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

Validation and application of a computational model for wrist and hand movements using surface markers

A kinematic model is presented based on surface marker placement generating wrist, metacarpal arch, fingers and thumb movements. Standard calculations are used throughout the model and then applied to the specified marker placement. A static trial involving eight unimpaired participants was carried out to assess inter-rater reliability. The standard deviations across the data were comparable to manual goniometers. In addition, a test retest trial of ten unimpaired participants is also reported to illustrate the variability of movement at the wrist joint, metacarpal arch, and index finger as an example of model output when repeating the same task many times. Light and heavyweight versions of the tasks are assessed and characteristics of individual movement strategies presented. The participant trial showed moderate correlation in radial/ulnar deviation of the wrist ( = 0 65), and strong correlation in both metacarpal arch joints ( = 075 and = 085), the MCP ( = 079), and PIP ( = 087) joints of the index finger. The results indicate that individuals use repeated strategies of movement when lifting light and heavyweight versions of the same object, but showed no obvious repeated pattern of movement across the population

Empowering patients in self-management of parkinson's disease through cooperative ICT systems

The objective of this chapter is to demonstrate the technical feasibility and medical effectiveness of personalised services and care programmes for Parkinson's disease, based on the combination of mHealth applications, cooperative ICTs, cloud technologies and wearable integrated devices, which empower patients to manage their health and disease in cooperation with their formal and informal caregivers, and with professional medical staff across different care settings, such as hospital and home. The presented service revolves around the use of two wearable inertial sensors, i.e. SensFoot and SensHand, for measuring foot and hand performance in the MDS-UPDRS III motor exercises. The devices were tested in medical settings with eight patients, eight hyposmic subjects and eight healthy controls, and the results demonstrated that this approach allows quantitative metrics for objective evaluation to be measured, in order to identify pre-motor/pre-clinical diagnosis and to provide a complete service of tele-health with remote control provided by cloud technologies. © 2016, IGI Global. All rights reserved

Occupational Therapy Certified Hand Therapists\u27 Perceptions of Remaining Rooted in Occupation in the Hand Clinic: A Phenomenological Study

Background: Occupational Therapy Certified Hand Therapists (OT CHTs) working in the outpatient hand clinic tend to use the dominant biomechanical approach in the rehabilitation of their upper extremity (UE) clients. Due to the existence of a multitude of barriers and challenges for implementing an occupation-based approach, OT CHTs may not treat their UE clients holistically, placing less focus on treating the occupational performance deficits caused by the UE impairment. Purpose: The purpose of this Capstone is to explore the essence of OT CHTs’ current lived experiences in the use of occupation-based approach in the outpatient hand therapy clinic. Theoretical Framework. The Capstone project is guided by the dominant biomechanical approach used in the outpatient hand clinic, The Canadian Model of Occupational Performance and Engagement (CMOP-E) an occupational-performance model, and the International Classification of Functioning, Disability, and Health (ICF). The ICF is a framework that can bring balance to applying the occupation-based approach in hand therapy along with the dominant biomechanical approach. Methods. The descriptive phenomenological study included a questionnaire that was completed through interviewing six study participants on their perspectives on using an occupation-based approach with their UE clients. The results of the interviews were then analyzed for codes that resulted in four themes on the participants’ perspectives of the use of an occupation-based approach in outpatient hand therapy. Results. The results from the study indicate that the participants value occupation and do apply occupation-based interventions (OBI). The use of an occupation-based approach was found to be implemented at varying degrees in the hand clinic determined by the challenges and existing barriers each of the OT CHTs faced in the hand clinic culture and environment. Conclusions: The study participants demonstrated an awareness of occupation as the core value of the occupational therapy profession and implemented it to varying degrees in the outpatient hand clinic

The effect of prefabricated wrist-hand orthoses on performing activities of daily living

Wrist-hand orthoses (WHOs) are commonly prescribed to manage the functional deficit associated with the wrist as a result of rheumatoid changes. The common presentation of the wrist is one of flexion and radial deviation with ulnar deviation of the fingers. This wrist position Results in altered biomechanics compromising hand function during activities of daily living (ADL). A paucity of evidence exists which suggests that improvements in ADL with WHO use are very task specific. Using normal subjects, and thus in the absence of pain as a limiting factor, the impact of ten WHOs on performing five ADLs tasks was investigated. The tasks were selected to represent common grip patterns and tests were performed with and without WHOs by right-handed, females, aged 20-50 years over a ten week period. The time taken to complete each task was recorded and a wrist goniometer, elbow goniometer and a forearm torsiometer were used to measure joint motion. Results show that, although orthoses may restrict the motion required to perform a task, participants do not use the full range of motion which the orthoses permit. The altered wrist position measured may be attributable to a modified method of performing the task or to a necessary change in grip pattern, resulting in an increased time in task performance. The effect of WHO use on ADL is task specific and may initially impede function. This could have an effect on WHO compliance if there appears to be no immediate benefits. This orthotic effect may be related to restriction of wrist motion or an inability to achieve the necessary grip patterns due to the designs of the orthoses