Mini-review: Rehabilitation engineering: Research priorities and trends.

Rehabilitation Engineering is the use of engineering principles applied to rehabilitation, disability, and independent living. Google Scholar is a searchable resource that allows people from around the world to create profiles of their interests and collaborations, and it provides a means to search the broad scientific and technical literature. Google Scholar was used to identify the 150 most cited people who listed Rehabilitation Engineering in their profile. Research impact, characteristics, and areas of research of the most cited rehabilitation engineers were examined. Furthermore, gender and geographical differences in research metrics of the highest citied rehabilitation engineers were investigated. Consumer priorities in rehabilitation engineering were identified using a voice of consumer (VoC) survey and recent literature based on VoC studies. Gaps between research publication and activities and consumer priorities were identified to recommend seven areas of research with high demand and opportunity for growth and innovation. Implications.

Development of the Ultralight Hybrid Pneumatic Artificial Muscle: Modelling and optimization.

Pneumatic artificial muscles (PAMs) are one of the key technologies in soft robotics, and they enable actuation in mobile robots, in wearable devices and exoskeletons for assistive and rehabilitative purposes. While they recently showed relevant improvements, they still present quite low payload, limited bandwidth, and lack of repeatability, controllability and robustness. Vacuum-based actuation has been recently demonstrated as a very promising solution, and many challenges are still open, like generating at the same time a large contraction ratio, and a high blocking force with enhanced axial stiffness. In this paper, a novel Ultralight Hybrid PAM (UH-PAM), based on bellow-type elastomeric skin and vacuum actuation, is presented. In particular, open-cell foam is exploited as a structural backbone, together with plastic rings, all embedded in a thin skin. The design and optimization combine numerical, analytical, and experimental data. Both static and dynamic analysis are performed. The weight of the optimized actuator is only 20 g. Nevertheless, a contraction ratio up to 50% and a maximum payload of 3 kg can be achieved. From a dynamic point of view, a rise time of 0.5 s for the contraction phase is observed. Although hysteresis is significant when using the whole contraction span, it can be reduced (down to 11.5%) by tuning both the vacuum range and the operating frequency for cyclic movements. Finally, to demonstrate the potentiality of this soft actuation approach, a 3 DoFs Stewart platform is built. The feasibility of performing smooth movements by exploiting open-loop control is shown through simple and more complex handwriting figures projected on the XY plane.

National Institutes of Health Research Plan on Rehabilitation: Analysis and Progress.

OBJECTIVE: To summarize the progress toward the National Institutes of Health (NIH) Research Plan on Rehabilitation goals and the methods by which tracking occurred. DESIGN: Each grant award was manually coded by NIH staff for research plan goals, type of science categories (eg, basic, applied, infrastructure, etc), and if applicable, training, and then validated by NIH institute and center (IC) experts. Data for years 2015 through 2017 were used to develop a coding algorithm to automatically code grants in 2018 for validation by NIH IC experts. Additional data for all years (2015-2018) were also analyzed to track changes and progress. SETTING: The research utilized administrative data from NIH Reporter and internal NIH databases. PARTICIPANTS: The data sample included research grants and programs funded from fiscal years 2015 through 2018. The year 2015 was considered a baseline year as the research plan was published in 2016. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The primary outcome measures were substantial growth in NIH funding and numbers of awards for rehabilitation research, across most research plan goals and types of science, as well as validation of an automatic algorithm for coding grants. RESULTS: Number of grants, funding dollars, funding mechanisms, patent data, scientific influence and translational science, research plan goals, and type of science categories were tracked across years (2015-2018). Algorithm validation is presented for 2018 data. CONCLUSIONS: NIH advanced the goals stated in the Research Plan on Rehabilitation, but gap areas remain. Though funding in this portfolio is growing, continued focus and participation by the field is needed to advance rehabilitation science.

Low-Cost Robotic Guide Based on a Motor Imagery Brain-Computer Interface for Arm Assisted Rehabilitation.

Motor imagery has been suggested as an efficient alternative to improve the rehabilitation process of affected limbs. In this study, a low-cost robotic guide is implemented so that linear position can be controlled via the user's motor imagination of movement intention. The patient can use this device to move the arm attached to the guide according to their own intentions. The first objective of this study was to check the feasibility and safety of the designed robotic guide controlled via a motor imagery (MI)-based brain-computer interface (MI-BCI) in healthy individuals, with the ultimate aim to apply it to rehabilitation patients. The second objective was to determine which are the most convenient MI strategies to control the different assisted rehabilitation arm movements. The results of this study show a better performance when the BCI task is controlled with an action-action MI strategy versus an action-relaxation one. No statistically significant difference was found between the two action-action MI strategies.

Visual vs vibrotactile feedback for posture assessment during upper-limb robot-aided rehabilitation.

Repetitive and intensive exercises during robot-aided rehabilitation may expose patients to inappropriate and unsafe postures. The introduction of a sensory feedback can help the subject to perform the rehabilitation task with an ergonomic posture. In this work, the introduction of visual and vibrotactile feedback in a robotic platform for upper limb rehabilitation has been proposed to ensure ergonomic posture during rehabilitation. The two feedback modalities have been used to provide information about incorrect neck and trunk posture. Ten healthy subjects have been involved in this study. Each of them performed 3D reaching movements with the aid of the robotic platform in three different conditions, i.e. without feedback, with visual feedback and with vibrotactile feedback, and a comparative analysis has been carried out to evaluate feedback effectiveness, acceptance and performance. Experimental results show that in case of no feedback the subjects reach and maintain configurations that can lead to incorrect neck and trunk configurations and therefore, if repeated, to musculoskeletal disorders. Conversely, with visual or vibrotactile feedback, the subjects tend to correct inappropriate posture with both trunk and head during task performing.

Harnessing smartphone technology and three dimensional printing to create a mobile rehabilitation system, mRehab: assessment of usability and consistency in measurement.

BACKGROUND: Residual sensorimotor deficits are common following stroke. While it has been demonstrated that targeted practice can result in improvements in functional mobility years post stroke, there is little to support rehabilitation across the lifespan. The use of technology in home rehabilitation provides an avenue to better support self-management of recovery across the lifespan. We developed a novel mobile technology, capable of quantifying quality of movement with the purpose of providing feedback to augment rehabilitation and improve functional mobility. This mobile rehabilitation system, mRehab, consists of a smartphone embedded in three dimensional printed items representing functional objects found in the home. mRehab allows individuals with motor deficits to practice activities of daily living (ADLs) and receive feedback on their performance. The aim of this study was to assess the usability and consistency of measurement of the mRehab system. METHODS: To assess usability of the mRehab system, four older adults and four individuals with stroke were recruited to use the system, and complete surveys to discuss their opinions on the user interface of the smartphone app and the design of the 3D printed items. To assess the consistency of measurement by the mRehab system, 12 young adults were recruited and performed mRehab ADLs in three lab sessions within 1 week. Young adults were chosen for their expected high level of consistency in motor performance. RESULTS: Usability ratings from older adults and individuals with stroke led us to modify the design of the 3D printed items and improve the clarity of the mRehab app. The modified mRehab system was assessed for consistency of measurement and six ADLs resulted in coefficient of variation (CV) below 10%. This is a commonly used CV goal for consistency. Two ADLs ranged between 10 and 15% CV. Only two ADLs demonstrated high CV. CONCLUSIONS: mRehab is a client-centered technology designed for home rehabilitation that consistently measures performance. Development of the mRehab system provides a support for individuals working on recovering functional upper limb mobility that they can use across their lifespan.

Assessment of Physical Activity by Wearable Technology During Rehabilitation After Cardiac Surgery: Explorative Prospective Monocentric Observational Cohort Study.

BACKGROUND: Wearable technology is finding its way into clinical practice. Physical activity describes patients' functional status after cardiac surgery and can be monitored remotely by using dedicated trackers. OBJECTIVE: The aim of this study was to compare the progress of physical activity in cardiac rehabilitation by using wearable fitness trackers in patients undergoing coronary artery bypass surgery by either the conventional off-pump coronary artery bypass (OPCAB) or the robotically assisted minimally invasive coronary artery bypass (RA-MIDCAB). We hypothesized faster recovery of physical activity after RA-MIDCAB in the first weeks after discharge as compared to OPCAB. METHODS: Patients undergoing RA-MIDCAB or OPCAB were included in the study. Each patient received a Fitbit Charge HR (Fitbit Inc, San Francisco, CA) physical activity tracker following discharge. Rehabilitation progress was assessed by measuring the number of steps and physical activity level daily. The physical activity level was calculated as energy expenditure divided by the basic metabolic rate. RESULTS: A total of 10 RA-MIDCAB patients with a median age of 68 (min, 55; max, 83) years and 12 OPCAB patients with a median age of 69 (min, 50; max, 82) years were included. Baseline characteristics were comparable except for body mass index (RA-MIDCAB: 26 kg/m²; min, 22; max, 28 versus OPCAB: 29 kg/m²; min, 27; max, 33; P<.001). Intubation time (P<.05) was significantly lower in the RA-MIDCAB group. A clear trend, although not statistically significant, was observed towards a higher number of steps in RA-MIDCAB patients in the first week following discharge. CONCLUSIONS: RA-MIDCAB patients have an advantage in recovery in the first weeks of revalidation, which is reflected by the number of steps and physical activity level measured by the Fitbit Charge HR, as compared to OPCAB patients. However, unsupervised assessment of daily physical activity varied widely and could have consequences with regard to the use of these trackers as research tools.

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals.

Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group. METHOD: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context. DATA ANALYSIS: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes. DISCUSSION: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa. Implications for rehabilitation Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process. Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources. Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals. Home and school visits during assessment ensure a good match between assistive technology and users within the particular context. Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

Design and control of system for elbow rehabilitation: Preliminary findings.

BACKGROUND: The use of an exoskeleton elbow is considered an effective treatment in several pathologies, including post-stroke complications, traumatic brain injury (TBI) and spinal cord injury (SCI), as well as in patients with neurodegenerative disorders. The effectiveness of rehabilitation is closely linked to a suitably chosen therapy. The treatment can be performed only by specialized personnel, significantly supported by the use of automated devices. OBJECTIVES: The aim of this study was to present a novel exoskeleton for elbow rehabilitation without a complicated control system. MATERIAL AND METHODS: Single-degree-of-freedom (SDOF) solution in constructing the prototype of an elbow exoskeleton for rehabilitation purposes has been applied. The simplicity of the actuation mechanism was set as one of the priorities in the design; thus, a single-axis stepper motor with a controller was found to be adequate for providing a reliable and precise source of motion for the exoskeleton. RESULTS: Technological development may provide novel solutions, such as an exoskeleton - a wearable, external structure which supports or (in selected applications) even replaces the muscle actuation in the patient. The reported advantages of the proposed exoskeleton reflect current state-of-the-art. The proposed control strategy relies on closed-loop position control, performance, low manufacturing cost, and predicted performance in a rehabilitation scenario. All these factors play an important role in establishing the directions for further research, e.g., an integrated force sensor in the device, measurements of torque interactions on the elbow joint, and assessment and response to an overload of articulation. CONCLUSIONS: This study suggests not only the clinical but also the possible economic and logistical advantages offered by the portability of the system, and its effective support for therapists applying an elbow exoskeleton.

Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art.

Robots were introduced in rehabilitation in the 90s to meet different needs, that is, reducing the physical effort of therapists. This work consists of a meta-analysis of robot-mediated lower limbs rehabilitation for stroke-affected patients; it aims at evaluating the effectiveness of the robotic approach through the use of wearable robots or operational machines with respect to the conventional approach (i.e., manual rehabilitation therapy). The primary assessed outcome is the patient's ability to recover walking independence, whereas the secondary outcome is the average walking speed. The therapy acceptability and the treatment costs are also assessed. The assessment shows that the robot-mediated therapy is more effective than the conventional one in reaching the primary outcome. As for the secondary outcome, there is no significant difference between the robotic (wearable robots or operational machines) and the conventional approach. Rehabilitation using wearable robots has a greater acceptability than the conventional one. This does not apply to operational machines. The cost of robotic treatment with wearable robots ranges from double to triple the cost of the conventional approach. On the contrary, rehabilitation using operational machines costs the same as the conventional treatment. Robotic rehabilitation based on operational machines is the most cost-effective approach.

Design and characterization of low-cost fabric-based flat pneumatic actuators for soft assistive glove application.

We present the design of low-cost fabric-based Hat pneumatic actuators for soft assistive glove application. The soft assistive glove is designed to assist hand impaired patients in performing activities of daily living and rehabilitation. The actuators consist of flexible materials such as fabric and latex bladder. Using zero volume actuation concept, the 2D configuration of the actuators simplifies the manufacturing process and allows the actuators to be more compact. The actuators achieve bi-directional flexion and extension motions. Compared to previously developed inflatable soft actuators, the actuators generate sufficient force and torque to assist in both finger flexion and extension at lower air pressure. Preliminary evaluation results show that the glove is able to provide both active finger flexion and extension assistance for activities of daily living and rehabilitative training.

Robotic assessment of neuromuscular characteristics using musculoskeletal models: A pilot study.

OBJECTIVE: Non-invasive neuromuscular characterization aims to provide greater insight into the effectiveness of existing and emerging rehabilitation therapies by quantifying neuromuscular characteristics relating to force production, muscle viscoelasticity and voluntary neural activation. In this paper, we propose a novel approach to evaluate neuromuscular characteristics, such as muscle fiber stiffness and viscosity, by combining robotic and HD-sEMG measurements with computational musculoskeletal modeling. This pilot study investigates the efficacy of this approach on a healthy population and provides new insight on potential limitations of conventional musculoskeletal models for this application. METHODS: Subject-specific neuromuscular characteristics of the biceps and triceps brachii were evaluated using robot-measured kinetics, kinematics and EMG activity as inputs to a musculoskeletal model. RESULTS: Repeatability experiments in five participants revealed large variability within each subjects evaluated characteristics, with almost all experiencing variation greater than 50% of full scale when repeating the same task. CONCLUSION: The use of robotics and HD-sEMG, in conjunction with musculoskeletal modeling, to quantify neuromuscular characteristics has been explored. Despite the ability to predict joint kinematics with relatively high accuracy, parameter characterization was inconsistent i.e. many parameter combinations gave rise to minimal kinematic error. SIGNIFICANCE: The proposed technique is a novel approach for in vivo neuromuscular characterization and is a step towards the realization of objective in-home robot-assisted rehabilitation. Importantly, the results have confirmed the technical (robot and HD-sEMG) feasibility while highlighting the need to develop new musculoskeletal models and optimization techniques capable of achieving consistent results across a range of dynamic tasks.

Automatic Assessment of a Rollator-User's Condition During Rehabilitation Using the i-Walker Platform.

Patient condition during rehabilitation has been traditionally assessed using clinical scales. These scales typically require the patient and/or the clinician to rate a number of condition-related items to obtain a final score. This is a time-consuming task, specially if a large number of patients are involved. Furthermore, during rehabilitation, user condition is expected to change steadily in time, so assessment may require to run these scales several times to each user. To save time, much effort has been focused on developing clinical scales that require little time to be completed. This is usually achieved by measuring a reduced set of features, i.e., focusing the scales on specific features of a defined target population (Parkinson's disease, Stroke, and so on). However, these scales still require the therapist's intervention and may be tiresome for patients who have to fill them repeatedly. This paper proposes a novel approach to automatically obtain balance scales from the onboard sensors of a robotic rollator. These sensors are used to extract spatiotemporal gait parameters from patients using the rollator for support. These parameters are derived from the user forces on the rollator handles and its odometry. Resulting parameters are used to predict the Tinetti mobility clinical scale on the fly, without therapist intervention. Our approach has been validated with 19 rollator volunteers with a variety of physical and neurological disabilities at Hospital Civil (Malaga) and Fondazione Santa Lucia (Rome). Clinicians provided traditionally obtained Tinetti scores and the proposed system was used to estimate them on the fly. Results show a small root mean squared prediction error. This method can be used for any rollator user anywhere in everyday walking conditions to obtain the Tinetti scores as often as desired and, hence evaluate their progress.

Effectiveness of physical activity promoting technology-based distance interventions compared to usual care. Systematic review, meta-analysis and meta-regression.

INTRODUCTION: Technology has been thought to have strong potential for promoting physical activity, but the evidence has remained unclear. The aim of this study was to examine whether a technology-based distance intervention promoting physical activity is more effective than a physical activity intervention without the use of technology. This systematic review is registered in Prospero (CRD42016035831). EVIDENCE ACQUISITION: A systematic literature search of studies published between January 2000 to December 2015 was conducted in CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OT-Seeker, WOS and PEDro. Studies were selected by two independent authors applying the following PICOS criteria P) adults, I) technology-based distance intervention promoting physical activity, C) distance intervention promoting physical activity without technology, O) physical activity, S) RCT. Quality was assessed following the guidelines of Cochrane Back Review Group. Meta-analysis and meta-regression were performed using R. EVIDENCE SYNTHESIS: From 3 031 studies, 23 randomized controlled trials with a total of 4 645 participants were included in the meta-analysis. The quality of the studies was moderate (mean 6 out of the maximum 12, with range of 4-9). Technology-based interventions were 12% more effective than similar or minimal control interventions in increasing physical activity (RR: 1.12; 95% CI: 1.01 to 1.25, P=0.03). Compared to minimal control interventions, technology-based interventions were 19% more effective (RR: 1.19; 95% CI 1.05 to 1.35, P=0.0096). In the interventions targeting patients, use of technology was 25% more effective than non-use (P=0.027). No differences were observed in physical activity between the effectiveness of interactive, non-interactive and self-monitoring technologies. Study quality, intervention duration and whether the measures used were subjective or objective were not significantly related to the amount of physical activity engaged in. CONCLUSIONS: Technology-based delivery of interventions seems to be more effective than usual care in promoting physical activity, particularly in the interventions targeting patients. Future research should investigate the cost-effectiveness of the use of distance technology for this purpose. Technology benefits rehabilitation, and can be considered for use in clinical practice, may adequately replace face-to-face meetings and stimulate more intensive rehabilitation in daily life.

Automobile or Other Conveyance and Adaptive Equipment Certificate of Eligibility for Veterans or Members of the Armed Forces With Amyotrophic Lateral Sclerosis Connected to Military Service. Final rule.

The Department of Veterans Affairs (VA) published an Interim Final Rule on February 25, 2015, to amend its adjudication regulations to provide a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment for all veterans with service-connected amyotrophic lateral sclerosis (ALS) and servicemembers serving on active duty with ALS. The amendment authorized automatic issuance of a certificate of eligibility for financial assistance in the purchase of an automobile or other conveyance and adaptive equipment to all veterans with service-connected ALS and members of the Armed Forces serving on active duty with ALS. The intent of this final rule is to confirm the amendment made by the interim final rule without change.

Meeting needs for rehabilitation equipment and home adjustments among the disabled in their life environment.

INTRODUCTION: The elimination of functional barriers resulting from disability through the provision of adequate orthopaedic and rehabilitation equipment, and homes adjusted for disability is the precondition for an efficient and independent functioning, and high quality of life of the disabled. The objective of the study was recognition of the needs of the disabled declared by them, and the degree of satisfaction with these needs. METHODS: The study covered 478 disabled from the Lublin Region. The research instrument was the 'Questionnaire for the Disabled' designed by the authors. RESULTS: Considering the needs expressed by the respondents concerning the provision of orthopaedic and rehabilitation equipment and meeting these needs, four groups were distinguished: No Needs - 30.1%, Needs Partially Met - 22.4%, Needs Fully Met - 37.7%, Needs Not Met - 9.8%. The group Needs Not Met was characterized by younger age, in the group Needs Partially Met worse indicators of the state of health were noted, more frequent independent living, loneliness and low material standard. Considering the expressed needs for home adjustments adequate to disability and meeting these needs, three groups were distinguished: No Needs - 59.6%, Needs Not Met - 15.9%, and Needs Met - 24.7%. The group Needs Not Met more rarely covered respondents living in residential homes, compared to those living independently in rural or urban areas. The group Needs Met more rarely included rural inhabitants, while more frequently including the disabled who had a high material standard. CONCLUSIONS: Both the provision of orthopaedic equipment and adjustment of the home to disability are insufficient with respect to the needs. The meeting of these needs is significantly conditioned by high or very high material standard. The lack or incomplete satisfaction with the needs for rehabilitation equipment is associated with a relatively younger age, independent, single residence and low material standard. Living in an residential home means better adjustment of the living environment, and better provision with orthopaedic and rehabilitation equipment.

Assessment of the effects of body weight unloading on overground gait biomechanical parameters.

BACKGROUND: Gait rehabilitation with body weight unloading is a common method of gait rehabilitation for clinical subjects with neurological and musculoskeletal impairments. However, the efficiency of this method was hard to assess given the confounding variables walking modality (treadmill vs. overground) and subjects' inability to maintain a comfortable speed when pulling a body weight unloading system by which they were suspended. By controlling the gait modality (overground) and devising a mechanical device that pulled the system at a constant speed, this study could examine the unique effects of body weight unloading on the biomechanical parameters of healthy subjects walking overground at comfortable speed. METHODS: Ten healthy subjects were instructed to walk overground under a control (no suspension vest) and three (0%, 15%, 30%) body weight unloading experimental conditions. Hip, knee and ankle spatiotemporal, kinematic, and kinetic measures were recorded for all conditions (six trials per condition). FINDINGS: ANOVA showed no changes in cadence, speed and stride length, a reduction in double limb support and increase in single limb support. Pairwise comparisons of gait parameters under 0%,15% and 30% body weight unloading conditions indicated significant reductions in lower joint kinematics and kinetics with increased body weight unloading. Additionally, despite changes in the peak values of kinematic and kinetic measures, the curvature patterns remained unchanged. INTERPRETATION: This study shows that overground gait with up to 30% body weight unloading reduces joint loads without modifying gait curvature patterns or the plantarflexion angle. Several clinical applications for gait reeducation conducted in situ with unloading are enumerated.