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

A Universalist strategy for the design of Assistive Technology

Assistive Technologies are specialized products aiming to partly compensate for the loss of autonomy experienced by disabled people. Because they address special needs in a highly-segmented market, they are often considered as niche products. To improve their design and make them tend to Universality, we propose the EMFASIS framework (Extended Modularity, Functional Accessibility, and Social Integration Strategy). We first elaborate on how this strategy conciliates niche and Universalist views, which may appear conflicting at first sight. We then present three examples illustrating its application for designing Assistive Technologies: the design of an overbed table, an upper-limb powered orthose and a powered wheelchair. We conclude on the expected outcomes of our strategy for the social integration and participation of disabled people

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

In-home and remote use of robotic body surrogates by people with profound motor deficits

By controlling robots comparable to the human body, people with profound motor deficits could potentially perform a variety of physical tasks for themselves, improving their quality of life. The extent to which this is achievable has been unclear due to the lack of suitable interfaces by which to control robotic body surrogates and a dearth of studies involving substantial numbers of people with profound motor deficits. We developed a novel, web-based augmented reality interface that enables people with profound motor deficits to remotely control a PR2 mobile manipulator from Willow Garage, which is a human-scale, wheeled robot with two arms. We then conducted two studies to investigate the use of robotic body surrogates. In the first study, 15 novice users with profound motor deficits from across the United States controlled a PR2 in Atlanta, GA to perform a modified Action Research Arm Test (ARAT) and a simulated self-care task. Participants achieved clinically meaningful improvements on the ARAT and 12 of 15 participants (80%) successfully completed the simulated self-care task. Participants agreed that the robotic system was easy to use, was useful, and would provide a meaningful improvement in their lives. In the second study, one expert user with profound motor deficits had free use of a PR2 in his home for seven days. He performed a variety of self-care and household tasks, and also used the robot in novel ways. Taking both studies together, our results suggest that people with profound motor deficits can improve their quality of life using robotic body surrogates, and that they can gain benefit with only low-level robot autonomy and without invasive interfaces. However, methods to reduce the rate of errors and increase operational speed merit further investigation.Comment: 43 Pages, 13 Figure

Overcoming barriers and increasing independence: service robots for elderly and disabled people

This paper discusses the potential for service robots to overcome barriers and increase independence of elderly and disabled people. It includes a brief overview of the existing uses of service robots by disabled and elderly people and advances in technology which will make new uses possible and provides suggestions for some of these new applications. The paper also considers the design and other conditions to be met for user acceptance. It also discusses the complementarity of assistive service robots and personal assistance and considers the types of applications and users for which service robots are and are not suitable

A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission

INTRODUCTION The cost of medical care is spiraling out of control, and one of the many reasons is lack of preventative care, poor communication to the patient and primary caregiver(s) both in an inpatient and outpatient setting. There are potentially many reasons for this cost escalation, one of the drivers of this cost is 30 day readmission after a hospitalization and this is what was examined in this analysis. The purpose of this paper in particular is to share what has been learned using a systems thinking approach to hospital readmissions and the patient experience. It is critical to understand the problems that occurred in the past. In addition, we will explain the methodology utilized and bring awareness to the iterative process. We will also demonstrate a suggested redesigned model

Surface electromyographic control of a novel phonemic interface for speech synthesis

Many individuals with minimal movement capabilities use AAC to communicate. These individuals require both an interface with which to construct a message (e.g., a grid of letters) and an input modality with which to select targets. This study evaluated the interaction of two such systems: (a) an input modality using surface electromyography (sEMG) of spared facial musculature, and (b) an onscreen interface from which users select phonemic targets. These systems were evaluated in two experiments: (a) participants without motor impairments used the systems during a series of eight training sessions, and (b) one individual who uses AAC used the systems for two sessions. Both the phonemic interface and the electromyographic cursor show promise for future AAC applications.F31 DC014872 - NIDCD NIH HHS; R01 DC002852 - NIDCD NIH HHS; R01 DC007683 - NIDCD NIH HHS; T90 DA032484 - NIDA NIH HHShttps://www.ncbi.nlm.nih.gov/pubmed/?term=Surface+electromyographic+control+of+a+novel+phonemic+interface+for+speech+synthesishttps://www.ncbi.nlm.nih.gov/pubmed/?term=Surface+electromyographic+control+of+a+novel+phonemic+interface+for+speech+synthesisPublished versio

Music Maker – A Camera-based Music Making Tool for Physical Rehabilitation

The therapeutic effects of playing music are being recognized increasingly in the field of rehabilitation medicine. People with physical disabilities, however, often do not have the motor dexterity needed to play an instrument. We developed a camera-based human-computer interface called "Music Maker" to provide such people with a means to make music by performing therapeutic exercises. Music Maker uses computer vision techniques to convert the movements of a patient's body part, for example, a finger, hand, or foot, into musical and visual feedback using the open software platform EyesWeb. It can be adjusted to a patient's particular therapeutic needs and provides quantitative tools for monitoring the recovery process and assessing therapeutic outcomes. We tested the potential of Music Maker as a rehabilitation tool with six subjects who responded to or created music in various movement exercises. In these proof-of-concept experiments, Music Maker has performed reliably and shown its promise as a therapeutic device.National Science Foundation (IIS-0308213, IIS-039009, IIS-0093367, P200A01031, EIA-0202067 to M.B.); National Institutes of Health (DC-03663 to E.S.); Boston University (Dudley Allen Sargent Research Fund (to A.L.)

Suggested approach for establishing a rehabilitation engineering information service for the state of California

An ever expanding body of rehabilitation engineering technology is developing in this country, but it rarely reaches the people for whom it is intended. The increasing concern of state and federal departments of rehabilitation for this technology lag was the stimulus for a series of problem-solving workshops held in California during 1977. As a result of the workshops, the recommendation emerged that the California Department of Rehabilitation take the lead in the development of a coordinated delivery system that would eventually serve the entire state and be a model for similar systems across the nation