Design and acceptability assessment of a new reversible orthosis

International audience— We present a new device aimed at being used for upper limb rehabilitation. Our main focus was to design a robot capable of working in both the passive mode (i.e. the robot shall be strong enough to generate human-like movements while guiding the weak arm of a patient) and the active mode (i.e. the robot shall be able of following the arm without disturbing human natural motion). This greatly challenges the design, since the system shall be reversible and lightweight while providing human compatible strength, workspace and speed. The solution takes the form of an orthotic structure, which allows control of human arm redundancy contrarily to clinically available upper limb rehabilitation robots. It is equipped with an innovative transmission technology, which provides both high gear ratio and fine reversibility. In order to evaluate the device and its therapeutic efficacy, we compared several series of pointing movements in healthy subjects wearing and not wearing the orthotic device. In this way, we could assess any disturbing effect on normal movements. Results show that the main movement characteristics (direction, duration, bell shape profile) are preserved

Wearable inertial sensors and range of motion metrics in physical therapy remote support

Abstract. The practice of physiotherapy diagnoses patient ailments which are often treated by the daily repetition of prescribed physiotherapeutic exercise. The effectiveness of the exercise regime is dependent on regular daily repetition of the regime and the correct execution of the prescribed exercises. Patients often have issues learning unfamiliar exercises and performing the exercise with good technique. This design science research study examines a back squat classifier design to appraise patient exercise regime away from the physiotherapy practice. The scope of the exercise appraisal is limited to one exercise, the back squat. Kinematic data captured with commercial inertial sensors is presented to a small group of physiotherapists to illustrate the potential of the technology to measure range of motion (ROM) for back squat appraisal. Opinions are considered from two fields of physiotherapy, general musculoskeletal and post-operative rehabilitation. While the exercise classifier is considered not suitable for post-operative rehabilitation, the opinions expressed for use in general musculoskeletal physiotherapy are positive. Kinematic data captured with gyroscope sensors in the sagittal plane is analysed with Matlab to develop a method for back squat exercise recognition and appraisal. The artefact, a back squat classifier with appraisal features is constructed from Matlab scripts which are proven to be effective with kinematic data from a novice athlete

Smart Footwear Insole for Recognition of Foot Pronation and Supination Using Neural Networks

Abnormal foot postures during gait are common sources of pain and pathologies of the lower limbs. Measurements of foot plantar pressures in both dynamic and static conditions can detect these abnormal foot postures and prevent possible pathologies. In this work, a plantar pressure measurement system is developed to identify areas with higher or lower pressure load. This system is composed of an embedded system placed in the insole and a user application. The instrumented insole consists of a low-power microcontroller, seven pressure sensors and a low-energy bluetooth module. The user application receives and shows the insole pressure information in real-time and, finally, provides information about the foot posture. In order to identify the different pressure states and obtain the final information of the study with greater accuracy, a Deep Learning neural network system has been integrated into the user application. The neural network can be trained using a stored dataset in order to obtain the classification results in real-time. Results prove that this system provides an accuracy over 90% using a training dataset of 3000+ steps from 6 different users.Ministerio de Economía y Competitividad TEC2016-77785-

Evaluating perceptual maps of asymmetries for gait symmetry quantification and pathology detection

Le mouvement de la marche est un processus essentiel de l'activité humaine et aussi le résultat de nombreuses interactions collaboratives entre les systèmes neurologiques, articulaires et musculo-squelettiques fonctionnant ensemble efficacement. Ceci explique pourquoi une analyse de la marche est aujourd'hui de plus en plus utilisée pour le diagnostic (et aussi la prévention) de différents types de maladies (neurologiques, musculaires, orthopédique, etc.). Ce rapport présente une nouvelle méthode pour visualiser rapidement les différentes parties du corps humain liées à une possible asymétrie (temporellement invariante par translation) existant dans la démarche d'un patient pour une possible utilisation clinique quotidienne. L'objectif est de fournir une méthode à la fois facile et peu dispendieuse permettant la mesure et l'affichage visuel, d'une manière intuitive et perceptive, des différentes parties asymétriques d'une démarche. La méthode proposée repose sur l'utilisation d'un capteur de profondeur peu dispendieux (la Kinect) qui est très bien adaptée pour un diagnostique rapide effectué dans de petites salles médicales car ce capteur est d'une part facile à installer et ne nécessitant aucun marqueur. L'algorithme que nous allons présenter est basé sur le fait que la marche saine possède des propriétés de symétrie (relativement à une invariance temporelle) dans le plan coronal.The gait movement is an essential process of the human activity and also the result of coordinated effort between the neurological, articular and musculoskeletal systems. This motivates why gait analysis is important and also increasingly used nowadays for the (possible early) diagnosis of many different types (neurological, muscular, orthopedic, etc.) of diseases. This paper introduces a novel method to quickly visualize the different parts of the body related to an asymmetric movement in the human gait of a patient for daily clinical. The goal is to provide a cheap and easy-to-use method to measure the gait asymmetry and display results in a perceptually relevant manner. This method relies on an affordable consumer depth sensor, the Kinect. The Kinect was chosen because this device is amenable for use in small, confined area, like a living room. Also, since it is marker-less, it provides a fast non-invasive diagnostic. The algorithm we are going to introduce relies on the fact that a healthy walk has (temporally shift-invariant) symmetry properties in the coronal plane

Developing a three-dimensional (3D) assessment method for clubfoot-A study protocol

© 2018 Ganesan, Luximon, Al-Jumaily, Yip, Gibbons and Chivers. Background: Congenital talipes equinovarus (CTEV) or clubfoot is a common pediatric congenital foot deformity that occurs 1 in 1,000 live births. Clubfoot is characterized by four types of foot deformities: hindfoot equinus; midfoot cavus; forefoot adductus; and hindfoot varus. A structured assessment method for clubfoot is essential for quantifying the initial severity of clubfoot deformity and recording the progress of clubfoot intervention. Aim: This study aims to develop a three-dimensional (3D) assessment method to evaluate the initial severity of the clubfoot and monitor the structural changes of the clubfoot after each casting intervention. In addition, this study explores the relationship between the thermophysiological changes in the clubfoot at each stage of the casting intervention and in the normal foot. Methods: In this study, a total of 10 clubfoot children who are < 2 years old will be recruited. Also, the data of the unaffected feet of a total of 10 children with unilateral clubfoot will be obtained as a reference for normal feet. A Kinect 3D scanner will be used to collect the 3D images of the clubfoot and normal foot, and an Infrared thermography camera (IRT camera) will be used to collect the thermal images of the clubfoot. Three-dimensional scanning and IR imaging will be performed on the foot once a week before casting. In total, 6-8 scanning sessions will be performed for each child participant. The following parameters will be calculated as outcome measures to predict, monitor, and quantify the severity of the clubfoot: Angles cross section parameters, such as length, width, and the radial distance; distance between selected anatomical landmarks, and skin temperature of the clubfoot and normal foot. The skin temperature will be collected on selected areas (forefoot, mid foot, and hindfoot) to find out the relationship between the thermophysiological changes in the clubfoot at each stage of the casting treatment and in the normal foot. Ethics: The study has been reviewed and approved on 17 August 2016 by the Sydney Children's Hospitals Network Human Research Ethics Committee (SCHN HREC), Sydney, Australia. The Human Research Ethics Committee (HREC) registration number for this study is: HREC/16/SCHN/163

Surgical aspects of pediatric neuromuscular scoliosis: Perioperative bleeding, bone mineral density and health-related quality of life related to spinal fusion

Neuromuscular scoliosis (NMS), the three-dimensional deformity of the spine, has neurologic or muscular origin. Conservative treatment offers limited possibilities for severe deformities in NMS, hence surgical treatment is often ultimately necessary. Fusion surgery is a difficult procedure for the patient and carries substantial risks. In NMS, the surgical risks and complications are considerably higher than in patients with Adolescent idiopathic scoliosis (AIS). The aim of this dissertation was to investigate the characteristics associated with spinal fusion surgery in NMS patients in terms of perioperative bleeding, health-related quality of life (HRQoL) and bone mineral density. Studies I and II examined perioperative bleeding and its risk factors. Perioperative bleeding was significantly higher in NMS patients compared to AIS. The risk factor profile differed between the study groups. Increasing operative time was a risk factor for intraoperative and total bleeding, whereas extent of fusion correlated to amount of drainage bleeding. Study III investigated health-related quality of life changes associated with spinal fusion. NMS patients showed a significant improvement in quality of life at post-operative two-year follow-up, and the improvement of HRQoL was not inferior in comparison to AIS patients. In study IV, the bone mineral density (BMD) of spinal muscular atrophy patients was investigated from spinal CT-imaging taken prior to spinal fusion. Patients pre-treated with growth-friendly spinal implants had poorer bone mineral density in a comparison to patients followed prior fusion without surgical interventions. Bone quality was poorer in both groups in comparison to healthy controls. This study suggests that there are higher risks associated in spinal fusion for neuromuscular scoliosis patients compared to surgical treatment of idiopathic scoliosis. Perioperative bleeding is more extensive, and previous operative treatment further compromises the poorer bone quality of patients with neuromuscular scoliosis. Importantly, despite the risks, quality of life appears to improve significantly after spinal fusion surgery. KEYWORDS: neuromuscular scoliosis, spinal fusion, perioperative bleeding, health-related quality of life, bone mineral densityNeuromuskulaariskolioosissa (NMS) selän kolmiulotteisen virheasennon taustalla on jokin lihas- tai hermosairaus. Konservatiiviset hoitovaihtoehdot tarjoavat rajoitetusti mahdollisuuksia neuromuskulaariskolioosipotilaiden vaikeiden virheasentojen korjauksessa, joten kirurgiset hoitokeinot ovat lopulta usein välttämättömiä. Luudutusleikkaus on potilaalle raskas toimenpide, johon liittyy monia riskejä. Neuromuskulaariskolioosissa leikkausriskit ja komplikaatiot ovat selvästi yleisempiä kuin idiopaattisen skolioosin (AIS) leikkaushoidossa. Tämän väitöskirja-tutkimuksen tavoitteena oli selvittää NMS-potilaiden luudutusleikkauksiin liittyviä erityispiirteitä leikkauksenaikaisen verenvuodon, elämänlaadun muutoksen sekä leikkausta edeltävän luuntiheyden osalta. Osatöissä I ja II tutkittiin leikkauksenaikaista verenvuotoa ja sen riskitekijöitä. Leikkausverenvuoto oli merkittävästi suurempaa NMS-potilailla AIS-potilaisiin verrattuna. Riskitekijäprofiili erosi tutkimusryhmien välillä. Leikkauksen kesto oli vuotoa lisäävä riskitekijä leikkauksenaikaiselle ja kokonaisverenvuodolle ja luudutuksen laajuus korreloi positiivisesti leikkauksen jälkeiseen verenvuotoon. Osatyössä III selvitettiin luudutusleikkauksen aiheuttamaa elämänlaadun muutosta tapaus-verrokkitutkimusasetelmassa. NMS-potilaiden elämänlaatu parani merkittävästi kahden vuoden seurannassa luudutusleikkauksen jälkeen, eikä elämänlaadun paraneminen ollut AIS-potilaita heikompaa. Osatyössä IV tutkittiin SMA (spinaalinen lihasatrofia) potilaiden luuntiheyttä luudutusleikkausta edeltävästi otetuista tietokonetomografiakuvista. Kasvuystävällisillä implanteilla hoidettujen potilaiden luuntiheys oli heikompaa ennen luudutusleikkausta verrattuna potilaisiin, joita ei ollut hoidettu operatiivisesti ennen luudutusleikkausta. Luunlaatu oli molemmissa ryhmissä tervettä verrokkiväestöä heikompaa. Tämän tutkimuksen perusteella neuromuskulaariskolioosipotilaiden luudutusleikkauksiin liittyy suurempia riskejä verrattuna idiopaattisen skolioosin leikkaushoitoon. Perioperatiivinen verenvuoto on runsaampaa, ja aiempi operatiivinen hoito heikentää neuromuskulaaripotilaiden entisestään heikompaa luunlaatua. Huomattavaa on, että riskeistä huolimatta elämänlaatu vaikuttaa parantuvan merkittävästi luudutusleikkauksen jälkeen. AVAINSANAT: Neuromuskulaariskolioosi, luudutusleikkaus, perioperatiivinen verenvuoto, elämänlaatu, luuntihey

A review of computer vision-based approaches for physical rehabilitation and assessment

The computer vision community has extensively researched the area of human motion analysis, which primarily focuses on pose estimation, activity recognition, pose or gesture recognition and so on. However for many applications, like monitoring of functional rehabilitation of patients with musculo skeletal or physical impairments, the requirement is to comparatively evaluate human motion. In this survey, we capture important literature on vision-based monitoring and physical rehabilitation that focuses on comparative evaluation of human motion during the past two decades and discuss the state of current research in this area. Unlike other reviews in this area, which are written from a clinical objective, this article presents research in this area from a computer vision application perspective. We propose our own taxonomy of computer vision-based rehabilitation and assessment research which are further divided into sub-categories to capture novelties of each research. The review discusses the challenges of this domain due to the wide ranging human motion abnormalities and difficulty in automatically assessing those abnormalities. Finally, suggestions on the future direction of research are offered