Desarrollo de exo-guante para terapias de rehabilitación

The increase in life expectancy has led to an increase in the number of people aged over 65 years old. For individuals over 65 years old, due to certain comorbidities (hypertension, high blood cholesterol levels, diabetes, etc.), it is more likely that they may suffer from strokes, both ischemic and hemorrhagic, leading to the loss of mobility in certain limbs. Additionally, due to physical deterioration, they are more likely to suffer injuries that affect their mobility. They may even experience a loss of mobility due to certain age-related diseases such as osteoarthritis and arthritis. With the aim of achieving the highest social welfare, certain investigations have emerged to improve the life of the people. Technological advances have made it possible for robotic devices to be used in rehabilitation therapies to assist individuals in regaining the mobility they have lost due to illness, so that they can retrieve their normal life. The hand is one of the most frequently used extremities and is also one of the most complex due to the large number of degrees of freedom and skill required to perform daily tasks. Therefore, this work has focused on the design of an actuated exo-glove for hand rehabilitation. This exo-glove is a wearable device based on a glove on which artificial tendons have been placed, simulating the placement of tendons and muscles of the human hand. This ensures patient comfort and a bio-inspired movement of the glove. The artificial tendons are mobilized by actuators based on Shape Memory Alloys (SMAs), and their interconnection is made through a sensorized box, which measures the displacement of each actuator through linear potentiometers. The movements that are actuated in this glove correspond to the flexion and extension of the 5 fingers of the hand, and also include opposition of the thumb as it is an important movement in grasping everyday objects. The designed device can be used during hand rehabilitation therapies, both active, where the patient is involved, detecting the patient’s movement intention through electromyography (EMG) signals, and passive, where the patient does not make any movement, with the exoglove performing repetitive movements. Two algorithms have been studied for detecting hand movements through EMG signals. For one of them, the Quattro device is used for EMG signal acquisition, and a neural network is used for movement classification, while the other uses the MYO Armband device for EMG signal acquisition and a KNN algorithm for movement classification. Finally, functional validation tests of the device have been performed, developing tests similar to rehabilitation therapies. Firstly, finger mobilization is performed independently to evaluate the joint ranges of the specific patient. Then, repetitive movements are performed for 5 cycles of simple hand movements (fist-opening, pinch-opening, open-relax). In addition, tests are performed for exo-glove movement to grip certain objects found in the daily environment. Lastly, functional validation tests of the device were carried out on 12 patients. The tests were based on independent finger-to-finger mobilisation, followed by repetitive movement therapy involving fisting and opening, and gripping and opening. Patients rated the most important features of the device by filling in the QUEST form. In conclusion, this work has developed an adjustable, comfortable, and lightweight rehabilitation exo-glove whose performance is acceptable in both active and passive rehabilitation therapies. Future work is proposed to improve the designed prototype.El incremento en la esperanza de vida de la población, ha generado un aumento en el número de personas con edad superior a 65 años. En el caso de las personas mayores de 65 años, debido a ciertas comorbilidades (hipertensión, niveles altos de colesterol en sangre, diabetes, etc), el riesgo de un posible ictus, tanto isquémico como hemorrágico, provocando la pérdida de movilidad en determinadas extremidades, es más elevado. También debido al deterioro físico tienen más probabilidad de sufrir lesiones que afecten a la movilidad, incluso pueden sufrir pérdida de movilidad por determinadas enfermedades relacionadas con la edad avanzada, como pueden ser la artrosis, artritis, etc. Debido a todo esto y con el objetivo de conseguir el mayor bienestar social, han surgido determinadas investigaciones que mejoran la vida de las personas. El avance de las tecnologías ha hecho posible la aparición de líneas de investigación basadas en dispositivos robóticos para terapias de rehabilitación, con el propósito de ayudar a las personas en la recuperación de la movilidad que han perdido debido a alguna enfermedad, para que de esta forma puedan recuperar su vida normal. Una de las extremidades más utilizadas a diaria es la mano, siendo también una de las más complejas, por su gran número de grados de libertad y la destreza que requiere para la realización de las tareas cotidianas. La pérdida de movilidad en esta extremidad dificulta la autonomía de las personas en actividades de la vida diaria y crea dependencia de otras personas. Por esto, este trabajo se ha centrado en el diseño de un exo-guante actuado para la rehabilitación de la mano. Dicho exo-guante es un dispositivo "wearable", basado en un guante de neopreno sobre el que se han colocado unos tendones artificiales, simulando la colocación de tendones y músculos de la mano humana, manteniéndose las principales características de un exoesqueleto rígido, en un diseño compacto, cómodo y bioinspirado. Los tendones artificiales son movilizados por actuadores basados en Shape Memory Alloys (SMA), y su interconexión se realiza a través de una caja sensorizada, la cual mide el desplazamiento de cada actuador a través de potenciómetros lineales. Además de los movimientos de flexión y extensión de los cinco dedos de la mano, el exo-guante permite la movilización de la oposición del pulgar puesto que, es un movimiento importante en agarres de la vida diaria. El dispositivo diseñado puede ser utilizado durante las terapias de rehabilitación de la mano, tanto activas, en las que el paciente está involucrado, detectando la intención de movimiento del paciente a través de señales de electromiografía (EMG), como pasivas, en las que el paciente no realiza ningún movimiento, realizando el exo-guante movimientos repetitivos. En este trabajo se han estudiado dos algoritmos para la detección de movimientos de la mano a través de señales de EMG. Para uno de ellos se utiliza el dispositivo Quattro de la empresa OT Bioelettronica para la adquisición de señales EMG, y utilizando una red neuronal para la clasificación de movimientos, sin embargo, el otro utiliza el dispositivo MYO Armband para la adquisición de señales EMG y un algoritmo KNN (del inglés K-nearest neighbors) para la clasificación de los movimientos. Finalmente, en este trabajo se han realizado pruebas de validación funcional del dispositivo, desarrollando unos tests similares a las terapias de rehabilitación. En primer lugar, se ha realizado la movilización de los dedos de forma independiente para evaluar los rangos articulares del paciente concreto, a continuación se realizan movimientos repetitivos durante 5 ciclos de combinaciones de movimientos simples de la mano (puño-apertura, pinza-apertura, apertura-relax). Además, se han realizado pruebas de movimiento del exo-guante para el agarre de determinados objetos que se encuentran en el entorno cotidiano. Por último, se han llevado a cabo pruebas de validación funcional del dispositivo sobre 12 pacientes. Las pruebas se han basado en la movilización dedo a dedo independientemente, y posteriormente se ha aplicado una terapia de movimientos repetitivos de puño y apertura, y, pinza y apertura. Los pacientes han valorado las características más importantes del dispositivo, rellenando el formulario QUEST. Se concluye que en este trabajo se ha desarrollado un exo-guante de rehabilitación que es ajustable, cómodo y de bajo peso, cuyo funcionamiento es aceptable tanto en terapias de rehabilitación activa como pasivas. Con el objetivo de mejorar el prototipo diseñado se proponen trabajos futuros.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: Rafael Raya López.- Secretario: David Álvarez Sánchez.- Vocal: Cristina Bayón Calderó

A High-Level Control Algorithm Based on sEMG Signalling for an Elbow Joint SMA Exoskeleton

A high-level control algorithm capable of generating position and torque references from surface electromyography signals (sEMG) was designed. It was applied to a shape memory alloy (SMA)-actuated exoskeleton used in active rehabilitation therapies for elbow joints. The sEMG signals are filtered and normalized according to data collected online during the first seconds of a therapy session. The control algorithm uses the sEMG signals to promote active participation of patients during the therapy session. In order to generate the reference position pattern with good precision, the sEMG normalized signal is compared with a pressure sensor signal to detect the intention of each movement. The algorithm was tested in simulations and with healthy people for control of an elbow exoskeleton in flexion&-extension movements. The results indicate that sEMG signals from elbow muscles, in combination with pressure sensors that measure arm&-exoskeleton interaction, can be used as inputs for the control algorithm, which adapts the reference for exoskeleton movements according to a patient's intention.The research was funded by RoboHealth (DPI2013-47944-C4-3-R) and the EDAM (DPI2016-75346-R) Spanish research projects

SMA-based soft exo-glove

Nowadays, robotic technologies are used in many fields, one of them is medicine. The breakthrough of technologies has enabled the development of robotic devices for rehabilitation therapies. The exoskeletons can be found as robotic device for rehabilitation therapy, whose rigidity limits the users freedom of movement, complicating his interaction with the environment in an easy and natural way. To overcome this current limitation, researchers invest effort in the development of soft devices, wearable, portable and comfortable for patients, maintaining the rigid exoskeletons performance. The soft exo-glove proposed in this work, accomplishes three main previous features. It is actuated by Shape Memory Alloys (SMA) that reduce the device weight and turn it into a portable exoskeleton. The exo-glove is easier to wear and it is comfortable. The proposed exo-glove represents a safe and adaptable solution for the human hand rehabilitation therapy with special emphasis on the activities of daily living (ADL). We are going to analyze exo-glove performance during ADL movements, e.g. gripping different objects with diverse dimensions, in which, other exoskeletons have some limitations. In terms to address this challenge, a specific position controller was designed which enables the single displacement of each finger with a linear actuator precision of 5%.This work was supported in part by the “Discover2Walk: Sistema robótico para propiciar la marcha en niños pequeños con Parálisis Cerebral” under Grant PID2019-105110RB-C32/AEI/10.13039/501100011033, in part by the Agencia Estatal de Investigación (AEI), in part by the R&D&I project under Grant PLEC2021-007819, in part by MCIN/AEI/10.13039/501100011033, and in part by European Union NextGenerationEU/PRTR

Efficiency analysis of SMA-based actuators: Possibilities of configuration according to the application

Shape memory alloy (SMA) actuators have recently demonstrated their potential for various applications in fields such as robotics, medicine, aerospace, and automotive. Its features, such as low weight and high force, simplicity, noiseless operation, and low cost compared with other conventional actuator, are only a few advantages of this actuator, which is receiving increasing interest among researchers. However, the use of these actuators is still limited by some of their characteristics: high position error in the cooling stage when the actuator works at frequencies that exceed the necessary cooling time and high electrical energy consumption. Different actuator configurations can help minimize these disadvantages through modifying the length, the number of cables, or the sheath used in the actuator, which modify the characteristics of the complete system. In this work, we developed different configurations of SMA actuators and tested their performance in terms of efficiency and the position error in the cooling stage. The findings demonstrate that over-dimensioned actuators are more energetically efficient and present a faster initial form recovery. The multi-wires actuator configuration produce a better response in terms of position but are less energy efficient. These conclusions allow for the selection of the most appropriate configuration based on the requirements of each particular application.For this research, we received funding from the Sistema robótico para propiciar la marcha en niños pequeños con Parálisis Cerebral under Grant PID2019-105110RB-C32/AEI/10.13039/501100011033, Spanish research project; from RoboCity2030-DIH-CM, Madrid Robotics Digital Innovation Hub, S2018/NMT-4331, funded by Programas de Actividades I&D en la Comunidad de Madrid; and co-funded by Structural Funds of the EU

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pasados y presente. Estudios para el profesor Ricardo García Cárcel

Ricardo García Cárcel (Requena, 1948) estudió Historia en Valencia bajo el magisterio de Joan Reglà, con quien formó parte del primer profesorado de historia moderna en la Universidad Autónoma de Barcelona. En esta universidad, desde hace prácticamente cincuenta años, ha desarrollado una extraordinaria labor docente y de investigación marcada por un sagaz instinto histórico, que le ha convertido en pionero de casi todo lo que ha estudiado: las Germanías, la historia de la Cataluña moderna, la Inquisición, las culturas del Siglo de Oro, la Leyenda Negra, Felipe II, Felipe V, Austrias y Borbones, la guerra de la Independencia, la historia cultural, los mitos de la historia de España... Muy pocos tienen su capacidad para reflexionar, ordenar, analizar, conceptualizar y proponer una visión amplia y llena de matices sobre el pasado y las interpretaciones historiográficas. A su laboriosidad inimitable se añade una dedicación sin límites en el asesoramiento de alumnos e investigadores e impulsando revistas, dosieres, seminarios o publicaciones colectivas. Una mínima correspondencia a su generosidad lo constituye este volumen a manera de ineludible agradecimiento

Efficiency Analysis of SMA-Based Actuators: Possibilities of Configuration According to the Application

Shape memory alloy (SMA) actuators have recently demonstrated their potential for various applications in fields such as robotics, medicine, aerospace, and automotive. Its features, such as low weight and high force, simplicity, noiseless operation, and low cost compared with other conventional actuator, are only a few advantages of this actuator, which is receiving increasing interest among researchers. However, the use of these actuators is still limited by some of their characteristics: high position error in the cooling stage when the actuator works at frequencies that exceed the necessary cooling time and high electrical energy consumption. Different actuator configurations can help minimize these disadvantages through modifying the length, the number of cables, or the sheath used in the actuator, which modify the characteristics of the complete system. In this work, we developed different configurations of SMA actuators and tested their performance in terms of efficiency and the position error in the cooling stage. The findings demonstrate that over-dimensioned actuators are more energetically efficient and present a faster initial form recovery. The multi-wires actuator configuration produce a better response in terms of position but are less energy efficient. These conclusions allow for the selection of the most appropriate configuration based on the requirements of each particular application

Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial

Background Rosiglitazone is a thiazolidinedione that reduces insulin resistance and might preserve insulin secretion. The aim of this study was to assess prospectively the drugs ability to prevent type 2 diabetes in individuals at high risk of developing the condition