Transcranial Doppler Remote Positioning System with Virtual Reality Integration for Vestibular Studies.

Transcranial doppler (TCD) ultrasound probes are an invaluable tool in cerebral blood flow (CBF) studies. Their operation demands maintaining consistent pose on the subject throughout the experimental protocol. However, the displacement of the TCD probe during vestibular studies is common and substantially prolongs the experiment or even terminates it. This is a significant challenge for integrating motion-based vestibular studies with CBF investigations. In response, a mechatronics system is designed to allow remote repositioning of the TCD probe during data collection experiments while the subject is wearing a head mounted virtual reality (VR) display and seated in a vestibular disorientation device. This paper presents the design, prototype, and operation of this mechatronics apparatus.Clinical Relevance- The mechatronics apparatus of this paper can enable motion-based vestibular studies that entail the use of CBF velocity measurement and head-mounted virtual reality display.

Analyzing the outcomes of a robotics workshop on the self-efficacy, familiarity, and content knowledge of participants and examining their designs for end-of-year robotics contests.

Rapid advances in science and engineering, and pervasive adoption of resulting technological products, are influencing every aspect of human living and fueling a growing demand for a workforce that is adequately prepared for the emerging occupations in STEM fields. Educating students for success in the modern technology-rich workplace requires teachers who have the knowledge, comfort, capability, and training to adopt and integrate new technologies for classroom teaching and learning. Thus, to prepare high school teachers for incorporating robotics in their students' education and promoting their understanding of engineering concepts and technology applications, a four-week long robotics workshop was designed and conducted annually for three summers. Examination of changes in the workshop participants' levels of robotics self-efficacy, familiarity, and content knowledge, as well as analysis of outcomes of robotics capstone projects and end-of-year contests, is suggestive of study findings being promising for education researchers and professional development providers interested in leveraging the potential of robotics in STEM education.

A Lymphatic Drainage Robot for Lymphedema Rehabilitation.

Lymphedema is a medical condition that results in swelling and discomfort in human arms or legs. Caused due to the build-up of lymph fluid in the tissues under the skin, lymphedema commonly affects one of the arms or legs and it is an incurable condition that requires treatment for control. A common treatment is manual lymphatic drainage (MLD), a massage therapy to remove the excess lymphatic fluid out of the tissues back into the lymphatic vessels. This paper proposes a portable and mobile device, lymphatic drainage robot (LDR), as an alternative to MLD. The prototype LDR, a combination of soft and hard robotic hardware, stimulates the lymphatic system. The robot climbs up the human limb, i.e., an arm or a leg, while applying radial pressure on the skin to remove the excess lymph fluid into the lymph vessels towards the upper side of the limb. The preliminary design of the device stipulated in this paper can be transformed into a product that can be commercially-produced and provided directly to the rehabilitation clinics and lymphedema patients. Clinical relevance - This paper presents a working prototype of an autonomous robotic product that simulates MLD towards the rehabilitation of lymphedema condition.

Range of Motion Assessment using a Digital Voice Assistant.

Range of motion (ROM) is an important indicator of an individual's physical health, and its degradation impacts their ability to perform activities of daily living. The elderly are particularly susceptible to mobility loss due to muscular decline, neuromuscular disorders, sedentary lifestyle, etc. Thus, they must undergo periodic ROM assessments to track their physical well-being and consult doctors for any decline in ROM. An at-home ROM assessment device can assist the elderly to self-perform ROM assessment and facilitate remote monitoring of and compliance to therapy. The pervasive adoption of digital voice assistants (DVAs), that include a monocular camera, offers an opportunity for at-home ROM assessment. This paper proposes using a DVA for ROM measurement by utilizing 2D pose estimation techniques to estimate 3D limb pose for specific exercises. The system employs the MediaPipe library to perform 2D pose estimation and uses the joint coordinates to find the 3D pose of the limb using a 2D projection method. To validate the system, it is first compared with a 3D human model performing various shoulder and elbow exercises in a virtual environment. Next, for further validation, a neurologically intact individual performs the same exercises and the results of the proposed system are compared with the results from a markerless optical motion capture system (Kinect). The Bland-Altman limits of agreement (LOA) are computed and provided for the two sets of comparisons. The results demonstrate the feasibility of the proposed system in providing reliable ROM measurements using a DVA and suggest possible enhancements. Clinical relevance- This paper introduces the concept of ROM measurement using digital voice assistants embedded with a monocular camera.

A COVID-19 Emergency Response for Remote Control of a Dialysis Machine with Mobile HRI.

Healthcare workers face a high risk of contagion during a pandemic due to their close proximity to patients. The situation is further exacerbated in the case of a shortage of personal protective equipment that can increase the risk of exposure for the healthcare workers and even non-pandemic related patients, such as those on dialysis. In this study, we propose an emergency, non-invasive remote monitoring and control response system to retrofit dialysis machines with robotic manipulators for safely supporting the treatment of patients with acute kidney disease. Specifically, as a proof-of-concept, we mock-up the touchscreen instrument control panel of a dialysis machine and live-stream it to a remote user's tablet computer device. Then, the user performs touch-based interactions on the tablet device to send commands to the robot to manipulate the instrument controls on the touchscreen of the dialysis machine. To evaluate the performance of the proposed system, we conduct an accuracy test. Moreover, we perform qualitative user studies using two modes of interaction with the designed system to measure the user task load and system usability and to obtain user feedback. The two modes of interaction included a touch-based interaction using a tablet device and a click-based interaction using a computer. The results indicate no statistically significant difference in the relatively low task load experienced by the users for both modes of interaction. Moreover, the system usability survey results reveal no statistically significant difference in the user experience for both modes of interaction except that users experienced a more consistent performance with the click-based interaction vs. the touch-based interaction. Based on the user feedback, we suggest an improvement to the proposed system and illustrate an implementation that corrects the distorted perception of the instrumentation control panel live-stream for a better and consistent user experience.

Usability study of wearable inertial sensors for exergames (WISE) for movement assessment and exercise.

BACKGROUND: Accurate assessment of movement limitations and compliance monitoring of exercises to restore movement are necessary to tailor treatments for individuals with motor deficits. Although several commercial-grade technologies are available to clinicians for evaluating movement limitations, they require one-on-one time-consuming assessments with limited reproducibility across care settings. To address these limitations, a wearable inertial sensors for exergames (WISE) system has been designed with: (I) an animated virtual coach to deliver instruction and (II) a subject-model whose movements are animated by real-time sensor measurements from the WISE system worn by a subject. This paper examines the WISE system's accuracy and usability for the assessment of upper limb range of motion (ROM). METHODS: Seventeen neurologically intact subjects were recruited to participate in a usability study of the WISE system. The subjects performed five shoulder and elbow exercises for each arm instructed by the animated virtual coach. The accuracy of ROM measurements obtained with the WISE system versus those obtained with the Kinect™ were compared using the root mean square error (RMSE) of the computed joint angles. The subjects additionally completed a system usability scale (SUS) to evaluate the usability of the virtual coach for tutoring ROM exercises. RESULTS: The absolute agreement between the WISE and Kinect devices was moderate to very good and it was limited because the Kinect sensor suffers from occlusion. The Bland-Altman limits of agreement for the exercises in the coronal and transverse planes were within the acceptable limits of ±10°. The SUS response data produced relatively high third and first quartile scores of 97.5 and 82.5, respectively, with the interquartile range of 15 and the minimum score of 65, suggesting that the subjects were interested in using the animated virtual coach for tutoring ROM exercises. CONCLUSIONS: An animated virtual coach-based WISE system for mHealth is presented, tested, and validated for guided upper limb ROM exercises. Future studies with patient populations will facilitate the use of these devices in clinical and telerehabilitation settings.

Developing a Framework for Designing and Deploying Technology-Assisted Rehabilitation After Stroke: A Qualitative Study.

OBJECTIVE: Many unmet rehabilitation needs of patients with stroke can be addressed effectively using technology. However, technological solutions have not yet been seamlessly incorporated into clinical care. The purpose of this pilot study was to examine how to bridge the gaps between the recovery process, technology, and clinical practice to impact stroke rehabilitation meaningfully. DESIGN: Semistructured interviews were performed using a grounded theory approach with purposive sampling of 17 diverse expert providers in acute care, inpatient, and outpatient stroke rehabilitation settings. Common themes were identified from qualitative analyses of the transcribed conversations to develop a guiding framework from the emerging concepts. RESULTS: Four core themes emerged that addressed major barriers in stroke rehabilitation and technology-assisted solutions to overcome these barriers: (1) accessibility to quality rehabilitation, (2) adaptability to patient differences, (3) accountability or compliance with rehabilitation, and (4) engagement with rehabilitation. CONCLUSIONS: The results suggest a four-pronged framework, the A3E framework that stands for Accessibility, Adaptability, Accountability, and Engagement, to comprehensively address existing barriers in providing rehabilitation services. This framework can guide technology developers and clinicians in designing and deploying technology-assisted rehabilitation solutions for poststroke rehabilitation, particularly using telerehabilitation.

Wearable Inertial Sensors for Exergames and Rehabilitation.

This paper presents the design and development of an exergame for the wearable inertial sensor (WIS) system for performing range of motion (ROM) exercises. The salient features of the exergame include: (i) a sensor calibration user-interface (UI); (ii) a sensor mounting UI, (iii) a patient gaming UI; (iv) an instructor playback UI; and (v) an instructor exercise development UI. Along with the WIS system, the developed exergame UIs enable a user to perform ROM exercises in clinical and home-based environments. The exergame UIs can also be employed in a telerehabilitation setting for remote monitoring and assessment. Preliminary results on the efficacy of using the exergame environment is documented with: (i) sensor calibration time; (ii) sensor mounting and alignment time on the human body; and (iii) examination of user adherence to instructor programmed exercise routines.

A Wearable Pendant Sensor to Monitor Compliance with Range of Motion Lymphatic Health Exercise.

Lymphedema is a chronic and debilitating condition affecting 1 in 1000 Americans and there is no known cure for it. The optimal lymph flow (TOLF) is an effective preventive exercise program designed to reduce the risks of lymphedema. This paper proposes a portable and wearable medical device to monitor compliance with the TOLF therapy. Specifically, the wearable pendant sensor (WPS), a low-fidelity prototype of the proposed design, is developed and tested in comparison with a markerless optical motion capture system (Kinect) for measurement accuracy during shoulder abduction-adduction and flexion-extension exercises. It is shown that the Kendall's Tau between the measurements obtained from the WPS and Kinect devices yields a correlation coefficient ρ = 0.807 for abduction-adduction exercise and ρ = 0.783 for flexion-extension exercise with a significance level of p < 0.001, indicating a strong correlation and high statistical significance. Following careful clinical assessment and validation, preliminary engineering design of this paper can be transformed into an Internet of Things (IoT)-based medical device to facilitate telemonitoring of TOLF therapy. Deployment of such an IoT-based device in patient homes can permit remote assessment of motor function to enhance treatment adherence.Clinical Relevance-This paper documents a WPS with potential to render an IoT-based medical device for monitoring adherence to TOLF exercise program to prevent the risk of post-operative lymphedema.

RehabFork: An Interactive Game-assisted Upper Limb Stroke Rehabilitation System.

In this paper, we present the design and development of a game-assisted stroke rehabilitation system RehabFork that allows a user to train their upper-limb to perform certain functions related to the task of eating. The task of eating is divided into several components: (i) grasping the eating utensils such as a fork and knife; (ii) lifting the eating utensils; (iii) using the eating utensils to cut a piece of food; (iv) transferring the food to the mouth; and (v) chewing the food. The RehabFork supports the user through sub-tasks (i)-(iii). The hardware components of RehabFork consist of an instrumented fork and knife, and a 3D printed pressure pad, that measure and communicate information on user performance to a gaming environment to render an integrated rehabilitation system. The gaming environment consists of an interactive game that utilizes sensory data as well as user information about the severity of their disability and current level of progress to adjust the difficulty levels of the game to maintain user motivation. Information pertaining to the user, including performance data, is stored and can be shared with care providers for ongoing oversight.

Wearable Inertial Sensors for Range of Motion Assessment.

This paper presents the design and development of wearable inertial sensors (WIS) for real-time simultaneous triplanar motion capture of the upper extremity (UE). The sensors simultaneously capture in the frontal, sagittal, and horizontal planes UE range of motion (ROM), which is critical to assess an individual's movement limitations and determine appropriate rehabilitative treatments. Off-the-shelf sensors and microcontrollers are used to develop the WIS system, which wirelessly streams real-time joint orientation for UE ROM measurement. Key developments include: 1) two novel approaches, using earth's gravity (EG approach) and magnetic field (EGM approach) as references, to correct misalignments in the orientation between the sensor and its housing to minimize measurement errors; 2) implementation of the joint coordinate system (JCS)-based method for triplanar ROM measurements for clinical use; and 3) an in-situ guided mounting technique for accurate sensor placement and alignment on human body. The results 1) compare computational time between two orientation misalignment correction approaches (EG approach = 325.05 µs and EGM approach = 92.05µs); 2) demonstrate the accuracy and repeatability of measurements from the WIS system (percent deviation of measured angle from applied angle is less than ±6.5% and percent coefficient of variation is less than 11%, indicating acceptable accuracy and repeatability, respectively); and 3) demonstrate the feasibility of using the WIS system within the JCS framework for providing anatomically-correct simultaneous triplanar ROM measurements of shoulder, elbow, and forearm movements during several upper limb exercises.

Mounted Smartphones as Measurement and Control Platforms for Motor-Based Laboratory Test-Beds.

Laboratory education in science and engineering often entails the use of test-beds equipped with costly peripherals for sensing, acquisition, storage, processing, and control of physical behavior. However, costly peripherals are no longer necessary to obtain precise measurements and achieve stable feedback control of test-beds. With smartphones performing diverse sensing and processing tasks, this study examines the feasibility of mounting smartphones directly to test-beds to exploit their embedded hardware and software in the measurement and control of the test-beds. This approach is a first step towards replacing laboratory-grade peripherals with more compact and affordable smartphone-based platforms, whose interactive user interfaces can engender wider participation and engagement from learners. Demonstrative cases are presented in which the sensing, computation, control, and user interaction with three motor-based test-beds are handled by a mounted smartphone. Results of experiments and simulations are used to validate the feasibility of mounted smartphones as measurement and feedback control platforms for motor-based laboratory test-beds, report the measurement precision and closed-loop performance achieved with such platforms, and address challenges in the development of platforms to maintain system stability.