Towards Implementing Upper Limb Spasticity Simulator(ULSS) in Medical Education; An Integrative Literature Review and Methodology

Simulation is widely used in Medical Education as a teaching and learning method. The purpose of this paper is to discover the implication of the simulator into clinical trainee behaviour, medical education, and patient safety. At the other hand, a methodology of quantitative research design towards implementing Upper Limb Spasticity Simulator (ULSS) named BITA1.0 is discussed. The Descriptive Quantitative Research design is focused on formative clinical assessment with students of Master in Rehabilitation, Universiti Teknologi MARA as subjects with pre and post-response test. With the intention of implementing BITA1.0 into medical education, the result from The Descriptive Quantitative Research is essential. Keywords: simulation; spasticity; upper limb; medical education eISSN: 2398-4287© 2020. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia. DOI: https://doi.org/10.21834/ebpj.v5iSI3.255

A Design Methodology for Development of Clinically Compliant Upper Limb Spasticity Part-Task Trainer

芝浦工業大学201

Design of a passive hydraulic simulator for abnormal muscle behavior replication

Spasticity and rigidity are two abnormal hypertonic muscle behaviors commonly observed in passive joint flexion and extension evaluation. Clinical evaluation for spasticity and rigidity is done through in-person assessment using qualitative scales. Due to the subjective nature of this evaluation method, diagnostic results produced from these clinical assessments can have poor reliability and inconsistency. Incorrect diagnosis and treatment often result in worsening of the abnormal muscle behaviors, reducing the quality of life and leading to an increased cost of healthcare. Several programmable, robotic simulators had been developed to improve the accuracy of clinical evaluation by providing clinician practical training opportunities; however none of these training devices are commercially available due to technical and manufacturing limitations. For this reason, a novel, purely mechanical, hydraulic-based simulator design was proposed as an alternative approach to abnormal muscle behavior simulation. The original goal of the project presented in this thesis was to address both spasticity and rigidity in the elbow joint during flexion; however due to time constraints, the initial prototype can only mimic spasticity. The hydraulic-based simulator utilized a novel damper design using viscous fluid in combination with creative flow channel configurations to replicate different levels of spasticity behaviors depicted on a qualitative scale. The simulator was capable of generating a wide range of speed-dependent force feedbacks without need for any computational controls. Preliminary results obtained from evaluating the simulator suggested the possibility of using this novel design in replicating the speed-dependent characteristics of spasticity. The framework and method implemented in the current simulator prototype could be further developed and expanded to replicate spasticity or other types of abnormal behaviors, such as rigidity, in various human joints (not limiting the design to just the elbow joint)

Design and evaluation of a passive hydraulic simulator for biceps spasticity

This thesis presents the design framework for a passive (unpowered) clinical training simulator using purely mechanical components to help improve the accuracy and reliability of clinical assessment. In the scope of this thesis, a prototype simulator was developed to replicate a common abnormal muscle behavior, biceps spasticity, at different levels of severities. Spasticity is often found in patients with stroke, spinal cord injuries, and other neurological disorders causing abnormal motor activity. The current assessment of spasticity is via in-person evaluation using qualitative clinical scales, and the accuracy and reliability of this method heavily depend on assessors’ previous training and clinical experience. However, the current training methods cannot provide students sufficient amount of practice, resulting in lack of proficiency and missing clear understanding of spasticity behavior. The motivation of this project is to develop a self-contained, unpowered simulator to complement the current clinical assessment training. The design process started by characterizing the main behavioral features of the spasticity and selecting the appropriate mechanical design features that provides haptic feedback comparable to a spastic biceps muscle. The prototype was further validated by a two-stage evaluation process. The first part of evaluation involved examining the performance of individual mechanical design features and their combined performance through bench-top experiments. In the second part of evaluation, clinicians were invited to assess the replicated spasticity behavior and to compare the simulation with their previous experience interacting with actual patients. The bench-top performance and clinical feedback help design iteration and provide insights into the future development of the training simulator. Preliminary results suggested the feasibility of using the simulator as a training tool to teach spasticity assessment in a classroom setting

Quantification of spasticity and rigidity for biceps and triceps using the PVRM (position, velocity, and resistance meter)

Spasticity and rigidity are two common types of abnormal muscle behavior seen among patients with neurological disorders (e.g., stroke, Parkinson’s Disease). Clinical assessment of increased muscle resistance during passive movement, or hypertonicity, involves qualitative and subjective scales such as the Modified Ashworth Scale (MAS) for spasticity or the Unified Parkinson’s Disease Rating Scale (UPDRS) for rigidity. Inaccurate and inconsistent assessments may occur depending on the rater’s level of experience and scale interpretation. Recently, researchers have been developing medical training simulators that mimic hypertonicity to aid the training of these clinician learners. However, there is a lack of quantitative data representing the kinetic and kinematic characteristics of these abnormal muscle behaviors. Thus, we developed a portable measurement device (the PVRM – Position, Velocity, and Resistance Meter) that measures the joint angle, velocity, and muscle resistance of the upper-arm extensor and flexor muscles. In Study 1, the accuracy and reliability of the PVRM was validated by comparing its measurements to a commercial dynamometer (Biodex), a gold standard for measuring biomechanical data. The PVRM measurements were similar to the gold standard Biodex measurements during the passive flexion movement, since the residuals for all measurements were between 1-13%. Therefore, the PVRM was able to quantify behavioral features of spasticity (e.g., catch-release behavior), rigidity (e.g., uniformly elevated muscle tone), and healthy (e.g., no muscle resistance) subjects. In Study 2, we conducted a clinical study of 38 participants using the validated PVRM to establish a database quantifying different levels of spasticity (n=15, MAS 1-4); rigidity (n=11, UPDRS 1-3), and normal healthy (n=12) behavior of the biceps and triceps during passive flexion and extension of the elbow. Spasticity subjects demonstrated stretch speed and MAS score dependent hypertonia marked by a catch-release behavior, resulting in a convex parabolic stretch speed profile. Rigidity subjects exhibited uniformly increased muscle tone that was dependent on UPDRS score but independent of stretch speed. The PVRM can provide a database for development of physical training simulators to realistically mimic hypertonicity and serve as a clinical measurement tool to reliably quantify the type and degree of hypertonicity

Development of a biological signal-based evaluator for robot-assisted upper-limb rehabilitation: a pilot study

Bio-signal based assessment for upper-limb functions is an attractive technology for rehabilitation. In this work, an upper-limb function evaluator is developed based on biological signals, which could be used for selecting different robotic training protocols. Interaction force (IF) and participation level (PL, processed surface electromyography (sEMG) signals) are used as the key bio-signal inputs for the evaluator. Accordingly, a robot-based standardized performance testing (SPT) is developed to measure these key bio-signal data. Moreover, fuzzy logic is used to regulate biological signals, and a rules-based selector is then developed to select different training protocols. To the authors’ knowledge, studies focused on biological signal-based evaluator for selecting robotic training protocols, especially for robot-based bilateral rehabilitation, has not yet been reported in literature. The implementation of SPT and fuzzy logic to measure and process key bio-signal data with a rehabilitation robot system is the first of its kind. Five healthy participants were then recruited to test the performance of the SPT, fuzzy logic and evaluator in three different conditions (tasks). The results show: (1) the developed SPT has an ability to measure precise bio-signal data from participants; (2) the utilized fuzzy logic has an ability to process the measured data with the accuracy of 86.7% and 100% for the IF and PL respectively; and (3) the proposed evaluator has an ability to distinguish the intensity of biological signals and thus to select different robotic training protocols. The results from the proposed evaluator, and biological signals measured from healthy people could also be used to standardize the criteria to assess the results of stroke patients later

Computer vision methods applied to person tracking and identification

2013 - 2014Computer vision methods for tracking and identification of people in constrained and unconstrained environments have been widely explored in the last decades. De- spite of the active research on these topics, they are still open problems for which standards and/or common guidelines have not been defined yet. Application fields of computer vision-based tracking systems are almost infinite. Nowadays, the Aug- mented Reality is a very active field of the research that can benefit from vision-based user’s tracking to work. Being defined as the fusion of real with virtual worlds, the success of an augmented reality application is completely dependant on the efficiency of the exploited tracking method. This work of thesis covers the issues related to tracking systems in augmented reality applications proposing a comprehensive and adaptable framework for marker-based tracking and a deep formal analysis. The provided analysis makes possible to objectively assess and quantify the advantages of using augmented reality principles in heterogeneous operative contexts. Two case studies have been considered, that are the support to maintenance in an industrial environment and to electrocardiography in a typical telemedicine scenario. Advan- tages and drawback are provided as well as future directions of the proposed study. The second topic covered in this thesis relates to the vision-based tracking solution for unconstrained outdoor environments. In video surveillance domain, a tracker is asked to handle variations in illumination, cope with appearance changes of the tracked objects and, possibly, predict motion to better anticipate future positions. ... [edited by Author]XIII n.s

Mechatronic Systems

Mechatronics, the synergistic blend of mechanics, electronics, and computer science, has evolved over the past twenty five years, leading to a novel stage of engineering design. By integrating the best design practices with the most advanced technologies, mechatronics aims at realizing high-quality products, guaranteeing at the same time a substantial reduction of time and costs of manufacturing. Mechatronic systems are manifold and range from machine components, motion generators, and power producing machines to more complex devices, such as robotic systems and transportation vehicles. With its twenty chapters, which collect contributions from many researchers worldwide, this book provides an excellent survey of recent work in the field of mechatronics with applications in various fields, like robotics, medical and assistive technology, human-machine interaction, unmanned vehicles, manufacturing, and education. We would like to thank all the authors who have invested a great deal of time to write such interesting chapters, which we are sure will be valuable to the readers. Chapters 1 to 6 deal with applications of mechatronics for the development of robotic systems. Medical and assistive technologies and human-machine interaction systems are the topic of chapters 7 to 13.Chapters 14 and 15 concern mechatronic systems for autonomous vehicles. Chapters 16-19 deal with mechatronics in manufacturing contexts. Chapter 20 concludes the book, describing a method for the installation of mechatronics education in schools

Soft pneumatic actuators: a review of design, fabrication, modeling, sensing, control and applications

Soft robotics is a rapidly evolving field where robots are fabricated using highly deformable materials and usually follow a bioinspired design. Their high dexterity and safety make them ideal for applications such as gripping, locomotion, and biomedical devices, where the environment is highly dynamic and sensitive to physical interaction. Pneumatic actuation remains the dominant technology in soft robotics due to its low cost and mass, fast response time, and easy implementation. Given the significant number of publications in soft robotics over recent years, newcomers and even established researchers may have difficulty assessing the state of the art. To address this issue, this article summarizes the development of soft pneumatic actuators and robots up until the date of publication. The scope of this article includes the design, modeling, fabrication, actuation, characterization, sensing, control, and applications of soft robotic devices. In addition to a historical overview, there is a special emphasis on recent advances such as novel designs, differential simulators, analytical and numerical modeling methods, topology optimization, data-driven modeling and control methods, hardware control boards, and nonlinear estimation and control techniques. Finally, the capabilities and limitations of soft pneumatic actuators and robots are discussed and directions for future research are identified