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

Monitoring Functional Capability of Individuals with Lower Limb Amputations Using Mobile Phones

To be effective, a prescribed prosthetic device must match the functional requirements and capabilities of each patient. These capabilities are usually assessed by a clinician and reported by the Medicare K-level designation of mobility. However, it is not clear how the K-level designation objectively relates to the use of prostheses outside of a clinical environment. Here, we quantify participant activity using mobile phones and relate activity measured during real world activity to the assigned K-levels. We observe a correlation between K-level and the proportion of moderate to high activity over the course of a week. This relationship suggests that accelerometry-based technologies such as mobile phones can be used to evaluate real world activity for mobility assessment. Quantifying everyday activity promises to improve assessment of real world prosthesis use, leading to a better matching of prostheses to individuals and enabling better evaluations of future prosthetic devices.Max Nader Center for Rehabilitation Technologies and Outcome

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0-15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed

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

aQRdate: assessing how ubiquitous computing can help people with acquired brain injury in their rehabilitation process

This is an electronic version of the paper presented at the International Symposium on Ubiquitous Computing and Ambient Intelligence, held in Riviera Maya on 2011In this paper we present our ideas about how Ubiquitous Computing (UbiComp) could help people with acquired brain injury. Since these people have problems to engage in daily life activities (e.g. how to do the laundry or prepare breakfast), we propose a system based on mobile devices and QR codes to help them to remember these tasks. The environment will be tagged with QR Codes that will provide mobile devices with personal and interactive manuals for routine tasks. This work has been tested with one user with acquired brain injury as a proof-of-concept.This work was partially funded by ASIES (Adapting Social \& Intelligent Environments to Support people with special needs), Ministerio de Ciencia e Innovación - TIN2010-17344, and e-Madrid (Investigación y desarrollo de tecnologías para el e-learning en la Comunidad de Madrid) S2009/TIC-1650

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Adaptive manuals as assistive technology to support and train people with acquired brain injury in their daily life activities

The final publication is available at Springer via http://dx.doi.org/10.1007/s00779-012-0560-zAssistive technologies and ubiquitous computing can be related since both try to help people in their lives. This common objective motivated us to develop and evaluate a system that puts ubiquitous computing technologies into the rehabilitation process of people with acquired brain injury. Thus, in this paper, we present and evaluate a system that shows adaptive manuals for daily-life activities for people with acquired brain injury. This first evaluation allowed us to validate our approach and also to extract valuable information about these systems as well as environmental factors that may affect the patients.This work was partially funded by ASIES (Adapting Social & Intelligent Environments to Support people with special needs), Ministerio de Ciencia e Innovación - TIN2010-17344, and e-Madrid (Investigación y desarrollo de tecnologías para el e-learning en la Comunidad de Madrid) S2009/TIC-1650

Bridging the gap between robotic technology and health care

Although technology and computation power have become more and more present in our daily lives, we have yet to see the same tendency in robotics applied to health care. In this work we focused on the study of four distinct applications of robotic technology to health care, named Robotic Assisted Surgery, Robotics in Rehabilitation, Prosthetics and Companion Robotic Systems. We identified the main roadblocks that are limiting the progress of such applications by an extensive examination of recent reports. Based on the limitations of the practical use of current robotic technology for health care we proposed a general modularization approach for the conception and implementation of specific robotic devices. The main conclusions of this review are: (i) there is a clear need of the adaptation of robotic technology (closed loop) to the user, so that robotics can be widely accepted and used in the context of heath care; (ii) for all studied robotic technologies cost is still prohibitive and limits their wide use. The reduction of costs influences technology acceptability; thus innovation by using cheaper computer systems and sensors is relevant and should be taken into account in the implementation of robotic systems

Scoping Research Report on Assistive Technology - On The Road For Universal Assistive Technology Coverage

Over one billion people – largely disabled people and older people – are currently in need of Assistive Technology (AT). By 2050, this number is predicted to double. Despite the proven advantages of AT for disabled and older people, their families, and society, there is still a vast and stubborn gap between the need and the supply; currently only 10% of those who need AT currently have access to it. This Scoping Research Report on Assistive Technology (AT) seeks to unpick and understand the multi-layered and multifaceted ways in which economic, social, and political factors interplay and interact to create barriers to AT for those who need it the most. Through primary and secondary research, they explore the current landscape, the limitations, and current initiatives, ultimately answering the question: “How best should a target intervention around AT sphere affect positive change for poor, disabled and older people in Global South priority countries?”. To understand this question, the research team asked two specific questions: What are the barriers which prevent access to AT for the people that need it, with a focus on those living in low resource settings within DFID priority Global South countries? How should DFID, in partnership with others best direct its intervention toward overcoming these barriers? The work reveals that, while levels of AT market development vary across countries, key barriers are common. These barriers can be classified into 5 main categories related to both supply and demand factors and across the 5Ps of People, Products, Provision, Personnel, and Policy. This work is part of the ‘Frontier Technology Livestreaming’ programm