Journal of Rehabilitation and Assistive Technologies Engineering

The goal of rehabilitation after stroke is to restore safe and sufficient function to hemiplegic patients, and prescription of an ankle-foot orthosis (AFO) to improve speed and functional ambulation is a part of this program.

This crossover randomized interventional study aimed to evaluate the effect of an anterior ankle-foot orthosis (AAFO) and posterior leaf-spring ankle-foot orthosis (PLS AFO) on speed and functional ambulation in hemiplegic stroke patients.

Clinical assessments were performed on 11 hemiplegic stroke patients by the AAFO, PLS AFO, and wearing shoes. Functional ambulation was measured by the 6-min walking test, Timed Up and Go Test, Time Up and Down Stair Test, and Functional Ambulation Category. Walking speed was measured by the 10-m test.

Both PLS AFO and AAFO significantly improved the performance of TUDS and TUG tests in hemiplegic patients. However, by using PLS AFO, walking distance was significantly greater than walking with shoes. There was no significant effect on the walking speed improvement using PLS AFO or AAFO compared to wearing shoes.

The positive effects of the AAFO and PLS AFO on functional ambulation were significant. By using PLS AFO, hemiplegic patients could walk a longer distance than wearing shoes.

Evaluate differences in sleep characteristics between older adults with and without mild Alzheimer’s disease using waist-worn actigraphy monitors.

Actigraph GT3X+ monitors and self-reported sleep and activity logs were used for one week and compared between older adults (N = 85) with (n = 35) and without Alzheimer’s disease (n = 51).

Participants with Alzheimer’s disease had greater total sleep time and spent more time in bed than nonimpaired older adults. Estimates for sleep efficiency and total sleep time for the total sample were elevated compared to previous studies of wrist-worn devices in similar populations, while estimates of sleep onset latency and wake after sleep onset for the total sample were lower.

Actigraphy-based sleep studies in older adults with Alzheimer’s disease should consider discrepancies between objective and subjective estimates of sleep and monitor placement to maximize the ability to measure both activity and sleep.

Ankle dorsiflexor muscle strength is a crucial component of gait.

We describe the development of a simple, hand-held dynamometer to measure the ankle dorsiflexor muscle strength in the sitting position. In addition, we examine its intra- and inter-rater reliability.

Measurements of the peak ankle dorsiflexor muscle strength were obtained by two examiners for 30 ankles of 15 healthy adults at two time points, with a one-day interval between measurements, to determine the inter- and intra-rater reliability. The intraclass correlation coefficients were calculated, and an intraclass correlation coefficient > 0.90 was considered as excellent reliability. A Bland–Altman analysis was used to assess systemic bias. The minimal detectable change in muscle strength was calculated with a confidence level of 95% (MDC₉₅).

The reliability of the device was excellent for both intra- (intraclass correlation coefficients [1,3] = 0.94) and inter-rater (intraclass correlation coefficients [2,3] = 0.96) comparisons. No fixed or proportional bias was observed between the two examiners. The MDC₉₅ was 0.77 N/kg.

Our results indicate the excellent reliability and responsiveness of our device. By obtaining the measurements of dorsiflexor strength while sitting, compensatory motions are suppressed, yielding a more consistent measurement that can be reliably used to detect subtle changes in the ankle dorsiflexor muscle strength.

Wheelchair caster bearings often suffer high-risk failures that lead to adverse consequences such as user injuries, suggesting that design improvements are necessary. This study aimed to compare thermoplastic bushings to standard roller bearings for potential improvements in durability and cost-effectiveness.

The durability and cost-effectiveness of two thermoplastic bushing models and two metallic ball-bearing models were tested using a standard lab-based accelerated wear testing protocol. Bushings and bearings were installed on a standard 8″ caster, and four samples per model underwent testing (16 total samples).

All failures were experienced by the stem rolling element. The thermoplastic bushings experienced higher mean durability than the standard ball-bearings. There were significant differences in durability across the tested models, F(3,12) = 3.88, p = 0.04. The durability of thermoplastic bushing #2 was higher than the standard type ZZ shielded deep groove ball bearings, p < 0.05. There were significant differences in cost-effectiveness across the tested models, F(3,12) = 7.64, p = 0.004. The cost-effectiveness of both thermoplastic bushings were significantly higher compared to type 2RS sealed deep groove bearings, p < 0.05.

The use of thermoplastic bushings can lower product cost and potentially reduce caster failures in the community that are associated with adverse consequences including user injuries.

The use of a smart electromechanical material, dielectric elastomer, is investigated for the development of an active bracing technique, which modifies the stiffness and damping of the knee brace during energy harvesting so as to reduce knee joint torque deviation during late swing in braced walking.

The bracing technique considered involves a dielectric elastomer energy harvesting cycle, which activates only when the knee flexor muscles are contracting eccentrically during late swing. The brace reduces the leg extension deviation during late swing in braced walking by transforming a portion of the mechanical stored energy into electrical energy, reducing the required internal work performed within the body.

Simulated behavior of the dielectric elastomer brace worn across the knee joint demonstrates that when properly activated, the dielectric elastomer brace’s reduction in stiffness and increase in damping minimize the added energy expenditure of knee joint bracing during late swing.

The modeling results demonstrate the effective application of a soft, circumferential, dielectric elastomer energy harvesting knee brace, which utilizes the changes in the dynamic behavior of the knee joint occurring during energy harvesting in order to reduce the added demand placed on the knee joint under braced conditions.

Force platforms and pressure-measuring insoles are the most common tools used for measuring center of pressure. Earlier studies to assess these instruments suffered from limited sample sizes or an inadequate range of participant foot sizes. The purpose of this study was to propose new methods to extract and calculate comparably accurate center of pressure for the Kistler® force platform and Medilogic® insoles.

Center of pressure data were collected from 65 participants wearing pressure-measuring insoles (six different sizes). Participants walked over consecutive force platforms for three trials while wearing pressure-measuring insoles within socks. Onset force thresholds and center of pressure segment length thresholds were used to determine accurate center of pressure path length and width. A single step for each foot and trial was extracted from both instruments.

A strong correlation was observed between instruments in center of pressure length (4.12 ± 6.72% difference, r = 0.74). Center of pressure width varied and was weakly correlated (–7.04 ± 4.48% difference, r = 0.11).

The results indicate that both instruments can measure center of pressure path length consistently and with comparable accuracy (differences < 10%). There were differences between instruments in measuring center of pressure path width, which were attributed to the limited number of sensors across the width of the insoles.

Sleep systems are supports used in lying, forming part of 24 h posture management programmes, for children and adults with severe motor disorders. Improved posture reduces likelihood of secondary complications such as pain and poor sleep quality, thus improving quality of life. The study aims are to investigate the effect of sleep systems on sleep quality and quantity, pain for young people with Cerebral Palsy and outcomes for carers.

Baseline data were gathered for 1 month prior to sleep system provision. Comparative data with the sleep system in place, were gathered for 5 months. The sample comprised four children with Cerebral Palsy, GMFCS level V, average age of 11.5, who did not have a sleep system. Data on sleep quality and quantity was gathered using the Chailey Sleep Questionnaire and sleep diaries and pain levels using the Paediatric Pain Profile. GAS Light verbal outcome measure was used to measure carer goals.

Descriptive statistics and paired sample t-tests were used, demonstrating pain levels remained static, improvements in sleep quality and quantity were found and carer goals achieved.

A small sample size and subjective data collection methods were used; further research is required to obtain more conclusive results.

A large body of research in the field of virtual reality is focused on making user interfaces more natural and intuitive by leveraging natural body movements to explore a virtual environment. For example, head-tracked user interfaces allow users to naturally look around a virtual space by moving their head. However, such approaches may not be appropriate for users with temporary or permanent limitations of their head movement.

In this paper, we present techniques that allow these users to get virtual benefits from a reduced range of physical movements. Specifically, we describe two techniques that augment virtual rotations relative to physical movement thresholds.

We describe how each of the two techniques can be implemented with either a head tracker or an eye tracker, e.g. in cases when no physical head rotations are possible.

We discuss their differences and limitations and we provide guidelines for the practical use of such augmented user interfaces.

Upper limb research is currently lacking detailed clinical guidance on the provision of unilateral transradial prostheses. Clinical practice guidelines are meant to serve as assistance for the decision-making process, and Delphi surveys have been used with increasing frequency within orthotics and prosthetics to create these guidelines for clinical practice.

A three round Delphi survey was used to gain consensus on clinical statements regarding unilateral transradial prostheses.

We achieved consensus (> 80% agreement) on a total of 40 statements by surveying 22 experts on upper limb prosthetics over three rounds of surveys. Response rate ranged from 81.8–86.4% with a total of 55 total statements under consideration throughout the duration of the survey. The 40 passing statements were arranged into nine guidelines for provision of prosthetic care in this population.

The Delphi technique allowed for the creation of a set of clinical practice guidelines for the unilateral transradial patient in the absence of conclusive empirical evidence.

The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults’ vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely.

This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care.

Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians.

The findings demonstrated the system’s capability to support remote examination of participants, and validated the system’s perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination.

This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

A challenge in the engineering of auto-adjusting prosthetic sockets is to maintain stable operation of the control system while users change their bodily position and activity. The purpose of this study was to test the stability of a socket that automatically adjusted socket size to maintain fit. Socket release during sitting was conducted between bouts of walking.

Adjustable sockets with sensors that monitored distance between the liner and socket were fabricated. Motor-driven panels and a microprocessor-based control system adjusted socket size during walking to maintain a target sensed distance. Limb fluid volume was recorded continuously. During eight sit/walk cycles, the socket panels were released upon sitting and then returned to position for walking, either the size at the end of the prior bout or a size 1.0% larger in volume.

In six transtibial prosthesis users, the control system maintained stable operation and did not saturate (move to and remain at the end of the actuator’s range) during 98% of the walking bouts. Limb fluid volume changes generally matched the panel position changes executed by the control system.

Stable operation of the control system suggests that the auto-adjusting socket is ready for testing in users’ at-home settings.

Available robot-assisted stroke rehabilitation systems are often limited in their utilization in the home environment, due to several barriers such as high cost, absence of therapists, tedious training tasks, or encumbering interfaces. This paper presents a low-cost robotic rehabilitation and assessment device for restoring wrist function, offering wrist exercises incorporating pronation-supination and flexion-extension movements. Furthermore, the device is designed for the assessment of joint stiffness of the wrist, and range of motion in two degrees of freedom. Methods: Mechanical/electrical design of the device as well as the control system is described. A preliminary evaluation focused on the measurement of the torsional stiffness of the limb is presented. It is evaluated by reconstructing the known stiffness values of torsional springs by measuring the motor current required to displace them.

The device demonstrates the ability to determine the stiffness of an object with low-cost hardware. Use case scenarios of the device for training and assessment of the wrist are presented, allowing for a range of motion of ± 75 ° and ± 65 ° , for pronation-supination and flexion-extension respectively.

The device shows potential to help objectively quantify the stiffness of the wrist movement, which consecutively could be used to represent and quantify the degree of impairment of patients after stroke in a more objective manner. Further clinical study is necessary to examine this.

Many barriers to physical activity (PA) exist for individuals with spinal cord injury (SCI). Social engagement may improve motivation to perform PA, which in turn may increase PA levels. This pilot study investigates how social engagement facilitated by mobile technology may reduce lack of motivation as a barrier to PA in individuals with SCI and demonstrates design implications for future technologies.

A user-needs survey was conducted with participants in the community. We recruited 26 participants (16 individuals with SCI and 10 family members or peers). A participatory design process using semi-structured interviews was used to identify themes relating to PA barriers.

One theme related to PA barriers was lack of PA-focused forums to connect with peers. Participants with SCI considered connecting with other individuals with SCI more motivating than connecting with their family members. Another key finding was that participants with SCI did not perceive that personal fitness trackers were targeted towards wheelchair-based activities.

Engagement and communication with peers who have similar functional mobility levels and life experiences can potentially improve motivation for PA; however, PA-motivational platforms are not tailored towards wheelchair-users. Our preliminary findings show that some individuals with SCI are not satisfied with current mobile-technologies for wheelchair-based PA.

Step counting can be used to estimate the activity level of people in daily life; however, commercially available accelerometer-based step counters have shown inaccuracies in detection of low-speed walking steps (<2.2 km/h), and thus are not suitable for older adults who usually walk at low speeds. This proof-of-concept study explores the feasibility of using force myography recorded at the ankle to detect low-speed steps.

Eight young healthy participants walked on a treadmill at three speeds (1, 1.5, and 2.0 km/h) while their force myography signals were recorded at the ankle using a customized strap embedded with an array of eight force-sensing resistors. A K-nearest neighbour model was trained and tested with the recorded data. Additional three mainstream machine learning algorithms were also employed to evaluate the performance of force myography band as a pedometer.

Results showed a low error rate of the step detection (<1.5%) at all three walking speeds.

This study demonstrates not only the feasibility of the proposed approach but also the potential of the investigated technology to reliably monitor low-speed step counting.

This article describes the development and initial clinical testing of an innovative home-based treatment for upper extremity hemiplegia that integrates contralaterally controlled functional electrical stimulation with hand therapy video games.

We explored the ability of seven participants with moderate-to-severe hand impairment to self-administer 12 weeks of contralaterally controlled functional electrical stimulation video game therapy at home for 10 h/week and in-lab with a therapist for four h/week. Clinical suitability was assessed by device usage logs, qualitative surveys, and clinical motor and cognitive outcomes.

Three participants completed the study with > 95% compliance and four did not. Factors linked to incompletion included development of trigger finger in the non-paretic hand, acceptance of a new full-time job, residence relocation, and persistence of drowsiness from anti-spasticity medication. Those who completed the treatment perceived qualitative benefits and experienced gains in motor and cognitive outcomes.

Individuals with moderate-to-severe chronic post-stroke upper extremity hemiplegia can self-administer contralaterally controlled functional electrical stimulation video game therapy for up to 90 min/day at home. We also identified social and physiological factors that may preclude its use for daily home treatment. Further studies are warranted and are in progress to estimate treatment effect and optimal dose of this intervention.

Increasing physical activity in older adults has preventative and therapeutic health benefits. We have developed STARFISH, a smartphone application, to increase physical activity. This paper describes the features of STARFISH, presents the views of older users on the acceptability and usability of the app and reports the results of a six week pilot study of the STARFISH app in older adults.

The operationalisation of the behaviour change techniques (BCTs) within the STARFISH app was mapped against the BCT Taxonomy of Michie et al. Sixteen healthy older adults (eight women and eight men; age 71.1 ± 5.2 years) used the app, in groups of four, for six weeks. Focus groups explored the user experience and objective measure of steps per day recorded.

Participants were very positive about using the STARFISH app, in particular the embedded BCTs of self-monitoring, feedback and social support (in the form of group rewards). Objective step data, available for eight participants, showed that step counts increased by an average of 14% (p = 0.077, d = 0.56).

The STARFISH app was acceptable and straightforward to use for older adults. STARFISH has potential to increase physical activity in older adults; however, a fully powered randomised controlled trial is required.

Soft-robotic gloves have been developed to enhance grip to support stroke patients during daily life tasks. Studies showed that users perform tasks faster without the glove as compared to with the glove. It was investigated whether it is possible to detect grasp intention earlier than using force sensors to enhance the performance of the glove.

This was studied by distinguishing reach-to-grasp movements from reach movements without the intention to grasp, using minimal inertial sensing and machine learning. Both single-user and multi-user support vector machine classifiers were investigated. Data were gathered during an experiment with healthy subjects, in which they were asked to perform grasp and reach movements.

Experimental results show a mean accuracy of 98.2% for single-user and of 91.4% for multi-user classification, both using only two sensors: one on the hand and one on the middle finger. Furthermore, it was found that using only 40% of the trial length, an accuracy of 85.3% was achieved, which would allow for an earlier prediction of grasp during the reach movement by 1200 ms.

Based on these promising results, further research will be done to investigate the possibility to use classification of the movements in stroke patients.