Development of an assistive soft exoskeleton : a multistakeholder endeavour

Background As in other areas, digitalization and new technologies become increasingly relevant for physiotherapy. However, often these developments are driven by technological feasibility rather than by clinical demand. In order to grant maximum acceptability and effective implementation of a technology multiple stakeholders i.e. engineers, patients and therapists need to collaborate throughout the planning and development processes. Here, we describe the design and development of three prototype-generations of a soft and modular exoskeleton. Purpose Development of a soft and modular exoskeleton, which incorporates the needs and requirements of future users. Methods Nine research groups including therapists, designers and engineers from seven European countries were involved in this project. As stakeholders we considered patients with gait limitations due to stroke, incomplete spinal cord injury or age-related weakness (primary end-users, PU), therapists with professional experience in the area of the PU’s conditions and non-professional carers (secondary end-users, SU). The perspectives of PU and SU were incorporated into the technical concepts adopting a user-centered design approach. The initial prototype was designed according to the requirements, which were derived from use-cases representing the target populations. Evaluations of all prototypes were performed using semi-structured interviews with both, PU and SU. Functions of the respective prototypes were evaluated with a predefined testing protocol. The conclusions of the evaluations were fed back to the engineers and informed the development of the consecutive prototypes. All data collection procedures were approved by the local ethics committee and participants provided written informed consent. Results In total eight PU and eight SU were recruited. In general, the prototypes were in an early stage of development and the operation required staff with engineering knowledge and an experimental laboratory. In general, PU and SU rated the technology positively. The individually analyzed data from the interviews and functionality tests revealed heterogeneous results indicating the diversity of the PU’s functional impairments and expectations of PU and SU. Conclusions Based on this project’s experience, we are convinced that future PU and SU of a technology must be involved in the development from the very beginning. However, in order to obtain adequate feedback, the choice of individuals (PU and SU) and the level of involvement must be considered carefully. For example, inadequate expectations may draw the attention to irrelevant issues. In our project, research physiotherapists played a key role by bridging PU and SU with engineers. This information exchange was partially challenging because of different areas of interest, different terminology and geographical distance. Implications A common understanding of the project goals among the project teams and adherence to timelines are essential for successful progress such a large project. The project should assure that all stakeholders can acquire basic knowledge and perspectives of the other involved stakeholders, especially from other disciplines. Specifically for physiotherapists, basic and continuing education should incorporate technological knowledge from engineering disciplines in order to enable physiotherapists to contribute to the development of new devices. This opens the chance to participate in the development of technology for clinical applications. Funding acknowledgements This work has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 688175 (XoSoft)

KINEMATICS AND KINETICS OF SQUATS, DROP JUMPS AND IMITATION JUMPS OF SKI JUMPERS

The purpose of this study was to find objective factors in athleticism training which influence the performance of ski jumpers on the hill. Therefore, barbell squats, drop jumps and imitation jumps were measured in a laboratory environment for ten ski jumpers. Force and motion capture data was gathered and forces, velocities as well as an index for the knee valgus were calculated. The results show that especially for the imitation jumps there is a good correlation of the take-off velocity with the performance on the hill. What surprised more is that the more the athletes tended to a knee valgus during all measured movements, the worse the performance. Therefore, athleticism training should concentrate more on improving the knee stability

Influence of functional rider and horse asymmetries on saddle force distribution during stance and in sitting trot

Asymmetric forces exerted on the horse's back during riding are assumed to have a negative effect on rider–horse interaction, athletic performance, and health of the horse. Visualized on a saddle pressure mat, they are initially blamed on a nonfitting saddle. The contribution of horse and rider to an asymmetric loading pattern, however, is not well understood. The aim of this study was to investigate the effects of horse and rider asymmetries during stance and in sitting trot on the force distribution on the horse's back using a saddle pressure mat and motion capture analysis simultaneously. Data of 80 horse-rider pairs (HRP) were collected and analyzed using linear (mixed) models to determine the influence of rider and horse variables on asymmetric force distribution. Results showed high variation between HRP. Both rider and horse variables revealed significant relationships to asymmetric saddle force distribution (P < .001). During sitting trot, the collapse of the rider in one hip increased the force on the contralateral side, and the tilt of the rider's upper body to one side led to more force on the same side of the pressure mat. Analyzing different subsets of data revealed that rider posture as well as horse movements and conformation can cause an asymmetric force distribution. Because neither horse nor rider movement can be assessed independently during riding, the interpretation of an asymmetric force distribution on the saddle pressure mat remains challenging, and all contributing factors (horse, rider, saddle) need to be considered

Exploiting Human Memory B Cell Heterogeneity for Improved Vaccine Efficacy

The major goal in vaccination is establishment of long-term, prophylactic humoral memory to a pathogen. Two major components to long-lived humoral memory are plasma cells for the production of specific immunoglobulin and memory B cells that survey for their specific antigen in the periphery for later affinity maturation, proliferation, and differentiation. The study of human B cell memory has been aided by the discovery of a general marker for B cell memory, expression of CD27; however, new data suggests the existence of CD27− memory B cells as well. These recently described non-canonical memory populations have increasingly pointed to the heterogeneity of the memory compartment. The novel B memory subsets in humans appear to have unique origins, localization, and functions compared to what was considered to be a “classical” memory B cell. In this article, we review the known B cell memory subsets, the establishment of B cell memory in vaccination and infection, and how understanding these newly described subsets can inform vaccine design and disease treatment

An investigation into the association of the physical fitness of equestrians and their riding performance : a cross-sectional study

Poor riding performance may be due to medical issues with the horse or a variety of other factors, such as inadequate equipment or deficiencies in training. The physical fitness of the equestrian is one of the most unexplained factors of current research. The aim of this study is to investigate the association between the physical fitness of the equestrian and riding performance. 115 equestrians were assessed for physical fitness and riding performance. Seven components of physical fitness (balance, endurance, flexibility, reaction, speed, strength, symmetry) were measured by a physiotherapist using equestrian-specific tests. Based on a video-recorded riding test, individual riding performance was rated by two equestrian judges. The riding test included the horse and rider performing a walk, sitting trot, rising trot and canter in both directions. A linear model for riding performance, including the domains of physical fitness and potential confounders (body-mass-index, riding experience, hours of riding per week, and test-motivation), was fitted to the data. Inter-rater reliability of the judges was investigated by calculating the intraclass correlation coefficient (ICC). Endurance, reaction and strength were positively associated with riding performance, whereas flexibility had a negative association. The final model could explain 16.7% of the variance in riding performance. The effects of endurance and strength were significant (P<0.05), but not that of reaction. No association with riding performance was found for the components of balance, speed and symmetry. The inter-rater reliability of judges was confirmed to be ‘good’ to ‘excellent’ (ICC=0.9, 95% confidence interval: 0.86-0.93). Findings suggest that physical fitness is positively associated with riding performance. Fitness-training for equestrians should be included in current training concepts. Future research should investigate whether similar associations exist for junior and elite athletes

Frequent IgE recognition of Blomia tropicalis allergen molecules in asthmatic children and young adults in equatorial Africa

BackgroundAsthma is not well investigated in equatorial Africa and little is known about the disease-associated allergen molecules recognized by IgE from patients in this area. The aim was to study the molecular IgE sensitization profile of asthmatic children and young adults in a semi-rural area (Lambaréné) of an equatorial African country (Gabon), to identify the most important allergen molecules associated with allergic asthma in equatorial Africa.MethodsFifty-nine asthmatic patients, mainly children and few young adults, were studied by skin prick testing to Dermatophagoides pteronyssinus (Der p), D. farinae (Der f), cat, dog, cockroach, grass, Alternaria and peanut. Sera were obtained from a subset of 35 patients, 32 with positive and 3 with negative skin reaction to Der p and tested for IgE reactivity to 176 allergen molecules from different allergen sources by ImmunoCAP ISAC microarray technology and to seven recombinant Blomia tropicalis (Blo t) allergens by IgE dot blot assay.ResultsThirty-three of the 59 patients (56%) were sensitized to Der p and 23 of them (39%) were also sensitized to other allergen sources, whereas 9 patients (15%) were only sensitized to allergen sources other than Der p. IgE serology analyses (n=35) showed high IgE-binding frequencies to the Blo t allergens Blo t 5 (43%), Blo t 21 (43%) and Blo t 2 (40%), whereas the Der p allergens rDer p 2, rDer p 21 and rDer p 5 (34%, 29% and 26%) were less frequently recognized. Only few patients showed IgE reactivity to allergens from other allergen sources, except to allergens containing carbohydrate determinants (CCDs) or to wasp venom allergens (i.e., antigen 5).ConclusionOur results thus demonstrate that IgE sensitization to mite allergens is very prevalent in asthmatics in Equatorial Africa with B. tropicalis allergen molecules representing the most important ones associated with allergic asthma

Basic functionality of a prototype wearable assistive soft exoskeleton for people with gait impairments : a case study

XoSoft is a soft modular wearable assistive exoskeleton for peo- ple with mild to moderate gait impairments. It is currently being developed by a European Consortium (www.xosoft.eu) and aims to provide tailored and active lower limb support during ambu- lation. During development, user-centered design principles were followed in parallel with the aim of providing functional support during gait. A prototype was developed and was tested for practi- cability, usability, comfort and assistive function (summarized as basic functionality) with a potential end user. The prototype con- sisted of a garment, electromagnetic clutch-controlled elastic bands supporting knee- and hip flexion and a backpack containing the sensor and actuator control of the system. The participant had ex- perienced a stroke and presented with unilateral impairment of the lower and upper extremities. In testing, he donned and doffed the prototype independently as far as possible, and performed walk- ing trials with the system in both active (powered on) and pas- sive (powered off) modes. Afterwards, the participant rated the perceived pressure and various elements of usability. Results high- lighted aspects of the system for improvement during future phases of XoSoft development, and also identified useful aspects of proto- type design to be maintained. The basic functionality of XoSoft could be assumed as satisfactory given that it was the first version of a working prototype. The study highlights the benefits of this participatory evaluation design approach in assistive soft robotics development

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy