Smartphone accessibility: understanding the lived experience of users with cervical spinal cord injuries.

PURPOSE: To explore accessibility challenges encountered by smartphone users with cervical spinal cord injuries (C1-C8).To investigate the suitability of current technology and make recommendations to help future technology meet user needs. METHODS: The study uses a mixed-method approach combining an inductive thematic analysis of nine semi-structured interviews with a quantitative analysis of thirty-nine questionnaires. RESULTS: The analysis generated four themes: 'the drive for independence and self-efficacy'; 'trying to make it work'; 'getting the right technology for me'; 'using the phone as and when I want to'. These themes highlighted how unresolved access issues and situational barriers limited independence and created unwanted privacy compromises for effective communication. There was a lack of information or support on available smartphone accessibility features and assistive technology (AT). Smartphone AT was regarded as overpriced, poorly designed and lacking the voices of people with disabilities. CONCLUSIONS: The smartphone's potential to improve quality of life, participation, and well-being is limited by accessibility challenges hindering independent and private smartphone use. Future design work should focus on improving accessibility, investigating reasons for AT's poor quality and high cost, and removing barriers to end-user inclusion. To enhance user awareness of available technology, stakeholders should build and maintain an open platform to act as an information source for peer and professional support on assistive technology.Implications for RehabilitationA smartphone's potential to empower, connect, and improve the quality of life of people with a cervical spinal cord injury (SCI) is limited by unresolved accessibility barriers, causing isolation.Standard interaction methods used by people with a cervical SCI to mitigate smartphone access barriers can require unwanted privacy compromises and limit independence.Participants struggled to find information and support on available accessibility solutions and assistive technologies that might enable easier smartphone use.Participants rarely used assistive technology (AT) to facilitate smartphone use, and available AT was regarded as expensive and poorly designed.

fNIRS-EEG BCIs for Motor Rehabilitation: A Review.

Motor impairment has a profound impact on a significant number of individuals, leading to a substantial demand for rehabilitation services. Through brain-computer interfaces (BCIs), people with severe motor disabilities could have improved communication with others and control appropriately designed robotic prosthetics, so as to (at least partially) restore their motor abilities. BCI plays a pivotal role in promoting smoother communication and interactions between individuals with motor impairments and others. Moreover, they enable the direct control of assistive devices through brain signals. In particular, their most significant potential lies in the realm of motor rehabilitation, where BCIs can offer real-time feedback to assist users in their training and continuously monitor the brain's state throughout the entire rehabilitation process. Hybridization of different brain-sensing modalities, especially functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG), has shown great potential in the creation of BCIs for rehabilitating the motor-impaired populations. EEG, as a well-established methodology, can be combined with fNIRS to compensate for the inherent disadvantages and achieve higher temporal and spatial resolution. This paper reviews the recent works in hybrid fNIRS-EEG BCIs for motor rehabilitation, emphasizing the methodologies that utilized motor imagery. An overview of the BCI system and its key components was introduced, followed by an introduction to various devices, strengths and weaknesses of different signal processing techniques, and applications in neuroscience and clinical contexts. The review concludes by discussing the possible challenges and opportunities for future development.

Power Wheelchair Navigation Assistance Using Wearable Vibrotactile Haptics.

People with severe disabilities often rely on power wheelchairs for moving around. However, if their driving abilities are affected by their condition, driving a power wheelchair can become very dangerous, both for themselves and the surrounding environment. This article proposes the use of wearable vibrotactile haptics for wheelchair navigation assistance. We use one or two haptic armbands, each composed of four evenly-spaced vibrotactile actuators, for providing different navigation information to power wheelchair users. With respect to other available solutions, our approach provides rich navigation information while always leaving the patient in control of the wheelchair motion. Moreover, our armbands can be easily adapted for different limbs and can be used by all those patients who are unable to safely maneuver a kinesthetic interface. The results of two human subjects studies show the viability and effectiveness of the proposed technique with respect to not providing any environmental cue. Collisions were reduced by 49% when using the vibrotactile armbands. Moreover, most subjects expressed a preference for receiving haptic feedback and found the armbands comfortable to wear and use.

Computer analysis of individual cataract surgery segments in the operating room.

PURPOSE: Objective feedback is important for the continuous development of surgical skills. Motion tracking, which has previously been validated across an entire cataract procedure, can be a useful adjunct. We aimed to measure quantitative differences between junior and senior surgeons' performance in three distinct segments. We further explored whether automated analysis of trainee surgical videos through PhacoTracking could be aligned with metrics from the EyeSi virtual reality simulator, allowing focused improvement of these areas in a controlled environment. METHODS: Prospective cohort analysis, comparing junior vs. senior surgeons' real-life performance in distinct segments of cataract surgery: continuous curvilinear capsulorhexis (CCC), phacoemulsification, and irrigation and aspiration (I&A). EyeSi metrics that could be aligned with motion tracking parameters were identified. Motion tracking parameters (instrument path length, number of movements and total time) were measured. t-test used between the two cohorts for each component to check for any significance (p < 0.05). RESULTS: A total of 120 segments from videos of 20 junior and 20 senior surgeons were analysed. Significant differences between junior and senior surgeons were found during CCC (path length p = 0.0004; number of movements p < 0.0001; time taken p < 0.0001), phacoemulsification (path length p < 0.0001; number of movements p < 0.0001; time taken p < 0.0001), and irrigation and aspiration (path length p = 0.006; number of movements p = 0.013; time taken p = 0.036). CONCLUSION: Individual segments of cataract surgery analysed using motion tracking appear to discriminate between junior and senior surgeons. Alignment of motion tracking and EyeSi parameters could enable independent, task specific, objective and quantitative feedback for each segment of surgery thus mirroring the widely utilised modular training.

VIBROfocus: Design of a focal vibro-tactile robotic-assistive system for spasticity rehabilitation.

The main focus of spasticity treatment is to alleviate pain, improve function and reduce risk of additional complications. In this paper the design of a robotic system with enhanced focal vibro-tactile stimulation for the treatment of spasticity in the upper limbs is presented. Building on emerging evidence on the use of vibrations in the treatment of spasticity, we propose a new integrated approach. Our design combines the use of vibro-tactile stimulation of the high tone muscle with robotic movement assistance to augment rehabilitation outcomes in patients with spasticity in the upper limbs.

Probabilistic vs linear blending approaches to shared control for wheelchair driving.

Some people with severe mobility impairments are unable to operate powered wheelchairs reliably and effectively, using commercially available interfaces. This has sparked a body of research into "smart wheelchairs", which assist users to drive safely and create opportunities for them to use alternative interfaces. Various "shared control" techniques have been proposed to provide an appropriate level of assistance that is satisfactory and acceptable to the user. Most shared control techniques employ a traditional strategy called linear blending (LB), where the user's commands and wheelchair's autonomous commands are combined in some proportion. In this paper, however, we implement a more generalised form of shared control called probabilistic shared control (PSC). This probabilistic formulation improves the accuracy of modelling the interaction between the user and the wheelchair by taking into account uncertainty in the interaction. In this paper, we demonstrate the practical success of PSC over LB in terms of safety, particularly for novice users.

Lipid production in Nannochloropsis gaditana is doubled by decreasing expression of a single transcriptional regulator.

Lipid production in the industrial microalga Nannochloropsis gaditana exceeds that of model algal species and can be maximized by nutrient starvation in batch culture. However, starvation halts growth, thereby decreasing productivity. Efforts to engineer N. gaditana strains that can accumulate biomass and overproduce lipids have previously met with little success. We identified 20 transcription factors as putative negative regulators of lipid production by using RNA-seq analysis of N. gaditana during nitrogen deprivation. Application of a CRISPR-Cas9 reverse-genetics pipeline enabled insertional mutagenesis of 18 of these 20 transcription factors. Knocking out a homolog of fungal Zn(II)2Cys6-encoding genes improved partitioning of total carbon to lipids from 20% (wild type) to 40-55% (mutant) in nutrient-replete conditions. Knockout mutants grew poorly, but attenuation of Zn(II)2Cys6 expression yielded strains producing twice as much lipid (∼5.0 g m-2 d-1) as that in the wild type (∼2.5 g m-2 d-1) under semicontinuous growth conditions and had little effect on growth.

MoRe-T2 (mobility research trajectory tracker): validation and application.

It is important to assess the suitability of mobility aids before prescribing them to patients. This assessment is often subjectively completed by a therapist and it often includes a variety of basic practical tests. An objective assessment of a patient's capability, which captures not only speed of task completion and success, but also accuracy and risk of manoeuvres, would be both a fairer and safer approach. Yet until now such an assessment would have been cost-prohibitive, especially in low resource settings. We pave the way towards this end goal, by describing, validating and demonstrating a low-cost computer vision based system called MoRe-T2 (mobility research trajectory tracker). The open-source MoRe-T2 system uses low-cost off-the-shelf webcams to track the pose of fiducial markers, which are simply printed onto regular office paper. In this article, we build upon previous work and benchmark the accuracy of MoRe-T2 against an industry standard motion capture system. In particular, we show that MoRe-T2 achieves accuracy comparable to CODA motion tracking system. We go on to demonstrate a use case of MoRe-T2 in assessing wheelchair manoeuvrability over a relatively large area. The results show that MoRe-T2 is scalable at a much lower cost than typical industry-standard motion trackers. Therefore, MoRe-T2 can be used to develop more objective and reliable assessments of mobility aids, especially in low-resource settings.

Quantifying the human-robot interaction forces between a lower limb exoskeleton and healthy users.

To counter the many disadvantages of prolonged wheelchair use, patients with spinal cord injuries (SCI) are beginning to turn towards robotic exoskeletons. However, we are currently unaware of the magnitude and distribution of forces acting between the user and the exoskeleton. This is a critical issue, as SCI patients have an increased susceptibility to skin lesions and pressure ulcer development. Therefore, we developed a real-time force measuring apparatus, which was placed at the physical human-robot interface (pHRI) of a lower limb robotic exoskeleton. Experiments captured the dynamics of these interaction forces whilst the participants performed a range of typical stepping actions. Our results indicate that peak forces occurred at the anterior aspect of both the left and right legs, areas that are particularly prone to pressure ulcer development. A significant difference was also found between the average force experienced at the anterior and posterior sensors of the right thigh during the swing phase for different movement primitives. These results call for the integration of instrumented straps as standard in lower limb exoskeletons. They also highlight the potential of such straps to be used as an alternative/complementary interface for the high-level control of lower limb exoskeletons in some patient groups.

Muscular activity and physical interaction forces during lower limb exoskeleton use.

Spinal cord injury (SCI) typically manifests with a loss of sensorimotor control of the lower limbs. In order to overcome some of the disadvantages of chronic wheelchair use by such patients, robotic exoskeletons are an emerging technology that has the potential to transform the lives of patients. However, there are a number of points of contact between the robot and the user, which lead to interaction forces. In a recent study, the authors have shown that peak interaction forces are particularly prominent at the anterior aspect of the right leg. This study uses a similar experimental protocol with additional electromyography (EMG) analysis to examine whether such interaction forces are due to the muscular activity of the participant or the movement of the exoskeleton itself. Interestingly, the authors found that peak forces preceded peak EMG activity. This study did not find a significant correlation between EMG activity and force data, which would indicate that the interaction forces can largely be attributed to the movement of the exoskeleton itself. However, we also report significantly higher correlation coefficients in muscle/force pairs located at the anterior aspect of the right leg. In their previous research, the authors have shown peak interaction forces at the same locations, which suggests that muscular activity of the participant makes a more significant contribution to the interaction forces at these locations. The findings of this study are of significance for incomplete SCI patients, for whom EMG activity may provide an important input to an intuitive control schema.

Statically vs dynamically balanced gait: Analysis of a robotic exoskeleton compared with a human.

In recent years exoskeletons able to replicate human gait have begun to attract growing popularity for both assistive and rehabilitative purposes. Although wearable robots often need the use of external support in order to maintain stability, the REX exoskeleton by REX Bionics is able to self-balance through the whole cycle. However this statically balanced gait presents important differences with the dynamically balanced gait of human subjects. This paper will examine kinematic and kinetic differences between the gait analysis performed on a subject wearing the REX exoskeleton and human gait analysis data as presented in literature. We will also provide an insight on the impact that these differences can have for both rehabilitative and assistive applications.

A hybrid BCI for enhanced control of a telepresence robot.

Motor-disabled end users have successfully driven a telepresence robot in a complex environment using a Brain-Computer Interface (BCI). However, to facilitate the interaction aspect that underpins the notion of telepresence, users must be able to voluntarily and reliably stop the robot at any moment, not just drive from point to point. In this work, we propose to exploit the user's residual muscular activity to provide a fast and reliable control channel, which can start/stop the telepresence robot at any moment. Our preliminary results show that not only does this hybrid approach increase the accuracy, but it also helps to reduce the workload and was the preferred control paradigm of all the participants.

Transferring brain-computer interfaces beyond the laboratory: successful application control for motor-disabled users.

OBJECTIVES: Brain-computer interfaces (BCIs) are no longer only used by healthy participants under controlled conditions in laboratory environments, but also by patients and end-users, controlling applications in their homes or clinics, without the BCI experts around. But are the technology and the field mature enough for this? Especially the successful operation of applications - like text entry systems or assistive mobility devices such as tele-presence robots - requires a good level of BCI control. How much training is needed to achieve such a level? Is it possible to train naïve end-users in 10 days to successfully control such applications? MATERIALS AND METHODS: In this work, we report our experiences of training 24 motor-disabled participants at rehabilitation clinics or at the end-users' homes, without BCI experts present. We also share the lessons that we have learned through transferring BCI technologies from the lab to the user's home or clinics. RESULTS: The most important outcome is that 50% of the participants achieved good BCI performance and could successfully control the applications (tele-presence robot and text-entry system). In the case of the tele-presence robot the participants achieved an average performance ratio of 0.87 (max. 0.97) and for the text entry application a mean of 0.93 (max. 1.0). The lessons learned and the gathered user feedback range from pure BCI problems (technical and handling), to common communication issues among the different people involved, and issues encountered while controlling the applications. CONCLUSION: The points raised in this paper are very widely applicable and we anticipate that they might be faced similarly by other groups, if they move on to bringing the BCI technology to the end-user, to home environments and towards application prototype control.

Collaborative control for a robotic wheelchair: evaluation of performance, attention, and workload.

Powered wheelchair users often struggle to drive safely and effectively and, in more critical cases, can only get around when accompanied by an assistant. To address these issues, we propose a collaborative control mechanism that assists users as and when they require help. The system uses a multiple-hypothesis method to predict the driver's intentions and, if necessary, adjusts the control signals to achieve the desired goal safely. The main emphasis of this paper is on a comprehensive evaluation, where we not only look at the system performance but also, perhaps more importantly, characterize the user performance in an experiment that combines eye tracking with a secondary task. Without assistance, participants experienced multiple collisions while driving around the predefined route. Conversely, when they were assisted by the collaborative controller, not only did they drive more safely but also they were able to pay less attention to their driving, resulting in a reduced cognitive workload. We discuss the importance of these results and their implications for other applications of shared control, such as brain-machine interfaces, where it could be used to compensate for both the low frequency and the low resolution of the user input.

Brain-controlled telepresence robot by motor-disabled people.

In this paper we present the first results of users with disabilities in mentally controlling a telepresence robot, a rather complex task as the robot is continuously moving and the user must control it for a long period of time (over 6 minutes) to go along the whole path. These two users drove the telepresence robot from their clinic more than 100 km away. Remarkably, although the patients had never visited the location where the telepresence robot was operating, they achieve similar performances to a group of four healthy users who were familiar with the environment. In particular, the experimental results reported in this paper demonstrate the benefits of shared control for brain-controlled telepresence robots. It allows all subjects (including novel BMI subjects as our users with disabilities) to complete a complex task in similar time and with similar number of commands to those required by manual control.