Kinematic and Kinetic Comparisons of Arm and Hand Reaching Movements with Mild and Moderate Gravity-Supported, Computer-Enhanced Armeo®spring: A Case Study

Background: Stroke has been recognized as a leading cause of serious long-term disability in the United States (U.S.) with 795,000 people experience a new or recurrent stroke each year (Roger et al., 2011). The most apparent defect after stroke is motor impairments (Masiero, Armani, & Rosati, 2011). Statistically, half of stroke survivors suffer from upper extremity hemiparesis and approximately one quarter become dependent in activities of daily living (Sanchez et al., 2006). There is strong evidence that intensity and task specificity are the main drivers in an effective treatment program after stroke. In addition, this training should be repetitive, functional, meaningful, and challenging for a patient (Van Peppen et al., 2004). The use of robotic systems to complement standard poststroke multidisciplinary programs is a recent approach that looks very promising. Robotic devices can provide high-intensity, repetitive, task-specific, interactive treatment of the impaired limb and can monitor patients\u27 motor progress objectively and reliably, measuring changes in quantitative movement kinematics and forces (Masiero, Armani, & Rosati, 2011). Objective: The purpose of this study was to examine the role of Armeo®Spring (Hocoma, Inc.), a gravity-supported, computer-enhanced robotic devise, on reaching movements while using two different gravity-support levels (mild and moderate weight support) on individuals with stroke. Methods: One stroke subject and one gender-matched healthy control participated in this study after gaining their informed consent. Both subjects performed a computer-based game (picking apples successfully and placing them in a shopping cart) under two gravity weight-support conditions (mild and moderate) provided by the Armeo®Spring device. The game tasks were described as a reaching cycle which consisted of five phases (initiation, reaching, grasping, transporting, and releasing). Joint angles for the glenohumeral and elbow joints throughout the reaching cycle were found. Three kinematic parameters (completion time, moving velocity, acceleration) and one kinetic parameter (vertical force acting on the forearm) was calculated for various instances and phases of the reaching motion. In addition, the muscle activation patterns for anterior deltoid, middle deltoid, biceps, triceps, extensor digitorum, flexor digitorum, and brachioradialis were found and the mean magnitude of the electromyography (EMG) signal during each phase of the reaching cycle was found as a percentage of the subject\u27s maximum voluntary contraction (MVC). Results: Within the healthy control subject, results demonstrated no significant differences in mean completion time, moving velocity, or acceleration between mild to moderate gravity-support levels during all phases of the cycle. The stroke subject results revealed a significant decrease in the cycle mean completion time (p= 0.042) between the two gravity-support levels, specifically in mean completion time of the grasping phase. A significant increase was found in the initiation phase moving velocity (p=0.039) and a significant decrease was found in the grasping phase (p=0.048) between two gravity-support levels in the stroke subject. Between subjects, significant increase in the cycle mean completion time was found under both mild and moderate conditions (p\u3c.001 for both conditions). Additionally, significant decreases in the moving velocities were found in all phases of the cycle between the healthy control and the stroke subject under both conditions. With increasing weight support, the healthy control subject showed an increase in abduction and flexion degrees at the glenohumeral joint level, and an increase in flexion degrees of the elbow joint. On the other hand, the stroke subject showed a decrease in abduction degrees and an increase in flexion degrees at the glenohumeral joint level, and a decrease in flexion degrees of the elbow joint after increasing the weight-support level. Results demonstrated an increase in the mean of vertical forces when changing gravity-support levels from mild to moderate during all phases of the cycle in both stroke and healthy subjects. Last, the average EMG magnitude during the reaching cycle phases was reduced for muscles acting against gravity (anterior deltoid, middle deltoid, biceps, and brachioradialis) in both the healthy control and the stroke subject. Conclusion: The significant differences in movement performance between mild and moderate physical weight support suggested a preliminary result that the gravity-supported mechanism provides a mean to facilitate functional upper limb motor performance in individuals with stroke. Future studies should examine such effects with larger sample sizes

Feasibility of a Self-Paced Educational Intervention Protocol on Standardized Assessment of Public Building Accessibility

Limited research informs the implementation of web-based and mobile learning (mLearning) protocols for the assessment of public building accessibility in occupational therapy graduate students. This study tested the feasibility of a self-paced protocol designed to teach students how to evaluate community environment accessibility. Students across five sites completed an online learning module and community building evaluations. Students were randomized into lecture or lab educational groups and then crossed over to receive the second experience. Outcomes were student satisfaction, self-perceived learning, and knowledge on a researcher-developed measure. Data were analyzed using descriptive statistics. Two hundred and twelve students completed the study. The students were satisfied with their education and their community accessibility knowledge significantly increased from approximately 60% to 85%. Site and order of the learning components did not impact student ability to achieve competence. This multi-site approach is feasible and effective in instructing students in this highly protocolized and specialized area of practice

Assistive technology products: a position paper from the first global research, innovation, and education on assistive technology (GREAT) summit

This paper is based on work from the Global Research, Innovation, and Education on Assistive Technology (GREAT) Summit that was coordinated by WHO’s Global Cooperation on Assistive Technology (GATE). The purpose of this paper is to describe the needs and opportunities embedded in the assistive product lifecycle as well as issues relating to the various stages of assistive product mobilization worldwide. The paper discusses assistive technology product terminology and the dangers of focusing on products outside the context and rolling out products without a plan. Additionally, the paper reviews concepts and issues around technology transfer, particularly in relation to meeting global needs and among countries with limited resources. Several opportunities are highlighted including technology advancement and the world nearing a state of readiness through a developing capacity of nations across the world to successfully adopt and support the assistive technology products and applications. The paper is optimistic about the future of assistive technology products reaching the people that can use it the most and the excitement across large and small nations in increasing their own capacities for implementing assistive technology. This is expressed as hope in future students as they innovate and in modern engineering that will enable assistive technology to pervade all corners of current and potential marketplaces. Importantly, the paper poses numerous topics where discussions are just superficially opened. The hope is that a set of sequels will follow to continue this critical dialog