Recent developments in biofeedback for neuromotor rehabilitation

The original use of biofeedback to train single muscle activity in static positions or movement unrelated to function did not correlate well to motor function improvements in patients with central nervous system injuries. The concept of task-oriented repetitive training suggests that biofeedback therapy should be delivered during functionally related dynamic movement to optimize motor function improvement. Current, advanced technologies facilitate the design of novel biofeedback systems that possess diverse parameters, advanced cue display, and sophisticated control systems for use in task-oriented biofeedback. In light of these advancements, this article: (1) reviews early biofeedback studies and their conclusions; (2) presents recent developments in biofeedback technologies and their applications to task-oriented biofeedback interventions; and (3) discusses considerations regarding the therapeutic system design and the clinical application of task-oriented biofeedback therapy. This review should provide a framework to further broaden the application of task-oriented biofeedback therapy in neuromotor rehabilitation

A presença da metáfora em artigos de investigação biomédica

O projecto “O Uso de Metáforas na Pesquisa Biomédica” tem como objectivo geral compreender como a utilização das metáforas pode influenciar a pesquisa biomédica e prevê a inclusão de uma revisão da literatura recentemente publicada sobre o assunto, tanto em formato livro como em artigos de investigação. Nesta comunicação, apresentamos os resultados da revisão dos artigos de investigação com origem em áreas biomédicas e conexas recentemente publicados e acessíveis através da base de dados online da PubMed®. Através do respectivo sítio na Internet, foram compilados 319 artigos com data de publicação entre Janeiro de 2010 e Setembro de 2012, mencionando o termo “metaphor” no título ou resumo. Depois de enquadrados num panorama cronológico mais amplo, estes artigos foram caracterizados segundo a respectiva tipologia e identificadas as áreas disciplinares de maior interesse pelo tema. Seguidamente, foram analisados o modo como a influência da metáfora neles é percebida pelos próprios investigadores e as interpretações mais comuns do termo, revelando quais serão as suas acepções mais correntes entre um público de formação superior, mas presumivelmente alheio aos aspectos técnicos dos debates que se têm desenvolvido acerca da metáfora na área da filosofia. Finalmente, procurámos distinguir nos artigos compilados as linhas de investigação mais relevantes sobre a metáfora na área da biomedicina.The overall objective of the project “The use of metaphors in biomedical research” is to understand some of the ways by which the use of metaphor may influence biomedical research and includes a survey of the most recently published literature on the subject, in books as well as in research papers. This paper presents the results of a survey of research articles in biomedical areas that have been recently published and are accessible through PubMed®, an online database. Through its internet site, 319 research articles have been compiled, with publishing dates ranging from January 2010 to September 2012. All of these articles hold the word “metaphor” in their title and / or their abstract. These articles were then included within a wider chronological frame. They were then divided by different categories according to the disciplinary areas that are more keen on the subject. Subsequently, we were able to identify the way the use of metaphor is acknowledged and understood by researchers themselves and what are the most common interpretations of this notion amidst the scientific community. Finally we were able to identify what are the most relevant areas of research on metaphor within biomedical studies.info:eu-repo/semantics/publishedVersio

Authority as an interactional achievement: Exploring Deference to Smart Devices in hospital-based resuscitation

Over the years, healthcare has been an important domain for CSCW research. One significant theme carried through this body of work concerns how hospital workers coordinate their work both spatially and temporally. Much has been made of the coordinative roles played by the natural rhythms present in hospital life, and by webs of mundane artefacts such as whiteboards, post-it notes and medical records. This paper draws upon the coordinating role of rhythms and artefacts to explore the nested rhythms of the Cardio-Pulmonary Resuscitation (CPR) protocol conducted to restore the proper heart rhythm in a patient who has suffered a cardiac arrest. We are interested in how the teams delivering CPR use various ‘smart’ assistive devices. The devices contain encoded versions of the CPR protocol and are able to sense (in a limited way) the situation in order to give instructions or feedback to the team. Using an approach informed by ethnomethodology and conversation analysis (EM/CA) we analysed video of trainee nurses using these devices as they delivered CPR in dramatized training scenarios. This analysis helped us to understand concepts such as autonomy and authority as interactional accomplishments, thus filling a gap in CSCW literature, which often glosses over how authority is formed and how it is exercised in medical teams. It also helps us consider how to respond to devices that are becoming more active in that they are being increasingly imbued with the ability to sense, discriminate and direct activity in medical settings

Human Observer and Automatic Assessment of Movement Related Self-Efficacy in Chronic Pain: from Exercise to Functional Activity

Clinicians tailor intervention in chronic pain rehabilitation to movement related self-efficacy (MRSE). This motivates us to investigate automatic MRSE estimation in this context towards the development of technology that is able to provide appropriate support in the absence of a clinician. We first explored clinical observer estimation, which showed that body movement behaviours, rather than facial expressions or engagement behaviours, were more pertinent to MRSE estimation during physical activity instances. Based on our findings, we built a system that estimates MRSE from bodily expressions and bodily muscle activity captured using wearable sensors. Our results (F1 scores of 0.95 and 0.78 in two physical exercise types) provide evidence of the feasibility of automatic MRSE estimation to support chronic pain physical rehabilitation. We further explored automatic estimation of MRSE with a reduced set of low-cost sensors to investigate the possibility of embedding such capabilities in ubiquitous wearable devices to support functional activity. Our evaluation for both exercise and functional activity resulted in F1 score of 0.79. This result suggests the possibility of (and calls for more studies on) MRSE estimation during everyday functioning in ubiquitous settings. We provide a discussion of the implication of our findings for relevant areas

Reassembling Knowledge Translation Through a Case of Autism Genomics: Multiplicity and Coordination Amidst Practiced Actor-Networks

Knowledge translation (KT) has become a ubiquitous and important component within the Canadian health research funding environment. Despite a large and burgeoning literature on the topic of KT, research on the science of KT spans a very narrow philosophical spectrum, with published studies almost exclusively positioned within positivism. Grounded in a constructionist philosophical position and influenced by actor-network theory, this dissertation aims to contribute to the Canadian KT discussion by imagining new possibilities for conceptualizing KT. This is an empirical-theoretical study which is based on eight months of data collection, including interviews, participant observation, and document analysis. This data collection took place in a basic science laboratory, a clinic, and amongst families involved in genomic research pertaining to Autism Spectrum Disorder in a Canadian city. Interviews were transcribed verbatim and organization of the data was aided by QSR Nvivo software. Theoretical insights put forward in this dissertation are based on a detailed description of the everyday, local, micro-dynamics of knowledge translation within a particular case study of an autism genomics project. Through data collection I have followed the practices of a laboratory, clinic, and family homes through which genomic knowledge was assembled and re-assembled. Through the exploration of the practices of scientists, clinicians, and families involved in an autism genetics study, I examine the concepts of multiplicity, difference, and coordination. I argue that autism is practiced differently, through different technologies and assessments, in the laboratory, clinic, and home. This dissertation closes with a new framework for and model of the knowledge translation process called the Local Translations of Knowledge in Practice model. I argue that expanding the range of theoretical and philosophical positions attended to in KT research will contribute to a richer understanding of the KT process and move forward the Canadian KT agenda. Ethics approval for this research was obtained from The University of Western Ontario and from the hospital in which the data was gathered

Gesture-Based Robot Path Shaping

For many individuals, aging is frequently associated with diminished mobility and dexterity. Such decreases may be accompanied by a loss of independence, increased burden to caregivers, or institutionalization. It is foreseen that the ability to retain independence and quality of life as one ages will increasingly depend on environmental sensing and robotics which facilitate aging in place. The development of ubiquitous sensing strategies in the home underpins the promise of adaptive services, assistive robotics, and architectural design which would support a person\u27s ability to live independently as they age. Instrumentation (sensors and processing) which is capable of recognizing the actions and behavioral patterns of an individual is key to the effective component design in these areas. Recognition of user activity and the inference of user intention may be used to inform the action plans of support systems and service robotics within the environment. Automated activity recognition involves detection of events in a sensor data stream, conversion to a compact format, and classification as one of a known set of actions. Once classified, an action may be used to elicit a specific response from those systems designed to provide support to the user. It is this response that is the ultimate use of recognized activity. Hence, the activity may be considered as a command to the system. Extending this concept, a set of distinct activities in the form of hand and arm gestures may form the basis of a command interface for human-robot interaction. A gesture-based interface of this type promises an intuitive method for accessing computing and other assistive resources so as to promote rapid adoption by elderly, impaired, or otherwise unskilled users. This thesis includes a thorough survey of relevant work in the area of machine learning for activity and gesture recognition. Previous approaches are compared for their relative benefits and limitations. A novel approach is presented which utilizes user-generated feedback to rate the desirability of a robotic response to gesture. Poorly rated responses are altered so as to elicit improved ratings on subsequent observations. In this way, responses are honed toward increasing effectiveness. A clustering method based on the Growing Neural Gas (GNG) algorithm is used to create a topological map of reference nodes representing input gesture types. It is shown that learning of desired responses to gesture may be accelerated by exploiting well-rewarded actions associated with reference nodes in a local neighborhood of the growing neural gas topology. Significant variation in the user\u27s performance of gestures is interpreted as a new gesture for which the system must learn a desired response. A method for allowing the system to learn new gestures while retaining past training is also proposed and shown to be effective

A realist process evaluation of robot-assisted surgery: integration into routine practice and impacts on communication, collaboration and decision-making

YesBackground: The implementation of robot-assisted surgery (RAS) can be challenging, with reports of surgical robots being underused. This raises questions about differences compared with open and laparoscopic surgery and how best to integrate RAS into practice. Objectives: To (1) contribute to reporting of the ROLARR (RObotic versus LAparoscopic Resection for Rectal cancer) trial, by investigating how variations in the implementation of RAS and the context impact outcomes; (2) produce guidance on factors likely to facilitate successful implementation; (3) produce guidance on how to ensure effective teamwork; and (4) provide data to inform the development of tools for RAS. Design: Realist process evaluation alongside ROLARR. Phase 1 – a literature review identified theories concerning how RAS becomes embedded into practice and impacts on teamwork and decision-making. These were refined through interviews across nine NHS trusts with theatre teams. Phase 2 – a multisite case study was conducted across four trusts to test the theories. Data were collected using observation, video recording, interviews and questionnaires. Phase 3 – interviews were conducted in other surgical disciplines to assess the generalisability of the findings. Findings: The introduction of RAS is surgeon led but dependent on support at multiple levels. There is significant variation in the training provided to theatre teams. Contextual factors supporting the integration of RAS include the provision of whole-team training, the presence of handpicked dedicated teams and the availability of suitably sized operating theatres. RAS introduces challenges for teamwork that can impact operation duration, but, over time, teams develop strategies to overcome these challenges. Working with an experienced assistant supports teamwork, but experience of the procedure is insufficient for competence in RAS and experienced scrub practitioners are important in supporting inexperienced assistants. RAS can result in reduced distraction and increased concentration for the surgeon when he or she is supported by an experienced assistant or scrub practitioner. Conclusions: Our research suggests a need to pay greater attention to the training and skill mix of the team. To support effective teamwork, our research suggests that it is beneficial for surgeons to (1) encourage the team to communicate actions and concerns; (2) alert the attention of the assistant before issuing a request; and (3) acknowledge the scrub practitioner’s role in supporting inexperienced assistants. It is beneficial for the team to provide oral responses to the surgeon’s requests. Limitations: This study started after the trial, limiting impact on analysis of the trial. The small number of operations observed may mean that less frequent impacts of RAS were missed. Future work: Future research should include (1) exploring the transferability of guidance for effective teamwork to other surgical domains in which technology leads to the physical or perceptual separation of surgeon and team; (2) exploring the benefits and challenges of including realist methods in feasibility and pilot studies; (3) assessing the feasibility of using routine data to understand the impact of RAS on rare end points associated with patient safety; (4) developing and evaluating methods for whole-team training; and (5) evaluating the impact of different physical configurations of the robotic console and team members on teamwork.National Inst for Health Research (NIHR

Washington University Record, October 21, 2005

https://digitalcommons.wustl.edu/record/2051/thumbnail.jp

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not