A practical design and implementation of a low cost platform for remote monitoring of lower limb health of amputees in the developing world

In many areas of the world accessing professional physicians ‘when needed/as needed’ might not be always possible for a variety of reasons. Therefore, in such cases a targeted e-Health solution to safeguard patient long-term health could be a meaningful approach. Today’s modern healthcare technologies, often built around electronic and computer-based equipment, require an access to a reliable electricity supply. Many healthcare technologies and products also presume access to the high speed internet is available, making them unsuitable for use in areas where there is no fixed-line internet connectivity, access is slow, unreliable and expensive, yet where the most benefit to patients may be gained. In this paper a full mobile sensor platform is presented, based around readily-purchased consumer components, to facilitate a low cost and efficient means of monitoring the health of patients with prosthetic lower limbs. This platform is designed such that it can also be operated in a standalone mode i.e. in the absence of internet connectivity, thereby making it suitable to the developing world. Also, to counter the challenge of power supply issues in e-Health monitoring, a self-contained rechargeable solution to the platform is proposed and demonstrated. The platform works with an Android mobile device, in order to allow for the capture of data from a wireless sensor unit, and to give the clinician access to results from the sensors. The results from the analysis, carried out within the platform’s Raspberry Pi Zero, are demonstrated to be of use for remote monitoring. This is specifically targeted for monitoring the tissue health of lower limb amputees. The monitoring of residual limb temperature and gait can be a useful indicator of tissue viability in lower limb amputees especially those suffering from diabetes. We describe a route wherein non-invasive monitoring of tissue health is achievable using the Gaussian process technique. This knowledge will be useful in establishing biomarkers related to a possible deterioration in a patient’s health or for assessing the impact of clinical interventions

Design and development of an ultra-low-cost electro - resistive band based myo activated prosthetic upper limb

In developing countries, many amputees have no access to the prosthesis. This is due to the challenges of the environment they are living in and to the prohibitive costs of available prostheses. To reduce this gap, a new concept design for an extremely low cost but highly functional upper limb prosthesis is presented. This goal is attained using a low-cost embedded platform (Arduino) and a wearable stretch-sensor adapted from Electro resistive bands (ERBs). In the proposed design, a sensor based on ERB is used to detect residual muscle contraction which detects the volumetric shifts of contraction instead of electromyography signals. The signals received via this sensor is then processed via an Arduino micro-controller to drive a single DC servo motor. The DC servo motor is directly geared onto a claw-style two-fingered prosthesis which is printed in-house from PLA plastic using a standard 3-D printer. The amount of closure of the prosthesis is fed-back to the user via a second ERB sensor directly connected to the claw in the form of haptic feedback. To make the design easier to maintain, the gears and mechanical parts are made so simple that can be crafted even from recovered materials. The entire design of prosthesis is presented in this thesis. The overall cost for the proposed prosthesis is estimated to be AUD 29. The proposed design can be easily scaled up to accommodate more complex designs such as having multiple individual fingers or wrist rotation

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Towards electrodeless EMG linear envelope signal recording for myo-activated prostheses control

After amputation, the residual muscles of the limb may function in a normal way, enabling the electromyogram (EMG) signals recorded from them to be used to drive a replacement limb. These replacement limbs are called myoelectric prosthesis. The prostheses that use EMG have always been the first choice for both clinicians and engineers. Unfortunately, due to the many drawbacks of EMG (e.g. skin preparation, electromagnetic interferences, high sample rate, etc.); researchers have aspired to find suitable alternatives. One proposes the dry-contact, low-cost sensor based on a force-sensitive resistor (FSR) as a valid alternative which instead of detecting electrical events, detects mechanical events of muscle. FSR sensor is placed on the skin through a hard, circular base to sense the muscle contraction and to acquire the signal. Similarly, to reduce the output drift (resistance) caused by FSR edges (creep) and to maintain the FSR sensitivity over a wide input force range, signal conditioning (Voltage output proportional to force) is implemented. This FSR signal acquired using FSR sensor can be used directly to replace the EMG linear envelope (an important control signal in prosthetics applications). To find the best FSR position(s) to replace a single EMG lead, the simultaneous recording of EMG and FSR output is performed. Three FSRs are placed directly over the EMG electrodes, in the middle of the targeted muscle and then the individual (FSR1, FSR2 and FSR3) and combination of FSR (e.g. FSR1+FSR2, FSR2-FSR3) is evaluated. The experiment is performed on a small sample of five volunteer subjects. The result shows a high correlation (up to 0.94) between FSR output and EMG linear envelope. Consequently, the usage of the best FSR sensor position shows the ability of electrode less FSR-LE to proportionally control the prosthesis (3-D claw). Furthermore, FSR can be used to develop a universal programmable muscle signal sensor that can be suitable to control the myo-activated prosthesis

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses

Use of stance control knee-ankle-foot orthoses : a review of the literature

The use of stance control orthotic knee joints are becoming increasingly popular as unlike locked knee-ankle-foot orthoses, these joints allow the limb to swing freely in swing phase while providing stance phase stability, thus aiming to promote a more physiological and energy efficient gait. It is of paramount importance that all aspects of this technology is monitored and evaluated as the demand for evidence based practice and cost effective rehabilitation increases. A robust and thorough literature review was conducted to retrieve all articles which evaluated the use of stance control orthotic knee joints. All relevant databases were searched, including The Knowledge Network, ProQuest, Web of Knowledge, RECAL Legacy, PubMed and Engineering Village. Papers were selected for review if they addressed the use and effectiveness of commercially available stance control orthotic knee joints and included participant(s) trialling the SCKAFO. A total of 11 publications were reviewed and the following questions were developed and answered according to the best available evidence: 1. The effect SCKAFO (stance control knee-ankle-foot orthoses) systems have on kinetic and kinematic gait parameters 2. The effect SCKAFO systems have on the temporal and spatial parameters of gait 3. The effect SCKAFO systems have on the cardiopulmonary and metabolic cost of walking. 4. The effect SCKAFO systems have on muscle power/generation 5. Patient’s perceptions/ compliance of SCKAFO systems Although current research is limited and lacks in methodological quality the evidence available does, on a whole, indicate a positive benefit in the use of SCKAFOs. This is with respect to increased knee flexion during swing phase resulting in sufficient ground clearance, decreased compensatory movements to facilitate swing phase clearance and improved temporal and spatial gait parameters. With the right methodological approach, the benefits of using a SCKAFO system can be evidenced and the research more effectively converted into clinical practice

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers