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

Jurisprudential aspects regarding the action in annulment of the debtor’s patrimonial transfers, the debtor being in insolvency procedure

The study aims to present relevant aspects from the jurisprudential solutions of the High Court of Cassation and Justice in matters of the action in annulment of the patrimonial transfers of the debtor in insolvency procedure and of other judicial actions introduced by the procedure bodies or, by case, the participants to the procedure who are enabled to use the measures prescribed by the law for the purpose of restoring the debtor’s patrimony. The jurisprudential solutions adopted under the incidence of the former Law no.85/2006 on the insolvency procedure represent, in present, under diverse aspects, elements of continuity with the principles and rules established by the new law in this matter. Law no.85/2014 on the prevention insolvency procedures and of insolvency establishes the legal frame for the exertion of the measures having as purpose the restoration, in the debtor’s patrimony, of certain assets, transferred by the debtor to the fraud of the creditors’ interests, or of their value, in the scope of covering the passive part to satisfy the creditors’ interests. The new law continues the tradition of the former regulations in this matter but, also, brings some novelty elements such as the decrease or, in some cases, the increase of the duration of certain terms that the exertion of the mentioned judicial actions or their object refer to or the completion of the category of the persons entitled to introduce the mentioned judicial actions with the creditor who holds more than 50% of the value of the claims enlisted in the amount of claims

The associative forms in Romania following the new Civil Code, republished in 2011

During time, the association has evolved as a form of socio-economic organisation in order to perform non-professional or, by case, professional activities. The legislative sources have emphasized, in time, the variety of the ways of manifestation of the association among different law subjects – physical and/or legal persons. The new Civil Code (2009), republished in 2011, in force since the 1st October 2011, fundamented on the monist approach of regulation, as the common-law norm for all the domains that the letter and the spirit of its provisions refer to, regulates the contract of association, in chapter VII of the 5thBook; apart from the general norms applicable to all such contracts of association, the present code replaces the former civil society without legal personality with the present simple society and, also as a novelty element, transposes the regulation of the silent partnership from the former framework of the Commercial Code (1887, abrogated almost in totality) in the section 3 of the same chapter VII, the 5th Book of the code. The elements that are similar with the former regulation outline the continuity aspects in the conception of these juridical institutions in a modern approach that transposes aspects which were clarified by the jurisprudence or the legal doctrine

Roll-over shapes of the able-bodied knee-ankle-foot system during gait initiation, steady-state walking, and gait termination

A few investigators have described the movement of the center of pressure (COP) of the ground reaction force and the activation patterns of the lower limb muscles during gait initiation and termination. This study examines the effective rocker (roll-over shape) behavior of the knee-ankle-foot (KAF) system during gait initiation, steady-state walking (i.e. constant speed gait), and gait termination. The KAF roll-over shapes were characterized by transforming COP data of 10 able-bodied subjects from a laboratory-based coordinate system into a leg-based coordinate system. The resulting roll-over shapes (effective rockers) were characterized using a circular arc model. The KAF roll-over shapes exhibit an overall ''flexed'' orientation during the first step of gait initiation and an ''extended'' orientation during the last step of gait termination. Understanding the behavior of the anatomical KAF system during gait initiation and termination may aid in the design of prosthetic components, i.e. mechanical devices that replace complete anatomical structures. Prostheses that intend to mimic the overall behavior of physiological KAF systems (biomimetic designs) could be manufactured using approaches that are much simpler than attempting to reconstruct the complexity of the lower limb. Copy Right 2007 Elsevier B.V. All rights reserved. Keywords: Rocker; Roll-over shape; Center of pressure; Prosthetic

Net external energy of the biologic and prosthetic ankle during gait initiation

The net external energy of the biologic human ankle joint and of some lower limb prosthetic ankle-foot systems was examined during gait initiation. The purpose of the study was to better understand the ankle's behavior during the acceleration phase of walking for use in the design of improved lower limb prostheses and orthoses. Quantitative gait data were collected from 10 able-bodied subjects and 10 persons with unilateral transtibial amputations during gait initiation. The behaviors of the biologic and prosthetic 'ankle' joints were examined by analyzing the relationship between sagittal plane ankle angles and moments. Net external energy at the ankle was estimated by calculating the area under the moment versus angle curves (hysteresis) created during the loading and unloading phases. Results indicate that able-bodied persons utilize energy input from the trailing ankle after the first step is made in gait initiation, most likely to help transition the body into steady-state walking. The passive prosthetic ankle-foot systems tested were unable to put energy into the system during gait initiation

Learning from an equitable, data‐informed response to COVID‐19: Translating knowledge into future action and preparation

Abstract Introduction The COVID‐19 pandemic revealed numerous barriers to effectively managing public health crises, including difficulties in using publicly available, community‐level data to create learning systems in support of local public health decision responses. Early in the COVID‐19 pandemic, a group of health care partners began meeting to learn from their collective experiences. We identified key tools and processes for using data and learning system structures to drive equitable public health decision making throughout different phases of the pandemic. Methods In fall of 2021, the team developed an initial theory of change directed at achieving herd immunity for COVID‐19. The theoretical drivers were explored qualitatively through a series of nine 45‐min telephonic interviews conducted with 16 public health and community leaders across the United States. Interview responses were analyzed into key themes to inform potential future practices, tools, and systems. In addition to the interviews, partners in Dallas and Cincinnati reflected on their own COVID‐19 experiences. Results Interview responses fell broadly into four themes that contribute to effective, community driven responses to COVID‐19: real‐time, accessible data that are mindful of the tension between community transparency and individual privacy; a continued fostering of public trust; adaptable infrastructures and systems; and creating cohesive community coalitions with shared alignment and goals. These themes and partner experiences helped us revise our preliminary theory of change around the importance of community collaboration and trust building and also helped refine the development of the Community Protection Dashboard tool. Conclusions There was broad agreement amongst public health and community leaders about the key elements of the data and learning systems required to manage public health responses to COVID‐19. These findings may be informative for guiding the use of data and learning in the management of future public health crises or population health initiatives

Identification of trunk and pelvis movement compensations in patients with transtibial amputation using angular momentum separation

Patients with unilateral dysvascular transtibial amputation (TTA) have a higher risk of developing low back pain than their healthy counterparts, which may be related to movement compensations used in the absence of ankle function. Assessing components of segmental angular momentum provides a unique framework to identify and interpret these movement compensations alongside traditional observational analyses. Angular momentum separation indicates two components of total angular momentum: (1) transfer momentum and (2) rotational momentum. The objective of this investigation was to assess movement compensations in patients with dysvascular TTA, patients with diabetes mellitus (DM), and healthy controls (HC) by examining patterns of generating and arresting trunk and pelvis segmental angular momenta during gait. We hypothesized that all groups would demonstrate similar patterns of generating/arresting total momentum and transfer momentum in the trunk and pelvis in reference to the groups (patients with DM and HC). We also hypothesized that patients with amputation would demonstrate different (larger) patterns of generating/arresting rotational angular momentum in the trunk. Patients with amputation demonstrated differences in trunk and pelvis transfer angular momentum in the sagittal and transverse planes in comparison to the reference groups, which indicates postural compensations adopted during walking. However, patients with amputation demonstrated larger patterns of generating and arresting of trunk and pelvis rotational angular momentum in comparison to the reference groups. These segmental rotational angular momentum patterns correspond with high eccentric muscle demands needed to arrest the angular momentum, and may lead to consequential long-term effects such as low back pain

Differentiation between solid-ankle cushioned heel and energy storage and return prosthetic foot based on step-to-step transition cost

Decreased push-off power by the prosthetic foot and inadequate roll-over shape of the foot have been shown to increase the energy dissipated during the step-to-step transition in human walking. The aim of this study was to determine whether energy storage and return (ESAR) feet are able to reduce the mechanical energy dissipated during the step-to-step transition. Fifteen males with a unilateral lower-limb amputation walked with their prescribed ESAR foot (Vari-Flex, Ossur; Reykjavík, Iceland) and with a solid-ankle cushioned heel foot (SACH) (1D10, Ottobock; Duderstadt, Germany), while ground reaction forces and kinematics were recorded. The positive mechanical work on the center of mass performed by the trailing prosthetic limb was larger (33%, p = 0.01) and the negative work performed by the leading intact limb was lower (13%, p = 0.04) when walking with the ESAR foot compared with the SACH foot. The reduced step-to-step transition cost coincided with a higher mechanical push-off power generated by the ESAR foot and an extended forward progression of the center of pressure under the prosthetic ESAR foot. Results can explain the proposed improvement in walking economy with this kind of energy storing and return prosthetic foot