The Art of Waiting – Interactive displays in healthcare settings

Waiting in healthcare settings can be an anxious and fearful experience for children and their families. Opportunities for play are an important part of child-friendly healthcare and have been shown to reduce waiting anxiety. Conventional toys and games, however, usually have contact surfaces through which infections may be passed. Additionally, they often require fine motor movements which may not be available to children with disabilities. In this paper, we describe the design of an accessible and interactive large display to meet the needs of a hospital waiting room. We discuss the detailed design requirements, the participatory process by which the design was developed, and our plans to evaluate the efficacy of the interactive display for reducing waiting anxiety in healthcare settings

High cable forces deteriorate pinch force control in voluntary-closing body-powered prostheses

It is generally asserted that reliable and intuitive control of upper-limb prostheses requires adequate feedback of prosthetic finger positions and pinch forces applied to objects. Body-powered prostheses (BPPs) provide the user with direct proprioceptive feedback. Currently available BPPs often require high cable operation forces, which complicates control of the forces at the terminal device. The aim of this study is to quantify the influence of high cable forces on object manipulation with voluntary-closing prostheses. Able-bodied male subjects were fitted with a bypass-prosthesis with low and high cable force settings for the prehensor. Subjects were requested to grasp and transfer a collapsible object as fast as they could without dropping or breaking it. The object had a low and a high breaking force setting. Subjects conducted significantly more successful manipulations with the low cable force setting, both for the low (33 % more) and high (50 %) object’s breaking force. The time to complete the task was not different between settings during successful manipulation trials. In conclusion: high cable forces lead to reduced pinch force control during object manipulation. This implies that low cable operation forces should be a key design requirement for voluntary-closing BPPs

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

Bridging the gap between robotic technology and health care

Although technology and computation power have become more and more present in our daily lives, we have yet to see the same tendency in robotics applied to health care. In this work we focused on the study of four distinct applications of robotic technology to health care, named Robotic Assisted Surgery, Robotics in Rehabilitation, Prosthetics and Companion Robotic Systems. We identified the main roadblocks that are limiting the progress of such applications by an extensive examination of recent reports. Based on the limitations of the practical use of current robotic technology for health care we proposed a general modularization approach for the conception and implementation of specific robotic devices. The main conclusions of this review are: (i) there is a clear need of the adaptation of robotic technology (closed loop) to the user, so that robotics can be widely accepted and used in the context of heath care; (ii) for all studied robotic technologies cost is still prohibitive and limits their wide use. The reduction of costs influences technology acceptability; thus innovation by using cheaper computer systems and sensors is relevant and should be taken into account in the implementation of robotic systems

Using interactive computer play in physical therapy and occupational therapy clinical practice: an explanatory sequential mixed methods study

IntroductionThis study explored the extent to which an interactive computer play system, Bootle Blast, supports motor learning in a clinical context and examined clinicians’ perceptions of their therapeutic role in the system’s use as an intervention tool.MethodsIn this observational sequential explanatory mixed methods study, five children with cerebral palsy [mean age 9.4 years (SD, 0.5), Gross Motor Function Classification System Levels I–III] used Bootle Blast during a single video-recorded therapy session with their treating clinicians (physical therapists, occupational therapists, and therapy assistants). Children played one Bootle Blast mini game independently (without clinician involvement) before clinicians carried out therapy sessions with the game as per usual care. The type and extent of motor learning strategies (MLS) delivered by Bootle Blast and clinicians were rated from video recordings by a trained assessor using the 22-item Motor Learning Strategies Rating Instrument. Semi-structured interviews with clinicians were conducted to gain insights into MLS use and clinicians’ perceived role during Bootle Blast use. Interviews were audio recorded, transcribed verbatim, and analyzed independently by two researchers using thematic analysis. Quantitative and qualitative data were merged and reported using narrative and joint display approaches.ResultsBootle Blast provided eight MLS, with clinicians adding or enhancing another eight. Four themes reflected clinicians’ perspectives: (1) Bootle Blast disguises therapy as play, (2) clinicians give Bootle Blast the human touch; (3) home use of Bootle Blast is promising; and (4) Bootle Blast is not always the right fit but some shortcomings could be addressed. Agreement was found for nine MLS and disagreement for four MLS when quantitative and qualitative findings were merged.DiscussionBootle Blast delivers several MLS as part of game play and clinicians can enhance and provide additional MLS to suit the child's needs/abilities. Further game refinements that were identified in this study may optimize its clinical use

Towards a synergy framework across neuroscience and robotics: Lessons learned and open questions. Reply to comments on: "Hand synergies: Integration of robotics and neuroscience for understanding the control of biological and artificial hands"

We would like to thank all commentators for their insightful commentaries. Thanks to their diverse and complementary expertise in neuroscience and robotics, the commentators have provided us with the opportunity to further discuss state-of-the-art and gaps in the integration of neuroscience and robotics reviewed in our article. We organized our reply in two sections that capture the main points of all commentaries [1–9]: (1) Advantages and limitations of the synergy approach in neuroscience and robotics, and (2) Learning and role of sensory feedback in biological and robotics synergies

A pin-array method for capturing tissue deformation under defined pressure distributions and its application to prosthetic socket design

The Fit4Purpose project aims to develop upper limb prosthetic devices which are suitable for deployment in lower- and middle-income countries (LMIC's). Open-frame trans-radial socket designs are being considered, formed of several, linked components, including pads which interface directly with the skin surface. A mechanical tool has been developed to aid the design of pad shapes, using an array of square brass bars of varying lengths (i.e. a pin-array) to apply a chosen normal pressure distribution to an area of tissue. The shape to which the tissue is displaced can then be captured by clamping the bars together to fix their relative positions. The device is described, then three short studies are used to demonstrate its use on the forearm of a single, anatomically intact subject. The first investigates the effect of array size on the measured surface stiffness, finding an inverse relationship with a similar characteristic to previous published results. The second tests the hypothesis that a pad with a shape which duplicates that captured by the device will generate a similar overall load to the original pins if applied to the same region of tissue. The results support the hypothesis, but also highlight the sensitivity of the interface loading to the underlying muscle activation. Finally, the tool is used to demonstrate that different tissue displacements are observed when the same pressure distribution is applied to different areas of the forearm. Whilst the tool itself is a simple device, and the techniques used are not sophisticated, the studies suggest that the approach could be useful in pad design. Although it is clearly not appropriate for clinical application in its current form, there may be potential to develop the concept into a more practical device. Other applications could include the design of other devices which interface with the skin, the generation of data for validation of finite element models, including the application of known pressure distributions and tissue deformations during Magnetic Resonance Imaging, and the assessment of matrix pressure sensing devices on compliant materials with complex geometries

Ionic liquids at electrified interfaces

Until recently, “room-temperature” (<100–150 °C) liquid-state electrochemistry was mostly electrochemistry of diluted electrolytes(1)–(4) where dissolved salt ions were surrounded by a considerable amount of solvent molecules. Highly concentrated liquid electrolytes were mostly considered in the narrow (albeit important) niche of high-temperature electrochemistry of molten inorganic salts(5-9) and in the even narrower niche of “first-generation” room temperature ionic liquids, RTILs (such as chloro-aluminates and alkylammonium nitrates).(10-14) The situation has changed dramatically in the 2000s after the discovery of new moisture- and temperature-stable RTILs.(15, 16) These days, the “later generation” RTILs attracted wide attention within the electrochemical community.(17-31) Indeed, RTILs, as a class of compounds, possess a unique combination of properties (high charge density, electrochemical stability, low/negligible volatility, tunable polarity, etc.) that make them very attractive substances from fundamental and application points of view.(32-38) Most importantly, they can mix with each other in “cocktails” of one’s choice to acquire the desired properties (e.g., wider temperature range of the liquid phase(39, 40)) and can serve as almost “universal” solvents.(37, 41, 42) It is worth noting here one of the advantages of RTILs as compared to their high-temperature molten salt (HTMS)(43) “sister-systems”.(44) In RTILs the dissolved molecules are not imbedded in a harsh high temperature environment which could be destructive for many classes of fragile (organic) molecules

Design and testing of a textile EMG sensor for prosthetic control

Nowadays, Electromyography (EMG) signals generated by the amputee’s residual limbs are widely used for the control of myoelectric prostheses, usually with the aid of pattern-recognition algorithms. Since myoelectric prostheses are wearable medical devices, the sensors that integrate them should be appropriate for the users’ daily life, meeting the requirements of lightness, flexibility, greater motion identification, and skin adaptability. Therefore, this study aims to design and test an EMG sensor for prosthetic control, focusing on aspects such as adjustability, lightness, precise and constant signal acquisition; and replacing the conventional components of an EMG sensor with textile materials. The proposed sensor was made with Shieldex Technik-tex P130 + B conductive knitted fabric, with 99% pure silver plating. EMG data acquisition was performed twice on three volunteers: one with the textile sensor, and other with a commercial sensor used in prosthetic applications. Overall, the textile and the commercial sensor presented total average Signal-to-Noise Ratio (SNR) values of 10.24 ± 5.45 dB and 11.74 ± 8.64 dB, respectively. The authors consider that the obtained results are promising and leave room for further improvements in future work, such as designing strategies to deal with known sources of noise contamination and to increase the adhesion to the skin. In sum, the results presented in this paper indicate that, with the appropriate improvements, the proposed textile sensor may have the potential of being used for myoelectric prosthetic control, which can be a more ergonomic and accessible alternative to the sensors that are currently used for controlling these devices.This work is financed by Project “Deus ex Machina”, NORTE-01-0145-FEDER-000026, funded by CCDRN, through Sistema de Apoio à Investigação Científica e Tecnológica (Projetos Estruturados I&D&I) of Programa Operacional Regional do Norte, from Portugal 2020 and by Project UID/CTM/00264/2019 of 2C2T –Centro de Ciência e TecnologiaTêxtil, funded by National Founds through FCT/MCTES