Assessment of Neurocognitive Functions, Olfaction, Taste, Mental, and Psychosocial Health in COVID-19 in Adults: Recommendations for Harmonization of Research and Implications for Clinical Practice

Assessment; COVID-19; Guidelines; Neuropsychological functions.Avaluació; COVID 19; Directrius; Funcions neuropsicològiques.Evaluación; COVID-19; Pautas; Funciones neuropsicológicasObjective: To propose a set of internationally harmonized procedures and methods for assessing neurocognitive functions, smell, taste, mental, and psychosocial health, and other factors in adults formally diagnosed with COVID-19 (confirmed as SARS-CoV-2 + WHO definition). Methods: We formed an international and cross-disciplinary NeuroCOVID Neuropsychology Taskforce in April 2020. Seven criteria were used to guide the selection of the recommendations' methods and procedures: (i) Relevance to all COVID-19 illness stages and longitudinal study design; (ii) Standard, cross-culturally valid or widely available instruments; (iii) Coverage of both direct and indirect causes of COVID-19-associated neurological and psychiatric symptoms; (iv) Control of factors specifically pertinent to COVID-19 that may affect neuropsychological performance; (v) Flexibility of administration (telehealth, computerized, remote/online, face to face); (vi) Harmonization for facilitating international research; (vii) Ease of translation to clinical practice. Results: The three proposed levels of harmonization include a screening strategy with telehealth option, a medium-size computerized assessment with an online/remote option, and a comprehensive evaluation with flexible administration. The context in which each harmonization level might be used is described. Issues of assessment timelines, guidance for home/remote assessment to support data fidelity and telehealth considerations, cross-cultural adequacy, norms, and impairment definitions are also described. Conclusions: The proposed recommendations provide rationale and methodological guidance for neuropsychological research studies and clinical assessment in adults with COVID-19. We expect that the use of the recommendations will facilitate data harmonization and global research. Research implementing the recommendations will be crucial to determine their acceptability, usability, and validity

Remote-controlled ambidextrous robot hand actuated by pneumatic muscles: from feasibility study to design and control algorithms

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University LondonThis thesis relates to the development of the Ambidextrous Robot Hand engineered in Brunel University. Assigned to a robotic hand, the ambidextrous feature means that two different behaviours are accessible from a single robot hand, because of its fingers architecture which permits them to bend in both ways. On one hand, the robotic device can therefore behave as a right hand whereas, on another hand, it can behave as a left hand. The main contribution of this project is its ambidextrous feature, totally unique in robotics area. Moreover, the Ambidextrous Robot Hand is actuated by pneumatic artificial muscles (PAMs), which are not commonly used to drive robot hands. The type of the actuators consequently adds more originality to the project. The primary challenge is to reach an ambidextrous behaviour using PAMs designed to actuate non-ambidextrous robot hands. Thus, a feasibility study is carried out for this purpose. Investigating a number of mechanical possibilities, an ambidextrous design is reached with features almost identical for its right and left sides. A testbench is thereafter designed to investigate this possibility even further to design ambidextrous fingers using 3D printing and an asymmetrical tendons routing engineered to reduce the number of actuators. The Ambidextrous Robot Hand is connected to a remote control interface accessible from its website, which provides video streaming as feedback, to be eventually used as an online rehabilitation device. The secondary main challenge is to implement control algorithms on a robot hand with a range twice larger than others, with an asymmetrical tendons routing and actuated by nonlinear actuators. A number of control algorithms are therefore investigated to interact with the angular displacement of the fingers and the grasping abilities of the hand. Several solutions are found out, notably the implementations of a phasing plane switch control and a sliding-mode control, both specific to the architecture of the Ambidextrous Robot Hand. The implementation of these two algorithms on a robotic hand actuated by PAMs is almost as innovative as the ambidextrous design of the mechanical structure itself

Wearable and IoT technologies application for physical rehabilitation

This research consists in the development an IoT Physical Rehabilitation solution based on wearable devices, combining a set of smart gloves and smart headband for use in natural interactions with a set of VR therapeutic serious games developed on the Unity 3D gaming platform. The system permits to perform training sessions for hands and fingers motor rehabilitation. Data acquisition is performed by Arduino Nano Microcontroller computation platform with ADC connected to the analog measurement channels materialized by piezo-resistive force sensors and connected to an IMU module via I2C. Data communication is performed using the Bluetooth wireless communication protocol. The smart headband, designed to be used as a first- person-controller in game scenes, will be responsible for collecting the patient's head rotation value, this parameter will be used as the player's avatar head rotation value, approaching the user and the virtual environment in a semi-immersive way. The acquired data are stored and processed on a remote server, which will help the physiotherapist to evaluate the patients' performance around the different physical activities during a rehabilitation session, using a Mobile Application developed for the configuration of games and visualization of results. The use of serious games allows a patient with motor impairments to perform exercises in a highly interactive and non-intrusive way, based on different scenarios of Virtual Reality, contributing to increase the motivation during the rehabilitation process. The system allows to perform an unlimited number of training sessions, making possible to visualize historical values and compare the results of the different performed sessions, for objective evolution of rehabilitation outcome. Some metrics associated with upper limb exercises were also considered to characterize the patient’s movement during the session.Este trabalho de pesquisa consiste no desenvolvimento de uma solução de Reabilitação Física IoT baseada em dispositivos de vestuário, combinando um conjunto de luvas inteligentes e uma fita-de-cabeça inteligente para utilização em interações naturais com um conjunto de jogos terapêuticos sérios de Realidade Virtual desenvolvidos na plataforma de jogos Unity 3D. O sistema permite realizar sessões de treino para reabilitação motora de mãos e dedos. A aquisição de dados é realizada pela plataforma de computação Arduino utilizando um Microcontrolador Nano com ADC (Conversor Analógico-Digital) conectado aos canais de medição analógicos materializados por sensores de força piezo-resistivos e a um módulo IMU por I2C. A comunicação de dados é realizada usando o protocolo de comunicação sem fio Bluetooth. A fita-de-cabeça inteligente, projetada para ser usada como controlador de primeira pessoa nos cenários de jogo, será responsável por coletar o valor de rotação da cabeça do paciente, esse parâmetro será usado como valor de rotação da cabeça do avatar do jogador, aproximando o utilizador e o ambiente virtual de forma semi-imersiva. Os dados adquiridos são armazenados e processados num servidor remoto, o que ajudará o fisioterapeuta a avaliar o desempenho dos pacientes em diferentes atividades físicas durante uma sessão de reabilitação, utilizando uma Aplicação Móvel desenvolvido para configuração de jogos e visualização de resultados. A utilização de jogos sérios permite que um paciente com deficiências motoras realize exercícios de forma altamente interativa e não intrusiva, com base em diferentes cenários de Realidade Virtual, contribuindo para aumentar a motivação durante o processo de reabilitação. O sistema permite realizar um número ilimitado de sessões de treinamento, possibilitando visualizar valores históricos e comparar os resultados das diferentes sessões realizadas, para a evolução objetiva do resultado da reabilitação. Algumas métricas associadas aos exercícios dos membros superiores também foram consideradas para caracterizar o movimento do paciente durante a sessão

Designing Cost-Effective Telemedicine Camps for Underprivileged Individuals in Less Developed Countries: A Decomposed Affordance-Effectivity Framework

Free telemedicine camps (telecamps) are emergent joint initiatives of healthcare organizations, national and local governments, and not-for-profit nongovernmental organizations (NGOs) with the goal of alleviating the health divide for underprivileged individuals in rural areas of less developed countries. Our study seeks to understand the effectiveness of physician-patient communication at telecamps with several salient characteristics: rural underprivileged patients, physicians in remote cities, and frugal telemedicine technology—specifically, videoconferencing—deployed in Hospitals on Wheels and appropriated by operators. We adopt a multiple-actor perspective, propose a decomposed affordance-effectivity framework, and combine variance and process perspectives to examine the phenomenon of interest. We collaborated with Apollo Hospitals, a leading hospital system in India, and collected multisource data from two major telecamps in rural South India. Based on an analysis of survey data from 216 telecamp participants through a variance perspective, we found support for the fit of patient-perceived media richness with two contingency factors—(1) disease diagnostic complexity and (2) patient healthcare needs fulfillment—in influencing patient satisfaction with teleconsultation. Based on an analysis of 46 sessions of teleconsultation video archives through a process perspective, we found that technology appropriation is realized through verbal and nonverbal communication events between patients and physicians, with on-site operators playing multiple roles that serve as “compensatory user effectivity.” Our findings yield theoretical and practical implications for how effective telemedicine encounters using frugal technologies can be designed in combination with other cost-effective support personnel resources to broaden healthcare access for underprivileged individuals in less developed countries and, more broadly, to actualize technology affordances in use situations involving multiple actors

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

A comprehensive method to design and assess mixed reality simulations

AbstractThe scientific literature highlights how Mixed Reality (MR) simulations allow obtaining several benefits in healthcare education. Simulation-based training, boosted by MR, offers an exciting and immersive learning experience that helps health professionals to acquire knowledge and skills, without exposing patients to unnecessary risks. High engagement, informational overload, and unfamiliarity with virtual elements could expose students to cognitive overload and acute stress. The implementation of effective simulation design strategies able to preserve the psychological safety of learners and the investigation of the impacts and effects of simulations are two open challenges to be faced. In this context, the present study proposes a method to design a medical simulation and evaluate its effectiveness, with the final aim to achieve the learning outcomes and do not compromise the students' psychological safety. The method has been applied in the design and development of an MR application to simulate the rachicentesis procedure for diagnostic purposes in adults. The MR application has been tested by involving twenty students of the 6th year of Medicine and Surgery of Università Politecnica delle Marche. Multiple measurement techniques such as self-report, physiological indices, and observer ratings of performance, cognitive and emotional states of learners have been implemented to improve the rigour of the study. Also, a user-experience analysis has been accomplished to discriminate between two different devices: Vox Gear Plus® and Microsoft Hololens®. To compare the results with a reference, students performed the simulation also without using the MR application. The use of MR resulted in increased stress measured by physiological parameters without a high increase in perceived workload. It satisfies the objective to enhance the realism of the simulation without generating cognitive overload, which favours productive learning. The user experience (UX) has found greater benefits in involvement, immersion, and realism; however, it has emphasized the technological limitations of devices such as obstruction, loss of depth (Vox Gear Plus), and narrow FOV (Microsoft Hololens)

Support of remote medical diagnostics using HTML5 - Possibility to detect changes in the facial functions caused by face paralysis in order to evaluate therapy s effectiveness or find some new abnormalities.

In this project I propose to cast the problem of remote patient monitoring into an application available on every device that supports a web browser. The research was done with taking into account the aim of the project which was fo- cused on checking whether it is possible to detect changes in the facial functions caused by the facial paralysis. The motivation for this work was to provide algorithms for detecting geometrical and colours differences between two halves of the face for patients who suffer from facial paralysis. The features were collected during making sequence of special facial gestures. Moreover I took advantage of existing solutions to magnify local colour and motion changes. This combination may uncover new dependencies between data set and lead to conclusions that were previously undiscovered. In my thesis, I focused on analyzing different factors that can have influence on the processes of the extracting functional and geometrical features. The research I present aims at reviewing face, eye and mouth recognition performances in function of: distance from/to a camera, hardware used to decode information, personal features, head rotation and light conditions. Moreover, I also analyze accuracy of counting distances between specific facial points and colours differences between two halves of the face for the same parameters. Considering possible signs, symptoms and diagnose methods of facial paralysis, I present a fully functional application, which can potentially provide a faster access to medical care and help to evaluate effectiveness of the rehabilitation methods. I believe that it may be very useful, because the telemedicine allows to reduce health care costs and give medical institutions faster access to information about their patients. Additionally, during the research the restrictions of the measurement conditions affecting the reliability and repeatability of the results were examine and the application was tested on the group of potential users. My first conclusions are the facts that following factors may have influence on implemented algorithms: distance from the camera rotation and slope of the head personal features light conditions Under preliminary studies, using different devices did not affect the results. Based on the results it can be assumed that by analyzing distances between characteristic facial features it is possible to detect changes in the facial functions caused by face paralysis in order to evaluate therapy s effectiveness or find some new abnormalities. For colours differences it is much more difficult to formulate a clear diagnose as this parameter is influenced by measurement conditions. In the last part of this thesis, I conclude the project and describe possibilities for future work in this area which include for example combining this application with professional diagnosis methods

The Effect of Augmented Reality Treatment on Learning, Cognitive Load, and Spatial Visualization Abilities

This study investigated the effects of Augmented Reality (AR) on learning, cognitive load and spatial abilities. More specifically, it measured learning gains, perceived cognitive load, and the role spatial abilities play with students engaged in an astronomy lesson about lunar phases. Research participants were 182 students from a public university in southeastern United States, and were recruited from psychology research pool. Participants were randomly assigned to two groups: (a) Augmented Reality and Text Astronomy Treatment (ARTAT); and (b) Images and Text Astronomy Treatment (ITAT). Upon entering the experimental classroom, participants were given (a) Paper Folding Test to measure their spatial abilities; (b) the Lunar Phases Concept Inventory (LPCI) pre-test; (c) lesson on Lunar Phases; (d) NASA-TLX to measure participants’ cognitive load; and (e) LPCI post-test. Statistical analysis found (a) no statistical difference for learning gains between the ARTAT and ITAT groups; (b) statistically significant difference for cognitive load; and (c) no significant difference for spatial abilities scores

An Overview of Self-Adaptive Technologies Within Virtual Reality Training

This overview presents the current state-of-the-art of self-adaptive technologies within virtual reality (VR) training. Virtual reality training and assessment is increasingly used for five key areas: medical, industrial & commercial training, serious games, rehabilitation and remote training such as Massive Open Online Courses (MOOCs). Adaptation can be applied to five core technologies of VR including haptic devices, stereo graphics, adaptive content, assessment and autonomous agents. Automation of VR training can contribute to automation of actual procedures including remote and robotic assisted surgery which reduces injury and improves accuracy of the procedure. Automated haptic interaction can enable tele-presence and virtual artefact tactile interaction from either remote or simulated environments. Automation, machine learning and data driven features play an important role in providing trainee-specific individual adaptive training content. Data from trainee assessment can form an input to autonomous systems for customised training and automated difficulty levels to match individual requirements. Self-adaptive technology has been developed previously within individual technologies of VR training. One of the conclusions of this research is that while it does not exist, an enhanced portable framework is needed and it would be beneficial to combine automation of core technologies, producing a reusable automation framework for VR training