A review of gait disorders in the elderly and neurological patients for robot-assisted training

Abstract

Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users.

Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted.

Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients.

Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices.

• Implications for rehabilitation

• The support requirements provide the foundation for designing assistive devices.

• The findings will be crucial in defining the design criteria for robot assistive devices.

     

Identification and analysis of knee–ankle–foot orthosis design requirements based on a feedback survey of orthosis users in India

Purpose: The world is advancing towards a technological revolution in various fields, yet the assistive devices available for people with disability, especially in developing countries, are in the most primitive stage. For many years, lower limb orthotics has been a neglected area of research and there is an urgent need to address the problems faced by lower limb orthosis users to enable them to lead an independent life. This work is a first step in this direction and aims to identify and analyse the needs of knee–ankle–foot orthosis (KAFO) users in India.

Method: A structured feedback survey of 29 KAFO users was conducted at three rehabilitation centres located in South India. A feedback questionnaire and a novel outcome measure tool (trigger cards) were used as means to assess user satisfaction about their existing KAFOs. The results of the survey were analysed to obtain quantitative and qualitative outcomes.

Results: The survey identifies various biomechanical and functional issues associated with lower limb orthosis design. The results of the survey imply that there is an urgent need to solve issues, especially related to locked orthotic knee joint design. Additionally, it sheds light on the lifestyle and socio-economic issues of KAFO users that are likely prevalent in many other low- and middle-income countries.

Conclusions: The outcomes of this survey can motivate and guide researchers to design improved orthotic solutions to meet the needs of lower limb orthosis users all over the world.

• Implications for Rehabilitation

• ???This is a first of its kind survey that brings forth the needs of lower limb orthosis users in India, and is an important step towards rehabilitation and empowerment of people with lower limb disability.

• ???The pilot survey helps to identify critical areas for design improvements in a knee–ankle–foot orthosis.

• ???The outcomes of this survey can help researchers to design functionally improved assistive devices that better meet the needs of users than currently available technology in developing countries such as India.

     

The effects of assistive technology service delivery processes and factors associated with positive outcomes – a systematic review

Abstract

Purpose: The objective of this systematic review was to investigate effects of different assistive technology service delivery processes (AT-SDPs) for people with functional limitations, including investigation of factors associated with positive outcomes.

Materials and methods: The study was registered in PROSPERO, registration number CRD42018097030. Included were quantitative studies published in peer reviewed journals: randomized controlled trials, cohort, case-control and analytical cross-sectional studies investigating effects of different AT-SDPs or factors associated with the AT-SDP and with n?≥?10 participants. A systematic literature search was carried out in the databases PsycINFO, CINAHL, SSCI and Medline from 1 January 2008 to 25 July 2018. Besides, four journals were hand searched. The Joanna Briggs Institute MAStARI Critical Appraisal Tools were utilized to assess the risk of bias.

Results: The search resulted in a total of 2947 references of which 12 articles representing 10 studies were included. Five studies were experimental, two were cohort, and five were cross-sectional studies.

Conclusions: This systematic review confirms previous findings that assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes. The level of evidence is, however, low, and it is not clear which of the applied methods are most effective. The review also gives some indication that new technologies could be used to improve the AT-SDP and reduce costs and that training in using the assistive devices seems to be useful. Even though some evidence of effective AT-SDP methods has been identified, more research is still needed to give valid recommendations to AT-SDP practice.

• Implications for rehabilitation

• Assistive technology users should be involved in the AT-SDP in order to achieve positive outcomes, but it cannot be determined which methods are the most effective.

• New digital technologies could be used to improve the AT-SDP and reduce costs.

• Training of the users in using their devices is probably useful, but since no specific methods nor extent or dose can be recommended, the professionals still need to use their clinical experience and reasoning to assess the user’s needs for training.

     

Understanding independent wheelchair transfers. Perspectives from stakeholders

Abstract

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 rehabilitation

• The 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.

     

Influences on selection of assistive technology for young children in South Africa: perspectives from rehabilitation professionals

Abstract: Selection of assistive technology for young children is a complex process. Within a context with limited resources, such as South Africa, research is needed to determine the factors influencing the assistive technology selection process, as these could ultimately either facilitate or hinder the availability and accessibility of affordable, adaptable, acceptable, and high quality assistive technology for this age group.

Method: Two asynchronous online focus groups were conducted with 16 rehabilitation professionals to identify the factors they perceived to influence the selection and provision of assistive technology to young children within the South African context.

Data analysis: A process of deductive thematic analysis was followed by inductive analysis of the data. Components of the Assistive Technology Device Selection Framework were used as themes to guide the deductive analysis, followed by inductive analysis to create subthemes.

Discussion: The important role of the professional was highlighted in negotiating all the factors to consider in the assistive technology selection and provision process. Adaptation of the Assistive Technology Device Selection Framework is suggested in order to facilitate application to low resourced contexts, such as South Africa.

• Implications for rehabilitation

• Assistive technology selection is a complex process with factors pertaining to the users (child and family) of the assistive technology, as well as the rehabilitation professional recommending the assistive technology influencing the process.

• Although it may be an important factor, the availability of financial resources to purchase assistive technology is not the only determining factor in providing appropriate assistive technology to young children in contexts with limited resources.

• Formalized support, such as reflective supervision or mentorship programs should be facilitated and utilized by recommending professionals.

• Home and school visits during assessment ensure a good match between assistive technology and users within the particular context.

• Facilitating the availability of assistive technology for trial during assessment and/or for a period afterwards will increase the likelihood that appropriate recommendations for assistive technology are made.

     

Attitudes faced by young adults using assistive technology as depicted through photovoice

Abstract

Purpose: To explore how the attitudinal environment influences the participation experiences of young adults with disabilities who use assistive technology.

Methods: In this qualitative study, twenty young adults using assistive technology completed individual interviews before and after engaging in a photovoice process. Ten of the participants then took part in a focus group. Data were analyzed inductively using a thematic analysis approach.

Results: Analysis yielded three primary themes “seen and treated as different, assumptions made and impatience”. A fourth theme emerged through focus group discussion “photos as a means of consciousness-raising”. Findings suggest that young adults with disabilities who use assistive technology regularly encounter negative societal attitudes that hinder participation. The photovoice process promoted consciousness-raising at the individual, interpersonal and societal level for the participants.

Conclusion: Many young adults with disabilities use assistive technology to facilitate participation in everyday activities. However, the usefulness of assistive technology is susceptible to the environment in which it is used. Further actions are needed toward resolving this challenging participation barrier; these actions should draw on the perspectives and creativity of young adult assistive technology users.

• IMPLICATIONS FOR REHABILITATION

• Young adults with disabilities who use assistive technology describe how other people’s negative attitudes can make it challenging to participate in their important activities.

• Participants took photographs that represented the negative attitudes they face on a daily basis and saw their photos as a way to raise awareness of the negative attitudes.

• This research highlights the importance of addressing negative attitudes toward people using assistive technology: young adults with disabilities have expertise and creative ideas about how to do this, so their voices should guide future research projects.

     

Methodology and feasibility of a 3D printed assistive technology intervention

Abstract

Three-dimensional (3D) printing now allows rehabilitation professionals to design and manufacture assistive technologies in a few hours. However, there is limited guidance for researchers and clinicians for implementing 3D printing assistive technology interventions and measuring their outcomes. The goal of this study was to develop a standardized 3D printing assistive technology intervention and a research methodology, using pillboxes as an example. Fourteen pillbox users engaged in a study comparing their use of an off-the-shelf pillbox to a customized 3D printed pillbox. Study outcomes were evaluated on feasibility (recruitment capability, study procedures and outcome measures, acceptability of the study procedures, the research team’s ability to manage and implement the study, and the participant’s preliminary response to intervention). Participant outcomes were measured on satisfaction with the device and medication adherence. Fourteen participants completed the study and received customized 3D printed pillboxes. The study design performed well on all aspects of feasibility except the research team’s ability to manage and implement the study, as they experienced several technical issues. Notably, the participants reported improved device satisfaction and medication adherence with the 3D printed device with large effect sizes. The 3D printed assistive technology intervention is a replicable process that supports professionals in printing their own assistive technologies. Recommendations are made to further enhance feasibility of 3D printing assistive technology studies. Future research is warranted.

• IMPLICATIONS FOR REHABILITATION

• 3D printing is an increasingly feasible approach allowing for the design and manufacture of customized assistive technology

• Evaluation for assistive technology that will be 3D printed should include information about the person’s activities, routines, skills, abilities, and preferences. Evaluation of outcomes should include satisfaction with the device and a functional measure.

• 3D printed assistive technology interventions should include the collaboration between the assistive technology professional and client. It should also include device training.

• Future 3D printing research studies should report pragmatic data including printing device, time to print, and number of errors.

     

Are there differences in factors influencing access and continued use of assistive products for people with intellectual disabilities living in group homes?

Abstract

Background: The World Health Organization has launched a program to promote Global Cooperation on Assistive Technology (GATE) to implement those parts of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) referring to assistive technology and products. A particular vulnerable group deeply affected by health inequity affecting access to assistive products are people with intellectual disabilities.

Objective: The objective of this study is to understand the barriers and facilitators to effectively access and continuously use essential assistive products for people with intellectual disabilities.

Materials and methods: Face-to-face interviews with 15 adults with a mild to profound intellectual disability and 15 providers of assistive products were conducted to gain insights about current use, needs, knowledge, awareness, access, customization, funding, follow-up, social inclusion, stigma and policies around assistive products and intellectual disability. The technique of constant comparative analysis was used to analyze the data.

Results and conclusion: An overview of factors is presented that fit within seven domains for access and eight domains for continuous use of assistive products for people with intellectual disabilities. It illustrates that access and continuous use are influenced by different barriers and facilitators. These different influences should be taken into account in country policies and frameworks that seek to implement the UNCRPD through assistive technology.

• Implications for rehabilitation

• Proactive assessment for assistive products by health professionals is rare and the vast majority of people with intellectual disabilities depend on carers to signal the need .

• A lack of education for carers around available assistive products and the benefits of assistive products for people with intellectual disabilities may lead to an underutilization for this group.

• The paternalistic attitude of care providers towards people with intellectual disabilities limits access and use to certain (high-tech) assistive products.

• The segmented and disjointed aspect of public funding to support assistive products found in this study is a key issue for policymakers who aspire to adhere to implementing the UNCRPD equally in all areas of their country.

     

Appraisals of robotic locomotor exoskeletons for gait: focus group insights from potential users with spinal cord injuries

Abstract

Purpose: To describe appraisals of robotic exoskeletons for locomotion by potential users with spinal cord injuries, their perceptions of device benefits and limitations, and recommendations for manufacturers and therapists regarding device use.

Materials and methods: We conducted focus groups at three regional rehabilitation hospitals and used thematic analysis to define themes.

Results: Across four focus groups, 35 adults participated; they were predominantly middle-aged, male, and diverse in terms of race and ethnicity, well educated, and not working. Participants had been living with SCI an average of two decades. Most participants were aware of exoskeletons. Some were enthusiastic about the usability of the devices while others were more circumspect. They had many questions about device affordability and usability, and were discerning in their appraisal of benefits and suitability to their particular circumstances. They reflected on device cost, the need for caregiver assistance, use of hands, and environmental considerations. They weighed the functional benefits relative to the cost of preferred activities. Their recommendations focused on cost, battery life, and independent use.

Conclusions: Potential users’ appraisals of mobility technology reflect a nuanced appreciation of device costs; functional, social, and psychological benefits; and limitations. Results provide guidance to therapists and manufacturers regarding device use.

• Implications for Rehabilitation

• Potential users of robotic locomotor exoskeletons with spinal cord injuries appreciate the functional, social, and psychological benefits that these devices may offer.

• Their appraisals reflect nuanced consideration of device cost and features, and the suitability of the assistive technology to their circumstances.

• They recommend that manufacturers focus on reducing cost, extending battery life, and features that allow independent use.

     

Assistive technology for students with visual disability in schools for the blind in Delhi

Abstract

Background: To understand the awareness and utilization of assistive technology in students at schools for the blind in Delhi.

Methods: A cross sectional study was conducted among 250 students selected randomly from 10 blind schools in Delhi. Binocular distance presenting and pinhole vision acuity were assessed using Snellen “E” chart and a multiple pinhole occluder. Students were also interviewed using a questionnaire about 42 assistive devices to understand their awareness and use.

Results: Male participants were 72.8%. Of the total, 27.6% students had best corrected visual acuity <6/18 to 1/60, and the rest had <1/60 vision. The awareness about tactile and sound-based technology was good among students: Braille books (98%), Braille slate and stylus (99.2%), handheld audio recorders (77.6%) and screen readers (77.2%). Good awareness was reported for abacus (88.8%), walking long canes (94.4%) and smart cane (89.6%), audible balls (96%), Braille chess (82.8%) and talking watch (98%). Among the students with <6/18 to 1/60 vision, the awareness of visual based technology ranged from 0.8% (typoscope) to 43.6% (video magnifiers). Braille technology was used for reading by 96.4% (books) and for writing by 96.8% (Braille slate and stylus) irrespective of visual status. Other devices were poorly used ranging from nil (typoscope) to 55% (screen readers). The use of math and science learning devices was poor (<20%). Walking canes were used by 59% of students whereas 87.2% students used audible ball for games.

Conclusion: The results showed that majority of students used tactile based technology irrespective of visual status.

• Implications for rehabilitation

• Students with visual disability need assistive technology for a wide range of activities including academic learning.

• Students in schools for the blind who have binocular best corrected vision acuity of 1/60 or better should be encouraged to use visual based assistive technology instead of tactile based.

• Students with binocular best corrected vision acuity less than1/60 should be encouraged to use other available tactile and sound-based assistive technologies as well as Braille books and Braille slate and stylus for their academic activities including maths and sciences.

• Teachers should be trained in the use of various assistive technologies for reading, writing, maths, sciences, sports, mobility and activities of daily living.

     

Assistive communication devices for patients with hearing loss: a cross-sectional survey of availability and staff awareness in outpatient clinics in England

Abstract

Purpose: Fair and equal access to health care for all is a fundamental principle of the National Health Service (NHS) in England. However, findings from a previous national survey examining the experiences of hearing-impaired patients when accessing services within the primary care setting have revealed that significant barriers continue to exist. The aim of this study was to examine the availability of assistive communication devices for patients with hearing loss at reception desks and in patient waiting areas in hospital outpatient settings.

Methods: We conducted a cross-sectional telephone survey involving Audiology and Ear, Nose and Throat (ENT) clinics in NHS hospitals in England. Questionnaires were administered to members of staff at clinic reception desks.

Results: All NHS hospital trusts in England providing Audiology and ENT services were included in the survey. Information was obtained from a total of 208 individual clinic reception desks. Assistive communication devices were reported to be available at 64 per cent of Audiology (49/76), 42 per cent of ENT (32/76) and 71 per cent of shared Audiology and ENT reception areas (40/56). The most common type of device was an induction loop system. A substantial proportion of survey respondents were not aware of existing facilities.

Conclusions: There is a shortage of assistive communication devices in Audiology and ENT clinic reception areas in England. The range of technology currently in place is insufficient. We have identified a significant lack of “deaf awareness” among frontline staff.

• Implications for rehabilitation

• Providers of health care services must recognize their legal obligation to ensure that their services are made more accessible to patients with hearing loss.

• The use of multimodal assistive technology ensures that more patients can benefit.

• Staff awareness and training is essential in improving the quality of service provision.

     

Methods to evaluate perspectives of safety,independence, activity,and participation in older persons using welfare technology. A systematic review

Abstract

Purpose: To conduct a systematic review of existing methods to evaluate the individual aspects of welfare technology from the perspectives of independence, safety, activity, and participation. Furthermore, the study aimed to describe outcomes that have been the focus of previous research to evaluate individual aspects of welfare technology in older persons living in ordinary housing. Materials and methods: A systematic literature review in PubMed, CINAHL Plus, PsycINFO, Scopus, and Web of Science. Studies selected were those that explored the use of assistive and welfare technology devices from older persons’ perspectives, and which considered the concepts of independence, safety, activity and participation, and quality of life. Results: A broad spectrum of instruments was applied in the studies. For independence, three questionnaires were used in the identified studies. For safety, one instrument was used in two versions. To study activity and participation as well as quality of life, several scales were used. Additionally, several studies included qualitative approaches for evaluation, such as interviews, or posed one or more questions regarding the effects of welfare technology. Conclusions: The integration of digital assistive and welfare technology should be based on the needs of older persons, and those needs must be assessed using reliable and relevant instruments. The heterogeneity of the target group, i.e., older persons, together with the fact that assessments must give consideration to identifying goals, obstacles, and risks as well as users’ preferences, implies a person-centred approach.

• Implications for rehabilitation

• The integration of digital assistive and welfare technology should be based on older persons’ needs, and those needs must be assessed using reliable and relevant instruments.

• The heterogeneity of the target group, i.e. older persons, together with the fact that assessments must give consideration to identifying goals, obstacles and risks as well as users’ preferences, implies a person-centred approach.

• The ideal would be one coherent model that explores the use of digital assistive and welfare technology from the individual, economic as well as organisational dimensions. This would cover the different needs and expectations of various stakeholders, including economic and organisational, but also the needs of the older person.

     

Everyday technology use among older deaf adults

Purpose: Technology holds great potential to support Deaf individuals as they age into older adulthood. However, it is unclear to what extent Deaf seniors are using technology in everyday life or whether they experience challenges in using technology. The current study explored technology use among older Deaf adults with regard to attitudes, adoption style, and frequency of use for a wide range of technologies, including assistive technologies (ATs) for persons with hearing loss and general, everyday technologies.

Materials and methods: We developed a questionnaire that assessed older Deaf adults’ use of and experiences with technology. The questionnaire was made available in online and paper versions. Participants (N?=?109) were recruited from national conferences and organizations for the Deaf.

Results: Overall, we found that the older Deaf adults were technology adopters and regularly use and feel comfortable with a variety of devices. However, we also identified a number of technologies that are not being used by this population, including an AT that appears to have become obsolete and technologies that use sound-based alerts.

Conclusions: Insights on how older Deaf adults are embracing technology and which devices they are actually using can help policy makers, technology developers, and a range of aging services professionals, better meet the needs of this understudied population.

• Implications for Rehabilitation:

• Older Deaf adults use a variety of assistive and everyday technologies and must be considered as consumers and included in the design process.

• Older Deaf adults are generally positive in their attitudes towards technologies but they are infrequent users of potentially beneficial health technologies, highlighting opportunities for future research and development.

• Assistive technology for the Deaf (TTY/TTD) appears to have become obsolete with advances in modern communication technologies, which has implications for policy decisions.

     

Opening the GATE: systems thinking from the global assistive technology alliance

Abstract

Purpose: This paper describes international actions to collaborate in the assistive technology (AT) arena and provides an update of programmes supporting AT globally.

Methods: The World Health Organisation (WHO) identifies the severe global uneven distribution of resources, expertise and extensive unmet need for AT, as well the optimistic substantial capability for innovations and developments in appropriate and sustainable AT design, development and delivery. Systems thinking and market shaping are identified as means to address these challenges and leverage the ingenuity and expertise of AT stakeholders.

Results: This paper is a ‘call to action’, showcasing emerging AT networks as exemplars of a distributed, but integrated mechanism for addressing AT needs globally, and describing the Global Alliance of Assistive Technology Organisations (GAATO) as a vehicle to facilitate this global networking.

Conclusion: Partners in this Global Alliance aim to advance the field of assistive technology by promoting shared research, policy advocacy, educating people and organisations within and outside the field, teaching, training and knowledge transfer by pulling together broad-based membership organisations.

• Implications for Rehabilitation

• Collegial, cross discipline and multi-stakeholder collaborations support assistive technology research and practice.

• Knowledge exchange within and across countries and regions is mutually beneficial.

• Self-organising assistive technology communities are emerging and supported by global movements such as WHO GATE and GAATO.

     

Engendering a conducive environment for university students with physical disabilities: assessing availability of assistive facilities in Nigeria

Purpose: This study assessed awareness and availability of assistive facilities in a Nigerian public university.

Methods: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university.

Results: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30?years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university’s administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD.

Conclusion: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required.

• Implications for Rehabilitation

• Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities.

• Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent.

• The design of buildings on university campus should be made disability friendly.

• A disability register should be open for SWD on campus.

     

Development of an unpowered ankle exoskeleton for walking assist

Abstract

Aim: Assistive technologies traditionally rely on either powered actuation or passive structures to provide increased strength, support or the ability to perform specific functions. At one end of the spectrum are powered exoskeletons, which significantly increase a user’s strength, but require powerful actuators, complex control systems and heavy power sources. At the other end are orthoses, which are generally unpowered and light in weight, relying on the mechanical properties of passive mechanical elements. Ideally, assistive technologies should combine the benefits of both systems and enhance human motion while remaining lightweight and efficient. This paper presents the development of a lightweight unpowered ankle exoskeleton that relies on the spring-like properties of a Pneumatic Artificial Muscle, which is inflated and sealed.

Methods: This flexible air-spring is used to harness gait energy and compliment the human ankle torque at push-off. To mechanically validate the proposed exoskeleton design, a prototype was fabricated and experimentally tested.

Results: Unlike other existing devices, the proposed unpowered exoskeleton was able to store a significant amount of energy and release it all at once. The timing mechanism worked as intended and triggered the release of 115?N?m of torque when the ankle reached a pre-determined angle.

Conclusion: Overall, the device demonstrated the ability to provide significant contribution to the ankle torque, timed to release precisely at the push-off phase of the gait cycle.

• Implications for Rehabilitation

• The currently proposed ankle exoskeleton makes use of an unpowered, fully mechanical system to provide walking assistance to users by providing additional torque to the ankle joint.

• The newly developed assistive device is devised as a solution for persons struggling with mobility issues, and can be used both as a means for rehabilitation or as a permanent assistive devices for patients struggling with long-term disabilities.

• The device also has potential to be used as a performance enhancing device for ablebodied users by reducing muscle fatigue during extended physical exertion.

     

Bone-anchored prostheses in patients with traumatic bilateral transfemoral amputations: rehabilitation description and outcome in 12 cases treated with the OPRA implant system

Purpose: To describe the rehabilitation experience and outcome of treatment with bone-anchored prostheses in individuals with bilateral transfemoral amputations (TFAs) treated in Sweden over a period of 25?years.

Method: Hospital records were reviewed for all patients with traumatic bilateral TFAs treated until 2015. The use of prostheses, walking aids and wheelchairs was noted.

Results: The cohort comprised 12 patients (nine men and three women with a mean age 35?years at treatment) and the median follow-up time was seven years (1–20). At baseline, 9/12 used prostheses and 3/12 did not. The main means of locomotion was in a wheelchair without wearing prostheses (n?=?8/12) or in a wheelchair in combination with prosthetic walking supported by walking aids (n?=?4/12). All prosthetic users had problems with sitting comfort. At follow-up, 11/12 patients used prostheses, while one did not. The means of locomotion was prosthetic walking in 3/12 cases, a combination of a wheelchair and prosthetic walking in 4/12, a wheelchair while wearing prostheses but not walking in 4/12 and a wheelchair without wearing prostheses in 1/12. Three patients walked unsupported by walking aids. Seven patients had no problem with prosthetic sitting comfort (n?=?3 had small problems).

Conclusions: Bone-anchored prostheses in patients with bilateral TFAs resulted in more prosthesis use during everyday locomotion, due hypothetically to improved comfort while wearing prostheses. The results further underline the importance of other assistive devices such as wheelchairs and walking aids used in combination with prostheses in this group of patients facing severe functional limitations.

• Implications for Rehabilitation

• This study provides an insight into the details of the rehabilitation and outcome in patients with traumatic bilateral transfemoral amputations treated with bone-anchored prostheses in Sweden.

• The treatment can lead to a large amount of prosthetic use, but most patients will also use a range of assistive devices including full-length prostheses, stubbies, walking aids and wheelchairs after treatment.

• The importance of sitting in comfort while wearing prostheses should not be underestimated in patients with bilateral transfemoral amputations.

     

Robotic exoskeletons for reengaging in everyday activities: promises,pitfalls, and opportunities

Abstract

Purpose: Media images and marketing materials suggest a future in which individuals with spinal cord injury (SCI) can utilize robotic exoskeletons to reengage in everyday activities, yet these narratives may not align with the current technological realities. The purpose of this paper is to present and describe the current use of robotic exoskeletons in rehabilitation and home settings and discuss the benefits and limitations of the devices.

Materials and methods: We provide an overview of the features and limitations of the four robotic exoskeleton products (EKSO Bionics, ReWalk, Rex Bionics, and Indego) that are currently being used in in the United States in rehabilitation settings. We follow by suggesting ways that these devices fall short of fulfilling the promise of reengage in everyday activities in real-world life contexts.

Results and discussion: Available devices appear to be better suited for rehabilitation settings than for home use. Device weight, the need for upper extremity supports, supervision requirements, and a limited range of movements are all issues that limit functionality and restrict opportunities for using such devices in real-world contexts. Designing the next generation of exoskeletons to be more useful in everyday life will require further collaboration among engineers, clinicians, and patients.

• Implications for Rehabilitation

• Exoskeletons offer the promise of allowing individuals with neurological injury to reengage in everyday activities from a standing position.

• Several exoskeleton devices are currently available for use in the United States.

• Weight of exoskeleton devices, the need for upper extremity supports, supervision requirements of hone units, and a limited range of movements are issues that restrict opportunities for using such devices in real-world contexts.

• Further development of exoskeleton technologies is warranted to improve the devices for real-world use.