Design Methodology for Rehabilitation Robots: Application in an Exoskeleton for Upper Limb Rehabilitation

This article presents a methodology for the design of rehabilitation devices that considers factors involved in a clinical environment. This methodology integrates different disciplines that work together. The methodology is composed by three phases and 13 stages with specific tasks, the first phase includes the clinical context considering the requirements of the patient and therapist during the rehabilitation, the second phase is focused in engineering based on the philosophy of digital twin, and in the third phase is evaluated the device. This article explains the characteristics of the methodology and how it was applied in the design of an exoskeleton for passive rehabilitation of upper limb

Design of an Exoskeleton based on Four Cases of Upper Limb Rehabilitation Study

En este artículo se presenta un enfoque para rehabilitación pasiva de miembro superior mediante la formulación de cuatro casos de estudio haciendo un análisis de las patologías y los ejercicios que se aplican. Para llevar a cabo la experimentación en los casos propuestos se registraron los datos de las trayectorias de las articulaciones del brazo de un paciente realizando los ejercicios de rehabilitación con un terapeuta. Se diseñó el exoesqueleto ERMIS de siete grados de libertad para emular los movimientos anatómicos en el brazo durante la rehabilitación a partir de los requerimientos de los casos de estudio. Para validar el funcionamiento del exoesqueleto en los casos se simuló el modelo dinámico del ERMIS y se compararon los datos con los datos muestreados de los ejercicios. Al final se presentan los resultados obtenidos de los ejercicios realizados con el exoesqueleto, obteniendo en la precisión un desempeño promedio del 95% en los movimientos de hombro, codo y muñeca al emular la terapia con timón.This paper presents an approach for passive upper limb rehabilitation based on four case studies by analyzing the pathologies and exercises that are applied. To carry out the experimentation in the proposed cases, the data from the trajectories of the patient’s arm articulations were registered, performing the rehabilitation exercises with a therapist. The ERMIS exoskeleton´s seven degrees of freedom was designed to emulate the anatomical movements in the arm during rehabilitation from the requirements of the case studies. To validate the exoskeleton performance in the study cases, the ERMIS’s dynamic model was simulated and the data were compared with the sampled data of the exercises. At the end, the results obtained from exoskeleton exercises emulating rudder therapy, where shoulder, elbow and wrist movements were showed with an accuracy of 95%

Actuadores de nitinol aplicados en la mimetización del sistema de propulsión de peces con median paired fin

Este artículo presenta una propuesta original para diseñar actuadores empleando una aleación con memoria de forma shape memory alloy conocida corno nitinol. La aplicación se centra en el uso de estos actuadores en un robot que mimetiza a los organismos poseedores de aletas de locomoción tipo median paired fin

MOPAREM: Passive Wrist Mobilizer implemented in Three Case Studies

Se pretende validar el diseño del movilizador pasivo para rehabilitación de muñeca (MOPAREM) en tres casos de estudio mediante una metodología de diseño conformada por tres etapas y trece fases. Los resultados sugieren el establecimiento de las características finales del MOPAREM, validadas en simulación y experimentación con una diferencia de datos de 0.1 Nm, ya que logran un nivel de madurez tecnológica TRL4 y constituyen un modelo físico experimental de bajo costo que opera con parámetros controlados de laboratorio. Son necesarias nuevas alternativas de solución al problema que representa la rehabilitación de la muñeca con base en el bajo costo para los pacientes.Se pretende validar el diseño del movilizador pasivo para rehabilitación de muñeca (MOPAREM) en tres casos de estudio mediante una metodología de diseño conformada por tres etapas y trece fases. Los resultados sugieren el establecimiento de las características finales del MOPAREM, validadas en simulación y experimentación con una diferencia de datos de 0.1 Nm, ya que logran un nivel de madurez tecnológica TRL4 y constituyen un modelo físico experimental de bajo costo que opera con parámetros controlados de laboratorio. Son necesarias nuevas alternativas de solución al problema que representa la rehabilitación de la muñeca con base en el bajo costo para los pacientes

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine