated their effect on kinematics in individuals with incomplete spinal cord injury (iSCI) compared to regular walking and to walking with an overground BWS system.

Methods: Fourteen individuals with iSCI were tested during overground walking in three conditions: regular, exosuit, and BWS. Kinematics were assessed using the Xsens MVN motion capture system.

Results: Maximum hip extension was larger for exosuit compared to regular walking (Δ4.7°, 95% CI [1.4, 7.9]), but was not different compared to BWS. Mean knee flexion was smaller for exosuit compared to regular walking (Δ-1.7°, 95% CI [-3.0, -0.4]) and compared to BWS (Δ-3.5°, 95% CI [-5.4, -1.6]). Most secondary outcome measures (e.g. walking speed, stride length, step width, ML COM excursion) showed no differences between exosuit and regular walking. Comparing exosuit to BWS, most secondary outcome measures (e.g., walking speed, stride length, stride time, trunk inclination) favored BWS.

Conclusions: An anti-gravity exosuit resulted in increased hip and knee extension, but did not translate into other gait improvements. Given the more favorable outcomes of the BWS system compared to the exosuit, exosuit design improvements are needed to be effectively implemented in gait rehabilitation after iSCI.

Introduction: Actimetry is increasingly used to measure physical activity (PA) for manual wheelchair (MWC) users. However, conversion of raw data into interpretable PA outcomes remains imprecise, and the differentiation between propulsion and non-propulsion is challenging. Using a previously developed algorithm, the objectives of this study were to: (1) measure the accuracy of total distance collected, and (2) validate the algorithm's accuracy in differentiating between self-propulsion and non-propulsion.

Methods: Experimental study consisting of two data collection sessions. Actimetry data (Actigraph GT3X+) were collected indoors (controlled conditions) during 100 repetitions (n = 40 MWC propulsion, n = 60 pushing the MWC) over three distances (10, 50 and 100 m). Actimetry data were also collected outdoors (uncontrolled condition) during self-propulsion over 1000 m (10 repetitions). Descriptive statistics (mean and standard deviation) with confidence intervals and accuracy measures (percentage of true value) were conducted for each trial.

Results: The algorithm measured total distance covered indoors with an excellent accuracy (98.9% to 99.8%). It differentiated between self-propulsion and non-propulsion with an accuracy between 96.2% and 99.2% under controlled condition, and between 91.3% and 100.0% under uncontrolled condition.

Conclusions: The algorithm tested allowed precise measurement of total distance covered, as well as an excellent discrimination between self-propulsion and non-propulsion.

Preprint: Gagnon R, Best KL and Routhier F. Validation of an innovative two-part algorithm for detecting self-propulsion in manual wheelchair users. medRxiv 2024: 2024.2011.2014.24313548. DOI: 10.1101/2024.11.14.24313548.

Objective: The objective of this study was to carry out a systematic review and meta-analysis of available literature on the relationships between spasticity, proprioception and motor function of the upper limb post-stroke.

Methods: Using the terms: stroke; movement; proprioception; spasticity; rehabilitation; and upper limb, a systematic search was conducted on Scopus, PubMed and Web of Science from database inception to November 2023. A study must have assessed two of spasticity, proprioception, or motor function of the upper limb post-stroke to be included. Random-effects meta-analyses were conducted to investigate changes in time and strength of correlations between variables.

Results: Fifty-two studies were included. Over time, spasticity increased (OR = 0.5, p = 0.0475); proprioception and motor function impairments decreased (OR = 3.15, p < 0.0001; OR = 3.21, p < 0.0001, respectively). The correlation between spasticity and proprioception was weak (r = 0.33, p = 0.0283); between proprioception and motor function was moderate (r = 0.45, p < 0.0001); and between spasticity and motor function was moderate (r = 0.55, p < 0.0001).

Conclusion: Despite the limitation of heterogeneity in the available evidence, relationships between variables were illustrated. Moderate correlations between proprioception and both spasticity and motor function suggest proprioception should be an important target for personalised rehabilitation interventions.

Introduction: Minimizing repetitive strain (RS) is a key recommendation from clinical practice guidelines for preservation of upper limb. Propulsion force, which is required to overcome wheel rolling resistance (RR), is a major source of RS. A drum-based RR test method has been developed but has not been directly validated against propulsion forces. A previous validation study compared Drum versus treadmill RR, with excellent consistency (intraclass correlation coefficient (ICC) = 0.94) and accuracy. Methods: Drum RR system estimates (N = 192) were compared to SmartWheel RR measurements and resultant force (Fres) for multiple wheelchair setups and surfaces. We hypothesized that Drum RR will consistently predict SmartWheel RR and Fres based on ICC and accuracy based on Bland Altman limits of agreement (LOA) and coefficient of determination (R²). Results: RR ICC = 0.966, 95%CI [0.955-0.975], mean difference between methods (4.2 N), and LOA [+/-5.5 N], which varied by surface. Drum RR explained 88% (R²) of SmartWheel RR variability. Drum RR prediction of Fres ICC = 0.83, 95%CI [0.77-0.87], explaining 60% of variability. Conclusions: Drum RR consistently predicts SmartWheel RR with excellent reliability and reasonable accuracy, and predicts Fres with good reliability and reasonable accuracy, reinforcing the validity of Drum RR for predicting system-level RR, and use guiding wheel selection to reduce RS.

Background: Suction cup handholds are sometimes recommended by Occupational Therapists for bathing transfers when permanent grab bars are not feasible. The efficacy of suction cup handholds on typical bathroom surfaces is unknown.

Purpose: This study evaluated the efficacy and failure characteristics of two brands of suction cup handholds on six typical bathtub wall surfaces, under environmental and loading conditions associated with bathing.

Method: Eighteen suction cup handholds underwent controlled longevity testing under wet and dry conditions in separate sessions. Handhold efficacy was evaluated through (a) visual inspection, (b) manual manipulation, and (c) controlled loading, with days to failure and other failure details as outcome measures.

Findings: No handhold-wall sample combinations were effective over the 28 day test period, with at least one handhold on each wall sample failing on day one. Handhold failure was most frequently due to sliding along the wall surface, and occurred most frequently during manual manipulation testing.

Conclusion: Handhold efficacy was poor in a controlled experimental environment. These results can inform clinicians of the risks suction cup handholds pose and assist in clinical recommendations against their use.

Introduction: Wrist hand orthoses are widely used in rehabilitation to improve hand function and alleviate pain. However, their use may restrict wrist motion, causing functional disabilities in activities of daily living (ADLs). This study aimed to evaluate the effects of wrist hand orthoses on upper limb activity during daily life, focusing on differences between padded fiberglass and thermoplastic wrist hand orthoses.

Methods: 35 healthy, right-handed adults wore two types of wrist hand orthoses (padded fiberglass and thermoplastic) for 24 h during daily activities. Upper limb activity was measured using accelerometers, while ADL difficulties were evaluated using the Hand20 questionnaire. Activity levels were compared across no-orthosis, fiberglass, and thermoplastic orthosis conditions.

Results: Both wrist hand orthoses significantly reduced upper limb activity (magnitude ratio and use ratio) compared to the no-orthosis condition (p < 0.05). The Hand20 scores indicated greater ADL difficulties under both orthotic conditions, with no significant difference between the two types of orthoses (p > 0.05).

Conclusions: Wrist hand orthoses restrict wrist and forearm motions, reduce upper limb activity, and increase perceived ADL difficulties. No significant differences were observed between fiberglass and thermoplastic orthoses, suggesting comparable effects on daily life. Design modifications can improve user comfort and functionality.