Utility and Usability of Two Forms of Supplemental Vibrotactile Kinesthetic Feedback for Enhancing Movement Accuracy and Efficiency in Goal-Directed Reaching.

Recent advances in wearable sensors and computing have made possible the development of novel sensory augmentation technologies that promise to enhance human motor performance and quality of life in a wide range of applications. We compared the objective utility and subjective user experience for two biologically inspired ways to encode movement-related information into supplemental feedback for the real-time control of goal-directed reaching in healthy, neurologically intact adults. One encoding scheme mimicked visual feedback encoding by converting real-time hand position in a Cartesian frame of reference into supplemental kinesthetic feedback provided by a vibrotactile display attached to the non-moving arm and hand. The other approach mimicked proprioceptive encoding by providing real-time arm joint angle information via the vibrotactile display. We found that both encoding schemes had objective utility in that after a brief training period, both forms of supplemental feedback promoted improved reach accuracy in the absence of concurrent visual feedback over performance levels achieved using proprioception alone. Cartesian encoding promoted greater reductions in target capture errors in the absence of visual feedback (Cartesian: 59% improvement; Joint Angle: 21% improvement). Accuracy gains promoted by both encoding schemes came at a cost in terms of temporal efficiency; target capture times were considerably longer (1.5 s longer) when reaching with supplemental kinesthetic feedback than without. Furthermore, neither encoding scheme yielded movements that were particularly smooth, although movements made with joint angle encoding were smoother than movements with Cartesian encoding. Participant responses on user experience surveys indicate that both encoding schemes were motivating and that both yielded passable user satisfaction scores. However, only Cartesian endpoint encoding was found to have passable usability; participants felt more competent using Cartesian encoding than joint angle encoding. These results are expected to inform future efforts to develop wearable technology to enhance the accuracy and efficiency of goal-directed actions using continuous supplemental kinesthetic feedback.

A Case of Hypercalcemic-Type Stage IVB Small-Cell Carcinoma of the Ovary in a Young Woman.

A 38-year-old nulliparous woman with severe obesity (BMI 66) and hypertension presented with constipation, fatigue, weakness, and poor appetite that had progressively worsened over the prior two to three weeks. Upon admission, the patient was found to have significant hypercalcemia, leukocytosis, and lactic acidosis. Computed tomography (CT) scan of the chest, abdomen, and pelvis revealed an adnexal mass with extensive lesions throughout her pelvis, abdomen, and chest. An ultrasound-guided omental core biopsy was performed, which was confirmatory for metastatic ovarian small cell carcinoma. Given her poor prognosis and clinical status, chemotherapy was likely to provide minimal benefit and ultimately the patient decided to pursue a comfort-oriented plan of care and passed away on day 9 of admission.

A Case of Distal Common Bile Duct Obstruction Due to a Neuroendocrine Tumor.

Neuroendocrine tumors (NETs) are a rare subset of malignancies in the biliary tract that may have an aggressive and initially asymptomatic course. A 93-year-old female presented with four days of abdominal pain with associated nausea, jaundice, and brown-colored urine. A CT scan revealed a soft-tissue lesion measuring 1.9 x 1.5 x 1.9 cm within the distal-most aspect of the common bile duct and papilla with marked bile duct dilatation, pancreatic duct dilatation, and multiple hepatic lesions of varying sizes. The biliary stricture was palliated with a stent via endoscopic retrograde cholangiopancreatography. Biopsies taken from the biliary mass were consistent with a well-differentiated NET: World Health Organization, Grade 3. The patient was minimally symptomatic after stenting and was discharged home. She ultimately decided not to pursue further treatment and passed away two months after the initial presentation. Currently, surgical excision is considered the main and only curative treatment for localized NETs, although chemotherapy and radiation therapy may be suitable. Early detection and treatment of these rare NETs in the biliary tree can potentially result in curative treatment.

Adaptive Sports in Spinal Cord Injury: a Systematic Review.

Purpose of Review: Adaptive sports (AdS), sports modified or created to accommodate persons with disabilities, have been gaining popularity over the last decade. The benefits of exercise in the able-bodied population are well-established. Literature in adaptive sport and the para-athlete continues to improve but is not yet as comprehensive as their able-bodied peers, in part due to the heterogeneity of participants. In this review, we appraise the recent literature pertaining to AdS and identify developing areas within the field. Recent Findings: AdS have been shown to have positive health benefits as well as positive psychosocial benefits. Para-athletes often must overcome a variety of barriers to participation, such as transportation, accessibility, and socioeconomic factors. Facilitators to participation have also been identified, including pre-injury interest in sports, male sex, younger age, and more. In addition to well-known sports like handcycling and wheelchair basketball, adaptive sport continues to evolve, in part due to the COVID-19 pandemic, now including virtual options and E-sports. Para-athletes are also being more closely monitored and evaluated pre, peri, and post competition for injury and injury prevention, including in the realm of concussion management, requiring healthcare professionals, coaches, players, and all to gain further knowledge in adaptive sport and the participating para-athletes. Summary: The physical, psychological, and social benefits of adaptive sports for individuals with disabilities are numerous. Addressing barriers to participation, including novel forms of AdS that utilize innovative technology, may allow more individuals to benefit from AdS.