Empowering and assisting natural human mobility: The simbiosis walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staf

Instrumentation and validation of a robotic cane for transportation and fall prevention in patients with affected mobility

Dissertação de mestrado integrado em Engenharia Física, (especialização em Dispositivos, Microssistemas e Nanotecnologias)O ato de andar é conhecido por ser a forma primitiva de locomoção do ser humano, sendo que este traz muitos benefícios que motivam um estilo de vida saudável e ativo. No entanto, há condições de saúde que dificultam a realização da marcha, o que por consequência pode resultar num agravamento da saúde, e adicionalmente, levar a um maior risco de quedas. Nesse sentido, o desenvolvimento de um sistema de deteção e prevenção de quedas, integrado num dispositivo auxiliar de marcha, seria essencial para reduzir estes eventos de quedas e melhorar a qualidade de vida das pessoas. Para ultrapassar estas necessidades e limitações, esta dissertação tem como objetivo validar e instrumentar uma bengala robótica, denominada Anti-fall Robotic Cane (ARCane), concebida para incorporar um sistema de deteção de quedas e um mecanismo de atuação que possibilite a prevenção de quedas, ao mesmo tempo que assiste a marcha. Para esse fim, foi realizada uma revisão do estado da arte em bengalas robóticas para adquirir um conhecimento amplo e aprofundado dos componentes, mecanismos e estratégias utilizadas, bem como os protocolos experimentais, principais resultados, limitações e desafios em dispositivos existentes. Numa primeira fase, foi estipulado o objetivo de: (i) adaptar a missão do produto; (ii) estudar as necessidades do consumidor; e (iii) atualizar as especificações alvo da ARCane, continuação do trabalho de equipa, para obter um produto com design e engenharia compatível com o mercado. Foi depois estabelecida a arquitetura de hardware e discutidos os componentes a ser instrumentados na ARCane. Em seguida foram realizados testes de interoperabilidade a fim de validar o funcionamento singular e coletivo dos componentes. Relativamente ao controlo de movimento, foi desenvolvido um sistema inovador, de baixo custo e intuitivo, capaz de detetar a intenção do movimento e de reconhecer as fases da marcha do utilizador. Esta implementação foi validada com seis voluntários saudáveis que realizaram testes de marcha com a ARCane para testar sua operabilidade num ambiente de contexto real. Obteve-se uma precisão de 97% e de 90% em relação à deteção da intenção de movimento e ao reconhecimento da fase da marcha do utilizador. Por fim, foi projetado um método de deteção de quedas e mecanismo de prevenção de quedas para futura implementação na ARCane. Foi ainda proposta uma melhoria do método de deteção de quedas, de modo a superar as limitações associadas, bem como a proposta de dispositivos de deteção a serem implementados na ARCane para obter um sistema completo de deteção de quedas.The act of walking is known to be the primitive form of the human being, and it brings many benefits that motivate a healthy and active lifestyle. However, there are health conditions that make walking difficult, which, consequently, can result in worse health and, in addition, lead to a greater risk of falls. Thus, the development of a fall detection and prevention system integrated with a walking aid would be essential to reduce these fall events and improve people quality of life. To overcome these needs and limitations, this dissertation aims to validate and instrument a cane-type robot, called Anti-fall Robotic Cane (ARCane), designed to incorporate a fall detection system and an actuation mechanism that allow the prevention of falls, while assisting the gait. Therefore, a State-of-the-Art review concerning robotic canes was carried out to acquire a broad and in-depth knowledge of the used components, mechanisms and strategies, as well as the experimental protocols, main results, limitations and challenges on existing devices. On a first stage, it was set an objective to (i) enhance the product's mission statement; (ii) study the consumer needs; and (iii) update the target specifications of the ARCane, extending teamwork, to obtain a product with a market-compatible design and engineering that meets the needs and desires of the ARCane users. It was then established the hardware architecture of the ARCane and discussed the electronic components that will instrument the control, sensory, actuator and power units, being afterwards subjected to interoperability tests to validate the singular and collective functioning of cane components altogether. Regarding the motion control of robotic canes, an innovative, cost-effective and intuitive motion control system was developed, providing user movement intention recognition, and identification of the user's gait phases. This implementation was validated with six healthy volunteers who carried out gait trials with the ARCane, in order to test its operability in a real context environment. An accuracy of 97% was achieved for user motion intention recognition and 90% for user gait phase recognition, using the proposed motion control system. Finally, it was idealized a fall detection method and fall prevention mechanism for a future implementation in the ARCane, based on methods applied to robotic canes in the literature. It was also proposed an improvement of the fall detection method in order to overcome its associated limitations, as well as detection devices to be implemented into the ARCane to achieve a complete fall detection system

Effect of a Tai Chi Chuan Slow Walking Intervention on Balance and Mobility in Individuals with Multiple Sclerosis

In people with Multiple Sclerosis (MS) balance impairments may lead to increased falls and mobility loss. In quiet stance, people with MS display greater postural sway than healthy controls. Tai Chi is a Chinese martial art that has decreased the risk of falling in frail elderly individuals (Wolf et al., 1996). The purpose of this study was to determine if a three week Tai Chi intervention would improve postural stability in people with MS. Seven participants (6F/1M, age 48.5 ± 10.8 years, height 1.66 ± 0.08m, mass 68.6 ± 19.8kg) attended nine one hour training sessions to practice two types of Tai Chi: standing meditation and slow walking. Postural stability was assessed before and after training using average center of pressure (CoP) velocity, total excursion and time to contact (TtC) for the static trials, and dual and single limb support times for the walking trials. To measure postural stability trials of quiet stance (QS), Tai Chi standing meditation with (SMA) and without arms (SM), tandem stance (TS), preferred speed walking (PW) and slow speed walking (SW) were assessed. Kinematic data recorded by a 12 camera motion capture system (Qualysis AB), and kinetic data collected from a single forceplate (AMTI) were used to compute net CoP. Because functional parameters can influence stability, strength obtained from a chair rise test and neural drive obtained from a foot tapping test were obtained. All results were assessed with paired t-tests (p.05). For SMA, average CoP velocity (p=.006) and excursions (p=.023) increased, and average TtC (p=.020) was reduced. For TS average CoP velocity (p=.06) and excursions (p=.09) trended towards decreased values, and average TtC (p=.045) increased. With the exception of increased left single limb support time (p=.009) PW and SW were not affected by the intervention. In conclusion, the increased neural drive, muscular strength, and postural stability in TS supports the idea that a three week Tai Chi intervention is effective at improving static balance in people with MS

Coordinated care plan to prevent older adult falls

The Coordinated Care Plan to Prevent Older Adult Falls offers primary care providers, practices, and healthcare systems a framework for managing their older patients\u2019 fall risk. The Plan was developed by fall prevention experts who were early adopters of STEADI.9, 11-13 Working together, these early adopters and CDC hope to provide other primary care providers and their teams with tips and strategies needed to integrate and evaluate their STEADI-based clinical fall prevention programs. The purpose of this plan is to offer practical suggestions to incorporate and evaluate fall prevention in primary care settings; thereby, reducing falls among community-dwelling older adults. Although the Coordinated Care Plan is developed for primary care, STEADI-based programs can be implemented in different healthcare settings, and steps described in this plan can be adapted accordingly.This plan compliments the CDC STEADI: Evaluation Guide for Older Adult Clinical Fall Prevention Programs. The Evaluation Guide is adapted from CDC\u2019s Framework for Program Evaluation in Public Health, and describes key steps to measure and report on the success of implementing a STEADI-based clinical fall prevention program. Evaluating the implementation and use of STEADI-based programs can help providers and organizations increase the quality of care provided to their older patients, and demonstrate program- related successes and areas for improvement.We recommend using both the Coordinated Care Plan and the Evaluation Guide simultaneously to ensure the team is able to collect the data needed to report on the clinical fall prevention program\u2019s overall success.Suggested Citation: Eckstrom E, Parker EM, Shakya I, Lee R. Coordinated Care Plan to Prevent Older Adult Falls. Edition 1.1. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2021.Steadi-Coordinated-Care-Plan.pdfIntroduction: Why Focus On Falls? -- Chapter 1: Coordinating Fall Prevention Activities In Primary Care -- Chapter 2: Components of a Clinical Fall Prevention Program -- Chapter 3: Follow-Up and Care Coordination -- References.2021968

Coordinated care plan to prevent older adult falls

The Coordinated Care Plan to Prevent Older Adult Falls offers primary care providers, practices, and healthcare systems a framework for managing their older patients\u2019 fall risk. The Plan was developed by fall prevention experts who were early adopters of STEADI. Working together, these early adopters and CDC hope to provide other primary care providers and their teams with tips and strategies needed to integrate and evaluate their STEADI-based clinical fall prevention programs. The purpose of this plan is to offer practical suggestions to incorporate and evaluate fall prevention in primary care settings; thereby, reducing falls among community-dwelling older adults. Although the Coordinated Care Plan is developed for primary care, STEADI-based programs can be implemented in different healthcare settings, and steps described in this plan can be adapted accordingly.This plan compliments the CDC STEADI: Evaluation Guide for Older Adult Clinical Fall Prevention Programs. The Evaluation Guide is adapted from CDC\u2019s Framework for Program Evaluation in Public Health, and describes key steps to measure and report on the success of implementing a STEADI-based clinical fall prevention program. Evaluating the implementation and use of STEADI-based programs can help providers and organizations increase the quality of care provided to their older patients, and demonstrate program-related successes and areas for improvement.Suggested Citation: Eckstrom E, Parker EM, Shakya I, Lee R. Coordinated Care Plan to Prevent Older Adult Falls. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2019.Steadi-Coordinated-Care-Final-4_24_19.pdf2019619

System Identification of Bipedal Locomotion in Robots and Humans

The ability to perform a healthy walking gait can be altered in numerous cases due to gait disorder related pathologies. The latter could lead to partial or complete mobility loss, which affects the patients’ quality of life. Wearable exoskeletons and active prosthetics have been considered as a key component to remedy this mobility loss. The control of such devices knows numerous challenges that are yet to be addressed. As opposed to fixed trajectories control, real-time adaptive reference generation control is likely to provide the wearer with more intent control over the powered device. We propose a novel gait pattern generator for the control of such devices, taking advantage of the inter-joint coordination in the human gait. Our proposed method puts the user in the control loop as it maps the motion of healthy limbs to that of the affected one. To design such control strategy, it is critical to understand the dynamics behind bipedal walking. We begin by studying the simple compass gait walker. We examine the well-known Virtual Constraints method of controlling bipedal robots in the image of the compass gait. In addition, we provide both the mechanical and control design of an affordable research platform for bipedal dynamic walking. We then extend the concept of virtual constraints to human locomotion, where we investigate the accuracy of predicting lower limb joints angular position and velocity from the motion of the other limbs. Data from nine healthy subjects performing specific locomotion tasks were collected and are made available online. A successful prediction of the hip, knee, and ankle joints was achieved in different scenarios. It was also found that the motion of the cane alone has sufficient information to help predict good trajectories for the lower limb in stairs ascent. Better estimates were obtained using additional information from arm joints. We also explored the prediction of knee and ankle trajectories from the motion of the hip joints

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

The Effects of Partial Body Weight Support for Gait for Patients with Neurological Dysfunction: A Case Study Approach

The purpose of this study was to determine the effects of partial body weight support during gait for individuals with neurological dysfunction. Body weight support (BWS) training provides a safe environment in which the individual can perform and practice mechanics of normal gait at a variety of speeds with or without body weight support, depending on the level of function. The subjects who participated in this study were community ambulators older than 20 years of age with a neurological diagnosis. Each subject was tested initially and at the conclusion of the study to compare data using a battery of balance and gait tests. Each subject participated in body weight support treadmill gait training using the LiteGaitTM three times a week for up to six weeks. Each subject was to begin with 40% body weight support (BWS) and a treadmill speed of .5 mph, progress to 20% BWS and a speed of .7 mph, and finally to 0% BWS and a speed of 1.0 mph. All three subjects made improvements when comparing initial to final testing results. Many factors may have limited the results of our study including the tester, sensitivity of the tests performed, or sudden changes in medical status

Gait, mobility, and falls in older people

My doctoral thesis contributes to the understanding of gait, mobility, and falls in older people. All presented projects investigated the most prominent and sensitive markers for fall-related gait changes, that is gait velocity and gait variability. Based on the measurement of these spatio-temporal gait parameters, particularly when using a change-sensitive dual task paradigm, it is possible to make conclusions regarding walking, balance, activities of daily living, and falls in older people. The research summarized in my doctoral thesis will help in the detection of early fall risk and modulation of therapeutic interventions to improve gait and consequently reduce fall risk in older people. To identify modifiable fall risk factors, such as gait disorders, the GAITRite electronic walkway system was used for objective spatio-temporal gait analysis. The simplicity and feasibility of the administration of single and dual task gait analysis make it a desirable clinical and research measurement tool. Gait analysis with walking as a single task condition alone is often insufficient to reveal underlying gait disorders present during everyday activities. However, measuring gait with a dual task paradigm can detect subtle gait deficits. Dual-tasking, walking while simultaneously performing an additional task, was used to assess the effects of divided attention on motor performance and gait control. The presented publications in this doctoral thesis investigated the association between gait parameters and several hypothesized fall-related modalities: (a) Our first review article highlighted the association between gait disorders and falls, and how related motor and cognitive impairments can be detected by measuring gait while dual-tasking. (b) A second review looked at how the dual task paradigm can be used for gait assessment in older people and how spatio-temporal gait parameters are associated with increased fall risk. (c) Our systematic literature review provided evidence about effective fall prevention interventions (exercise, home modifications, footwear, and walking aids) to reduce the risk of falls in vulnerable older people. (d) To evaluate which exercise modalities are effective in modifying risk factors for falls, we conducted an eight-week salsa intervention trial and measured the effect of dancing on static and dynamic balance, and leg muscle power in older people. (e) Besides exercise, inadequate nutritional intake is another modifiable risk factor for falls in older people, and therefore our most recent cross-sectional study examined how serum 25-hydroxvitamin D levels are associated with functional mobility in older people assessed in a memory clinic. (c) Walking aids are commonly prescribed for older people with a high risk of falls which is why we examined the influence of walking aids on spatio-temporal gait parameters in older people who used a cane, a crutch or a walker. (g) Finally, besides predominantly investigating fall risk factors for motor abilities, our prolonged and ongoing randomized, double-blind, and placebo-controlled intervention trial explores the potential influence of ginkgo biloba on the cognitive domain relevant for dual-tasking in older people with mild cognitive impairment

Pathophysiology of normal pressure hydrocephalus

Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH