11 Simposio CEA de Bioingeniería

El propósito de este simposio, que cumple ahora su undécima edición, es el de proporcionar un espacio de encuentro entre investigadores, desarrolladores, personal clínico, alumnos, industriales, profesionales en general e incluso usuarios que realicen su actividad en el ámbito que define el título de este foro, principalmente en España e Iberoamérica. Se trata de presentar,compartir y discutir nuevos avances en este campo con aportaciones tanto teóricas como experimentales y de validación e introducción en el mercado de soluciones que traten de cubrir en lo posible las necesidades especiales de personas con deficiencias físicas, sensoriales o cognitivas para ampliar así sus capacidades funcionales de relación, movilidad manipulación y acceso al conocimiento.Belda Lois, JM. (2019). 11 Simposio CEA de Bioingeniería. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/132664EDITORIA

Classification of Parkinson's disease stages with a two-stage deep neural network

IntroductionParkinson's disease is one of the most prevalent neurodegenerative diseases. In the most advanced stages, PD produces motor dysfunction that impairs basic activities of daily living such as balance, gait, sitting, or standing. Early identification allows healthcare personnel to intervene more effectively in rehabilitation. Understanding the altered aspects and impact on the progression of the disease is important for improving the quality of life. This study proposes a two-stage neural network model for the classifying the initial stages of PD using data recorded with smartphone sensors during a modified Timed Up & Go test.MethodsThe proposed model consists on two stages: in the first stage, a semantic segmentation of the raw sensor signals classifies the activities included in the test and obtains biomechanical variables that are considered clinically relevant parameters for functional assessment. The second stage is a neural network with three input branches: one with the biomechanical variables, one with the spectrogram image of the sensor signals, and the third with the raw sensor signals.ResultsThis stage employs convolutional layers and long short-term memory. The results show a mean accuracy of 99.64% for the stratified k-fold training/validation process and 100% success rate of participants in the test phase.DiscussionThe proposed model is capable of identifying the three initial stages of Parkinson's disease using a 2-min functional test. The test easy instrumentation requirements and short duration make it feasible for use feasible in the clinical context

Biomechanical Loading as an Alternative Treatment for Tremor: A Review of Two Approaches

Background: Tremor is the most common movement disorder and strongly increases in incidence and prevalence with aging. Although not life threatening, upper-limb tremors hamper the independence of 65% of people suffering from them affected persons, greatly impacting their quality of life. Current treatments include pharmacotherapy and surgery (thalamotomy and deep brain stimulation). However, these options are not sufficient for approximately 25% of patients. Therefore, further research and new therapeutic options are required to effectively manage pathological tremor. Methods: This paper presents findings of two research projects in which two different wearable robots for tremor management were developed based on force loading and validated. The first consisted of a robotic exoskeleton that applied forces to tremulous limbs and consistently attenuated mild and severe tremors. The second was a neuroprosthesis based on transcutaneous neurostimulation. A total of 22 patients suffering from parkinsonian or essential tremor (ET) of different severities were recruited for experimental validation, and both systems were evaluated using standard tasks employed for neurological examination. The inclusion criterion was a postural and/or kinetic pathological upper-limb tremor resistant to medication. Results: The results demonstrate that both approaches effectively suppressed tremor in most patients, although further research is required. The work presented here is based on clinical evidence from a small number of patients (n = 10 for robotic exoskeleton and n = 12 for the neuroprosthesis), but most had a positive response to the approaches. In summary, biomechanical loading is non-invasive and painless. It may be effective in patients who are insufficiently responsive (or have adverse reactions) to drugs or in whom surgery is contraindicated. Discussion: This paper identifies and evaluates biomechanical loading approaches to tremor management and discusses their potential

Assessment of Muscle Coordination Changes Caused by the Use of an Occupational Passive Lumbar Exoskeleton in Laboratory Conditions

[EN] The introduction of exoskeletons in industry has focused on improving worker safety. Exoskeletons have the objective of decreasing the risk of injury or fatigue when performing physically demanding tasks. Exoskeletons' effect on the muscles is one of the most common focuses of their assessment. The present study aimed to analyze the muscle interactions generated during load-handling tasks in laboratory conditions with and without a passive lumbar exoskeleton. The electromyographic data of the muscles involved in the task were recorded from twelve participants performing load-handling tasks. The correlation coefficient, coherence coefficient, mutual information, and multivariate sample entropy were calculated to determine if there were significant differences in muscle interactions between the two test conditions. The results showed that muscle coordination was affected by the use of the exoskeleton. In some cases, the exoskeleton prevented changes in muscle coordination throughout the execution of the task, suggesting a more stable strategy. Additionally, according to the directed Granger causality, a trend of increasing bottom-up activation was found throughout the task when the participant was not using the exoskeleton. Among the different variables analyzed for coordination, the most sensitive to changes was the multivariate sample entropy.This study was funded by Fundación Prevent.Iranzo-Egea, S.; Belda-Lois, J.; Martínez-De-Juan, JL.; Prats-Boluda, G. (2023). Assessment of Muscle Coordination Changes Caused by the Use of an Occupational Passive Lumbar Exoskeleton in Laboratory Conditions. Sensors. 23(24):1-14. https://doi.org/10.3390/s23249631114232

Analysis of the effect of high heel shoes design components on gait ground reaction forces

This work is part of the activities driven by ADDfactor, Advanced Digital technologies and virtual engineering for mini-factories. This project has receied funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement No. [609386].Baydal Bertomeu, JM.; Lopez Pascual, J.; Puigcerver Palau, SA.; Solves Camallonga, C.; Belda Lois, JM. (2015). Analysis of the effect of high heel shoes design components on gait ground reaction forces. Footwear Science. 7:S129-S131. https://doi.org/10.1080/19424280.2015.1038647S129S131

Accesibilidad horizontal: conocer y conservar el patrimonio, cómo conjugar un derecho con una necesidad

Históricamente, las personas han tratado de adaptar el entorno a sus necesidades. Hoy en día, el diseñar adecuadamente un entorno implica tener en cuenta a todos los usuarios. Por ello, la accesibilidad ha pasado a ser una característica básica a tener en cuenta desde el inicio de cualquier proyecto, lo que introduce la cuestión de cómo intervenir el patrimonio histórico para hacerlo accesible, es decir, cómo plantear la intervención en monumentos, jardines históricos, hallazgos arqueológicos, etc., teniendo en cuenta que todas las personas tenemos derecho a acceder al patrimonio como una parte fundamental de nuestra propia cultura. A pesar de ello, muchos de los bienes patrimoniales presentan barreras importantes de acceso. Además, la posibilidad de actuación sobre estos bienes es limitada debido a las necesidades de conservación de los mismos como parte fundamental de la cultura. Combinar los conceptos de patrimonio y accesibilidad puede parecer contradictorio, debido a que el primero busca intervenciones mínimas mientras que el segundo requiere de intervenciones que eliminen las barreras de acceso con el fin de conseguir una accesibilidad integral. El reto radica en facilitar el acceso a los contenidos de los bienes patrimoniales por toda la población. Para ello, es necesario el desarrollo de metodología específica para hacer accesible el patrimonio y que tenga en cuenta sus características especiales y sus necesidades de conservación. Actualmente, el proyecto “PATRAC Patrimonio Accesible: I+D+i para una cultura sin barreras” (proyecto liderado por GEOCISA y LABEIN en el que participa el IBV con otros 22 socios) ha desarrollado esta metodología incluyendo un análisis de la diversidad funcional de la población española, un análisis de las barreras existentes en el patrimonio español, un análisis de los productos de apoyo que pueden facilitar la accesibilidad al patrimonio y, al mismo tiempo, se está abordando el desarrollo de productos específicos que permitan el acceso a la cultura de todos. Con el objetivo de desarrollar los productos y sistemas necesarios para garantizar un acceso seguro y confortable al monumento, de forma no discriminatoria, para todos los ciudadanos, y de forma compatible con el bien cultural y reversible, tanto en las fases de conservación, como en la de “explotación” del patrimonio existente. En este contexto el IBV está desarrollando junto con AZTECA y ACCIONA soluciones específicas para la accesibilidad horizontal consistentes en estructuras ligeras con pavimentos cerámicos que permitan la inclusión de elementos que aporten información y orientación sobre el bien patrimonial y con un impacto reducido. Este sistema mejoraría la accesibilidad a la vez que permitiría distinguir la intervención con respecto del original. Para la construcción de un pavimento cerámico sobre-elevado accesible se deben considerar los aspectos que deben satisfacer los pavimentos en cuanto a su seguridad, su accesibilidad, y las cargas asociadas al uso. Además, el producto resultante habrá de tener en cuenta los requisitos emocionales y funcionales de los usuarios. Este desarrollo se espera que tenga un gran impacto debido a que de esta forma se conseguirá el acceso al patrimonio de visitantes que hasta ahora han tenido grandes dificultades, permitiendo que disfruten del derecho de acceder a los bienes patrimoniales y teniendo también en cuenta las necesidades de conservación del bien patrimonial.Historically, people have tried to adapt the environment to their needs. Today to design adequately an environment it is required to keep on mind all the potential users. Therefore, accessibility has become a basic condition to consider from the very beginning of the any architectural project. So, access to heritage is a right for all the people as a fundamental part of its own culture, which poses the issue: how to intervene in built heritage to make it accessible, which includes monuments, historic gardens and archaeological sites without excessive disturbance. There are important barriers in many heritage sites. Besides, the possibilities for intervention in the heritage are limited due to the needs of conservation as an important part of the culture. The novelty to combine the concepts of heritage and accessibility at first may seem antithetical, because the first looks to preserve existing assets while the second tends to remove whatever is possible to achieve integral accessibility. The thread connecting both ideas is the usability of the property by the entire population. To do so, it is very important to have tools and methodologies to make accessible the heritage and to take into account their special characteristics and needs. Currently, the project "PATRAC Accessible Heritage: R & D for a culture without barriers" (project led by GEOCISA LABEIN and in which the IBV with 22 other partners) has developed a methodology including an analysis of the functional diversity of Spanish population, an analysis of existing barriers in the Spanish heritage, an analysis of the product support that can facilitate access to heritage and at the same time, it is addressing the development of specific products that enable access to heritage for all the people. The goal is to develop products and systems that ensure a safe and comfortable access to the heritage for all citizens, in a reversible way which ensures the compatibility with the cultural assets, in phases of conservation and exploitation of existing buildings. In this context, an example of how to improve horizontal access is the creation of specific floors, which are being developed by AZTECA, ACCIONA and IBV. The idea is to use an in-ground-present irregularities elevated walkways composite tile digitally printed with the original pavement and the proper signals. Such a system improves the accessibility of the path and at the same time allow distinguish the intervention from the original. For the construction of a ceramic surface on high-accessible areas, requirements regarding safety, accessibility and use loads of the pavement should be took in account. Moreover, the resulting product will have to take into account emotional and functional requirements of users. The impact is very high by the novelty of the topic of the project. The devices to be generated will enable to carry out visits without any difficulty for the part of users who today have the biggest problems for access to the property because of their condition. And it will take in account the conservation needs of the heritage as well.Peer Reviewe

Aspects determining adherence to wrist-hand orthoses in patients with peripheral neuropathies

[EN] BACKGROUND: People with peripheral neuropathies suffer significant sensorimotor impairment. Prescribed treatment includes the use of orthosis. However, a common obstacle to treatment efficacy is patient adherence. Given the limited information available, gathering evidence on adherence to orthotic treatment is essential. OBJECTIVE: This study aims to identify aspects that influence adherence to orthotic treatment in patients with peripheral neuropathies. METHODS: We applied a survey including items from the assistive device evaluation section of Quest 2.0 and self-developed questions to assess the importance and satisfaction of wrist-hand orthosis users. We used the principles of the Kano model to understand the nature of issues influencing adherence and prioritize opportunities for product improvement. RESULTS: User satisfaction with the ease of adjustment, weight, comfort, effectiveness, durability, dimensions, and appearance of orthoses influences treatment adherence. CONCLUSIONS: We found differences in estimating the importance of orthosis aspects from direct consultation and estimation from the satisfaction-adherence correlation. Satisfaction is an indirect measure of importance and an adequate predictor of adherence. The application of Kano's model allows a more precise identification of the influence of orthosis attributes on adherence. This method describes relationships between aspects that are not discernible in linear models.Funding (EBO): Ph.D. supported by the academic training program of the Universidad del Norte and the Colombian Ministry of Science grant: "Formacion de capital humano de alto nivel para las regiones -Atlántico 2018".Bula-Oyola, E.; Belda Lois, JM.; Porcar Seder, R.; Page Del Pozo, AF. (2022). Aspects determining adherence to wrist-hand orthoses in patients with peripheral neuropathies. Technology and Disability. 34(4):247-260. https://doi.org/10.3233/TAD-21036524726034

Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis

[EN] Introduction People with ulnar, radial or median nerve injuries can present significant impairment of their sensory and motor functions. The prescribed treatment for these conditions often includes electrophysical therapies, whose effectiveness in improving symptoms and function is a source of debate. Therefore, this systematic review aims to provide an integrative overview of the efficacy of these modalities in sensorimotor rehabilitation compared to placebo, manual therapy, or between them. Methods We conducted a systematic review according to PRISMA guidelines. We perform a literature review in the following databases: Biomed Central, Ebscohost, Lilacs, Ovid, PEDro, Sage, Scopus, Science Direct, Semantic Scholar, Taylor & Francis, and Web of Science, for the period 1980¿2020. We include studies that discussed the sensorimotor rehabilitation of people with non-degenerative ulnar, radial, or median nerve injury. We assessed the quality of the included studies using the Risk of Bias Tool described in the Cochrane Handbook of Systematic Reviews of Interventions and the risk of bias across studies with the GRADE approach described in the GRADE Handbook. Results Thirty-eight studies were included in the systematic review and 34 in the meta-analysis. The overall quality of evidence was rated as low or very low according to GRADE criteria. Low-level laser therapy and ultrasound showed favourable results in improving symptom severity and functional status compared to manual therapy. In addition, the low-level laser showed improvements in pinch strength compared to placebo and pain (VAS) compared to manual therapy. Splints showed superior results to electrophysical modalities. The clinical significance of the results was assessed by effect size estimation and comparison with the minimum clinically important difference (MCID). Conclusions We found favourable results in pain relief, improvement of symptoms, functional status, and neurophysiological parameters for some electrophysical modalities, mainly when applied with a splint. Our results coincide with those obtained in some meta-analyses. However, none of these can be considered clinically significant. Trial registration PROSPERO registration number CRD42020168792; https://www.crd.york.ac.uk/ PROSPERO/display_record.php?RecordID=168792.EBO: scholarship from the Colombian Ministry of Science: "Formacion de capital humano de alto nivel para las regiones-Atlantico 2018". URL: https://minciencias.gov.co/convocatorias/oportunidades-formacion/formacion-capitalhumano-alto-nivel-para-las-regiones The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Bula-Oyola, E.; Belda Lois, JM.; Porcar Seder, R.; Page Del Pozo, AF. (2021). Effectiveness of electrophysical modalities in the sensorimotor rehabilitation of radial, ulnar, and median neuropathies: A meta-analysis. PLoS ONE. 16(3):1-26. https://doi.org/10.1371/journal.pone.0248484S12616

Identificación de factores clave en el desarrollo de tecnologías para la promoción de la autonomía personal y la atención a la dependencia

Objetivo Principal: Identificar factores, características personales y sociales que se tienen en cuenta en el desarrollo de tecnologías usables, accesibles y aceptables dirigidas a la promoción de la autonomía personal y la atención a la dependencia. Metodología: Revisión documental utilizando como referencia el método PRISMA. Bases bibliográficas: Latindex, Dialnet, Google Scholar. Summary Gerontology, TESEO, y SCOPUS. Periodo 2002 al 2018. Palabras de búsqueda: validación, diseño, desarrollo, personas mayores, tecnología, usabilidad y accesibilidad. Criterios de inclusión: revistas indexadas, artículos de congresos de prestigio en este campo, resultados de investigaciones y autores reconocidos. Realizada la preselección de 78 documentos se ha trabajado sobre 18 y se han seleccionado para la presente comunicación 13 artículos de revistas científicas. Los documentos se han analizado a texto completo, registrando en un formulario Excel la información relevan- te. A continuación, se han categorizado los factores en cinco temas: brecha digital, alfabetización y formación digital, incremento de la motivación y aceptación de uso, diseño de las tecnologías y aspectos del mercado y especificados los factores indicados por documentos. Resultados: Seleccionados 13 artículos para la comunicación. Los resultados indican que para conseguir tecnologías usables, accesibles, aceptables y asequibles desde el momento del diseño se debe aplicar metodología centrada en la persona mayor/para todos/inclusiva. Han sido identificados 4 temas clave: la brecha digital, la alfabetización y formación digital, el incremento de la motivación y aceptación de uso y el diseño de las tecnologías. Conclusiones: Esta revisión proporciona una primera aproximación donde es necesario seguir analizando los factores de usabilidad, accesibilidad y aceptación que aseguren los beneficios por tipología de tecnología y faciliten la aceptación de las tecnologías por perfil de los usuarios con una visión holística