Exploring the bases for a mixed reality stroke rehabilitation system, Part II: Design of Interactive Feedback for upper limb rehabilitation

abstract: Background Few existing interactive rehabilitation systems can effectively communicate multiple aspects of movement performance simultaneously, in a manner that appropriately adapts across various training scenarios. In order to address the need for such systems within stroke rehabilitation training, a unified approach for designing interactive systems for upper limb rehabilitation of stroke survivors has been developed and applied for the implementation of an Adaptive Mixed Reality Rehabilitation (AMRR) System. Results The AMRR system provides computational evaluation and multimedia feedback for the upper limb rehabilitation of stroke survivors. A participant's movements are tracked by motion capture technology and evaluated by computational means. The resulting data are used to generate interactive media-based feedback that communicates to the participant detailed, intuitive evaluations of his performance. This article describes how the AMRR system's interactive feedback is designed to address specific movement challenges faced by stroke survivors. Multimedia examples are provided to illustrate each feedback component. Supportive data are provided for three participants of varying impairment levels to demonstrate the system's ability to train both targeted and integrated aspects of movement. Conclusions The AMRR system supports training of multiple movement aspects together or in isolation, within adaptable sequences, through cohesive feedback that is based on formalized compositional design principles. From preliminary analysis of the data, we infer that the system's ability to train multiple foci together or in isolation in adaptable sequences, utilizing appropriately designed feedback, can lead to functional improvement. The evaluation and feedback frameworks established within the AMRR system will be applied to the development of a novel home-based system to provide an engaging yet low-cost extension of training for longer periods of time.The electronic version of this article is the complete one and can be found online at: https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-8-5

Smart vest for respiratory rate monitoring of COPD patients based on non-contact capacitive sensing

In this paper, a first approach to the design of a portable device for non-contact monitoring of respiratory rate by capacitive sensing is presented. The sensing system is integrated into a smart vest for an untethered, low-cost and comfortable breathing monitoring of Chronic Obstructive Pulmonary Disease (COPD) patients during the rest period between respiratory rehabilitation exercises at home. To provide an extensible solution to the remote monitoring using this sensor and other devices, the design and preliminary development of an e-Health platform based on the Internet of Medical Things (IoMT) paradigm is also presented. In order to validate the proposed solution, two quasi-experimental studies have been developed, comparing the estimations with respect to the golden standard. In a first study with healthy subjects, the mean value of the respiratory rate error, the standard deviation of the error and the correlation coefficient were 0.01 breaths per minute (bpm), 0.97 bpm and 0.995 (p < 0.00001), respectively. In a second study with COPD patients, the values were -0.14 bpm, 0.28 bpm and 0.9988 (p < 0.0000001), respectively. The results for the rest period show the technical and functional feasibility of the prototype and serve as a preliminary validation of the device for respiratory rate monitoring of patients with COPD.Ministerio de Ciencia e Innovación PI15/00306Ministerio de Ciencia e Innovación DTS15/00195Junta de Andalucía PI-0010-2013Junta de Andalucía PI-0041-2014Junta de Andalucía PIN-0394-201

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Textile sensor glove for health monitoring – Application in home assessment of Rheumatoid Arthritis

Background: Wearable sensors and smart garments can be used for continual monitoring of a person’s physiology or physical activities. These garments may be used to assess chronic conditions in the home setting and for rehabilitation by providing feedback and motivation to users and to identify effectiveness and adherence to therapists. This work focusses on the use of a sensor glove for home assessment of rheumatoid arthritis in assessing joint stiffness through range and velocity of movement. Material & Methods: A sensor glove has been developed using fabric stretch sensors integrated into an oedema glove. The stretch sensors are made of a knit fabric coated with conducting polymer, giving them piezoresistive properties. This means that when the fabric is stretched the resistance changes, which can be measured using straightforward circuitry and captured using a microprocessor platform. An arduino fio with integrated Xbee radio is used to collect and wirelessly transfer the data to a laptop. Results: Wooden blocks cut at various angles are used to calibrate the glove. To do this the user rests their hand on the block which maintains the joint position at a particular angle. A neural network is then used to calculate the joint position during dynamic movements. An animated hand on the computer gives immediate visual feedback to the user. The next stage will be to compare the glove performance to a motion capture system such as Vicon. Conclusions: The advantage of the glove is in the fit and comfort for the wearer, the sensors and the glove itself are made from a lycra spandex material. Conventional bend sensors and fibre optics are more rigid and while suitable for computer gaming and motion capture applications are not ideal for use in people with impaired dexterity and mobility. This work presents a low-cost solution for home assessment of conditions such as rheumatoid arthritis and a means user feedback to assist and motivate users with prescribed therapeutic exercises

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Future bathroom: A study of user-centred design principles affecting usability, safety and satisfaction in bathrooms for people living with disabilities

Research and development work relating to assistive technology 2010-11 (Department of Health) Presented to Parliament pursuant to Section 22 of the Chronically Sick and Disabled Persons Act 197

Design for Improving Hospital Stroke Unit Processes: Reducing Complex Systems Failures Leading to Adverse Patient Outcomes

This paper describes recent research involving a user-focused design analysis of in-hospital residential treatment for stroke patients. The focus of the research was to identify positive and negative design heuristics associated with addressing poor performance, errors and failures of patient care associated with current designs of hospital systems processes being inadequate to address actual levels of system complexity. The research findings are based on an in–depth case study following a single patient through a stroke unit in a medium scale hospital of (approximately 280 acute beds overall) with 26 stroke unit beds. The case study involved over 200 hours of observations over nine weeks and liaison with hospital and family over the four months of the patient’s stay in hospital. The findings suggest an explanation for the lack of effective advantage so far shown for integrated care as compared to conventional multidisciplinary care. In essence, they suggest that integrated stroke care and multidisciplinary care are both subject to similar serious systemic organisational failures that in effect reduce outcomes of both to a similar compromised position. The paper concludes with three design heuristics for improving stroke unit outcomes via improving the design of stroke unit organisational systems. These proposed heuristics may be of benefit more widely in hospital system design for improved outcomes. Keywords: Hospital System Design, Design Strategies, User-Based Assessment, Case Study, Viable System Model</p

Voltage stability analysis of load buses in electric power system using adaptive neuro-fuzzy inference system (anfis) and probabilistic neural network (pnn)

This paper presents the application of neural networks for analysing voltage stability of load buses in electric power system. Voltage stability margin (VSM) and load power margin (LPM) are used as the indicators for analysing voltage stability. The neural networks used in this research are divided into two types. The first type is using the neural network to predict the values of VSM and LPM. Multilayer perceptron back propagation (MLPBP) neural network and adaptive neuro-fuzzy inference system (ANFIS) will be used. The second type is to classify the values of VSM and LPM using the probabilistic neural network (PNN). The IEEE 30-bus system has been chosen as the reference electrical power system. All of the neural network-based models used in this research is developed using MATLAB

Buffalo Habitat for Humanity: The Challenges and Prospects of Green Building

Habitat for Humanity Buffalo has operated since 1985, and in that time has rehabilitated or built more than 150 homes in the cities of Buffalo and Lackawanna. An affiliate of Habitat for Humanity International (HFHI), Habitat builds affordable housing for qualified low-income people. Once approved, homeowners must put 500 hours of “sweat equity” into Habitat projects, including their homeowner education. In return, they receive a zero-interest mortgage, the proceeds of which pay their property taxes and homeowner’s insurance, as well as support the rehabilitation or construction of more Habitat homes in the Buffalo area

Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund