Comment l'information et le conseil sur les aides techniques contribuent-ils de manière pertinente au processus d'expression des besoins de la personne?

National audienceL'expression des besoins en aide technique d'une personne en situation de handicap passe par la confrontation de son appréciation de ses incapacités dans le cadre de son projet de vie, avec les informations disponibles sur les aides existantes et leurs usages possibles. Dans ce texte nous essayons de cerner les apports des différents acteurs dans ce processus d'expression des besoins. Quelles informations doit-on regrouper, rechercher, lesquelles donner et par qui pour que la personne concernée puisse exprimer ce besoin de façon efficace

Theme E: disabilities: analysis models and tools

International audienceThis paper presents the topics and the activity of the theme E “disabilities: analysis models and tools” within the GDR STIC Santé. This group has organized a conference and a workshop during the period 2011–2012. The conference has focused on technologies for cognitive, sensory and motor impairments, assessment and use study of assistive technologies, user centered method design and the place of ethics in these research topics. The objective of “bodily integration of technique” workshop, organized in the framework of Défi Sens (CNRS) was to develop a multidisciplinary approach (physiology, robotics and anthropology) of the relationships between body and technology taking as an example the prostheses for the compensation of sensorimotor disabilities. Efforts will focus on strengthening the development of a multidisciplinary research for the design of assistive technologies for elderly people and people with disabilities. The modelling of the user’s abilities and the designing of adaptable AT to the needs of the person will be carried out with other groups of this GDR and also with other GDRs

Changing human upper-limb synergies with an exoskeleton using viscous fields

International audienceRobotic exoskeletons can apply forces distributed on the limbs of the subject they are connected to. This offers a great potential in the field of neurorehabilitation, to address the impairment of interjoint coordination in hemiparetic stroke patients. In these patients, the normal flexible joint rotation synergies are replaced by pathological fixed patterns of rotation. In this paper, we investigate how the concept of synergy can be exploited in the control of an upper limb exoskeleton. The long term goal is to develop a device capable of changing the joint synchronization of a patient performing exercises during rehabilitation. The paper presents a controller able of generating joint viscous torques in such a way that constraints on joint velocities can be imposed to the subject without constraining the hand motion. On another hand, the same formalism is used to describe synergies observed on the arm joint motion of subjects realizing pointing tasks. This approach is experimented on a 4 Degrees Of Freedom (DoF) upper arm exoskeleton with subjects performing pointing 3-dimensional tasks. Results exhibit the basic properties of the controller and show its capacity to impose an arbitrary chosen synergy without affecting the hand motion

Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities

Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function

Movement-Based Control for Upper-Limb Prosthetics: Is the Regression Technique the Key to a Robust and Accurate Control?

Due to the limitations of myoelectric control (such as dependence on muscular fatigue and on electrodes shift, difficulty in decoding complex patterns or in dealing with simultaneous movements), there is a renewal of interest in the movement-based control approaches for prosthetics. The latter use residual limb movements rather than muscular activity as command inputs, in order to develop more natural and intuitive control techniques. Among those, several research works rely on the interjoint coordinations that naturally exist in human upper limb movements. These relationships are modeled to control the distal joints (e.g., elbow) based on the motions of proximal ones (e.g., shoulder). The regression techniques, used to model the coordinations, are various [Artificial Neural Networks, Principal Components Analysis (PCA), etc.] and yet, analysis of their performance and impact on the prosthesis control is missing in the literature. Is there one technique really more efficient than the others to model interjoint coordinations? To answer this question, we conducted an experimental campaign to compare the performance of three common regression techniques in the control of the elbow joint on a transhumeral prosthesis. Ten non-disabled subjects performed a reaching task, while wearing an elbow prosthesis which was driven by several interjoint coordination models obtained through different regression techniques. The models of the shoulder-elbow kinematic relationship were built from the recordings of fifteen different non-disabled subjects that performed a similar reaching task with their healthy arm. Among Radial Basis Function Networks (RBFN), Locally Weighted Regression (LWR), and PCA, RBFN was found to be the most robust, based on the analysis of several criteria including the quality of generated movements but also the compensatory strategies exhibited by users. Yet, RBFN does not significantly outperform LWR and PCA. The regression technique seems not to be the most significant factor for improvement of interjoint coordinations-based control. By characterizing the impact of the modeling techniques through closed-loop experiments with human users instead of purely offline simulations, this work could also help in improving movement-based control approaches and in bringing them closer to a real use by patients

Design and acceptability assessment of a new reversible orthosis

International audience— We present a new device aimed at being used for upper limb rehabilitation. Our main focus was to design a robot capable of working in both the passive mode (i.e. the robot shall be strong enough to generate human-like movements while guiding the weak arm of a patient) and the active mode (i.e. the robot shall be able of following the arm without disturbing human natural motion). This greatly challenges the design, since the system shall be reversible and lightweight while providing human compatible strength, workspace and speed. The solution takes the form of an orthotic structure, which allows control of human arm redundancy contrarily to clinically available upper limb rehabilitation robots. It is equipped with an innovative transmission technology, which provides both high gear ratio and fine reversibility. In order to evaluate the device and its therapeutic efficacy, we compared several series of pointing movements in healthy subjects wearing and not wearing the orthotic device. In this way, we could assess any disturbing effect on normal movements. Results show that the main movement characteristics (direction, duration, bell shape profile) are preserved

Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis

Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object.Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task.Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm.Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release

Le dessin, trace géométrique du mouvement humain.

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