Journal of Rehabilitation and Assistive Technologies Engineering最新文献

Purpose: This study designs and provides a pilot evaluation of a novel surrogate lower limb (SLL) that provides anatomically realistic three-dimensional (3D) foot motion, based on a literature consensus of passive lower limb motion. This SLL is intended to replace single axis surrogates currently used in mechanical testing of ankle-foot orthoses (AFO).

Material and methods: The SLL design is inspired by the Rizzoli foot model, with shank, hindfoot, midfoot, forefoot, and toe sections. Ball and socket joints were used between hindfoot-midfoot (HM)-forefoot sections. Forefoot-toes used a hinge joint. Three-dimensional printed nylon, thermoplastic polyurethane (TPU) and polylactic acid (PLA), as well as casted silicone rubber were used to re-create foot components. After fabrication, motion capture was performed to measure rotation using fiducial markers. The SLL was then loaded under both static and cyclic loads representing a 100 kg person walking for 500,000 cycles.

Results: Most joints were within 5° of target angles. The SLL survived static loads representing 1.5 times body weight for both static and cyclical loading.

Conclusions: This SLL moved as designed and survived testing loads, warranting further investigation towards enabling essential mechanical testing for AFO currently on the market, and helping to guide device prescription.

Introduction: The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults' vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely.

Aim: This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care.

Method: Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians.

Results: The findings demonstrated the system's capability to support remote examination of participants, and validated the system's perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination.

Conclusion: This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

Background: The goal of rehabilitation after stroke is to restore safe and sufficient function to hemiplegic patients, and prescription of an ankle-foot orthosis (AFO) to improve speed and functional ambulation is a part of this program.

Objective: This crossover randomized interventional study aimed to evaluate the effect of an anterior ankle-foot orthosis (AAFO) and posterior leaf-spring ankle-foot orthosis (PLS AFO) on speed and functional ambulation in hemiplegic stroke patients.

Method: Clinical assessments were performed on 11 hemiplegic stroke patients by the AAFO, PLS AFO, and wearing shoes. Functional ambulation was measured by the 6-min walking test, Timed Up and Go Test, Time Up and Down Stair Test, and Functional Ambulation Category. Walking speed was measured by the 10-m test.

Results: Both PLS AFO and AAFO significantly improved the performance of TUDS and TUG tests in hemiplegic patients. However, by using PLS AFO, walking distance was significantly greater than walking with shoes. There was no significant effect on the walking speed improvement using PLS AFO or AAFO compared to wearing shoes.

Conclusions: The positive effects of the AAFO and PLS AFO on functional ambulation were significant. By using PLS AFO, hemiplegic patients could walk a longer distance than wearing shoes.

Introduction: We have conducted research on building a robot dialogue system to support the independent living of older adults. In order to provide appropriate support for them, it is necessary to obtain as much information, particularly related to their health condition, as possible. As the first step, we have examined a method to allow dialogue to continue for longer periods.

Methods: A scenario-based dialogue system utilizing pause detection for turn-taking was built. The practicality of adjusting the system based on the dialogue rhythm of each individual was studied. The system was evaluated through user studies with a total of 20 users, 10 of whom were older adults.

Results: The system detected pauses in the user's speech using the sound level of their voice, and predicted the duration and number of pauses based on past dialogue data. Thus, the system initiated the robot's voice-call after the user's predicted speech.

Conclusions: Multiple turns of dialogue between robot and older adults are found possible under the system, despite several overlaps of robot's and users' speech observed. The users responded to the robot, including the questions related to health conditions. The feasibility of a scenario-based dialogue system was suggested; however, improvements are required.

The aim of this study was to estimate and compare the muscular metabolic power produced in the human body using musculoskeletal inverse-dynamics during cross-country sit-skiing. Two sitting positions were adapted for athletes with reduced trunk and hip muscle control, knee low with frontal trunk support (KL-fix), and knee high (KH). Five female national class able-bodied cross-country skiers performed submaximal and maximal exercise in both sitting positions, while recording 3-D kinematics, pole forces, electromyography and respiratory variables. Simulations were performed from these experimental results and muscular metabolic power was computed. The main part of the muscle metabolic power was produced in the upper limbs for both sitting positions, but KH produced more muscle metabolic power in lower limbs and trunk during maximal intensity. KH was also more efficient, utilizing less muscular metabolic power during submaximal intensities, relatively less power in the upper limbs and more power in the trunk, hip and lower limb muscles. This implies that sitting position KH is preferable for high power output when using able-bodied simulation models. This study showed the potential of using musculoskeletal simulations to improve the understanding of how different equipment design and muscles contribute to performance.

Introduction: Robotic exoskeletons are emerging as rehabilitation and assistive technologies that simultaneously restore function and enable independence for people with disabilities.

Aim: We investigated the feasibility and orthotic and restorative effects of an exoskeleton-supported goal-directed rehabilitation program for people with hand impairments after stroke or Spinal Cord Injury (SCI).

Method: A single-arm case-series feasibility study was conducted using a wearable untethered hand exoskeleton during goal-directed therapy programs with in-clinic and at-home components. Therapists trained stroke and SCI patients to use a hand exoskeleton during rehabilitation exercises, activities of daily living and patient-selected goals. Each patient received a 1-hour in-clinic training session on five consecutive days, then took the exoskeleton home for two consecutive days to perform therapist-recommended tasks. Goal Attainment Scaling (GAS) and the Box and Block Test (BBT) were administered at baseline, after in-clinic therapy and after home use, with and again without wearing the exoskeleton. The System Usability Scale (SUS), Motor Activity Log, and Fugl-Meyer Assessment were also administered to assess the intervention's acceptability, adherence, usability and effectiveness.

Results: Four stroke patients (Chedoke McMaster Stage of Hand 2-4) and one SCI patient (ASIA C8 Motor Stage 1) 23 ± 19 months post-injury wore the hand exoskeleton to perform 280 ± 23 exercise repetitions in the clinic and additional goal-oriented tasks at home. The patients performed their own goals and the dexterity task with higher performance following the 7-days therapy program in comparison to baseline for both exoskeleton-assisted (ΔGAS: 18 ± 10, ΔBBT: 1 ± 5) and unassisted (ΔGAS: 14 ± 14, ΔBBT: 3 ± 4) assessments. Therapists and patients provided 'good' SUS ratings of 78 ± 6 and no harmful events were reported.

Conclusions: The exoskeleton-supported stroke and SCI therapy program with in-clinic and at-home training components was feasible.

Introduction: A large proportion of a wheelchair user's body is in contact with their wheelchair. Integrated fan cooling systems fitted to a wheelchair's backrest aim to alleviate the build-up of heat at the skin-chair interface. The aim of this pilot study was to evaluate the effectiveness of an integrated fan cooling system at cooling the user during daily pushing activity.

Methods: Eight male able-bodied participants completed two conditions, with (FAN) and without (CON) fan cooling, pushing for four 15 min blocks. The fan was turned on (highest setting) at the end of block 1 (FAN), whilst in CON the fan remained off. Skin temperature was measured over the back and chest throughout alongside heart rate and perceptual responses (rating of perceived exertion, thermal sensation, thermal comfort, wetness sensation) at the end of each 15 min block.

Results: Wetness sensation and lower back skin temperature were lower in FAN (both p < 0.02), with the difference in lower back skin temperature between the two conditions being 2.20°C at the end of block 4.

Conclusion: The integrated fan cooling system provided significant cooling to the lower back without affecting any other physiological or perceptual response, besides wetness sensation.

Introduction: Individuals with acquired brain injury may find it difficult to self-manage and live independently. Brain-in-Hand is a smartphone app designed to support psychological problems and encourage behaviour change, comprised of a structured diary, reminders, agreed solutions, and traffic light monitoring system.

Aim: To evaluate the potential use and effectiveness of Brain-in-Hand for self-management in adults with acquired brain injury.

Methods: A-B mixed-methods case-study design. Individuals with acquired brain injury (n = 10) received Brain-in-Hand for up to 12 months. Measures of mood, independence, quality of life, cognition, fatigue, goal attainment, participation administered at baseline, 6 and 12 months. Semi-structured interviews conducted with acquired brain injury participants (n = 9) and healthcare workers (n = 3) at 6 months.

Results: Significant increase in goal attainment after 6 months use (t(7) = 4.20, p = .004). No significant improvement in other outcomes. Qualitative data suggested improvement in anxiety management. Contextual (personal/environmental) factors were key in influencing the use and effectiveness of Brain-in-Hand. Having sufficient insight, appropriate support and motivation facilitated use.

Conclusions: Brain-in-Hand shows potential to support acquired brain injury, but further work is required to determine its effectiveness. Context played a pivotal role in the effectiveness and sustained use of Brain-in-Hand, and needs to be explored to support implementation.

Introduction: Prosthetic feet have limited adaptability in the frontal plane. Research shows walking on uneven terrain is difficult for many prosthesis users. A new prosthetic foot, the META Arc, was designed with a polycentric ankle joint that allows relatively free movement in the frontal plane to address this limitation. Previous simulations of the polycentric ankle mechanism found potential benefits such as reduced lateral movement of a proximal mass during forward progress and reduced forces being transferred upward from the ground through the foot.

Methods: Standard mechanical testing protocols were used to evaluate the Meta Arc prosthetic foot's performance and six comparable feet commercially available.

Results: The results found the META Arc prosthetic foot had increased frontal plane adaptability as well as reduced lateral forces, and reduced inversion eversion moment compared to the six comparison feet on 10-degree cross-slope test conditions. All included prosthetic feet had similar results for the percent of energy return and dynamic force in the sagittal plane.

Conclusions: These results suggest the inclusion of the polycentric ankle within the META Arc foot will provide more stability without sacrificing forward walking performance.