User-Centered Design and Development of the Modular TWIN Lower Limb Exoskeleton.

For decades, powered exoskeletons have been considered for possible employment in rehabilitation and personal use. Yet, these devices are still far from addressing the needs of users. Here, we introduce TWIN, a novel modular lower limb exoskeleton for personal use of spinal-cord injury (SCI) subjects. This system was designed according to a set of user requirements (lightweight and autonomous portability, quick and autonomous donning and setup, stability when standing/walking, cost effectiveness, long battery life, comfort, safety) which emerged during participatory investigations that organically involved patients, engineers, designers, physiatrists, and physical therapists from two major rehabilitation centers in Italy. As a result of this user-centered process, TWIN's design is based on a variety of small mechatronic modules which are meant to be easily assembled and donned on or off by the user in full autonomy. This paper presents the development of TWIN, an exoskeleton for personal use of SCI users, and the application of user-centered design methods that are typically adopted in medical device industry, for its development. We can state that this approach revealed to be extremely effective and insightful to direct and continuously adapt design goals and activities toward the addressment of user needs, which led to the development of an exoskeleton with modular mechatronics and novel lateral quick release systems. Additionally, this work includes the preliminary assessment of this exoskeleton, which involved healthy volunteers and a complete SCI patient. Tests validated the mechatronics of TWIN and emphasized its high potential in terms of system usability for its intended use. These tests followed procedures defined in existing standards in usability engineering and were part of the formative evaluation of TWIN as a premise to the summative evaluation of its usability as medical device.

Prediction of chronic critical illness in a general intensive care unit / Predição de doença crítica crônica em uma unidade geral de cuidados intensivos resumo

OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

OBJETIVO: Avaliar a incidência, custos e mortalidade relacionados a doença crítica crônica (DCC) e identificar seus preditores clínicos em uma unidade de terapia intensiva geral. MÉTODOS: Trata-se de uma coorte observacional prospectiva. Todos pacientes que recebiam tratamento de suporte por mais de 20 dias eram considerados doentes críticos crônicos. Permaneceram 453 pacientes após a aplicação dos critérios de exclusão. RESULTADOS: A incidência de DCC foi de 11%. Permanência hospitalar, custos e mortalidade foram significativamente maiores na população com DCC. Ventilação mecânica, sepse, Glasgow escore < 15, inadequada ingestão calórica e elevado índice de massa corporal foram preditores independentes para dcc em um modelo multivariado de regressão logística. CONCLUSÃO: DCC abrangeumadistintapopulaçãonasunidadesde terapiaintensiva apresentando maiores mortalidade, custos e permanência hospitalar. Alguns fatores presentes na admissão ou durante a primeira semana na unidade de terapia intensiva podem ser usados como preditores de DCC.

Prediction of chronic critical illness in a general intensive care unit.

OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score <15, inadequate calorie intake, and higher body mass index were independent predictors for CCI in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.