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

Inclusion in Virtual Reality Technology: A Scoping Review

Despite the significant growth in virtual reality applications and research, the notion of inclusion in virtual reality is not well studied. Inclusion refers to the active involvement of different groups of people in the adoption, use, design, and development of VR technology and applications. In this review, we provide a scoping analysis of existing virtual reality research literature about inclusion. We categorize the literature based on target group into ability, gender, and age, followed by those that study community-based design of VR experiences. In the latter group, we focus mainly on Indigenous Peoples as a clearer and more important example. We also briefly review the approaches to model and consider the role of users in technology adoption and design as a background for inclusion studies. We identify a series of generic barriers and research gaps and some specific ones for each group, resulting in suggested directions for future research

A standardised and cost-effective VR approach for powered wheelchair training

Mastering wheelchair driving skills is essential for the safety of wheelchair users (WUs), yet the acquisition of these skills can be challenging, and training resources can be costly or not available. Technologies such as virtual reality (VR) have grown in popularity as they can provide a motivating training environment without the risks found in real-life training. However, these approaches often deploy navigation controllers which are different from the ones WUs utilise, and do not use a standardised approach in assessing the acquisition of skills. We propose a VR training system based on the wheelchair skills training program (WSTP) and utilizing a sensor device that can be retrofitted to any joystick and communicates wirelessly with a Head-Mounted Display. In this paper, we present a first-validation study with fourteen able-bodied participants, split between a VR test group and a non-VR control group. To determine the acquisition of skills, participants complete tasks in real-life before and after the VR training, where completion time and length of joystick movements are measured. We also assess our system using heart rate measurements, the WSTP questionnaire, the simulator sickness questionnaire and the igroup presence questionnaire. We found that the VR training facilitates the acquisition of skills for more challenging tasks; thus, our system has the potential of being used for training skills of powered wheelchair users, with the benefit of conducting the training in safely and in a low-cost setup

Disability resources for the educator

This thesis identifies what disability resources are currently accessible and needed by the educator in order to service the disabled student in the classroom. It is a compilation of medical, academic, financial and equipment resources currently available to the educator

DEVELOPMENT AND EVALUATION OF AN ADVANCED REAL-TIME ELECTRICAL POWERED WHEELCHAIR CONTROLLER

Advances in Electric Powered Wheelchairs (EPW) have improved mobility for people with disabilities as well as older adults, and have enhanced their integration into society. Some of the issues still present in EPW lie in the difficulties when encountering different types of terrain, and access to higher or low surfaces. To this end, an advanced real-time electrical powered wheelchair controller was developed. The controller was comprised of a hardware platform with sensors measuring the speed of the driving, caster wheels and the acceleration, with a single board computer for implementing the control algorithms in real-time, a multi-layer software architecture, and modular design. A model based real-time speed and traction controller was developed and validated by simulation. The controller was then evaluated via driving over four different surfaces at three specified speeds. Experimental results showed that model based control performed best on all surfaces across the speeds compared to PID (proportional-integral-derivative) and Open Loop control. A real-time slip detection and traction control algorithm was further developed and evaluated by driving the EPW over five different surfaces at three speeds. Results showed that the performance of anti-slip control was consistent on the varying surfaces at different speeds. The controller was also tested on a front wheel drive EPW to evaluate a forwarding tipping detection and prevention algorithm. Experimental results showed that the tipping could be accurately detected as it was happening and the performance of the tipping prevention strategy was consistent on the slope across different speeds. A terrain-dependent EPW user assistance system was developed based on the controller. Driving rules for wet tile, gravel, slopes and grass were developed and validated by 10 people without physical disabilities. The controller was also adapted to the Personal Mobility and Manipulation Appliance (PerMMA) Generation II, which is an advanced power wheelchair with a flexible mobile base, allowing it to adjust the positions of each of the four casters and two driving wheels. Simulations of the PerMMA Gen II system showed that the mobile base controller was able to climb up to 8” curb and maintain passenger’s posture in a comfort position

Virtual and Mixed Reality Support for Activities of Daily Living

Rehabilitation and training are extremely important process that help people who have suffered some form of trauma to regain their ability to live independently and successfully complete activities of daily living. VR and MR have been used in rehabilitation and training, with examples in a range of areas such as physical and cognitive rehabilitation, and medical training. However, previous research has mainly used non-immersive VR such as using video games on a computer monitor or television. Immersive VR Head-Mounted Displays were first developed in 1965 but the devices were usually large, bulky and expensive. In 2016, the release of low-cost VR HMDs allowed for wider adoption of VR technology. This thesis investigates the impact of these devices in supporting activities of daily living through three novel applications: training driving skills for a powered wheelchair in both VR and MR; and using VR to help with the cognitive rehabilitation of stroke patients. Results from the acceptability study for VR in cognitive rehabilitation showed that patients would be likely to accept VR as a method of rehabilitation. However, factors such as visual issues need to be taken into consideration. The validation study for the Wheelchair-VR project showed promising results in terms of user improvement after the VR training session but the majority of the users experienced symptoms of cybersickness. Wheelchair-MR didn’t show statistically significant results in terms of improvements but did show a mean average improvement compared to the control group. The effects of cybersickness were also greatly reduced compared to VR. We conclude that VR and MR can be used in conjunction with modern games engines to develop virtual environments that can be adapted to accelerate the rehabilitation and training of patients coping with different aspects of daily life

Uma arquitetura de telerreabilitação baseada em realidade aumentada para apoiar o treinamento de usuários de cadeiras de rodas motorizadas

Many people worldwide have been experimenting a decrease in their mobility as a result of aging, accidents and degenerative diseases. In many cases, a Powered Wheelchair (PW) is an alternative help. Currently, in Brazil, patients can receive a PW from the Unified Health System, following prescription criteria. However, they do not have an appropriate previous training for driving the PW. Consequently, users might suffer accidents since a customized training protocol is not available. Nevertheless, due to financial and/or health limitations, many users are unable to attend a rehabilitation center. To overcome these limitations, we developed an Augmented Reality (AR) Telerehabilitation System Architecture based on the Power Mobility Road Test (PMRT), for supporting PW user’s training. In this system, the therapists can remotely customize and evaluate training tasks and the user can perform the training in safer conditions. Video stream and data transfer between each environment were made possible through UDP (User Datagram Protocol). To evaluate and present the system architecture potential, a preliminary test was conducted with 3 spinal cord injury participants. They performed 3 basic training protocols defined by a therapist. The following metrics were adopted for evaluation: number of control commands; elapsed time; number of collisions; biosignals and a questionary was used to evaluate system features by participants. Results demonstrate the specific needs of individuals using a PW, thanks to adopted (qualitative and emotional) metrics. Also, the results have shown the potential of the training system with customizable protocols to fulfill these needs. User’s evaluation demonstrates that the combination of AR techniques with PMRT adaptations, increases user’s well-being after training sessions. Furthermore, a training experience helps users to overcome their displacement problems, as well as for appointing challenges before large scale use. The proposed system architecture allows further studies on telerehabilitation of PW users.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)Muitas pessoas em todo o mundo estão vivenciando uma diminuição de sua mobili- dade como resultado de envelhecimento, acidentes e doenças degenerativas. Em muitos casos, uma cadeira de rodas motorizada (CRM) é uma ajuda alternativa. Atualmente, no Brasil, os pacientes podem receber uma CRM do Sistema Único de Saúde, seguindo os critérios de prescrição. No entanto, eles não têm um treinamento prévio apropriado para dirigir a CRM. Conseqüentemente, os usuários podem sofrer acidentes, pois um protocolo de treinamento personalizado não está disponível. Além disto, devido a limi- tações financeiras e / ou de saúde, muitos usuários não podem comparecer a um centro de reabilitação. Para superar essas limitações, desenvolvemos uma arquitetura de sistema de telereabilitação com Realidade Aumentada (RA) baseado no PMRT (Power Mobility Road Test), para apoiar o treinamento de usuários de CRM. Nesse sistema, os terapeutas podem personalizar e avaliar remotamente as tarefas de treinamento e o usuário pode realizar o treinamento em condições mais seguras. O fluxo de vídeo e a transferência de dados entre cada ambiente foram possíveis através do UDP (User Datagram Protocol). Para avaliar e apresentar o potencial da arquitetura do sistema, foi realizado um teste preliminar de três participantes com lesão medular. Eles realizaram três protocolos básicos de treinamento definidos por um terapeuta. As seguintes métricas adotadas para avaliação foram: número de comandos de controle; tempo decorrido; número de colisões e biossinais. Além disso, um questionário foi usado para avaliar os recursos do sistema. Os resultados demonstram as necessidades específicas dos indivíduos que usam uma CRM, graças às métricas adotadas (qualitativas e emocionais). Além disso, os resultados mostraram o potencial do sistema de treinamento com protocolos personalizáveis para atender a essas necessidades. A avaliação do usuário demonstra que a combinação de técnicas de RA com adaptações PMRT aumenta o bem-estar do usuário após as sessões de treinamento. Além disso, esta experiência de treinamento ajuda os usuários a superar seus problemas de deslocamento, bem como a apontar desafios antes do uso em larga escala. A arquitetura de sistema proposta, permite estudos adicionais sobre a telerreabilitação de usuários de CRM

Smart city simulator "phase two" : the wheelchair challenge

Many Smart City infrastructures are physical models or Lego models that are static and difficult to scale. Other existing Smart City concepts have not taken wheelchair users and their needs into account. Oslo Metropolitan University (OsloMet), in cooperation with Oracle, assigned a project which sought to address these issues to a group from the European Project Semester. We are five international students trying to create a 3D- Simulation of a Smart City with Unity software to solve space and mobility problems. The main part of this task was to create a wheelchair accessible Smart City, which can be presented and visualized by a simulation. Right at the beginning of the project, we decided to focus not only on wheelchair users but on all kinds of physical limitations: blindness, deafness, mobility difficulties, old, young, and pregnant women. We analyzed existing concepts, asked why it is more important than ever to develop Smart City models, and make existing cities smarter. We also looked at what needs to be improved in cities in general, especially to make life easier for people with disabilities. We exchanged ideas with organizations that helped us to learn more about the everyday life of people with disabilities, we also exchanged ideas with companies that are already actively working on making cities smarter and last but not least we looked at the innovations in Oslo that are trying to make this city smarter. Based on our results and with the help of Proxima Lego City, a Lego model built by Oracle, we made a questionnaire to ask the participants what belongs in a smart city and what challenges specifically the participants with disabilities have in their everyday life in cities. After the research, the questionnaire, and the exchange with organizations and companies, we decided to create a Smart City in Universal Design, which is accessible for everyone and can be presented and experienced through a simulation. We implemented an electric autonomous public transport system, a smart trash system, a smart parking system and a smart lighting system. We also developed an app, especially adapted to our simulation, that makes the simulation appear even more real. With the help of real-time data, the app shows the advantages of a Smart City, and it also shows the advantage of having an app specifically adapted for the Smart City.Grado en Ingeniería en Electrónica Industrial y Automátic