Socioeconomic disparities and difficulties to access to healthcare services among Canadian children with neurodevelopmental disorders and disabilities

OBJECTIVES The aims of this study were to identify the associations of levels of severity of neurodevelopmental disorders and disabilities (NDD/D) in children with their household socioeconomic status (SES) and their frequency of visits to a healthcare provider, and to examine how the severity of disability varied with these determinants among NDD/D subgroups, in order to inform possible social policy changes and to improve access to the healthcare system. METHODS Data from the 2006 Participation and Activity Limitation Survey on children aged 5-14 years, collected by Statistics Canada, were analyzed (n=7,072 and weighted n=340,340). Children with NDD/D constituted those with impairments in motor, speech, neurosensory, and psychological functioning, as well as those who had issues with learning/cognition and social interactions. The weighted sample size for this group was n=111,630 (total sample size for children with limitations: n=174,810). We used logistic regression to assess the associations of household SES and frequency of visits to a healthcare provider with disability level. We included NDD/D subgroups as interaction terms in the model. Multiple correspondence analysis (MCA) was conducted to develop a profile of disability level. RESULTS After-tax low income, family assistance, out-of-pocket expenses, needing but not receiving health services from a social worker, condition of the dwelling, and residential location were associated with the severity of NDD/D. Using MCA, 2 disability profiles could be identified based on access to healthcare, household income status, and condition of the dwelling. CONCLUSIONS More social interventions are needed to reduce difficulties in accessing healthcare and to diminish the socially determined health inequalities faced by children with NDD/D

Motion planning of upper-limb exoskeleton robots : a review

ABSTRACT: Background: Motion planning is an important part of exoskeleton control that improves the wearer’s safety and comfort. However, its usage introduces the problem of trajectory planning. The objective of trajectory planning is to generate the reference input for the motion-control system. This review explores the methods of trajectory planning for exoskeleton control. In order to reduce the number of surveyed papers, this review focuses on the upper limbs, which require refined three-dimensional motion planning. Methods: A systematic search covering the last 20 years was conducted in Ei Compendex, Inspect-IET, Web of Science, PubMed, ProQuest, and Science-Direct. The search strategy was to use and combine terms “trajectory planning”, “upper limb”, and ”exoskeleton” as high-level keywords. “Trajectory planning” and “motion planning” were also combined with the following keywords: “rehabilitation”, “humanlike motion“, “upper extremity“, “inverse kinematic“, and “learning machine “. Results: A total of 67 relevant papers were discovered. Results were then classified into two main categories of methods to plan trajectory: (i) Approaches based on Cartesian motion planning, and inverse kinematics using polynomial-interpolation or optimization-based methods such as minimum-jerk, minimum-torque-change, and inertia-like models; and (ii) approaches based on “learning by demonstration” using machine-learning techniques such as supervised learning based on neural networks, and learning methods based on hidden Markov models, Gaussian mixture models, and dynamic motion primitives. Conclusions: Various methods have been proposed to plan the trajectories for upper-limb exoskeleton robots, but most of them plan the trajectory offline. The review approach is general and could be extended to lower limbs. Trajectory planning has the advantage of extending the applicability of therapy robots to home usage (assistive exoskeletons); it also makes it possible to mitigate the shortages of medical caregivers and therapists, and therapy costs. In this paper, we also discuss challenges associated with trajectory planning: kinematic redundancy and incompatibility, and the trajectory-optimization problem. Commonly, methods based on the computation of swivel angles and other methods rely on the relationship (e.g., coordinated or synergistic) between the degrees of freedom used to resolve kinematic redundancy for exoskeletons. Moreover, two general solutions, namely, the self-tracing configuration of the joint axis and the alignment-free configuration of the joint axis, which add the appropriate number of extra degrees of freedom to the mechanism, were employed to improve the kinematic incompatibility between human and exoskeleton. Future work will focus on online trajectory planning and optimal control. This will be done because very few online methods were found in the scope of this study

Current trends and challenges in pediatric access to sensorless and sensor-based upper limb exoskeletons

ABSTRACT: Sensorless and sensor-based upper limb exoskeletons that enhance or support daily motor function are limited for children. This review presents the different needs in pediatrics and the latest trends when developing an upper limb exoskeleton and discusses future prospects to improve accessibility. First, the principal diagnoses in pediatrics and their respective challenge are presented. A total of 14 upper limb exoskeletons aimed for pediatric use were identified in the literature. The exoskeletons were then classified as sensorless or sensor-based, and categorized with respect to the application domain, the motorization solution, the targeted population(s), and the supported movement(s). The relative absence of upper limb exoskeleton in pediatrics is mainly due to the additional complexity required in order to adapt to children’s growth and answer their specific needs and usage. This review highlights that research should focus on sensor-based exoskeletons, which would benefit the majority of children by allowing easier adjustment to the children’s needs. Sensor-based exoskeletons are often the best solution for children to improve their participation in activities of daily living and limit cognitive, social, and motor impairments during their development