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

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

The effect of prefabricated wrist-hand orthoses on grip strength

Prefabricated wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit and compromised grip strength as a result of rheumatoid changes. It is thought that an orthosis which improves wrist extension, reduces synovitis and increases the mechanical advantage of the flexor muscles will improve hand function. Previous studies report an initial reduction in grip strength with WHO use which may increase following prolonged use. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on grip strength was measured using a Jamar dynamometer. Tests were performed with and without WHOs by right-handed, female subjects, aged 20-50 years over a ten week period. During each test, a wrist goniometer and a forearm torsiometer were used to measure wrist joint position when maximum grip strength was achieved. The majority of participants achieved maximum grip strength with no orthosis at 30° extension. All the orthoses reduced initial grip strength but surprisingly the restriction of wrist extension did not appear to contribute in a significant way to this. Reduction in grip must therefore also be attributable to WHO design characteristics or the quality of fit. The authors recognize the need for research into the long term effect of WHOs on grip strength. However if grip is initially adversely affected, patients may be unlikely to persevere with treatment thereby negating all therapeutic benefits. In studies investigating patient opinions on WHO use, it was a stable wrist rather than a stronger grip reported to have facilitated task performance. This may explain why orthoses that interfere with maximum grip strength can improve functional task performance. Therefore while it is important to measure grip strength, it is only one factor to be considered when evaluating the efficacy of WHOs

Electromechanical System Integration for a Powered Upper Extremity Orthosis

Wearable robotics for assistance and rehabilitation are not yet considered commercially mainstream products, and as a result have not yet seen advanced controls systems and interfaces. Consequently, the available technology is mostly adapted from systems used in parallel technologies, rather than custom applications intended for human use. This study concerns itself with the design and development of a custom control system for a 2-degree of freedom powered upper extremity orthosis capable of driving elbow flexion/extension 135º and humeral rotation 95º . The orthosis has been evaluated for use as both a long-term assistive technology device for persons with disabilities, and as a short-term rehabilitative tool for persons recovering injury. The target demographics for such a device vary in age, cognitive ability and physical function, thus requiring several input parameters requiring consideration. This study includes a full evaluation of the potential users of the device, as well as parameter considerations that are required during the design phase. The final control system is capable of driving each DOF independently or simultaneously, for a more realistic and natural coupled-motion, with proportional control by pulse-width modulation. The dual-axis joystick interface wirelessly transmits to the 1.21 pound control pack which houses a custom microcontroller-driven PCB and 1800 milliamp-hour lithium-ion rechargeable battery capable of delivering 4 hours of running time. Upon integration with the 2 DOF orthosis device, a user may complete full range of motion with up to 5 pounds in their hand in less than 7 seconds, providing full functionality to complete acts of daily living, thus improving quality of life

International Conference on NeuroRehabilitation 2012

This volume 3, number 2 gathers a set of articles based on the most outstanding research on accessibility and disability issues that was presented in the International Conference on NeuroRehabilitation 2012 (ICNR).The articles’ research present in this number is centred on the analysis and/or rehabilitation of body impairment most due to brain injury and neurological disorders.JACCES thanks the collaboration of the ICNR members and the research authors and reviewers that have collaborated for making possible that issue

Robotic Platforms for Assistance to People with Disabilities

People with congenital and/or acquired disabilities constitute a great number of dependents today. Robotic platforms to help people with disabilities are being developed with the aim of providing both rehabilitation treatment and assistance to improve their quality of life. A high demand for robotic platforms that provide assistance during rehabilitation is expected because of the health status of the world due to the COVID-19 pandemic. The pandemic has resulted in countries facing major challenges to ensure the health and autonomy of their disabled population. Robotic platforms are necessary to ensure assistance and rehabilitation for disabled people in the current global situation. The capacity of robotic platforms in this area must be continuously improved to benefit the healthcare sector in terms of chronic disease prevention, assistance, and autonomy. For this reason, research about human–robot interaction in these robotic assistance environments must grow and advance because this topic demands sensitive and intelligent robotic platforms that are equipped with complex sensory systems, high handling functionalities, safe control strategies, and intelligent computer vision algorithms. This Special Issue has published eight papers covering recent advances in the field of robotic platforms to assist disabled people in daily or clinical environments. The papers address innovative solutions in this field, including affordable assistive robotics devices, new techniques in computer vision for intelligent and safe human–robot interaction, and advances in mobile manipulators for assistive tasks

DEVELOPMENT OF A CUSTOMIZED ELECTRONIC REMINDER TO FACILITATE POWERED SEATING FUNCTION USAGE AND COMPLIANCE WITH CLINICAL RECOMMENDATIONS: DESIGN PROCESS AND CLINICAL EFFICACY

Compliance with clinical guidance on powered seating function (PSF) usage is very low among individuals who use electric powered wheelchairs (EPWs), leading to high risks for secondary complications, with potentially devastating health consequences, and drastically reduced quality of life. The purposes of this research project were to 1) develop a pervasive and persuasive reminder system, Virtual Seating Coach (VSC), to facilitate appropriate use of PSFs for health management following clinical recommendations; and 2) evaluate the efficacy of VSC on facilitating PSF usage and improving compliance with clinical recommendations. Survey studies, in-lab tests, and a pilot test study were conducted to ensure that users' feedback was incorporated in the development of the VSC. The research team gradually improved and refined the VSC in the development process. A randomized group study was conducted to evaluate the efficacy of the VSC. Participants used study EPWs equipped with the VSC for 8 weeks, including 2 weeks of baseline data collection and 6 weeks of intervention by receiving an educational program or the VSC in conjunction with the educational program. The educational program included providing educational materials in video, pamphlet, and flash cards formats, and recurrent meetings with a clinician once every two weeks to discuss PSF usage. Twenty six individuals participated in the study, and sixteen of them completed the study protocol. The study results showed that the intervention of the VSC in conjunction with the educational program increased the compliance rate around 40%, while the intervention of the educational program alone increased the compliance rate around 18% compared to the baseline period. Providing timely cues, accessible instructions and feedback were critical to facilitate a desired health behavior. Participants had large variability in the directions and strength of correlations between PSF usage and measures of quality of life (QoL). Gender, experience in EPW and PSF usage, and ambulatory ability may affect the relationships between PSF usage and QoL. More studies are needed to determine how to interpret the measures of QoL as outcome measurements for the effect of PSF usage

Doctor of Philosophy

dissertationMost humans have difficulty performing precision tasks, such as writing and painting, without additional physical support(s) to help steady or offload their arm's weight. To alleviate this problem, various passive and active devices have been developed. However, such devices often have a small workspace and lack scalable gravity compensation throughout the workspace and/or diversity in their applications. This dissertation describes the development of a Spatial Active Handrest (SAHR), a large-workspace manipulation aid, to offload the weight of the user's arm and increase user's accuracy over a large three-dimensional workspace. This device has four degrees-of-freedom and allows the user to perform dexterous tasks within a large workspace that matches the workspace of a human arm when performing daily tasks. Users can move this device to a desired position and orientation using force or position inputs, or a combination of both. The SAHR converts the given input(s) to desired velocit

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