Analyse, modélisation et implémentation de stratégies d’assistance : déploiement d’orthèses cognitives pour les activités instrumentales de la vie quotidienne des traumatisés crâniens

De nos jours, les traumatismes cranio-cérébraux (TCC) sévères sont considérés comme un problème de santé publique au plan mondial. En effet, un TCC sévère engendre des répercussions importantes dans la vie des personnes l’ayant subi. Ces répercussions sont liées aux dysfonctionnements cognitifs, émotionnels et comportementaux. Ces troubles occasionnent une baisse, souvent très importante, de leur indépendance dans la réalisation des Activités Instrumentales de la Vie Quotidienne (AIVQ), telles que préparer un repas, gérer ses finances, utiliser son téléphone, conduire une automobile, faire des achats, etc. Très souvent, les personnes ayant subi un TCC sévère doivent retourner vivre au sein de leur domicile malgré les grandes difficultés liées à leur état. Les TCC sévères ressentiront très souvent le besoin d’assistance pour la réalisation des AIVQ. Cette thèse s’inscrit dans le cadre d’un grand projet de recherche financé par les Instituts de recherche en santé du Canada et le Conseil de Recherches en Sciences Naturelles et en Génie du Canada (CRSNG). En particulier, le Projet de Recherche Concertée sur la Santé (PRCS). L’objectif de cette thèse, au sein de ce projet, consiste à concevoir, représenter, formaliser et implémenter une structure d’assistance cognitive contextuelle et adaptative selon le profil des personnes atteintes de TCC sévère pour la réalisation des AIVQ. Cette assistance favorisera leur indépendance dans la réalisation des AIVQ au sein de leur domicile. La conception de cette assistance cognitive numérique implique un travail interdisciplinaire entre l’ergothérapie et l’informatique, afin de passer de la pratique d’assistance fournie par des cliniciens à la formulation formelle et à l’implémentation. Cette conception s’appuie sur une démarche de conception participative qui sollicite principalement les résidents d’un milieu d’hébergement alternatif domotisé.Abstract: Severe Traumatic Brain Injury (TBI) is considered a public health problem. Indeed, severe TBI causes significant cognitive, emotional and behavioral repercussions that impact the lives of these individuals, particularly their ndependence in Instrumental Activities of Daily Living (IADLs). Individuals who have experienced severe TBI frequently return to live in their homes despite the severe difficulties associated with their condition, though the need for assistance to perform IADLs frequently persists. The objective of this thesis is to design, represent, formalize and implement a context-aware and adaptive structure of cognitive assistance. This assistance is created according to the general needs of individuals with severe TBI for IADL performance. The proposed assistance will promote their independence to perform IADL in a home environment. The design of this cognitive assistance technology involves an interdisciplinary collaboration between occupational therapy and computer science, to evolve from the assistance provided by the clinicians to a formal computer science formulation and implementation. This design is based on a participative design approach that mainly involves TBI residents of a smart alternative housing unit. A prototype of a cognitive orthotic for meal preparation (COOK) was created and deployed within an alternative housing unit. Implementation of this cognitive orthotic lifted the prohibition on use of a stove for meal preparation that had previously been placed on their residents. By allowing these residents to cook independently, COOK has contributed to helping them become more independent in cooking and more confident in their ability to do so

FOOT DROP AND FATIGABILITY IN PEOPLE WITH MULTIPLE SCLEROSIS

People with Multiple Sclerosis (pwMS) often experience walking impairments such as foot drop which can lead to trip and falls. Foot drop can be either transient and is often induced by exercise (fatigability) in pwMS whose walking ability is not affected and can become more fixed with disease progression. The overall aim of this PhD was to explore foot drop, its presence in pwMS with different disability levels and the psychometric properties of outcomes used to evaluate walking impairments. The first study in this thesis was a systematic review into the level of evidence for the psychometric properties of walking measures that have been used to evaluate the effect of assistive technology such as FES for foot drop in MS. Moderate to strong psychometric evidence was found for the Multiple Sclerosis Walking Scale, Timed 25 Foot Walk, 6 minute and 10 meter walk tests. There were no psychometric studies for three-dimensional (3D) gait kinematics in pwMS even though it was one of the most frequently used outcome measures. The second study assessed the test-retest reliability of 3D ankle kinematics and spatiotemporal parameters in pwMS, with low Expanded Disability Status Scale (EDSS < 3.5) and in those with moderate to high EDSS (EDSS: 4-6). Reliability was excellent for ankle kinematics and spatiotemporal parameters in both groups, with lower minimal detectable change (MDC95%) values in the low EDSS group compared to the higher EDSS group. The third study investigated transient exercise induced foot drop in highly physically active pwMS (EDSS < 3.5) and health controls using 3D kinematics. It was found that 6 out of 15 pwMS and none of the healthy controls presented this phenomenon. The fourth study examined the direct orthotic effect of FES during dual-tasking (i.e. walking combined with a cognitive task) and after inducing fatigability. Low to moderate effect sizes indicated that the direct orthotic effect was higher under dual-task and fatiguing conditions but this needs to be confirmed in appropriately powered studies. In conclusion, the studies in this thesis have contributed to the psychometric evidence of gait kinematics in pwMS, have objectively documented the presence of transient foot drop in highly physically active pwMS and orthotic effect of FES under a variety of conditions simulating the perceived benefits in ‘real life’ reported by FES users. Key words: multiple sclerosis, foot drop, fatigability, FES, psychometric properties, 3D gait kinematic

Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study

Background: Friedreich’s ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. Methods: Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using the Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. Results: All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. Conclusions: Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients’ dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive

Investigating the Effects of Custom Made Orthotics on Brain Forms: A Pilot Study

OBJECTIVES: To determine (1) the feasibility of this novel approach and technique of recording brain activity, wirelessly and continuously, during human gait, and (2) if custom made orthotics will alter the brain activity patterns recorded. METHODS: Gait trials were performed on 16 participants walking with and without orthotic devices in their shoes while simultaneously collecting EEG data through the Emotiv wireless neuroheadset. RESULTS: The Emotiv neuroheadset was capable of detecting changes in brain activity between the two gait trials. The differences in brain activity identified between conditions were not statistically significant. CONCLUSION: The findings suggest the Emotiv EEG device is sensitive enough to detect changes in brain activation patterns during human gait. Further research is required before definite conclusions can be made about this novel device, or about what effects, if any, orthotics have on brain activation patterns during gait

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

An Innovative Solution Based on Human-Computer Interaction to Support Cognitive Rehabilitation

This contribution focuses its objective in describing the design and implementation of an innovative system to provide cognitive rehabilitation. People who will take advantage of this platform suffer from a post-stroke disease called Apraxia and Action Disorganisation Syndrome (AADS). The platform has been integrated at Universidad Politécnica de Madrid and tries to reduce the stay in hospital or rehabilitation center by supporting self-rehabilitation at home. So, the system acts as an intelligent machine which guides patients while executing Activities of Daily Living (ADL), such as preparing a simple tea, by informing them about the errors committed and possible actions to correct them. A short introduction to other works related to stroke, patients to work with, how the system works and how it is implemented are provided in the document. Finally, some relevant information from experiment made with healthy people for technical validation is also shown

Prospective memory intervention using visual imagery in individuals with brain injury [pre-print]

Prospective memory deficits are common after brain injury and can create impediments to independent living. Most approaches to management of such deficits are compensatory, such as the use of notebooks or electronic devices. While these can be effective, a restorative approach, in theory, could lead to greater generalisation of treatment. In the current study a metacognitive technique, using visual imagery, was employed under conditions of rote repetition and spaced retrieval. Treatment was provided in an AB-BA crossover design with A as the active treatment and B as a no-treatment attention control to 20 individuals with brain injury. A group of 20 healthy participants served to control for effects of re-testing. Individuals with brain injury demonstrated improvement on the main outcome measure of prospective memory, the Memory for Intentions Screening Test, only after the active treatment condition. In addition, some generalisation of treatment was measured in daily life. Moreover, treatment gains were maintained for one year after treatment was completed

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 386)

This bibliography lists 117 reports, articles and other documents introduced into the NASA Scientific and Technical Information System during Mar. 1994. Subject coverage includes: aerospace medicine and physiology, life support systems and man/system technology, protective clothing, exobiology and extraterrestrial life, planetary biology, and flight crew behavior and performance