Surgical Management of Aneurysmal Subarachnoid Haemorrhage in the Punjab Institute of Neuroscience (PINS) Decade and Need of Shunt for Hydrocephalus

Objective: Aneurysmal Subarachnoid Haemorrhage management is improving with the passage of time with the advancement of Microsurgery but still mortality is relatively high in the natural history of disease. The main stay of this gap is noted from the time of ictus to the time of presentation in the tertiary care centers. Management of Hydrocephalus was also studied in this study. Material and Methods: This is a prospective study conducted at PINS LGH Lahore. We studied a total of 50 cases in a period of July 2015 to July 2017. Results: Twenty nine (58.00%) were female and 21 (42.00%) male, the male to female ratio remained 1:1.5. The affected age group was mostly younger one in there productive years. Maximum patient were noted in 4th decade, equal incidence was seen in 5th and 6th decade of life. CT scan was done as initial investigation while CT angiogram and four vessels angiogram were used as definitive investigations. Grading of patient was done using the WFNS grade and 29 cases were found in good grades (58.00%). Maximum Aneurysm were founded at A.com artery 24 cases (45.00%) followed by 22 cases of middle cerebral artery (MCA) (41.00%).We predicted the vasospasm using the fisher grades and found 21 cases (42.00%) in Fisher Grade II, in grade III & IV there was 17 and 12 cases (24.00%) respectively. Surgical outcome of post clipping was analyzed by Glasgow outcome scale and 41 cases (82.00%) were present in Grade IV and V. We found in post-operative management that patent within older age had high chance to develop hydrocephalus and V-P shunt was required in 9 cases out of 28 in group of 55 – 65 years. While in younger group (52.00%) 20 – 49 years. 22 (19.00%) cases needed V-P shunt . relatively aggressive approach was used toward CSF diversion procedure in pre-clipping period 26% patient underwent ventriculoperitoneal V-P shunt (n+12). Triple therapy started in all the case post operatively to avoid vasospasm. Post-operative CT-scan was done on 1st post-operative day. Conclusion: Patients in Older Age group had higher tendency to be shunt dependent 32% vs. 19%; p-value = 0.04 (Chi Sq. test) (Table 3 & 4)

The Emerging Professional Practice of Remote Sighted Assistance for People with Visual Impairments

People with visual impairments (PVI) must interact with a world they cannot see. Remote sighted assistance (RSA) has emerged as a conversational assistive technology. We interviewed RSA assistants ( agents ) who provide assistance to PVI via a conversational prosthetic called Aira (https://aira.io/) to understand their professional practice. We identified four types of support provided: scene description, navigation, task performance, and social engagement. We discovered that RSA provides an opportunity for PVI to appropriate the system as a richer conversational/social support tool. We studied and identified patterns in how agents provide assistance and how they interact with PVI as well as the challenges and strategies associated with each context. We found that conversational interaction is highly context-dependent. We also discuss implications for design

Developing an ICT based navigation assistance system for blind and visually impaired persons

Abstract According to estimates by the World Health Organization (WHO), over one billion people worldwide suffer from some form of vision impairment. While being visually impaired (or blind) does not necessarily limit the ability to navigate from one location to another freely, research has revealed that accomplishing this safely and efficiently is one of the most significant barriers to independence for blind and visually impaired people (BVIP). It is known that BVIP develop additional orientation and mobility abilities relying on non-visual information (which is usually overlooked by sighted people) to support safe and efficient navigation. Even so, difficulties are often encountered when attempting to navigate safely. For example, common issues include encountering holes, hanging objects, stairs, traffic scenarios, signposts, and wet flooring. This doctoral thesis focuses on developing constructs to help BVIP through infrastructure-based assistance for independent navigation and through remote assistance in a collaborative assistance mode using a caretaker. The design science methodology was adopted to design, develop, and evaluate these constructs iteratively. Two constructs were developed for infrastructure-based navigation assistance, and one was developed for remote collaborative assistance. Each construct was evaluated for usability and user experiences with BVIP having differing degrees of visual impairment in Finland and Pakistan (with no other impediments). Further, empirical studies were conducted in Finland, Pakistan, and Sweden. The results demonstrate how remote collaboration systems can be developed to assist with navigation for BVIP and their caretakers. They also demonstrate how existing infrastructure-based tactile paving blocks can be enhanced to provide orientation and mobility assistance interactively. The thesis also provides future research directions to extend the work presented.Tiivistelmä Maailman terveysjärjestön arvioiden mukaan yli miljardi ihmistä maailmanlaajuisesti kärsii jostain näön heikkenemisestä. Vaikka näkövammaisuus ei välttämättä rajoita kykyä liikkua vapaasti paikasta toiseen, tutkimukset ovat paljastaneet, että navigoiminen turvallisesti ja tehokkaasti on yksi merkittävimmistä sokeiden ja näkövammaisten itsenäisyyden esteistä. Tiedetään, että sokeat ja näkövammaiset pystyvät suunnistamaan ja liikkumaan hyödyntämällä myös ei-visuaalista tietoa, jota näkevät ihmiset eivät välttämättä edes huomaa. Siitä huolimatta vaikeuksia kohdataan usein yritettäessä navigoida turvallisesti. Yleisiä ongelmia ovat esimerkiksi kulkureitillä olevien kuopat, roikkuvat esineet, portaat, liikenne, kyltit ja opasteet sekä märät alustat. Tämä väitöskirja keskittyy sokeiden ja näkövammaisten avuksi tarkoitettujen teknisten ratkaisujen kehittämiseen infrastruktuuripohjaisella avustamisella itsenäiseen navigointiin sekä etäavustamiseen yhteistoiminnassa lähiomaisen tai avustajan avulla. Suunnittelutieteen menetelmiä hyödynnettiin näiden ratkaisujen iteratiivisessa suunnittelussa, kehittämisessä ja arvioinnissa. Kaksi teknistä ratkaisua kehitettiin infrastruktuuripohjaista navigointiapua varten ja yksi kehitettiin etäyhteistyötä varten. Jokaisen ratkaisun käytettävyyden ja käyttökokemuksen arvioivat eriasteiset näkövammaiset Suomessa ja Pakistanissa. Lisäksi empiirisiä tutkimuksia tehtiin Suomessa, Pakistanissa ja Ruotsissa. Tulokset osoittavat, kuinka etäyhteistyöjärjestelmiä voidaan kehittää auttamaan sokeita ja näkövammaisia, ja tukea heidän avustajiensa etänavigointia. Ne osoittavat myös, kuinka jo olemassa olevaan infrastruktuuriin perustuvia infrastruktuuriin perustuvia ratkaisuja voidaan parantaa tarjoamaan vuorovaikutteista orientaatio- ja liikkumisapua. Väitöskirja tarjoaa myös tulevaisuuden tutkimussuuntia tehdyn tutkimustyön laajentamiseksi

Tele-guidance based navigation system for the visually impaired and blind persons

Abstract The design and development of tele-assistance services have taken a great consideration in the domain of healthcare lately. With the growing proportion of dependent people (ageing, disabled users) in the society, tele-assistance and tele-monitoring platforms will play a significant role to provide an efficient and economical remote care. It will allow aged or disabled persons to maintain their independence and lessen the burden and cost of care by caregivers. The concept of proposed tele-guidance system is based on the idea that a blind pedestrian can be assisted by spoken instructions from a remote caregiver who receives a live video stream from a camera carried by the visually impaired persons (VIP). The ICT based assistive tools have acceptance issues by visually impaired persons. It is important while designing navigation tools for the VIP to keep in view the factors that restrain them from the adoption of assistive technology. This paper presents a tele-guidance based navigation assistance system for the VIP and blind persons and reports a qualitative study about attitude of VIP towards technological navigation assistance

Studying the navigation assistance system for the visually impaired and blind persons and ICT use by their caretakers

Abstract Telecare solutions have been seen as a potential means of addressing the future care needs of ageing societies. With the growing proportion of dependent people (ageing, disabled users), tele-assistance and tele-monitoring platforms will play a significant role to provide an efficient and less-costly remote care and support. It will allow aged and disabled persons to maintain their independence and lessen the burden and cost of caregiving. In the case of visually impaired (VIP) and blind persons, guide dog and white cane provide them a fair degree of independence. However, those are very limited in guiding the user towards a specific desired location, especially in an unknown environment. The assistance of other people presents a feasible solution, though it does not improve the idea of autonomous guidance and privacy. This paper presents a tele-guidance based navigation assistance system that is based on the idea that a blind or VIP pedestrian can be assisted by haptics based cues and spoken instructions from a remote caretaker who receives a live video stream from a camera carried by the blind or VIP. Also, we present results of the study conducted in Pakistan with 14 blind and VIP participants for testing haptics user interface concept of proposed teleguidance system. In this study also two caretakers are interviewed. In addition, we present results of the attitude towards assistive technology study conducted with 19 blind and VIP in Finland. Moreover, we introduce the environmental model to aid development of assistive tools for blind and VIP

Development of cooperative assistive technology user experience evaluation model for blind and visually impaired people

Abstract Blind and visually impaired people are among those who require very specific types of assistive technology. This type of technology has been a research and development focus for decades. As technology has matured, more affordable and practical solutions have entered the market. Unfortunately, this has not resulted in a very positive trend in terms of acceptance or adoption. Our research on usability and user experience indicated that there is a need to extend standardized questionnaires when evaluating assistive technology. This paper details the development of an evaluation model with extended contexts that can be used with cooperative assistive technology aimed for blind or visually impaired people and their caretakers. We present our evaluation setting and procedure for the model. The development of the model is based on testing, literature review, expert interviews, and discussions. The extended contexts should also contribute towards the trend of modularity with standardized user experience questionnaires

Teleguidance-based remote navigation assistance for visually impaired and blind people:usability and user experience

Abstract This paper reports the development of a specialized teleguidance-based navigation assistance system for the blind and the visually impaired. We present findings from a usability and user experience study conducted with 11 blind and visually impaired participants and a sighted caretaker. Participants sent live video feed of their field of view to the remote caretaker’s terminal from a smartphone camera attached to their chest. The caretaker used this video feed to guide them through indoor and outdoor navigation scenarios using a combination of haptic and voice-based communication. Haptic feedback was provided through vibrating actuators installed in the grip of a Smart Cane. Two haptic methods for directional guidance were tested: (1) two vibrating actuators to guide left and right movement and (2) a single vibrating actuator with differentiating vibration patterns for the same purpose. Users feedback was collected using a meCUE 2.0 standardized questionnaire, interviews, and group discussions. Participants’ perceptions toward the proposed navigation assistance system were positive. Blind participants preferred vibrational guidance with two actuators, while partially blind participants preferred the single actuator method. Familiarity with cane use and age were important factors in the choice of haptic methods by both blind and partially blind users. It was found that smartphone camera provided sufficient field of view for remote assistance; position and angle are nonetheless important considerations. Ultimately, more research is needed to confirm our preliminary findings. We also present an expanded evaluation model developed to carry out further research on assistive systems