10:30
Rehabilitation Devices & E-health
10:30
15 mins
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THE DEVELOPMENT OF THE SCRIPT ACTIVE ORTHOSIS: AN ACTIVE HAND AND WRIST EXOSKELETON FOR STROKE REHABILITATION AT HOME
Serdar Ates, Israel Mora Moreno, Martijn Wessels, Piet Lammertse, Arno Stienen
Abstract: Impairments in the hand decrease the quality of life of stroke patients drastically since hand is an end-effector that people use to physically interact with the environment and essential for the most of the activities of daily living such as eating, drinking, buttoning, etc.
Repetitive training exercises during therapy sessions are crucial to the patients’ recovery of functional motor abilities after stroke. Rehabilitation robots have shown their importance to help patients and therapists to do these exercises in a more quantitative and effective way with large numbers of repetitions and have the growing evidence during last few decades. Since there is a tight correlation between therapy intensity and functional recovery, it is logical to deliver rehabilitation robots to patients’ home in order to let them customize their own therapy schedules in a more time-effective, affordable and motivational way. Yet, using hand exoskeletons at home is still a technical challenge due to the complexity of human hand anatomy. Besides the hand has many degrees of freedom with non-conventional joints, there is a limited space to put sensors and actuators in hand exoskeletons.
In the SCRIPT project (EU-FP7), we have developed a passive hand and wrist orthosis that assists patients in extension of the fingers and the wrist since most of the stroke patients need assistance only in extension and we tested it with 24 patients from three European countries at their homes for 6 weeks (~1 [hr/week] for 6 [days/week]) by each patient. Based on this feedback and the lessons we learned, we developed an active hand and wrist orthosis for home use to enable better control over the assist-as-needed characteristics of the orthosis which is essential to adjust the assistance according to recovery progress of the patients. We have developed and prototyped the SCRIPT Active Orthosis and it is in clinical evaluation phase. Based on these clinical evaluations, we aim to finalize the design to meet all user requirements such as ease of use, light weight, affordability, safety, comfort and robustness.
REFERENCES
[1] S. Ates et. al., “SCRIPT Passive Orthosis: Design and technical evaluation of the wrist and hand orthosis for rehabilitation training at home”, 13th IEEE International Conference on Rehabilitation Robotics (ICORR), 2013.
[2] S. Ates et. al., “Technical evaluation of and clinical experiences with the SCRIPT passive wrist and hand orthosis”, 7th IEEE International Conference in Human System Interactions (HSI), 2014.
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10:45
15 mins
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THE DESIGN OF ROPIT (ROBOTIC PIANO TEACHER): AN HAND EXOSKELETON FOR STROKE REHABILITATION
Vivian van Voorthuizen, Serdar Ates, Arno Stienen
Abstract: Rehabilitation robots are useful and important tools for quantitative measurements of post-stroke impairments and degree of recovery. It is also a valuable therapy tool for therapists and clinicians. They allow repetitive movements, which is considered to be crucial to recover motor skill impairments after stroke. The use of hand exoskeletons for intensive stroke therapy is an area which is still under explore since there are many technical challenges such as complexity of human hand anatomy, number of degrees of freedom, non-conventional joint structure, self-alignment of center of rotation of joints, mechanical transparency, non-invasiveness, safety, ease of use, light weight, affordability, etc. Besides these technical challenges, there are other challenges from the patient side such as motivation and independence to engage them with their therapy sessions. Playing piano improves upper extremity function of stroke patients in terms of speed, precision and smoothness of movements. It is also promising to engage patients with their therapy sessions.
RoPiT is a finger manipulator exoskeleton aiming at teaching people how to play piano. It has separate finger actuation mechanisms for flexion and extension of each finger. This mechanisms are attached to the fingers with a finger cap on MCP (metacarpophalangeal) joints and deliver required actuation torque from low-cost RC-servo motors via pulleys and mechanical wires. It allows to practice different melodies in different tempos which can be considered to improve the fine finger motor skills as a more enjoyable way of rehabilitation than conventional therapy sessions.
As a proof-of-concept, RoPiT is the first prototype which meets its primary user requirements including safety, low-weight, easy-of-use and low-cost. It also fits for different hands and aligns with different fingers. However there is still space for improvements such as higher and smoother torque delivery, larger range-of-motion and additional degree-of-freedom for abduction/adduction of the fingers.
REFERENCES
[1] V. A. van Voorthuizen, “The design of RoPiT – Robotic Piano Teacher”, Bachelor Assignment, Biomedische Werktuigbouwkunde, Universiteit Twente, 2014.
[2] E. Altenmüller et. al., “Using musical instruments to improve motor skill recovery following a stroke”, Journal of Neurology, 254(10): 1339–1346, 2007.
[3] Neurorehabilitation Technology, V. Dietz, T. Nef, W. Z. Rymer, Springer-Verlag (2012).
[4] H. Yamaura, et al. "Development of hand rehabilitation system for paralysis patient–universal design using wire-driven mechanism", Engineering in Medicine and Biology Society, IEEE EMBC Annual International Conference, 2009.
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11:00
15 mins
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A NEED FOR A MORE USER-CENTERED DESIGN IN BODY-POWERED PROSTHESES
Mona Hichert, Alistair Vardy, Dick Plettenburg
Abstract: Body powered prostheses (BPP), where the terminal device is controlled by applying shoulder movements to operate a control cable, remains a popular aid among upper limb amputees. However, users of BPP complain about too high operating forces, leading to pain and/or fatigue during or after prosthetic operation. In the worst case nerve and vessel damage can occur [1, 2], leading to non-use of prostheses. It is currently unclear to what extent the capability of BPP users is sufficient to operate BPP. A study from 1954 touched on this issue by measuring forces generated by isolated shoulder movements in healthy individuals [3]. Unfortunately, BPP are typically operated by combinations of shoulder movements.
The goal of this study is to investigate the maximum cable operating forces prosthetic users can develop on the control cable. This information will be used to answer two questions:
1) Are the maximal cable forces (MCF) sufficient to operate commercially available BPP?
2). Can users operate the BPP at 20% MCF to prevent fatigue during extended periods of operation [4]? Recently, These results will be used to assess these questions.
A total of 25 trans-radial amputees participated, and were requested to produce maximal force on the control cable (MCF) for 3 seconds. This procedure was repeated 3 times and the maximal value was taken. Cable forces were measured with a S-beam load cell and compared to cable forces and displacements required to operate a wide range of commercially available voluntary closing (VC) and voluntary opening (VO) hands and hooks as reported by Smit and co-workers [5, 6].
MCF’s were on average 267±123 N. For some subjects, these forces were insufficient to close 3 out of the 7 VC devices and open 2 out of the 14 VO devices. Moreover, some subjects were unable to operate any of the devices at 20% MCF. These results confirm the complaints from BPP users and indicate that knowing the capability of BPP users is vital in redesigning future BPP’s to prevent non-use.
REFERENCES
[1] E.A. Biddiss and T.T Chau, “Upper limb prosthesis use and abandonment: A survey of the last 25 years,” Prosthet Orthot Int, vol. 31, pp. 236-257, 2007.
[2] E. A. Biddiss, D. Beaton, and T.T Chau, “Consumer design priorities for upper limb prosthetics,” Disabil Rehabil Assist Technol., vol 2, pp. 346-357, 2007.
[3] C.L. Taylor, “The biomechanics of the normal and of the amputated upper extremity,” Human limbs and their substitutes. McGraw-Hill, New York (NY), pp. 169–221, 1954.
[4] H. Monod, “Contractility of muscle during prolonged static and repetitive dynamic activity, “ Ergonomics, vol. 28, pp.81-89, 1985.
[5] G. Smit and D.H. Plettenburg, “Efficiency of voluntary closing hand and hook prostheses,” Prosthet Orthot Int, vol. 34, pp. 411-427, 2010.
[6] G. Smit, R.M. Bongers, C.K. van der Sluis, and D.H. Plettenburg, “Efficiency of voluntary opening hand and hook prosthetic devices: 24 years of development?,” J Rehabil Res Dev, vol 49, pp. 523-534, 2012.
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11:15
15 mins
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USING THE NINTENDO WII BALANCE BOARD FOR AUTOMATIC FALL RISK CLASSIFICATION
Gert Mertes, Greet Baldewijns, Pieter-Jan Dingenen, Tom Croonenborghs, Bart Vanrumste
Abstract: Thirty percent of persons aged 65 or older fall at least once a year. Fall incidents not only cause physical injuries, but also affect the psychological health of the person that fell. Falling can also lead to fear of future falls, which in turn can cause the elderly to move less and spend more time inside. The resulting isolation can in turn reduce the muscle strength of the older person which causes an increase of the fall risk. Preventing fall incidents would therefore improve the quality of life of older persons.
Detecting an elevated fall risk at an early stage allows for preventive measures and hence reduce the number of fall incidents. Several methods to estimate a person’s fall risk exist today, e.g. the Timed-Get-Up-and-Go test, but these require specialised personnel and are typically only taken after a fall incident has occurred and are therefore not always useful in preventing falls.
A fall risk assessment tool using the Wii Balance Board that allows for an early detection of increased fall risk without the need for specialised personnel is presented in this study. The older person has to stand on the board and remain rigid for 40 seconds after which the algorithm determines whether or not that person has an increased fall risk.
Center of Pressure (CoP) recordings were acquired with the balance board of 47 participants, of which 39 were used as training data and 12 for validation. The training dataset contains 16 ‘healthy’ college students acting as a control group, 8 elderly people who had fallen at least once in the past year and 15 elderly who had not. Features of velocity and amplitude were extracted from the CoP recordings in both the mediolateral and anterior-posterior directions and used to train a Support Vector Machine (SVM) and K-Nearest-Neighbour (KNN) classifier.
Initial validation of the classifiers was done using 10-fold cross validation. A maximum average accuracy of 96.49% ± 4.02 was achieved with the SVM classifier with Radial Basis Function kernel and 95.72% ± 1.48 with the KNN classifier with k = 4. The classifiers were furthermore validated against the validation dataset of 12 participants. A maximum accuracy of 76.6% was achieved with the SVM with linear kernel. We conclude that it is possible to accurately distinguish between persons with and without an elevated fall risk using the Nintendo Wii Balance Board.
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11:30
15 mins
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AUTOMATIC MONITORING OF ACTIVITIES OF DAILY LIVING USING A WIRELESS ACOUSTIC SENSOR NETWORK
Lode Vuegen, Bert Van Den Broeck, Peter Karsmakers, Bart Vanrumste
Abstract: In 2060 26% of the EU’s population will be older than 65 years [1]. This causes significant budgetary implications on today’s elderly care facilities. Therefore, proactive measures must be taken to prevent rocketing costs and overcrowded facilities. A possible solution is to assist elderly to longer live safely at home by using modern information technology.
This research focusses on automatic home observation of alone living elders by using a Wireless Acoustic Sensor Network (WASN). Such networks consists of multiple so-called acoustic nodes each containing one or more microphones. These WASNs have the advantages that: a) they can be placed without any inconvenient cables, b) the nodes can be relatively small while maintaining large spatial sampling, c) spatial and multichannel filtering techniques can be applied network wide and c) the workload can be distributed over the different nodes.
In order to evaluate the proposed approach, a small residence was equipped with seven different acoustic nodes (each containing three linear spaced MEMS-microphones with an inter sensor distance of 2.5cm). In total, ten different activities related to the Katz Scale of independence (e.g. brushing teeth, toilet visit, preparing food, etc.) were simulated and recorded during a three day time span [2].
From this dataset, when a sound is detected features are extracted based on both the spectral properties (Mel-Frequency Cepstral Coefficients) and position of the sound sources (Steered Response Power). It is worth mentioning that only the spectral features are computed from the node receiving the acoustical data with the highest Signal-to-Noise ratio (SNR) while the position features are computed from all nodes. Evaluation of the classification algorithm is done by partitioning the data with a 4-fold cross validation into a training and test set. A Gaussian Mixture Model (GMM) with five mixture components and a full-covariance matrix was trained for each recorded activity. Promising initial classification results were achieved, i.e. 92±4% for the spectral features and 85±4% for the position features.
Future research will focus on the validation of the proposed method on a larger and real-life recorded dataset.
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11:45
15 mins
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BARRIERS AND REQUIREMENTS FOR ACHIEVING INTEROPERABLE EHEALTH TECHNOLOGY IN PRIMARY CARE
Wendy Oude Nijeweme – d’Hollosy, Lex van Velsen, Hermie Hermens
Abstract: Despite its great promises, eHealth is not yet structurally embedded within the IT infrastructure of primary care. This is mainly due to the fact that healthcare technologies have been developed without coordination and a centralized approach [1], which in turn has led to a lack of shared standards among the different systems for exchanging data (interoperability).
The benefits and barriers for interoperability in healthcare have thoroughly been described in literature. Benefits include the availability of up to date information, improved quality of care and cost savings, while barriers include information overload, costs, security & privacy, and liability issues [2,3]. None of these overviews, however, have listed the barriers and prerequisites towards interoperability within primary care on the level of single healthcare professionals in relation to their daily work practice.
In order to identify requirements for interoperable eHealth technology in the context of primary care, we conducted 24 online surveys and 25 in-depth interviews with 28 key users (general practitioners, somatic nurse practitioners and physical therapists) in six primary care practices in The Netherlands. The online survey inventoried the technological infrastructure of the practices; the interviews were a means to elicit context-driven requirements for (the implementation of) interoperable eHealth technologies. In all, six themes were addressed in the surveys and interviews: demographics, computer skills, organizational management, the organizational IT infrastructure, professionals’ understanding of eHealth (possibilities), and finally, personal experiences with and future expectations of eHealth usage.
Thematic analysis resulted in an overview of context-driven requirements and barriers for implementing interoperable eHealth technology into primary care. The most notable requirements were the need for a clear organization of the technology to encourage intuitive usage by the users, availability of workflow directives for eHealth usage, and as few as possible needed steps to perform a task. On the other hand, the most notable barriers found were anxiety for extra work, early technology failure that discourages eHealth usage, and no clarity about reimbursement by patients’ medical insurers. In order to cope with these requirements and barriers, it appears that designing interoperability for primary care is not only a technical challenge, but also an organizational one. On the technical level, one cannot expect primary care centres to have the necessary hardware for implementing state of the art, interoperable eHealth technology. This should be made available beforehand. On the organizational level directives on how to adjust working and reimbursement procedures on applying eHealth should be available and deployed. Only then the implementation of interoperability in primary care can succeed.
REFERENCES
[1] P. Kierkegaard, eHealth in Denmark: A case study. Journal of medical systems, 37, 9991, 2013
[2] P. Fontaine, S.E. Ross, T. Zink and L.M. Schilling, Systematic review of health information exchange in primary care practices. Journal of the American board of family medicine, 23(5), 655-670, 2010.
[3] M. Zwaanswijk, R.A. Verheij, F.J. Wiesman and R.D. Friele, Benefits and problems of electronic information exchange as perceived by health care professionals: An interview study. BMC health services research, 11: 256, 2011
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