Journal of Rehabilitation and Assistive Technologies Engineering最新文献

Introduction: Clinical observations of children with swallowing disorders using a traditional "sippy" or transitional drinking cup identified a need for a novel cup. Children with swallowing disorders are often unable to initiate the forces required to activate the cup and/or maintain suction pressure. Furthermore, fast flow rates can result in choking.

Methods: A new cup design tool is proposed using fluid-cup interactions to capture the changing geometry of the fluid during drinking. A Petri net formulation is integrated with standard fluid flow principles. A new parametric cup simulation provides visualization and direct implementation for microcontroller prototypes. A vent-based controller is developed and modeled for a novel transitional drinking cup design. A simulated pouring study is performed for water and a baseline liquid volume of 200 ml in the cup. The study varies rotation rates, initial volume, system control and desired flow rates.

Results: Volumetric flow rate curves over time are generated and compared in relation to a target flow rate. The simulation results show expected behavior for variations in cup parameters.

Conclusion: The new simulation model facilitates future dysphagia research through rapid prototyping by tuning cup geometry, liquid parameters and control signals to meet the varying needs of the users.

Introduction: We present Lil'Flo, a socially assistive robotic telerehabilitation system for deployment in the community. As shortages in rehabilitation professionals increase, especially in rural areas, there is a growing need to deliver care in the communities where patients live, work, learn, and play. Traditional telepresence, while useful, fails to deliver the rich interactions and data needed for motor rehabilitation and assessment.

Methods: We designed Lil'Flo, targeted towards pediatric patients with cerebral palsy and brachial plexus injuries using results from prior usability studies. The system combines traditional telepresence and computer vision with a humanoid, who can play games with patients and guide them in a present and engaging way under the supervision of a remote clinician. We surveyed 13 rehabilitation clinicians in a virtual usability test to evaluate the system.

Results: The system is more portable, extensible, and cheaper than our prior iteration, with an expressive humanoid. The virtual usability testing shows that clinicians believe Lil'Flo could be deployed in rural and elder care facilities and is more capable of remote stretching, strength building, and motor assessments than traditional video only telepresence.

Conclusions: Lil'Flo represents a novel approach to delivering rehabilitation care in the community while maintaining the clinician-patient connection.

Introduction: Physical human-robot interaction offers a compelling platform for assessing recovery from neurological injury; however, robots currently used for assessment have typically been designed for the requirements of rehabilitation, not assessment. In this work, we present the design, control, and experimental validation of the SE-AssessWrist, which extends the capabilities of prior robotic devices to include complete wrist range of motion assessment in addition to stiffness evaluation.

Methods: The SE-AssessWrist uses a Bowden cable-based transmission in conjunction with series elastic actuation to increase device range of motion while not sacrificing torque output. Experimental validation of robot-aided wrist range of motion and stiffness assessment was carried out with five able-bodied individuals.

Results: The SE-AssessWrist achieves the desired maximum wrist range of motion, while having sufficient position and zero force control performance for wrist biomechanical assessment. Measurements of two-degree-of-freedom wrist range of motion and stiffness envelopes revealed that the axis of greatest range of motion and least stiffness were oblique to the conventional anatomical axes, and approximately parallel to each other.

Conclusions: Such an assessment could be beneficial in the clinic, where standard clinical measures of recovery after neurological injury are subjective, labor intensive, and graded on an ordinal scale.

Introduction: When children with physical impairments cannot perform hand movements for haptic exploration, they miss opportunities to learn about object properties. Robotics systems with haptic feedback may better enable object exploration.

Methods: Twenty-four adults and ten children without physical impairments, and one adult with physical impairments, explored tools to mix substances or transport different sized objects. All participants completed the tasks with both a robotic system and manual exploration. Exploratory procedures used to determine object properties were also observed.

Results: Adults and children accurately identified appropriate tools for each task using manual exploration, but they were less accurate using the robotic system. The adult with physical impairment identified appropriate tools for transport in both conditions, however had difficulty identifying tools used for mixing substances. A new exploratory procedure was observed, Tapping, when using the robotic system.

Conclusions: Adults and children could make judgements on tool utility for tasks using both manual exploration and the robotic system, however they experienced limitations in the robotics system that require more study. The adult with disabilities required less assistance to explore tools when using the robotic system. The robotic system may be a feasible way for individuals with physical disabilities to perform haptic exploration.

Introduction: Neuromuscular electrical stimulation (NMES) could provide an alternative or adjunct treatment modality to induce muscle hypertrophy in the hip osteoarthritis population. This preliminary study evaluates the feasibility and acceptability of NMES to evoke involuntary muscle contractions in adults with advanced hip osteoarthritis.

Methods: Thirteen adults with moderate-to-severe hip osteoarthritis and fifteen healthy, older adults were invited to a lab-based testing session. NMES was applied unilaterally to the knee extensors and hip abductors for one continuous, five-minute testing session. Data were collected on device acceptability, tolerability and muscle contractile force, and compared between groups.

Results: Electrical stimulation of the knee extensors elicited a visible muscular contraction in 11 participants (85%) with hip osteoarthritis and 15 controls (100%) at an intensity acceptable to the participant. Electrical stimulation of the hip abductors elicited a muscular contraction in eight participants (62%) with osteoarthritis, and ten controls (67%). Muscle contractile force, pain, discomfort and acceptability did not differ between groups, however NMES of the knee extensors was favoured across all measures of assessment when compared to the hip abductors.

Conclusions: Electrical stimulation of the knee extensors may be a feasible and acceptable treatment modality to address muscle atrophy in adults with advanced hip osteoarthritis.

Introduction: Coronary artery disease (CAD) is the leading cause of death worldwide. Lifestyle change is a crucial part of secondary prevention. Only 30% of CAD patients follow the corresponding guideline recommendations. The widespread adoption of smartphones offers the opportunity to integrate secondary prevention into the daily routine of CAD patients.

Methods: We developed an app to integrate secondary prevention into CAD patients' everyday life (smartphone-guided secondary prevention, SGSP). The app provided a daily 15-minute program that included video-guided exercises, video sessions with background information about CAD, and a tool to record blood pressure and heart rate once a day. The SGSP app was tested with the primary outcome of 28-day adherence. The secondary outcome was a composite of (1) self-reported behavioral changes, (2) gain of knowledge about cardiovascular risk factors, and (3) an increase in quality of life.

Results: Of the 66 patients screened, 43 (65%) were included into the study and, of those, 17 (40%) used the app continuously for 28 days. From this group, 14 (82%) were physically more active and ten (59%) improved their dietary habits. Usage of the SGSP app was also associated with a gain of knowledge about cardiovascular risk factors (70% physical activity, 59% healthy diet).

Conclusion: The regular use of a SGSP app appears to support lifestyle changes in patients with CAD.

The developments in hip and knee arthroplasty over recent years have aimed to improve outcomes, reduce complications and improve implant survival. This review describes some of the most interesting trends and developments in this important and fast-moving field. Notable developments have included ceramic hip resurfacing, mini hip stems, cementless knee replacement and the wider adoption of the dual mobility articulation for hip arthroplasty. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases. Robotic assisted surgery is one of the most interesting developments in hip and knee surgery. The recent growth in the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

Introduction: Tremor is a disabling symptom of Multiple Sclerosis (MS). The development of objective methods of tremor characterisation to assess intervention efficacy and disease progression is therefore important. The possibility of using a Fast Fourier Transform (FFT) method for tremor detection was explored.

Methods: Acceleration from a wrist-worn device was analysed using FFTs to identify and characterise tremor magnitude and frequency. Processing parameters were explored to provide insight into the optimal algorithm. Participants wore a wrist tri-axial accelerometer during 9 tasks. The FAHN clinical assessment of tremor was used as the reference standard.

Results: Five people with MS and tremor (57.6 ± 15.3 years, 3 F/2M) and ten disease-free controls (42.4 ± 10.9 years, 5 M/5F) took part. Using specific algorithm settings tremor identification was possible (peak frequency 3-15Hz; magnitude greater than 0.06 g; 2 s windows with 50% overlap; using 2 of 3 axes of acceleration), giving sensitivity 0.974 and specificity 0.971 (38 tremor occurrences out of 108 tasks, 1 false positive, 2 false negatives). Tremor had frequency 3.5-13.0 Hz and amplitude 0.07-2.60g.

Conclusions: Upper limb tremor in people with MS can be detected using a FFT approach based on acceleration recorded at the wrist, demonstrating the possibility of using this minimally encumbering technique within clinical practice.

Introduction: Rolling resistance (RR) is a drag force acting on manual wheelchairs that is associated with increased propulsion force and is linked to secondary disabling conditions of the upper limbs. A scoping review was conducted to understand how RR of manual wheelchairs has been measured and to identify limitations of those test methods and the factors tested.

Methods: A total of 42 papers were identified and reviewed, and test methods were categorized based on the measurement style of RR, testing level, and if multiple parameters could be tested. Additionally, 34 articles were reviewed for what factors were tested.

Results: Seven different testing methods categories were identified: drag test, treadmill, motor draw, deceleration, physiological expenditure, ergometer/dynamometer, and robotic test rig. Relevant articles were categorized into testing factor categories: camber, toe, tire type, tire pressure, caster type, mass, mass distribution, and type of surface.

Conclusions: The variety of testing methods suggests the need for a standardized method that can be used for wheelchair wheel design and selection to reduce RR. It is important to use adjustments, such as a forward rear axle position to mitigate RR as well as using high-pressure pneumatic tires that are properly inflated.

Introduction: Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently.

Methods: We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance.

Results: The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines.

Conclusions: People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.