WHAT ARE USER PERSPECTIVES OF EXOSKELETON TECHNOLOGY? A LITERATURE REVIEW.

OBJECTIVES: Exoskeletons are electromechanical devices that are worn by a human operator to increase their physical performance. Several exoskeletons have been developed to restore functional movements, such as walking, for those with paralysis due to neurological impairment. However, existing exoskeletons have limitations with respect to affordability, size, weight, speed, and efficiency, which may reduce their functional application. Therefore, the aim of this scoping review is to collect and narratively synthesize the perspectives of users of exoskeleton technology. METHODS: A systematic literature search was conducted across several healthcare related online databases. RESULTS: A total of 4,619 articles were identified, of which 51 were selected for full review. Only three studies were identified that met the inclusion criteria. Of these, one showed an incongruence between users' expectations and experiences of device use; another reported perspectives on potential rather than actual device use, ranking design features in order of perceived importance; and the other reported ratings of ease of device use in training. CONCLUSIONS: The heterogeneity of studies included within this review, leave the authors unable to suggest consensus as to user perspectives of exoskeleton technology. However, it is apparent that users are able to suggest priorities for exoskeleton design and that users' perspectives of exoskeleton technology might change in response to experience of use. The authors, therefore, suggest that exoskeleton design should be an iterative process, whereby user perspectives are sought, incorporated and refined by tangible experience, to ensure that devices developed are acceptable to and usable by the populations they seek to re-enable.

Free-space quantum key distribution to a moving receiver.

Technological realities limit terrestrial quantum key distribution (QKD) to single-link distances of a few hundred kilometers. One promising avenue for global-scale quantum communication networks is to use low-Earth-orbit satellites. Here we report the first demonstration of QKD from a stationary transmitter to a receiver platform traveling at an angular speed equivalent to a 600 km altitude satellite, located on a moving truck. We overcome the challenges of actively correcting beam pointing, photon polarization and time-of-flight. Our system generates an asymptotic secure key at 40 bits/s.

The Kenyan assistive technology ecosystem: a network analysis.

BACKGROUND: Assistive technology is central to the realization of the rights of persons with disabilities. However, there remains limited access to assistive technology throughout much of the world, with particularly poor access in lower- and middle-income countries. Evaluating stakeholder engagement in assistive technology networks has been used as a successful strategy to understand and address gaps in the assistive technology ecosystem. OBJECTIVE: The objective of this research was to provide an overview of the Kenyan Assistive Technology Ecosystem, including available assistive products and related services, and an understanding of the nature and strength of relationships between stakeholders. METHODS: In this study, we employed an online qualitative stakeholder survey (2021) with representatives of organizations involved in assistive technology in Kenya. RESULTS: The assistive technology network in Kenya is distributed, with Government Ministries and Agencies and Organizations of persons with disabilities central to the network. The strength of relationships is concentrated on awareness and communication, with fewer organizations actively collaborating. Innovation training organizations are not yet well integrated into the network. CONCLUSIONS: Improving access to assistive technology in Kenya will benefit from greater collaboration amongst all assistive technology stakeholders.

A scoping review of digital fabrication techniques applied to prosthetics and orthotics: Part 1 of 2-Prosthetics.

BACKGROUND: Traditionally, the manufacture of prostheses is time-consuming and labor-intensive. One possible route to improving access and quality of these devices is the digitalizing of the fabrication process, which may reduce the burden of manual labor and bring the potential for automation that could help unblock access to assistive technologies globally. OBJECTIVES: To identify where there are gaps in the literature that are creating barriers to decision-making on either appropriate uptake by clinical teams or on the needed next steps in research that mean these technologies can continue on a pathway to maturity. STUDY DESIGN: Scoping literature review. METHODS: A comprehensive search was completed in the following databases: Allied and Complementary Medicine Database, MEDLINE, Embase, Global Health Archive, CINAHL Plus, Cochrane Library, Web of Science, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, and Engineering Village, resulting in 3487 articles to be screened. RESULTS: After screening, 130 lower limb prosthetic articles and 117 upper limb prosthetic articles were included in this review. Multiple limitations in the literature were identified, particularly a lack of long-term, larger-scale studies; research into the training requirements for these technologies and the necessary rectification processes; and a high range of variance of production workflows and materials which makes drawing conclusions difficult. CONCLUSIONS: These limitations create a barrier to adequate evidence-based decision-making for clinicians, technology developers, and wider policymakers. Increased collaboration between academia, industry, and clinical teams across more of the pathway to market for new technologies could be a route to addressing these gaps.

Unpacking 'What Works': A Commentary of the Key Learnings for ICT from the AT2030 Program.

The AT2030 programme was launched in 2018 to test 'what works' in getting assistive technology (AT) to people globally, specifically in low- and middle-income countries (LMIC), where there is often a systematic lack of provision. After four years, this paper reviews the project outcomes, focussing on published material. It provides the backdrop to the AT2030 program, contextualises current developments in global AT global and funding, and unpacks the key learnings of what works to get AT to the people that need it around the world, with a focus on ICT. The paper does this by applying Global Disability Innovation Hub's mission-led and transformative approach, concluding with contemporary actions to improve access to AT to illustrate the value of embracing complexity for AT ecosystem stakeholders, including researchers, practitioners, AT users and policymakers.

Experiences of lower limb prosthesis users in Kenya: a qualitative study to understand motivation to use and satisfaction with prosthetic outcomes.

PURPOSE: To explore the personal and system factors that motivate and enhance outcomes for patients accessing a prosthetic service and using a lower-limb prosthesis within a low resource setting. MATERIALS AND METHODS: This study employed a qualitative approach to explore the motivations and satisfaction of individuals with lower limb loss engaging with a prosthetic service in Mombasa, Kenya. In-depth interviews were conducted over Microsoft Teams with 10 lower limb prosthesis users and thematic analysis was applied. RESULTS: Five key themes emerged: acceptance, self-determination, hope, clinician relationship and perception. These findings demonstrate the importance of hopeful thinking and a supportive community in overcoming physical and stigmatising challenges. The findings further highlight the value of the service provider relationship beyond just prescribing an assistive device. CONCLUSION: These results have relevance in developing patient-centred services, assistive devices and personnel training that are responsive, motivating, and cognisant of the service user. This is of particular interest as assistive technology services are newly developed in low resource settings.IMPLICATIONS FOR REHABILITATIONThis research provides an understanding of lower-limb prosthesis users' satisfaction of a device and motivation for engaging with a prosthetic service within a low resource setting.The relationship the rehabilitation professional has with the service user plays a significant role in facilitating motivation during rehabilitation.Rehabilitation professionals should consider how they can foster a network of support amongst service users when planning services in remote, rural locations.Rehabilitation professionals should be aware of how hopeful thinking can be facilitated during rehabilitation to support motivation.When reviewing the success of services, or designing new service models, the service users should be consulted on what they would deem as a successful outcome.

Does the setting matter? Observing wheelchair transfers across different environmental conditions.

The setting in which wheelchair transfers are performed can affect the difficulty and the risks associated with completion. This article presents results from an observational study involving 13 wheelchair users performing independent transfers across four settings. The aim is to understand how the environment affects how different types of independent transfers are performed. Descriptive analysis was performed alongside an objective assessment using the Transfer Assessment Instrument (TAI). The perceived difficulty reported after each transfer was also collected. Two participants exhibited radically different transferring techniques in different scenarios. Additionally, the transferring scenario was found to significantly affect the perceived difficulty of sitting transfers (toilet 2.17 ±.88; bed 1.47 ±.65, p =.001; car 1.63 ±.82, p =.012) and standing transfers (car 3.5 ±.71; bed 1 ± 0, p =.03; toilet 1 ± 0, p =.03), and the TAI score attributed to sitting pivot with use of a transfer board (couch 4.3 ±.88; bed 6.93 ± 1.29, p =.022; car 7.13 ± 1.32, p =.018). Overall, environmental constraints can lead to major technique changes and, more often, to different positioning of hands and feet which could impact the transfer's biomechanics.

Evaluating the use of a thermoplastic socket in Kenya: A pilot study.

BACKGROUND: Many people with amputations who live in low-resourced settings struggle to access the workshops where qualified prosthetists provide appropriate care. Novel technologies such as the thermoplastic Confidence Socket are emerging, which could help facilitate easier access to prosthetic services. OBJECTIVES: The objective of this study was to evaluate the satisfaction and the performance of transtibial prosthesis featuring the Confidence Socket. STUDY DESIGN: This is a longitudinal repeated-measures design study. METHODS: A convenience sample of 26 participants who underwent transtibial amputation were fitted with the Confidence Socket. The performance of the socket was evaluated after a follow-up period between 1 month and 6 months using the L test of functional mobility and the amputee mobility predictor. Satisfaction with the prosthesis was measured using the Trinity Amputation and Prosthetic Experience Scales and purposefully designed 7-point Likert scales. RESULTS: Ten of the 26 participants returned for follow-up. Perceived activity restriction and L test times improved significantly at follow-up, but the self-reported satisfaction with the Confidence Socket was lower at follow-up compared with that after fitting. CONCLUSIONS: The Amparo Confidence Socket represents a potentially viable alternative to improve access to appropriate prosthesis in Kenya, but some aspects of users' self-reported satisfaction should be further investigated.

Assistive Technology Use and Provision During COVID-19: Results From a Rapid Global Survey.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted all segments of society, but it has posed particular challenges for the inclusion of persons with disabilities, those with chronic illness and older people regarding their participation in daily life. These groups often benefit from assistive technology (AT) and so it is important to understand how use of AT may be affected by or may help to mitigate the impacts of COVID-19. Objective: The objectives of this study were to explore the how AT use and provision have been affected during the initial stages of the COVID-19 pandemic, and how AT policies and systems may be made more resilient based on lessons learned during this global crisis. METHODS: This study was a rapid, international online qualitative survey in the 6 United Nations (UN) languages (English, French, Spanish, Russian, Arabic, Mandarin Chinese) facilitated by extant World Health Organization (WHO) and International Disability Alliance networks. Themes and subthemes of the qualitative responses were identified using Braun and Clarke's 6-phase analysis. RESULTS: Four primary themes were identified in in the data: Disruption of Services, Insufficient Emergency Preparedness, Limitations in Existing Technology, and Inadequate Policies and Systems. Subthemes were identified within each theme, including subthemes related to developing resilience in AT systems, based on learning from the pandemic. CONCLUSION: COVID-19 has disrupted the delivery of AT services, primarily due to infection control measures resulting in lack of provider availability and diminished one-to-one services. This study identified a need for stronger user-centred development of funding policies and infrastructures that are more sustainable and resilient, best practices for remote service delivery, robust and accessible tools and systems, and increased capacity of clients, caregivers, and clinicians to respond to pandemic and other crisis situations.

Quantum entanglement distribution with 810 nm photons through active telecommunication fibers.

We demonstrate the distribution of polarization-entangled photons for the purpose of quantum key distribution (QKD) along active telecom fibers. Entangled photon pairs of 810 nm wavelength generated by a Sagnac interferometer source were coupled into standard telecom single mode fibers. The fibers were either dark or carrying a standardized 1550 nm ethernet signals (1000BASE-ZX) with a nominal speed of 1 GBps from regular media converter devices, without any requirements on the optical power or spectrum transmitted. Our system demonstrates a QKD network covering 6 km in distance with a central service provider for classical and quantum data.

"When They See a Wheelchair, They've Not Even Seen Me"-Factors Shaping the Experience of Disability Stigma and Discrimination in Kenya.

Disability stigma in many low- and middle-income countries represents one of the most pervasive barriers preventing people with disabilities from accessing equal rights and opportunities, including the uptake of available assistive technology (AT). Previous studies have rarely examined how disability stigma may be shaped through factors endemic to social interactions, including how the use of assistive technology itself may precipitate or alleviate disability stigma. Through two strands of work, we address this gap. Via a series of focus groups with Kenyans without disabilities (Study 1) and secondary data analysis of consultations with Kenyans with disabilities and their allies (Study 2), we identify shared and divergent understandings of what shapes disability stigma and discrimination. Specifically, Kenyans with and without disabilities were cognizant of how religious/spiritual interpretations of disability, conceptions of impairments as "different" from the norm, and social stereotypes about (dis)ability shaped the experience of stigma and discrimination. Moreover, both groups highlighted assistive technology as an influential factor that served to identify or "mark" someone as having a disability. However, whereas participants without disabilities saw assistive technology purely as an enabler to overcome stigma, participants with disabilities also noted that, in some cases, use of assistive technologies would attract stigma from others.

A review of innovation strategies and processes to improve access to AT: Looking ahead to open innovation ecosystems.

It is essential to understand the strategies and processes which are deployed currently across the Assistive Technology (AT) space toward measuring innovation. The main aim of this paper is to identify functional innovation strategies and processes which are being or can be deployed in the AT space to increase access to AT globally. We conducted a scoping review of innovation strategies and processes in peer-reviewed literature databases and complemented this by identifying case studies demonstrating innovation strategies. The review includes WHO world region, publication year, AT type and a sector analysis against the Systems-Market for Assistive and Related Technologies Framework. We analyzed the case studies and interviews using thematic analysis. We included 91 papers out of 3,127 after review along with 72 case studies. Our results showed that product innovations were more prevalent than provision or supply innovations across papers and case studies. Case studies yielded two themes: open innovation (OI); radical and disruptive innovation. Financial instruments which encourage OI are needed and we recommend pursuing OI for AT innovation. Embedding AT within larger societal missions will be key to success governments and investors need to understand what AT is and their translational socioeconomic value.

Assembling networks of microbial genomes using linear programming.

BACKGROUND: Microbial genomes exhibit complex sets of genetic affinities due to lateral genetic transfer. Assessing the relative contributions of parent-to-offspring inheritance and gene sharing is a vital step in understanding the evolutionary origins and modern-day function of an organism, but recovering and showing these relationships is a challenging problem. RESULTS: We have developed a new approach that uses linear programming to find between-genome relationships, by treating tables of genetic affinities (here, represented by transformed BLAST e-values) as an optimization problem. Validation trials on simulated data demonstrate the effectiveness of the approach in recovering and representing vertical and lateral relationships among genomes. Application of the technique to a set comprising Aquifex aeolicus and 75 other thermophiles showed an important role for large genomes as 'hubs' in the gene sharing network, and suggested that genes are preferentially shared between organisms with similar optimal growth temperatures. We were also able to discover distinct and common genetic contributors to each sequenced representative of genus Pseudomonas. CONCLUSIONS: The linear programming approach we have developed can serve as an effective inference tool in its own right, and can be an efficient first step in a more-intensive phylogenomic analysis.

Understanding independent wheelchair transfers. Perspectives from stakeholders.

Purpose: Transferring to and from the wheelchair is among the most important routine tasks for many wheelchair users. Transfers are also greatly affected by many personal and external factors. The purpose of this study is to investigate personal experiences, needs and concerns of wheelchair users in relation to wheelchair transfers performed in their everyday lives.Methods: A series of focus groups and interviews were carried out with 11 wheelchair users and 4 occupational therapists. Data were analysed using a hybrid deductive and inductive approach of thematic analysis.Results: The seven themes identified emphasize the importance and complexity of wheelchair transfers. Transfers were described as gateways to independence that grant access to life opportunities, and community participation. Nonetheless, transferring skills are difficult to acquire and the concept of correct technique, although really important, is often poorly defined. Wheelchair transfers can be further complicated by the characteristics of the individual, the presence of upper limb pain, fear of falling or the characteristics of the environment. Despite the importance of transfer training to improve safety and reduce the risk of overload injuries, only a few people receive dedicated advice from health professionals. Currently available assistive technologies were perceived as only partially successful in providing support to wheelchair users during the execution of transfers, especially when environmental constraints make the transfer more challenging.Conclusion: Due to their multifactorial nature, creating effective solutions to improve any aspect of wheelchair transfers will require a collaborative effort from users, clinicians, designers and other professionals.Implications for rehabilitationThe ability to transfer independently is extremely important for many wheelchair users and can affect not only their personal and social lives, but also the way they perceive themselves and are perceived by others.The use of a correct transferring technique plays an important role in reducing the effort required to complete a transfer and decreases the risk factors for both falls and upper limb injury development. Unfortunately, few wheelchair users have access to in-person training to develop transferring skills. The remaining people rely on a combination of peer observation, personal research and simple trial and error to figure out the movement strategies that better suit their needs.Currently available assistive technologies are perceived by wheelchair users as only partially successful in providing support during the execution of transfers. Transfer boards and other devices are often described as only useful for basic transfers and for individuals with reduced, but still sufficient, upper limb function.

Breathing Biofeedback Relaxation Intervention for Wheelchair Users in City Navigation.

Manual wheelchair users experience numerous invisible barriers while navigating cities, often reporting how stressful journeys are. This stress affects a wheelchair user's quality of life. To alleviate such psychological burden, we propose a novel intervention strategy with a respiratory biofeedback interface which is designed to help users feel relaxed in urban navigation. We conducted a study in a real-world setting to explore its potential to provide real-time psychological support. From qualitative and quantitative analysis, we report on the strengths and weaknesses of the approach.

Neuroergonomic Assessment of Wheelchair Control Using Mobile fNIRS.

For over two centuries, the wheelchair has been one of the most common assistive devices for individuals with locomotor impairments without many modifications. Wheelchair control is a complex motor task that increases both the physical and cognitive workload. New wheelchair interfaces, including Power Assisted devices, can further augment users by reducing the required physical effort, however little is known on the mental effort implications. In this study, we adopted a neuroergonomic approach utilizing mobile and wireless functional near infrared spectroscopy (fNIRS) based brain monitoring of physically active participants. 48 volunteers (30 novice and 18 experienced) self-propelled on a wheelchair with and without a PowerAssist interface in both simple and complex realistic environments. Results indicated that as expected, the complex more difficult environment led to lower task performance complemented by higher prefrontal cortex activity compared to the simple environment. The use of the PowerAssist feature had significantly lower brain activation compared to traditional manual control only for novices. Expertise led to a lower brain activation pattern within the middle frontal gyrus, complemented by performance metrics that involve lower cognitive workload. Results here confirm the potential of the Neuroergonomic approach and that direct neural activity measures can complement and enhance task performance metrics. We conclude that the cognitive workload benefits of PowerAssist are more directed to new users and difficult settings. The approach demonstrated here can be utilized in future studies to enable greater personalization and understanding of mobility interfaces within real-world dynamic environments.

An investigation of factors affecting the performance of wheelchair transfers.

Purpose: Being able to transfer in and out of their wheelchair is an important task for wheelchair users that can be affected by a variety of different factors. The aim of this study was to investigate the interplay between personal characteristics, wheelchair users' transferring technique and the other factors that can affect the performance of wheelchair transfers. Method: A cross-sectional survey study was designed to recruit wheelchair users, aged 18 or older, performing sitting-pivot or standing-pivot wheelchair transfers, independently or with assistance. Results: Forty-two usable surveys were returned. Transferring technique is usually determined by the individual's impairment. In turn, transferring technique will greatly affect the perceived difficulty of different types of wheelchair transfers and, the number of transfers that people will perform in a day. The presence of upper limb pain increased the difficulty reported for certain types of transfers while the use of assistive technologies appears to be only partially successful in facilitating the performance of wheelchair transfers. Conclusion: This study highlights the complexity of the factors included in the performance of wheelchair transfers. Findings from this survey can be utilized to broaden the boundaries of future research. Implications for rehabilitation Transferring technique is usually determined by the individual?s impairment. In turn, transferring technique will greatly affect the perceived difficulty of different types of wheelchair transfers and, the number of transfers that people will perform in a day. The performance of wheelchair transfers exacerbate the painful symptomatology of the person, regardless of their medical condition or transferring technique. The presence of pain increases the reported difficulty of wheelchair trasnfers. Use of assistive technologies during transfers is linked to the increased body weight of the person, while the choice of the type of assistive technology seems to be dependent of the transferring technique used by the person. Overall, available ATs are only moderately effective in enabling people to perform wheelchair transfer and they can be cause of frustration for the users due to their high cost and limited functionality.

A pilot study towards long-term thermal comfort research for lower-limb prosthesis wearers.

BACKGROUND:: Thermal discomfort among lower-limb prosthesis wearers is prevalent with social and medical consequences. OBJECTIVES:: This study aimed to verify the feasibility of out-of-laboratory thermal comfort studies. STUDY DESIGN:: Repeated measures pilot study. METHODS:: Thermistors were placed on participants' residual limbs during two experimental phases. In phase 1, mean limb temperature was calculated over a controlled 55-min rest-exercise-rest protocol. In phase 2, participants conducted activities of their choosing wherever they wanted away from the lab, while limb temperature data were collected. Descriptive statistics and statistical differences between phases are presented. RESULTS:: Five male amputees participated with an average age ±standard deviation of 30 ± 9 years. In phase 1, mean limb temperature change ranged between 1.6°C and 3.7°C. In phase 2, mean limb temperature change ranged between 1.8°C and 5.1°C. Limb temperature was significantly higher in out-of-lab studies (+1.9°C, p = 0.043) compared to in-lab studies. CONCLUSION:: Independent multiple-hour temperature studies are shown to be feasible. Results also indicate that out-of-lab residual limb temperature can be significantly higher than in-lab temperatures. CLINICAL RELEVANCE: Thermal discomfort and sweating may lead to skin conditions and reduce quality of life among prosthesis wearers. Out-of-lab, long-term temperature studies are needed to comprehensively characterize thermal discomfort to create preventive solutions.

Detection and localisation of hesitant steps in people with Alzheimer's disease navigating routes of varying complexity.

People with Alzheimer's disease (AD) have characteristic problems navigating everyday environments. While patients may exhibit abnormal gait parameters, adaptive gait irregularities when navigating environments are little explored or understood. The aim of this study was to assess adaptive locomotor responses of AD subjects in a complex environment requiring spatial navigation. A controlled environment of three corridors was set up: straight (I), U-shaped (U) and dog-leg (S). Participants were asked to walk along corridors as part of a counterbalanced repeated-measures design. Three groups were studied: 11 people with posterior cortical atrophy (PCA), 10 with typical Alzheimer's disease (tAD) and 13 controls. Spatio-temporal gait parameters and position within the corridors were monitored with shoe-mounted inertial measurement units (IMUs). Hesitant steps were identified from statistical analysis of the distribution of step time data. Walking paths were generated from position data calculated by double integration of IMU acceleration. People with PCA and tAD had similar gait characteristics, having shorter steps and longer step times than controls. Hesitant steps tended to be clustered within certain regions of the walking paths. IMUs enabled identification of key gait characteristics in this clinical population (step time, length and step hesitancy) and environmental conditions (route complexity) modifying their expression.

Effect of technique and transfer board use on the performance of wheelchair transfers.

Transferring to and from the wheelchair seat is a necessary skill for many wheelchair users who wish to be independent of their everyday life. The performance of wheelchair transfers has been associated with the risk of falling and developing upper limb injuries. Both present a risk to the independence of the individual. Previous studies on wheelchair transfers have focused mainly on the analysis of sitting transfers performed by individuals with spinal cord injury, which only represent a small portion of the wider wheelchair users' population. The purpose of this study is to investigate the effect of different transferring techniques (sitting, standing) and transfer board use on the ground reaction forces under the hands during transfer performance and transfer quality measured using the transfer assessment instrument (TAI). Sitting transfers displayed generally higher peak and mean reaction forces underneath both leading and trailing hands compared with the other techniques, but the difference was only significant between sitting and standing transfers. Standing transfers had significantly lower TAI scores compared with sitting transfer, potentially indicating a decreased level of safety associated with their performance. Transfer boards were only partially effective in reducing the weight born by the upper limbs and they caused only a minor reduction in the overall TAI score in comparison to sitting transfers.