JNER at 15 years: analysis of the state of neuroengineering and rehabilitation.

On JNER's 15th anniversary, this editorial analyzes the state of the field of neuroengineering and rehabilitation. I first discuss some ways that the nature of neurorehabilitation research has evolved in the past 15 years based on my perspective as editor-in-chief of JNER and a researcher in the field. I highlight increasing reliance on advanced technologies, improved rigor and openness of research, and three, related, new paradigms - wearable devices, the Cybathlon competition, and human augmentation studies - indicators that neurorehabilitation is squarely in the age of wearability. Then, I briefly speculate on how the field might make progress going forward, highlighting the need for new models of training and learning driven by big data, better personalization and targeting, and an increase in the quantity and quality of usability and uptake studies to improve translation

Perspectives of End Users on the Potential Use of Trunk Exoskeletons for People With Low-Back Pain:A Focus Group Study

Objective: The objective of this study was to identify criteria to be considered when developing an exoskeleton for low-back pain patients by exploring the perceptions and expectations of potential end users. Background: Psychosocial, psychological, physical load, and personality influence incidence of low-back pain. Body-worn assistive devices that passively support the user’s trunk, that is exoskeletons, can decrease mechanical loading and potentially reduce low-back pain. A user-centered approach improves patient safety and health outcomes, increases user satisfaction, and ensures usability. Still, previous studies have not taken psychological factors and the early involvement of end users into account. Method: We conducted focus group studies with low-back pain patients (n = 4) and health care professionals (n = 8). Focus group sessions were audio-recorded, transcribed, and analyzed, using the general inductive approach. The focus group discussions included trying out an available exoskeleton. Questions were designed to elicit opinions about exoskeletons, desired design specifications, and usability. Results: Important design characteristics were comfort, individual adjustability, independency in taking it on and off, and gradual adjustment of support. Patients raised concerns over loss of muscle strength. Health care professionals mentioned the risk of confirming disability of the user and increasing guarded movement in patients. Conclusion: The focus groups showed that implementation of a trunk exoskeleton to reduce low-back pain requires an adequate implementation strategy, including supervision and behavioral coaching. Application: For health care professionals, the optimal field of application, prevention or rehabilitation, is still under debate. Patients see potential in an exoskeleton to overcome their limitations and expect it to improve their quality of life

Review of Cerebral Palsy: The Various Intervention Techniques

Cerebral palsy (CP) is a neurodevelopmental disorder that results from a disruption in the development in the infantile or fetal brain. It affects over 17 million people worldwide. The goal of this review paper is to provide an in-depth literature review behind the causes, diagnosis, associated disorders of CP as well as the treatment interventions that would lead to a comprehensive treatment plan for CP patients. There are many possible causes of CP, contrary to the popular belief that CP is only caused by hypoxia or ischemia at birth. Diagnosis requires determining the motor function, part(s) of the body affected, and the severity; diagnosis techniques have been recently improving. Identification of the associated disorders is also important for treatment. The treatment interventions comprehensively reviewed include physical therapy, occupational therapy, and the combination of physical therapy and occupational therapy. Additional treatment interventions examined are exercise interventions, speech and language pathology, medications, and surgical procedures. It can be concluded that the best treatment plan for a CP patient will be individualized for each specific patient and may include different amounts of the treatment interventions

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

Biomedical Technology: Supporting Movement

According to the National Institute on Disability and Rehabilitation Research, an estimated 8.5 million children 21 years and younger have a disability (Jans & Stoddard, 1999). After about a decade, with the development of new and sophisticated materials (aluminum alloys, titanium alloys, and carbon fibers) and the integration of electronics, it was then possible to significantly improve the performance of prostheses, built with the so-called endo skeletal (or skeletal-modular) method (Mora, Beratni & Pedrotti, 2006)

Stakeholder and Constraint-Driven Innovation of a Novel, Lever-Propelled, All-Terrain Wheelchair

The Leveraged Freedom Chair (LFC) is a low-cost, all-terrain, lever-propelled wheelchair designed primarily for use in developing countries. LFC technology was conceived because 70 percent of wheelchair users in these markets live in rural areas and no currently available mobility aid enables them to travel long distances on rough terrain and maneuver in tight, indoor confines. Because developing world markets impose constraints on cost, durability, and performance, a novel solution was required to satisfy stakeholder requirements. The key innovation behind the LFC is its single speed, variable mechanical advantage lever drivetrain. The user effectively changes gear by shifting his hands along the levers; grasping near the ends increases torque, while grasping near the pivots enables a larger angular displacement with every stroke, which increases speed. The drivetrain is made from low-cost bicycle parts found throughout the developing world, which enables the LFC to be sold for $200 and be repairable anywhere. During three user trials in East Africa, Guatemala, and India, stakeholder feedback was used to refine the chair between trials, resulting in a device 9.1 kg (20 lbs) lighter, 8.9 cm (3.5 in) narrower, and with a center of gravity 12.7 cm (5 in) lower than the first iteration. Survey data substantiated increases in performance after successive iterations. Quantitative biomechanical performance data were also measured during the Guatemala and India trials, which showed the LFC to be 76 percent faster and 41 percent more efficient during a common daily commute, and able to produce 53 percent higher peak propulsion force compared to conventional, pushrim-propelled wheelchairs. The LFC offers comparable performance at less than one-twentieth the cost of off road wheelchairs available in the rich world. Stakeholder feedback and the highly-constrained environment for which the LFC was created drove the technology towards a novel, innovative solution that offers a competitive advantage in both developing and developed markets. The paper concludes with a description of how the LFC is a “constraint-driven innovation.” This idea ties together the theories of “disruptive innovation” and “reverse innovation,” and may be used as a design tool for engineers striving to create technologies that have global impact.Singapore University of Technology and DesignInter-American Development BankNational Collegiate Inventors and Innovators AllianceD-Lab (Massachusetts Institute of Technology)Clinton Global InitiativeMassachusetts Institute of Technology. Office of the Dean for Graduate Education (Hugh Hampton Young Memorial Fellowship)Massachusetts Institute of Technology. Department of Mechanical EngineeringMassachusetts Institute of Technology. Public Service CenterMassachusetts Institute of Technology. Edgerton CenterMassachusetts Institute of Technology. Undergraduate Research Opportunities ProgramCalifornia Environmental Protection Agency. Air Resources Boar

A feasibility study to evaluate a purposeful walk intervention with a distance goal using a commercially available activity monitor in elderly people post total hip replacement surgery

INTRODUCTION: Total hip replacement (THR) is performed in an increasing number of individuals around the world and while improvements in pain reduction and long-term enhancement of muscle strength are well documented, the improvement in daily activity does not follow the same trend. This study aimed to determine the feasibility of a 5-week intervention where a personalised outdoor walking distance is monitored using a commercial activity monitor (Fitbit Charge 4). METHOD: Data was collected on gait and activities of daily living using patient reported outcome measures. Following the completion of the intervention period, participants took part in a semi-structured interview to voice their opinion on the use of the activity monitor, their experiences, and any challenges in order to assess the feasibility of the intervention. All quantitative data were presented descriptively, using appropriate summary statistics. Interviews were analysed using thematic analysis. RESULTS: Five participants who had undergone total hip replacement surgery within the postoperative period of 3 to 6 months were recruited from the local community. CONCLUSION: The findings suggest that the intervention was feasible and that it encouraged all participants to increase their daily activity. Therefore, it can be concluded that a follow-up effectiveness trial is warranted

Methods to design bespoke sockets

The socket is an integral and important part of the prosthetic limb, providing link between body and technology. The quality of this connection must be considered as we strive towards embodiment of the prosthetic limb. The purpose of the socket is not just to provide a container for the residual limb but to provide a vessel where biomechanical forces can be transmitted from the body to the prosthetic componentry in the most energy -efficient manner while protecting the underlying tissues. The residual limb consists of bone surrounded by an envelope of soft tissues, including muscles which may no longer have insertion points. As the bone is able to move within the envelope of soft tissues, poor transmission of force and discomfort within the prosthesis can occur. Stabilising tissues to minimise bone movement within the socket is considered one of the primary goals in designing and constructing a well-fitting socket