Control interfaces for active trunk support

People with Duchenne muscular dystrophy (DMD) lose the ability to move due to severe muscular weakness hindering their activities of daily living (ADL). As a consequence, they have difficulties with remaining independent and have to depend on caregivers. Medication cannot prevent or cure DMD but it can increase the life expectancy of patients. Notwithstanding the increase in life expectancy, people with DMD have a lower Health Related Quality of Life (HRQoL) compared to people without DMD. A possible improvement could be achieved with assistive devices to perform ADL and, as a result, to depend less on caregivers.Symbionics (2.1) has been focusing on developing dynamic trunk and head supportive devices for people with neuromuscular disorders to assist them when performing daily activities. Three sub-projects were defined; they investigated user involvement, passive trunk support and active trunk support. User involvement entailed the interaction between the trunk and arm when accomplishing daily tasks. A passive trunk support was designed and tested in an experimental environment by people without and with an early stage of DMD. As the DMD progresses, more assistance is needed which could possibly be provided by an active trunk support. Thus, an active trunk support (which is the focus of this thesis) concentrates on the actuation and control of a passive trunk support.Operating and controlling an active assistive device requires a control interface. The control interface is responsible for converting the intended movement of the user into a device movement. Several control interfaces have been proposed for the control of assistive devices, the most common ones being a joystick, force sensors and sEMG (surface electromyography). We evaluated their performance by building an experimental user-controllable trunk support.The goal of this dissertation, therefore, is to evaluate control interfaces for active trunk support.To this end, several research questions were formulated and investigated:I. Is there an alternative to the intuitive trunk control interface to steer trunk muscles?Current research on the control of orthotic devices that use sEMG signals as control inputs, focuses mainly on muscles that are directly linked to the movement being performed (intuitive control). However, in some cases, it is hard to detect a proper sEMG signal (e.g., when there is a significant amount of fat) or specifically for EMG from trunk muscles, respiratory muscles are located in the trunk as well and can easily disturb the control signal, which can result in poor control performance. A way to overcome this problem might be the introduction of other, non-intuitive forms of control. We performed an explorative, comparative study on the learning behaviour of two different control interfaces, one with trunk muscle sEMGs (intuitive) and one with leg muscle sEMGs (non-intuitive) that can be potentially used for an active trunk support. Six healthy subjects undertook a 2-D Fitts’ law style task. They were asked to steer a cursor towards targets that were radially distributed symmetrically in five directions. II. Which control interface aids an active trunk support better?A feasibility study evaluated control interface performance with a novel trunk support assistive device (Trunk Drive) for adult men with Duchenne Muscular Dystrophy (DMD) namely, joystick, force on sternum, force on feet and sEMG (electromyography). This was done as a discrete position tracking task. We built a one degree of freedom active trunk support device that was tested on 10 healthy men. An experiment, based on Fitts’ law, was conducted for the evaluation. III. Which assistive admittance controller performs best in a 1-D Fitts’ law task?This study was dedicated to the development and assessment of three different admittance control algorithms for a trunk supporting robot; a law with constant parameters, a law with added feedforward force, and a law with variable parameters. A Fitts’-like experiment with 12 healthy subjects was performed to compare the control laws. IV. Do people with DMD generate satisfactory signals which can potentially drive an active trunk support?In a previous study, we showed that healthy people were able to control an active trunk support using four different control interfaces (based on joystick, force on feet, force on sternum and sEMG). All four control interfaces had different advantages and disadvantages. The aim of this study was to explore which of the four inputs could be detectably used by people with DMD to control an active trunk support. Three subjects with DMD participated in two experiments: an active experiment with an active trunk support assistive device and a static experiment without the active trunk support. The challenge in both experiments was to steer the cursor into a target of a graphical user interface using the signals from the different control interfaces. We concluded that, although the non-intuitive force on feet control is one of the best interfaces for people with DMD to control an active trunk support some DMD patients find it easier to use the EMG from their leg muscles. The joystick is the only usable intuitive control interface but, the function of one hand has to be sacrificed. The decision, as to which control interface works best, must be made per individual.<br/

Getting to Know You: Key Clinical Concepts in Relationship-Based Interventions and Neurobehavioral Observations with Young Infants

The newborn infant is a social organism, pre-disposed to interact with his caregiver and able to elicit the kind of caregiving necessary for successful adaptation. The earliest developmental task of the newborn is to organize behavior to be able to play an active role in influencing the caregiving environment and eliciting the kind of support needed for development. This task is accomplished through the attainment of self-regulation or balanced neurobehavioral functioning of the infant\u27s autonomic, motor, state, and responsivity behavioral dimensions as described by Als

Functional Movement Screen Composite Scores for Collegiate Field Club Sport Athletes at One University

Context: Functional screening tools to detect musculoskeletal asymmetries and limitations present in functional movement patterns are available to use for the athletic population. Unfortunately, field club sport athletes do not have the opportunity to utilize functional screening tools. Further, normative data of Functional Movement Screen Composite Scores (FMS CS) has yet to be established in this population. Objective: The purpose of this study was to establish normative FMS CS among field club sport athletes, and determine if years of participation and current hours spent per week training have a significant effect on FMS CS. Foot type and orthotic use was also compared with FMS CS. Design: The study was a descriptive screening study. Setting: The assessments took place at an athletic training research lab and athletic training room at a DI Mid-Atlantic university. Patients and Other Participants: Thirty-one athletes (age 19.61+/-1.56 yrs, height 169.58+/-8.66 cm, weight 72.77+/-17.42 kg) participating in club soccer, rugby and lacrosse at a Division I Mid-Atlantic university during the 2017-2018 season volunteered for this study. Inclusion criteria for the study consisted of college students who are field club sport athletes between 18-23 years old who had not sustained an injury in the past twelve months that required removal from participation and training and completed the consent form. Exclusion criteria for the study consisted of an injury occurring in the past twelve months that required removal from participation and training and individuals not between the ages of 18-23 years old. Intervention: All participants completed the demographic questionnaire and seven movements of the FMS. A demographic questionnaire was completed to determine self-reported years of participation in the sport, number of hours spent training per week, foot type, and orthotic use. The participants were asked to complete the seven movements and three clearing tests of the FMS. Each participant completed three trials for each movement. Scores were calculated to determine FMS CS. Main Outcome Measures: The dependent variables were the Functional Movement Screen Composite Score and individual movement scores. Results: The mean FMS CS and standard deviation for all participants was 15.1+/-1.49. Women\u27s Lacrosse (n=4) had the highest average FMS CS (16.0+/-0.0). Participants with fewer years in sports (15.29+/-1.2 vs14.94+/-1.71) and hours of participation (15.17+/-1.63 vs 15+/-1.36) scored higher on the FMS CS. Those not wearing orthotics (n=28, 15.2+/-1.34) scored higher than those who do wear orthotics (n=3, 14.0+/-0.0). The one participant that reported a pes planus foot (15.0+/-0.0) scored higher than the seven participants with a pes cavus foot (14.7+/-1.98). Conclusions: Collegiate field club sport athletes score higher or comparable to varsity collegiate athletes on the FMS. More years of participation and hours per week were associated with decreased FMS CS

Management of Spasticity and Cerebral Palsy Update

Cerebral palsy is a very common medical problem, which has many challenges facing patients, family, caregivers, and medical team. The fast-based technology helped us to find new ways to manage and treat cerebral palsy. Treatment and management is a multi-disciplinary approach to reaching the optimal results. The managing team includes a general pediatrician, pediatric neurologist, pediatric rehabilitation, pediatric neurosurgeon, pediatric orthopedic surgeon, and other ancillary medical services. In our management plan, we have to consider the patient, family, and caregivers as parts of our plan. Raising awareness in the communities especially young mothers and general pediatricians to recognize the problem early and seek medical help and also early referrals to specialized centers will help to have early intervention and obtain better results

Ergonomics Study of a Helmet-Mounted Augmented Reality System for Coal Power Plant Workers

Augmented reality (AR) is a technology that combines real and virtual information presented to the user in an interactive way in real time. The Microsoft HoloLens and RealWear HMT-1 are two common types of head-mounted AR available to industrial field workers. These two AR systems were tested on how they affected indicators of eye strain and forces of the neck and shoulder muscles for electric utility power plant operators while they performed five routine inspection tasks using coal burning equipment. The inspection tasks were conducted under three conditions: HoloLens, HMT-1, and absence of AR (normal). The duration of the inspection tasks ranged from an average of 10 to 28 s. Twelve experienced power plant operators participated in the study. Surface electromyography (sEMG) of the right and left sternocleidomastoid, splenius, semispinalis capitis, and upper trapezius muscles were measured, and a small camera recorded blink rate of the right eye. Results show there were generally no significant differences in 50th and 90th percentile sEMG between the three conditions for all eight muscles. Although blink rate did not vary significantly between the experimental conditions, a trend appeared that showed average HoloLens blink rate lower than the HMT-1 and No AR (~ 4.5 blinks/min;28% decrease). Lower blink rate is a risk factor of eye strain, and data from this experiment suggest that the HoloLens may cause eye strain. Longer durations of sustained HoloLens usage must be tested to determine whether the HoloLens presents risk of eye strain to electric utility field workers