Vector Field Control Methods for Discretely Variable Passive Robotic Devices

Passive transmission-based robotic devices are capable of providing motion guidance while ensuring user safety and engagement. To circumvent some of the drawbacks associated with steering continuously variable transmissions based on rolling contacts, we are exploring a class of discretely variable devices, based on brakes and hydrostatic transmissions. Previously available control methods for discretely variable devices were built on velocity fields and only developed to stabilize a 1D target manifold. For n -DOF devices, methods to stabilize target manifolds of dimension 1 to n—1 are of interest. In this paper we contribute constraint field methods that stabilize n — 1 dimensional target manifolds while leaving the orthogonal subspace free to the control of the operator. We also contribute force-modulated SDOF velocity fields, which add between 1 and n— 2 virtual DOFs to the motion of devices whose physical constraints leave one DOF. Control performance is demonstrated in simulation for 3-DOF devices capable of imposing 1-D or 2-D constraints and in experiment for 2-DOF devices imposing 1-D constraints. Our experimental apparatus features digital hydraulic transmissions that are easily configured for n-dimensional space and capable of imposing constraints of any dimension, thus motivating the contributed methods

A qualitative method for analysing multivoicedness

‘Multivoicedness’ and the ‘multivoiced Self’ have become important theoretical concepts guiding research. Drawing on the tradition of dialogism, the Self is conceptualised as being constituted by a multiplicity of dynamic, interacting voices. Despite the growth in literature and empirical research, there remains a paucity of established methodological tools for analysing the multivoiced Self using qualitative data. In this article, we set out a systematic, practical ‘how-to’ guide for analysing multivoicedness. Using theoretically derived tools, our three-step method comprises: identifying the voices of I-positions within the Self’s talk (or text), identifying the voices of ‘inner-Others’, and examining the dialogue and relationships between the different voices. We elaborate each step and illustrate our method using examples from a published paper in which data were analysed using this method. We conclude by offering more general principles for the use of the method and discussing potential applications

Exploring emotional dysregulation and avoidance with caregivers as the mechanisms linking social communication understanding and aggressive behaviours

PurposeMany autistic adolescents and young adults present with aggressive behaviours, which can be challenging for caregivers. The present study aimed to explore the underlying mechanisms between social communication understanding and aggressive behaviours in autistic and non-autistic adolescents, specifically the role of emotional dysregulation and its impact on avoidance with caregivers. MethodsCaregivers of autistic (n = 275) and non-autistic adolescents (n = 123) completed standardised caregiver-report questionnaires measuring social communication understanding, emotional dysregulation, avoidance between the adolescent and caregiver and aggressive behaviours. ResultsA serial mediation analysis indicated that levels of social communication understanding were indirectly associated with aggressive behaviours. This occurred through increased emotional dysregulation, which may have led to increased avoidance between the autistic and non-autistic adolescents and their caregivers.ConclusionThese findings support a sequential process by which adolescents with low social communication understanding are more likely to behave aggressively through being emotionally dysregulated and the impact of this on the increased avoidance within the caregiver-adolescent dyad. This process was found within autistic and non-autistic adolescents, suggesting a mechanism across individuals with aggression. These findings indicate that interventions based on improving emotion regulation ability and responses between adolescents and their caregivers may aid in reducing aggressive behaviours in adolescents and young adults with lower social communication understanding

Toward Controllable Hydraulic Coupling of Joints in a Wearable Robot

In this paper, we develop theoretical foundations for a new class of rehabilitation robot: body powered devices that route power between a user’s joints. By harvesting power from a healthy joint to assist an impaired joint, novel bimanual and self-assist therapies are enabled. This approach complements existing robotic therapies aimed at promoting recovery of motor function after neurological injury. We employ hydraulic transmissions for routing power, or equivalently for coupling the motions of a user’s joints. Fluid power routed through flexible tubing imposes constraints within a limb or between homologous joints across the body. Variable transmissions allow constraints to be steered on the fly, and simple valve switching realizes free space and locked motion. We examine two methods for realizing variable hydraulic transmissions: using valves to switch among redundant cylinders (digital hydraulics) or using an intervening electromechanical link. For both methods, we present a rigorous mathematical framework for describing and controlling the resulting constraints. Theoretical developments are supported by experiments using a prototype fluid-power exoskeleton

The initial psychometric evaluation of a new Emergency Department Patient-Reported Experience Measure (ED PREM)

Patient-reported experience measures (PREMs) are critical to evaluating the person-centeredness, safety, and quality of healthcare services internationally. The aim of this study was to describe the initial psychometric evaluation of a new Emergency Department (ED) PREM. Adult patients presenting to the ED of a tertiary hospital in southeast Queensland, Australia during January 2022 were recruited in-person. Participants selected their preferred ED PREM mode of administration from online, telephone, or postal, and had 14 days from recruitment to complete the survey. Item reduction, structural validity, discriminant validity, and internal consistency reliability were assessed. A sample of 349 (68.4%) was achieved. Item reduction analysis indicated ceiling effects for all ED PREM items (ranging between 34.4-79.7%). Exploratory factor analysis revealed a 4-factor solution comprising 26-items that explained 55% of model variance. Cronbach’s α ranged between 0.84-0.97 per factor, demonstrating internal consistency reliability. Known groups analysis demonstrated the ED PREMs’ ability to discriminate experiences based on gender, age, and ED length of stay. The ED PREM is a valid and reliable instrument for capturing patient experiences in the ED. The content of the ED PREM emphasizes person-centeredness and shared decision making, making it suitable for use in clinical practice evaluation and health service performance measurement. The factor structure of the ED PREM should be confirmed in future research, and item redundancy addressed. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Psychometric validation of the Perceived Perioperative Competence Scale-Revised Short Form

Aim: To develop a parsimonious, shortened version of the Perceived Perioperative Competence Scale-Revised for perioperative nurses to complete as part of their specialty training while retaining good psychometric properties. Design: A longitudinal online survey was adopted. Methods: A national sample of perioperative nurses from Australia completed an online survey at two different time points 6 months apart between February and October 2021. Confirmatory factor analysis was conducted for item reduction and construct validity, while criterion, convergent validity and internal consistency were examined. Results: Usable data for psychometric assessment were obtained from 485 operating room nurses at time 1 and 164 nurses at time 2. The original 40-item revised scale was reduced to an 18-item measure, maintaining its six domains. Cronbach's alpha for the 18-item scale was .92 at time 1 and .90 at time 2. Scale validation demonstrated moderate to weak positive relationships in perceived competence scores relative to general self-efficacy, years of operating room experience, postgraduate education and recency of training. Conclusions: Results suggest the 18-item Perceived Perioperative Competence Scale-Revised Short Form has initial robust psychometric properties and may be implemented in clinical settings as part of perioperative transition-to-practice, orientation programs and yearly professional development reviews. Implications for the Profession: This short-form scale can help prepare perioperative nurses to demonstrate clinical competence in a climate of increasing professional demands using a valid measure of competence required in clinical practice. Impact: Short and validated scales of perioperative competence are needed in clinical practice. Assessment of practising operating room nurses' perceived competence is essential in quality care provision, workforce planning and human resource management. This study provides an 18-item measure of the previously validated 40-item Perceived Perioperative Competence Scale-Revised. This scale can help provide an option for future testing of perioperative nurses' competence in clinical or research settings. Patient or Public Contribution: Perioperative nurses were involved in the design of the study, particularly in the assessment of validation of the tools used in the study

Self-Powered Robots to Reduce Motor Slacking During Upper-Extremity Rehabilitation: A Proof of Concept Study

Background: Robotic rehabilitation is a highly promising approach to recover lost functions after stroke or other neurological disorders. Unfortunately, robotic rehabilitation currently suffers from motor slacking , a phenomenon in which the human motor system reduces muscle activation levels and movement excursions, ostensibly to minimize metabolic- and movement-related costs. Consequently, the patient remains passive and is not fully engaged during therapy. To overcome this limitation, we envision a new class of body-powered robots and hypothesize that motor slacking could be reduced if individuals must provide the power to move their impaired limbs via their own body (i.e., through the motion of a healthy limb). Objective: To test whether a body-powered exoskeleton (i.e. robot) could reduce motor slacking during robotic training. Methods: We developed a body-powered robot that mechanically coupled the motions of the user\u27s elbow joints. We tested this passive robot in two groups of subjects (stroke and able-bodied) during four exercise conditions in which we controlled whether the robotic device was powered by the subject or by the experimenter, and whether the subject\u27s driven arm was engaged or at rest. Motor slacking was quantified by computing the muscle activation changes of the elbow flexor and extensor muscles using surface electromyography. Results: Subjects had higher levels of muscle activation in their driven arm during self-powered conditions compared to externally-powered conditions. Most notably, subjects unintentionally activated their driven arm even when explicitly told to relax when the device was self-powered. This behavior was persistent throughout the trial and did not wane after the initiation of the trial. Conclusions: Our findings provide novel evidence indicating that motor slacking can be reduced by self-powered robots; thus demonstrating promise for rehabilitation of impaired subjects using this new class of wearable system. The results also serve as a foundation to develop more sophisticated body-powered robots (e.g., with controllable transmissions) for rehabilitation purposes

Avoidant Restrictive Food Intake Disorder (ARFID) - Looking beyond the eating disorder lens?

Avoidant Restrictive Food Intake Disorder (ARFID) was first included as a diagnostic category in 2013, and over the past 10 years has been adopted by the international eating disorder community. While greater awareness of these difficulties has increased identification, demand and enabled advocacy for clinical services, the heterogeneous nature of ARFID poses unique challenges for eating disorder clinicians and researchers. This commentary aims to reflect on some of these challenges, focussing specifically on the risk of viewing ARFID through an eating disorder lens. This includes potential biases in the literature as most recent research has been conducted in specialist child and adolescent eating disorder clinic settings, bringing in to question the generalisability of findings to the broad spectrum of individuals affected by ARFID. We also consider whether viewing ARFID predominantly through an eating disorder lens risks us as a field being blinkered to the range of effective skills our multi-disciplinary feeding colleagues may bring. There are opportunities that may come with the eating disorder field navigating treatment pathways for ARFID, including more joined up working with multi-disciplinary colleagues, the ability to transfer skills used in ARFID treatment to individuals with eating disorder presentations, and most notably an opportunity to provide more effective treatment and service pathways for individuals with ARFID and their families. However, these opportunities will only be realised if eating disorder clinicians and researchers step out of their current silos

Development and delivery of an exercise programme for falls prevention: the Prevention of Falls Injury Trial (PreFIT)

This paper describes the development and implementation of an exercise intervention to prevent falls within The Prevention of Fall Injury Trial (PreFIT), which is a large multi-centred randomised controlled trial based in the UK National Health Service (NHS).Using the template for intervention description and replication (TIDieR) checklist, to describe the rationale and processes for treatment selection and delivery of the PreFIT exercise intervention.Based on the results of a validated falls and balance survey, participants were eligible for the exercise intervention if they were at moderate or high risk of falling.Intervention development was informed using the current evidence base, published guidelines, and pre-existing surveys of clinical practice, a pilot study and consensus work with therapists and practitioners. The exercise programme targets lower limb strength and balance, which are known, modifiable risk factors for falling. Treatment was individually tailored and progressive, with seven recommended contacts over a six-month period. Clinical Trials Registry (ISCTRN 71002650)