The-state-of-the-art of soft robotics to assist mobility: a review of physiotherapist and patient identified limitations of current lower-limb exoskeletons and the potential soft-robotic solutions

Background: Soft, wearable, powered exoskeletons are novel devices that may assist rehabilitation, allowing users to walk further or carry out activities of daily living. However, soft robotic exoskeletons, and the more commonly used rigid exoskeletons, are not widely adopted clinically. The available evidence highlights a disconnect between the needs of exoskeleton users and the engineers designing devices. This review aimed to explore the literature on physiotherapist and patient perspectives of the longer-standing, and therefore greater evidenced, rigid exoskeleton limitations. It then offered potential solutions to these limitations, including soft robotics, from an engineering standpoint. Methods: A state-of-the-art review was carried out which included both qualitative and quantitative research papers regarding patient and/or physiotherapist perspectives of rigid exoskeletons. Papers were themed and themes formed the review’s framework. Results: Six main themes regarding the limitations of soft exoskeletons were important to physiotherapists and patients: safety; a one-size-fits approach; ease of device use; weight and placement of device; cost of device; and, specific to patients only, appearance of the device. Potential soft-robotics solutions to address these limitations were offered, including compliant actuators, sensors, suit attachments fitting to user’s body, and the use of control algorithms. Conclusions: It is evident that current exoskeletons are not meeting the needs of their users. Solutions to the limitations offered may inform device development. However, the solutions are not infallible and thus further research and development is required

The scope of practice of physiotherapists who work in intensive care in South Africa: a questionnaire-based survey

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters of Science in Physiotherapy. Johannesburg, 2015Patients admitted to the intensive care unit (ICU) require continuous monitoring and care from all staff working in ICU; this includes doctors, nursing staff, physiotherapists, dieticians and various other medical staff. Conventionally ICU was predominantly staffed by physicians and nursing personnel, with other members of health care having a minor part to play in the patient’s care whilst in ICU. Depending on the country, type of unit, amount of staff and level of training, the physiotherapist may screen the patients to assess if they require physiotherapy and if so, what intervention will be required; on the other hand, in some units the physiotherapist may rely on referral from the doctors and administer the treatment requested by the doctor for the particular patient. In 2000, Norrenberg and Vincent conducted a study to establish the profile of physiotherapists working in ICU in Europe. Van Aswegen and Potterton (2005) adjusted the questionnaire compiled by Norrenberg and Vincent (2000) to be more suitable for the South African setting. A pilot study using this questionnaire was done to determine the scope of practice of physiotherapists in ICU in South Africa. The content of the modified questionnaire used by Van Aswegen and Potterton (2005) was not validated prior to its implementation and a sample of convenience was used. Results reported from that survey were therefore only preliminary and no additional surveys had been performed to date. Objectives: The aim of this study was to establish the current scope of practice of physiotherapists in ICU in South Africa. To determine if physiotherapists’ scope of practice in ICU in South Africa has changed since the report published by Van Aswegen and Potterton (2005). To compare South African physiotherapists’ scope of practice in ICU with that reported on an international level. Methodology: A pre-existing questionnaire used by Van Aswegen and Potterton (2005) was content validated for this study. After consensus was reached on the final version of this questionnaire, it was uploaded onto SurveyMonkey. Physiotherapists that worked in ICU in the government sector, hospitals belonging to the Life, MediClinic and NetCare groups or that were members of the Cardiopulmonary Physiotherapy Rehabilitation Group of the South African Society of Physiotherapy were invited to participate in this study. Results: A total of 319 questionnaires were sent out and 108 responses were received. The combined response rate for this survey was 33.9%. An assessment technique that was performed ‘very often’ by respondents was an ICU chart assessment (n=90, 83.3%), auscultation (n=94, 81, 8%) and strength of cough effort (n=81, 75%). Assessment techniques that were ‘almost never’ or ‘never’ used included assessment of lung compliance (n=75; 69.4%), calculation for the presence of hypoxemia (n=74; 68.5%) and patient readiness for weaning (n=63; 58.3%). Treatment techniques performed by respondents ‘very often’ included manual chest clearance techniques (n=101, 93.5%), mobilising a patient in bed (n=91, 84.3%), positioning a patient in bed (n=91, 84.3%), airway suctioning (n=89, 82.4%), mobilising a patient out of bed (n=84, 77.8%), deep breathing exercises (n=83, 76.9%) and peripheral muscle strengthening exercises (n=79, 73.1%). Treatment techniques that were ‘never’ or ‘almost never’ used included the flutter device (n=77, 71.3%), implementation and supervision of non-invasive ventilatory support (n=77, 71.3%) and adjustment of mechanical ventilation settings for respiratory muscle training (n=76, 70.4%). Physiotherapists working in the private sector made up 60.2% (n=65) of the respondents. An afterhours physiotherapy service was provided to ICU patients by 78 (72.2%) of the respondents during the week. One hundred and five (97.2%) of the respondents provided a physiotherapy service for ICU patients over the weekend. When comparing the results of the current study to the studies by Norrenberg and Vincent (2000) and Van Aswegen and Potterton (2005), there was a significant difference (p < 0.05) in the usage of IPPB/NIPPV, weaning patients from MV, adjustment of MV settings and IS between the studies. Results from the current study showed a significant difference (p < 0.05) in the involvement of respondents in suctioning, extubation and adjustment of MV settings compared to that reported by Norrenberg and Vincent (2000). Conclusion: Physiotherapists in this study performed a multisystem assessment of their patient’s which is important since physiotherapists are first line practitioners in South Africa. Physiotherapists play an important role in treating and preventing respiratory and musculoskeletal complications that occur in ICU. The results from this study showed that physiotherapists in South Africa are treating their patient’s according to evidenced based practice but due to the high nonresponse bias these results should be interpreted with caution. The results from this study can be used to develop preliminary clinical practice guidelines for physiotherapists working in ICU in South Africa

Design for ageing and disability at Key Stage 4: An introduction to the nature of designing, available teaching materials and resources

This paper examines the nature of designing for elderly and disabled people. The paper also provides an assessment structure that may be used to review currently available teaching materials. The aims of the paper are to raise the awareness of design educators to available resources and to provide guidance to support teaching Key Stage 4 of the National Curriculum Design and Technology

Soft pneumatic muscles for post-stroke lower limb ankle rehabilitation: leveraging the potential of soft robotics to optimize functional outcomes

Introduction: A soft pneumatic muscle was developed to replicate intricate ankle motions essential for rehabilitation, with a specific focus on rotational movement along the x-axis, crucial for walking. The design incorporated precise geometrical parameters and air pressure regulation to enable controlled expansion and motion.Methods: The muscle’s response was evaluated under pressure conditions ranging from 100-145 kPa. To optimize the muscle design, finite element simulation was employed to analyze its performance in terms of motion range, force generation, and energy efficiency. An experimental platform was created to assess the muscle’s deformation, utilizing advanced techniques such as high-resolution imaging and deep-learning position estimation models for accurate measurements. The fabrication process involved silicone-based materials and 3D-printed molds, enabling precise control and customization of muscle expansion and contraction.Results: The experimental results demonstrated that, under a pressure of 145 kPa, the y-axis deformation (y-def) reached 165 mm, while the x-axis and z-axis deformations were significantly smaller at 0.056 mm and 0.0376 mm, respectively, highlighting the predominant elongation in the y-axis resulting from pressure actuation. The soft muscle model featured a single chamber constructed from silicone rubber, and the visually illustrated and detailed geometrical parameters played a critical role in its functionality, allowing systematic manipulation to meet specific application requirements.Discussion: The simulation and experimental results provided compelling evidence of the soft muscle design’s adaptability, controllability, and effectiveness, thus establishing a solid foundation for further advancements in ankle rehabilitation and soft robotics. Incorporating this soft muscle into rehabilitation protocols holds significant promise for enhancing ankle mobility and overall ambulatory function, offering new opportunities to tailor rehabilitation interventions and improve motor function restoration

Optimising Outcomes in Rehabilitation of Lower Limb Amputation

Limited research exists on outcomes following lower limb amputation. This is the first study to develop and validate Clinical Prediction Rules for prosthetic non-use at 4, 8 and 12 months after rehabilitation discharge. Performance thresholds that identify increased risk of prosthetic non-use have been generated for locomotor tests. Long term outcomes and comorbidities have been described for people with lower limb amputation. This thesis has contributed to evidence based health reform to models of care

USSR Space Life Sciences Digest, volume 1, no. 3

An overview of the developments and direction of the USSR Space Life Sciences Program is given. Highlights of launches, program development, and mission planning are given. Results of ground-based research and space flight studies are summarized. Topics covered include: space medicine and physiology; space biology; and life sciences technology