Questioning Classic Patient Classification Techniques in Gait Rehabilitation: Insights from Wearable Haptic Technology

Classifying stroke survivors based on their walking abilities is an important part of the gait rehabilitation process. It can act as powerful indicator of function and prognosis in both the early days after a stroke and long after a survivor receives rehabilitation. This classification often relies solely on walking speed; a quick and easy measure, with only a stopwatch needed. However, walking speed may not be the most accurate way of judging individual’s walking ability. Advances in technology mean we are now in a position where ubiquitous and wearable technologies can be used to elicit much richer measures to characterise gait. In this paper we present a case study from one of our studies, where within a homogenous group of stroke survivors (based on walking speed classification) important differences in individual results and the way they responded to rhythmic haptic cueing were identified during the piloting of a novel gait rehabilitation technique

Can integrated agriculture - nutrition programs change gender norms on land and asset ownership? Evidence from Burkina Faso.

There is a high degree of interest in the potential for agricultural programs to be designed and implemented to achieve health and nutrition objectives. Policymakers have often looked to the experience of civil society organizations in designing and implementing such programs, particularly in different social and cultural contexts. For the past 20 years, Helen Keller International (HKI) has implemented homestead food production programs in Asia and recently has started to adapt and implement these programs in Africa south of the Sahara. The goal of these programs is to improve the nutritional status of and young children through a number of production and nutrition interventions. These interventions are targeted to mothers under the presumption that increasing women’s access to and control over productive assets and enhancing women’s human capital to improve production and health and nutrition care practices will translate into improved nutritional status for their children. However, there is very little evidence documenting the ways in which HKI’s homestead food production programs influence women’s access to and control over productive assets and enhance women’s human capital in ways that may improve nutritional outcomes. This paper uses a mixed-methods approach to analyze the impact of HKI’s Enhanced-Homestead Food Production pilot program in Burkina Faso on women’s and men’s assets and on norms regarding ownership, use, and control of those assets. Even though men continue to own and control most land and specific assets in the study area, women’s control over and ownership of assets has started to change, both in terms of quantifiable changes as well as changes in people’s perceptions and opinions about who can own and control certain assets. The paper also discusses the implications of such changes for program sustainability

Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study

Background With expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health. Methods We created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (known as AMPATH) programme describing the routes into care, losses from care, and clinical outcomes. We simulated the cost and effect of interventions at different stages of HIV care, including improvements to diagnosis, linkage to care, retention and adherence of ART, immediate ART eligibility, and a universal test-and-treat strategy. Findings We estimate that, of people dying from AIDS between 2010 and 2030, most will have initiated treatment (61%), but many will never have been diagnosed (25%) or will have been diagnosed but never started ART (14%). Many interventions targeting a single stage of the health-care cascade were likely to be cost-effective, but any individual intervention averted only a small percentage of deaths because the effect is attenuated by other weaknesses in care. However, a combination of five interventions (including improved linkage, point-of-care CD4 testing, voluntary counselling and testing with point-of-care CD4, and outreach to improve retention in pre-ART care and on-ART) would have a much larger impact, averting 1·10 million disability-adjusted life-years (DALYs) and 25% of expected new infections and would probably be cost-effective (US$571 per DALY averted). This strategy would improve health more efficiently than a universal test-and-treat intervention if there were no accompanying improvements to care ($1760 per DALY averted). Interpretation When resources are limited, combinations of interventions to improve care should be prioritised over high-cost strategies such as universal test-and-treat strategy, especially if this is not accompanied by improvements to the care cascade. International guidance on ART should reflect alternative routes to programme strengthening and encourage country programmes to evaluate the costs and population-health impact in addition to the clinical benefits of immediate initiation

A pilot study using tactile cueing for gait rehabilitation following stroke

Recovery of walking function is a vital goal of post-stroke rehabilitation. Cueing using audio metronomes has been shown to improve gait, but can be impractical when interacting with others, particularly outdoors where awareness of vehicles and bicycles is essential. Audio is also unsuitable in environments with high background noise, or for those with a hearing impairment. If successful, lightweight portable tactile cueing has the potential to take the benefits of cueing out of the laboratory and into everyday life. The Haptic Bracelets are lightweight wireless devices containing a computer, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we review gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation. Tactile cueing during walking was well received in the pilot, and analysis of motion capture data showed immediate improvements in gait

A Gait Rehabilitation pilot study using tactile cueing following Hemiparetic Stroke

Recovery of walking function is a major goal of post-stroke rehabilitation. Audio metronomic cueing has been shown to improve gait, but can be impractical and inconvenient to use in a community setting, for example outdoors where awareness of traffic is needed, as well as being unsuitable in environments with high background noise, or for those with a hearing impairment. Silent lightweight portable tactile cueing, if similarly successful, has the potential to take the benefits out of the lab and into everyday life. The Haptic Bracelets, designed and built at the Open University originally for musical purposes, are self- contained lightweight wireless devices containing a computer, Wi-Fi chip, accelerometers and low-latency vibrotactiles with a wide dynamic range. In this paper we outline gait rehabilitation problems and existing solutions, and present an early pilot in which the Haptic Bracelets were applied to post-stroke gait rehabilitation

Loads Model Development and Analysis for the F/A-18 Active Aeroelastic Wing Airplane

The Active Aeroelastic Wing airplane was successfully flight-tested in March 2005. During phase 1 of the two-phase program, an onboard excitation system provided independent control surface movements that were used to develop a loads model for the wing structure and wing control surfaces. The resulting loads model, which was used to develop the control laws for phase 2, is described. The loads model was developed from flight data through the use of a multiple linear regression technique. The loads model input consisted of aircraft states and control surface positions, in addition to nonlinear inputs that were calculated from flight-measured parameters. The loads model output for each wing consisted of wing-root bending moment and torque, wing-fold bending moment and torque, inboard and outboard leading-edge flap hinge moment, trailing-edge flap hinge moment, and aileron hinge moment. The development of the Active Aeroelastic Wing loads model is described, and the ability of the model to predict loads during phase 2 research maneuvers is demonstrated. Results show a good match to phase 2 flight data for all loads except inboard and outboard leading-edge flap hinge moments at certain flight conditions. The average load prediction errors for all loads at all flight conditions are 9.1 percent for maximum stick-deflection rolls, 4.4 percent for 5-g windup turns, and 7.7 percent for 4-g rolling pullouts

Cenozoic Antarctic DiatomWare/BugCam: An aid for research and teaching

Cenozoic Antarctic DiatomWare/BugCam© is an interactive, icon-driven digital-imagedatabase/software package that displays over 500 illustrated Cenozoic Antarctic diatom taxa along with original descriptions (including over 100 generic and 20 family-group descriptions). This digital catalog is designed primarily for use by micropaleontologists working in the field (at sea or on the Antarctic continent) where hard-copy literature resources are limited. This new package will also be useful for classroom/lab teaching as well as for any paleontologists making or refining taxonomic identifications at the microscope. The database (Cenozoic Antarctic DiatomWare) is displayed via a custom software program (BugCam) written in Visual Basic for use on PCs running Windows 95 or later operating systems. BugCam is a flexible image display program that utilizes an intuitive thumbnail “tree” structure for navigation through the database. The data are stored on Micrsosoft EXCEL spread sheets, hence no separate relational database program is necessary to run the package

Association of Paternal Age and Risk for Major Congenital Anomalies From the National Birth Defects Prevention Study, 1997 to 2004

The objective of this study was to examine the associations between paternal age and birth defects of unknown etiologies while carefully controlling for maternal age

Conduction in ulnar nerve bundles that innervate the proximal and distal muscles: a clinical trial

<p>Abstract</p> <p>Background</p> <p>This study aims to investigate and compare the conduction parameters of nerve bundles in the ulnar nerve that innervates the forearm muscles and hand muscles; routine electromyography study merely evaluates the nerve segment of distal (hand) muscles.</p> <p>Methods</p> <p>An electrophysiological evaluation, consisting of velocities, amplitudes, and durations of ulnar nerve bundles to 2 forearm muscles and the hypothenar muscles was performed on the same humeral segment.</p> <p>Results</p> <p>The velocities and durations of the compound muscle action potential (CMAP) of the ulnar nerve bundle to the proximal muscles were greater than to distal muscles, but the amplitudes were smaller.</p> <p>Conclusions</p> <p>Bundles in the ulnar nerve of proximal muscles have larger neuronal bodies and thicker nerve fibers than those in the same nerve in distal muscles, and their conduction velocities are higher. The CMAPs of proximal muscles also have smaller amplitudes and greater durations. These findings can be attributed to the desynchronization that is caused by a wider range of distribution in nerve fiber diameters.</p> <p>Conduction parameters of nerve fibers with different diameters in the same peripheral nerve can be estimated.</p