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

Learning through playing for children with cerebral palsy

Guidelines for designing and developing a learning prototype that are compatible with the limited capabilities of children with Cerebral Palsy (CP) are established in the form of a model, known as Learning Software User Interface Design Model (LSUIDM), to ensure children with CP are able to grasp the concepts of a learning software application prototype. In this paper, the LSUIDM is applied in developing a learning software application for children with CP. We present a user study on evaluating a children education game for CP children at Pemulihan dalam Komuniti in Johor Bahru. The findings from the user study shows that the game, which was built, based on the LSUIDM can be applied in the learning process for children with CP and most notably, the children are engaged and excited using the software. This paper highlights the lessons learned from the user study, which should be significant especially in improving the application. The results of the study show that the application is proven to be interactive, useful and efficient as the users used it

Advanced Augmentative and Alternative Communication System Based in Physiological Control

Dyskinetic Cerebral Palsy (DCP) is mainly characterized by alterations in muscle tone and involuntary movements. Therefore, these people present with difficulties in coordination and movement control, which makes walking difficult and affects their posture when seated. Additionally, their cognitive performance varies between being completely normal and severe mental retardation. People with DCP were selected as the objective of this thesis due to their multiple and complex limitations (speech problems and motor control) and because their capabilities have a great margin for improvement thanks to physiological control systems. Given their communication difficulties, some people with DCP have good motor con-trol and can communicate with written language. However, most have difficulty using Augmentative and Alternative Communication (AAC) systems. People with DCP gen-erally use concept boards to indicate the idea they want to communicate. However, most communication solutions available today are based on proprietary software that makes it difficult to customize the concept board and this type of control system. This is the motivation behind this thesis, with the aim of creating an interface with characteristics, able to be adapted to the user needs and limitations. Thus, this thesis proposes an Augmentative and Alternative Communication System for people with DCP based on physiological control. In addition, an innovative system for direct con-trol of concept boards with EMG is proposed. This control system is based on a physi-cal model that reproduces the muscular mechanical response (stiffness, inertia and viscosity). It allows for a selection of elements thanks to small pulses of EMG signal with sensors on a muscle with motor control. Its main advantage is the possibility of correcting errors during selection associated with uncontrolled muscle impulses, avoid-ing sustained muscle effort and thus reduced fatigue.La Parálisis Cerebral de tipo Discinésica (DCP) se caracteriza principalmente por las alteraciones del tono muscular y los movimientos involuntarios. Por ello, estos pacientes presentan dificultades en la coordinación y en el control de movimientos, lo cual les dificulta el caminar y afecta su postura cuando están sentados. Cabe resaltar que la capacidad cognitiva de las personas con DCP puede variar desde completamente normal, hasta un retraso mental severo. Las personas con DCP han sido seleccionadas como objetivo de esta tesis ya el margen de mejora de sus capacidades es amplio gracias a sistemas de control fisiológico, debido a sus múltiples y complejas limitaciones (problemas de habla y control motor). Debido a sus dificultades de comunicación, algunas personas con DCP se pueden comunicar con lenguaje escrito, siempre y cuando tenga un buen control motor. Sin embargo, la mayoría tienen dificultades para usar sistemas de Comunicación Aumentativos y Alternativos (AAC). De hecho, las personas con DCP utilizan generalmente tableros de conceptos para indicar la idea que quieren transmitir. Sin embargo, la mayoría las soluciones de comunicación disponibles en la actualidad están basadas en software propietario que hacen difícil la personalización del tablero de conceptos y el tipo de sistema de control. Es aquí donde surge esta tesis, con el objetivo de crear una interfaz con esas características, capaz de adaptarse a las necesidades y limitaciones del usuario. De esta forma, esta tesis propone un sistema de comunicación aumentativo y alternativo para personas con DCP basado en control fisiológico. Además, se propone un Sistema innovador de control directo sobre tableros de conceptos basado en EMG. Este Sistema de control se basa en un modelo físico que reproduce la respuesta mecánica muscular (basado en parámetros como Rigidez, Inercia y Viscosidad), permitiendo la selección de elementos gracias a pequeños pulsos de señal EMG con sensores sobre un músculo con control motor. Sus principales ventajas son la posibilidad de corregir errores durante la selección asociado a los impulsos musculares no controlados, evitar el esfuerzo muscular mantenido para alcanzar un nivel y reducir la fatiga.La Paràlisi Cerebral de tipus Discinèsica (DCP) es caracteritza principalment per les alteracions del to muscular i els moviments involuntaris. Per açò, aquests pacients presenten dificultats en la coordinació i en el control de moviments, la qual cosa els dificulta el caminar i afecta la seua postura quan estan asseguts. Cal ressaltar que la capacitat cognitiva de les persones amb DCP pot variar des de completament normal, fins a un retard mental sever. Les persones amb DCP han sigut seleccionades com a objectiu d'aquesta tesi ja el marge de millora de les seues capacitats és ampli gràcies a sistemes de control fisiològic, a causa dels seus múltiples i complexes limitacions (problemes de parla i control motor). A causa de les seues dificultats de comunicació, algunes persones amb DCP es poden comunicar amb llenguatge escrit, sempre que tinga un bon control motor. No obstant açò, la majoria tenen dificultats per a usar sistemes de Comunicació Augmentatius i Alternatius (AAC). De fet, les persones amb DCP utilitzen generalment taulers de conceptes per a indicar la idea que volen transmetre. No obstant açò, la majoria les solucions de comunicació disponibles en l'actualitat estan basades en programari propietari que fan difícil la personalització del tauler de conceptes i el tipus de sistema de control. És ací on sorgeix aquesta tesi, amb l'objectiu de crear una interfície amb aqueixes característiques, capaç d'adaptar-se a les necessitats i limitacions de l'usuari. D'aquesta forma, aquesta tesi proposa un sistema de comunicació augmentatiu i alternatiu per a persones amb DCP basat en control fisiològic. A més, es proposa un sistema innovador de control directe sobre taulers de conceptes basat en EMG. Aquest sistema de control es basa en un model físic que reprodueix la resposta mecànica muscular (basat en paràmetres com a Rigidesa, Inèrcia i Viscositat), permetent la selecció d'elements gràcies a xicotets polsos de senyal EMG amb sensors sobre un múscul amb control motor. Els seus principals avantatges són la possibilitat de corregir errors durant la selecció associat als impulsos musculars no controlats, evitar l'esforç muscular mantingut per a aconseguir un nivell i reduir la fatiga.Díaz Pineda, JA. (2017). Advanced Augmentative and Alternative Communication System Based in Physiological Control [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/90418TESI

Advanced and natural interaction system for motion-impaired users

Human-computer interaction is an important area that searches for better and more comfortable systems to promote communication between humans and machines. Vision-based interfaces can offer a more natural and appealing way of communication. Moreover, it can help in the e-accessibility component of the e-inclusion. The aim is to develop a usable system, that is, the end-user must consider the use of this device effective, efficient and satisfactory. The research's main contribution is SINA, a hands-free interface based on computer vision techniques for motion impaired users. This interface does not require the user to use his upper body limbs, as only nose motion is considered. Besides the technical aspect, user's satisfaction when using an interface is a critical issue. The approach that we have adopted is to integrate usability evaluation at relevant points of the software developmen

A Robust Kalman Algorithm to Facilitate Human-Computer Interaction for People with Cerebral Palsy, Using a New Interface Based on Inertial Sensors

This work aims to create an advanced human-computer interface called ENLAZA for people with cerebral palsy (CP). Although there are computer-access solutions for disabled people in general, there are few evidences from motor disabled community (e.g., CP) using these alternative interfaces. The proposed interface is based on inertial sensors in order to characterize involuntary motion in terms of time, frequency and range of motion. This characterization is used to design a filtering technique that reduces the effect of involuntary motion on person-computer interaction. This paper presents a robust Kalman filter (RKF) design to facilitate fine motor control based on the previous characterization. The filter increases mouse pointer directivity and the target acquisition time is reduced by a factor of ten. The interface is validated with CP users who were unable to control the computer using other interfaces. The interface ENLAZA and the RKF enabled them to use the computer

Assistive and Adaptive Technology in Cerebral Palsy

Children who suffer from cerebral palsy (CP) face specific challenges, which arise due to motor dysfunction and communication disorders. In some cases, communication is only possible through eye movements and blink, as well as, low amplitude movements of the fingers and toes. Augmentative and alternative communication (AAC) strategies can be used to promote communication in these complex cases. This chapter discusses our experience developing AAC computer’s solutions for children with motor and communication disorders. Software and hardware approaches are discussed. This chapter describes solutions developed for desktop computers and mobile devices. These solutions act as complements of therapist’s activities, helping disabled people to communicate, and promoting social inclusion

Enabling self-directed computer use for individuals with cerebral palsy: a systematic review of available assistive devices and technologies

Aim  The purpose of this study was to systematically review published evidence on the development, use, and effectiveness of devices and technologies that enable or enhance self-directed computer access by individuals with cerebral palsy (CP). Methods  Nine electronic databases were searched using keywords ‘computer’, ‘software’, ‘spastic’, ‘athetoid’, and ‘cerebral palsy’; the reference lists of articles thus identified were also searched. Thirty articles were selected for review, with 23 reports of development and usability testing of devices and seven evaluations of algorithms to increase computer recognition of input and cursor movements. Results  Twenty-four studies had fewer than 10 participants with CP, with a wide age range of 5 to 77 years. Computer task performance was usually tested, but only three groups sought participant feedback on ease and comfort of use. International standards exist to evaluate effectiveness of non-keyboard devices, but only one group undertook this testing. None of the study designs were higher than American Academy for Cerebral Palsy and Developmental Medicine level IV. Interpretation  Access solutions for individuals with CP are in the early stages of development. Future work should include assessment of end-user comfort, effort, and performance as well as design features. Engaging users and therapists when designing and evaluating technologies to enhance computer access may increase acceptance and improve performance

Use of an agile bridge in the development of assistive technology

Engaging with end users in the development of assistive technologies remains one of the major challenges for researchers and developers in the field of accessibility and HCI. Developing usable software systems for people with complex disabilities is problematic, software developers are wary of using user-centred design, one of the main methods by which usability can be improved, due to concerns about how best to work with adults with complex disabilities, in particular Severe Speech and Physical Impairments (SSPI) and how to involve them in research. This paper reports on how the adoption of an adapted agile approach involving the incorporation of a user advocate on the research team helped in meeting this challenge in one software project and offers suggestions for how this could be used by other development teams