Wearable soft robotic device for post-stroke shoulder rehabilitation: identifying misalignments

Stroke is the leading cause of long-term disability in the United States, affecting over 795,000 people annually. In order to regain motor function of the upper body, patients are usually treated by regular sessions with a dedicated physical therapist. A cost-effective wearable upper body orthotics system that can be used at home to empower both the patients and physical therapists is described. The system is composed of a thin, compliant, lightweight, cost-effective soft orthotic device with an integrated cable actuation system that is worn over the upper body, an embedded limb position sensing system, an electric actuator package and controller. The proposed device is robust to misalignments that may occur during actuation of the compliant brace or when putting on the system. Through simulations and experimental evaluation, it was demonstrated i) that the soft orthotic cable-driven shoulder brace can be successfully actuated without the production of off-axis torques in the presence of misalignments and ii) that the proposed model can identify linear and angular misalignments online.

Infrared thermography and shoulder pain in wheelchair users = Termografía infrarroja y dolor de hombro en usuarios de sillas de ruedas

Las personas que usan la silla de ruedas como su forma de movilidad prioritaria presentan una elevada incidencia (73%) de dolor de hombro debido al sobreuso y al movimiento repetitivo de la propulsión. Existen numerosos métodos de diagnóstico para la detección de las patologías del hombro, sin embargo la literatura reclama la necesidad de un test no invasivo y fiable, y sugiere la termografía como una técnica adecuada para evaluar el dolor articular. La termografía infrarroja (IRT) proporciona información acerca de los procesos fisiológicos a través del estudio de las distribuciones de la temperatura de la piel. Debido a la alta correlación entre ambos lados corporales, las asimetrías térmicas entre flancos contralaterales son una buena indicación de patologías o disfunciones físicas subyacentes. La fiabilidad de la IRT ha sido estudiada con anterioridad en sujetos sanos, pero nunca en usuarios de sillas de ruedas. Las características especiales de la población con discapacidad (problemas de sudoración y termorregulación, distribución sanguínea o medicación), hacen necesario estudiar los factores que afectan a la aplicación de la IRT en usuarios de sillas de ruedas. La bibliografía discrepa en cuanto a los beneficios o daños resultantes de la práctica de la actividad física en las lesiones de hombro por sobreuso en usuarios de sillas de ruedas. Recientes resultados apuntan a un aumento del riesgo de rotura del manguito rotador en personas con paraplejia que practican deportes con elevación del brazo por encima de la cabeza. Debido a esta falta de acuerdo en la literatura, surge la necesidad de analizar el perfil termográfico en usuarios de sillas de ruedas sedentarios y deportistas y su relación con el dolor de hombro. Hasta la fecha sólo se han publicado estudios termográficos durante el ejercicio en sujetos sanos. Un mayor entendimiento de la respuesta termográfica al ejercicio en silla de ruedas en relación al dolor de hombro clarificará su aparición y desarrollo y permitirá una apropiada intervención. El primer estudio demuestra que la fiabilidad de la IRT en usuarios de sillas de ruedas varía dependiendo de las zonas analizadas, y corrobora que la IRT es una técnica no invasiva, de no contacto, que permite medir la temperatura de la piel, y con la cual avanzar en la investigación en usuarios de sillas de ruedas. El segundo estudio proporciona un perfil de temperatura para usuarios de sillas de ruedas. Los sujetos no deportistas presentaron mayores asimetrías entre lados corporales que los sedentarios, y ambos obtuvieron superiores asimetrías que los sujetos sin discapacidad reportados en la literatura. Los no deportistas también presentaron resultados más elevados en el cuestionario de dolor de hombro. El área con mayores asimetrías térmicas fue hombro. En deportistas, algunas regiones de interés (ROIs) se relacionaron con el dolor de hombro. Estos resultados ayudan a entender el mapa térmico en usuarios de sillas de ruedas. El último estudio referente a la evaluación de la temperatura de la piel en usuarios de sillas de ruedas en ejercicio, reportó diferencias significativas entre la temperatura de la piel antes del test y 10 minutos después del test de propulsión de silla de ruedas, en 12 ROIs; y entre el post-test y 10 minutos después del test en la mayoría de las ROIs. Estas diferencias se vieron atenuadas cuando se compararon las asimetrías antes y después del test. La temperatura de la piel tendió a disminuir inmediatamente después completar el ejercicio, e incrementar significativamente 10 minutos después. El análisis de las asimetrías vs dolor de hombro reveló relaciones significativas negativas en 5 de las 26 ROIs. No se encontraron correlaciones significativas entre las variables de propulsión y el cuestionario de dolor de hombro. Todas las variables cinemáticas correlacionaron significativamente con las asimetrías en múltiples ROIs. Estos resultados indican que los deportistas en sillas de ruedas exhiben una capacidad similar de producir calor que los deportistas sin discapacidad; no obstante, su patrón térmico es más característico de ejercicios prolongados que de esfuerzos breves. Este trabajo contribuye al conocimiento de la termorregulación en usuarios de sillas de ruedas durante el ejercicio, y aporta información relevante para programas deportivos y de rehabilitación. ABSTRACT Individuals who use wheelchairs as their main means of mobility have a high incidence (73%) of shoulder pain (SP) owing to overuse and repetitive propulsion movement. There are numerous diagnostic methods for the detection of shoulder pathologies, however the literature claims that a noninvasive accurate test to properly assess shoulder pain would be necessary, and suggests thermography as a suitable technique for joint pain evaluation. Infrared thermography (IRT) provides information about physiological processes by studying the skin temperature (Tsk) distributions. Due to the high correlation of skin temperature between both sides of the body, thermal asymmetries between contralateral flanks are an indicator of underlying pathologies or physical dysfunctions. The reliability of infrared thermography has been studied in healthy subjects but there are no studies that have analyzed the reliability of IRT in wheelchair users (WCUs). The special characteristics of people with disabilities (sweating and thermoregulation problems, or blood distribution) make it necessary to study the factors affecting the application of IRT in WCUs. Discrepant reports exist on the benefits of, or damage resulting from, physical exercise and the relationship to shoulder overuse injuries in WCUs. Recent findings have found that overhead sports increase the risk of rotator cuff tears in wheelchair patients with paraplegia. Since there is no agreement in the literature, the thermographic profile of wheelchair athletes and nonathletes and its relation with shoulder pain should also be analysed. Infrared thermographic studies during exercise have been carried out only with able-bodied population at present. The understanding of the thermographic response to wheelchair exercise in relation to shoulder pain will offer an insight into the development of shoulder pain, which is necessary for appropriate interventions. The first study presented in this thesis demonstrates that the reliability of IRT in WCUs varies depending on the areas of the body that are analyzed. Moreover, it corroborates that IRT is a noninvasive and noncontact technique that allows the measurement of Tsk, which will allow for advances to be made in research concerned with WCUs. The second study provides a thermal profile of WCUs. Nonathletic subjects presented higher side-to-side skin temperature differences (ΔTsk) than athletes, and both had greater ΔTsk than the able-bodied results that have been published in the literature. Nonathletes also revealed larger Wheelchair Users Shoulder Pain Index (WUSPI) score than athletes. The shoulder region of interest (ROI) was the area with the highest ΔTsk of the regions measured. The analysis of the athletes’ Tsk showed that some ROIs are related to shoulder pain. These findings help to understand the thermal map in WCUs. Finally, the third study evaluated the thermal response of WCUs in exercise. There were significant differences in Tsk between the pre-test and the post-10 min in 12 ROIs, and between the post-test and the post-10 in most of the ROIs. These differences were attenuated when the ΔTsk was compared before and after exercise. Skin temperature tended to initially decrease immediately after the test, followed by a significant increase at 10 minutes after completing the exercise. The ΔTsk versus shoulder pain analysis yielded significant inverse relationships in 5 of the 26 ROIs. No significant correlations between propulsion variables and the results of the WUSPI questionnaire were found. All kinematic variables were significantly correlated with the temperature asymmetries in multiple ROIs. These results present indications that high performance wheelchair athletes exhibit similar capacity of heat production to able-bodied population; however, they presented a thermal pattern more characteristic of a prolonged exercise rather than brief exercise. This work contributes to improve the understanding about temperature changes in wheelchair athletes during exercise and provides implications to the sports and rehabilitation programs.

Mejora del comportamiento térmico de los morteros de cal aditivados y su empleo en la rehabilitación de inmuebles = Improvement of thermal behaviour of additived lime mortars and their use in rehabilitation of buildings

La envolvente de la edificación es la responsable de equilibrar el intercambio energético entre el interior y el exterior, por lo tanto cualquier actuación encaminada a la reducción del consumo energético ha de establecer, como uno de sus objetivos prioritarios, la mejora del comportamiento de la misma. Las edificaciones anteriores a 1940 constituyen la mayor parte de las existentes en áreas rurales y centros urbanos. En ellas, la repercusión de la fachada sobre las transmitancias globales pone de manifiesto la necesidad de intervención. Sin embargo, su elevada inercia térmica y los importantes saltos térmicos característicos de gran parte de España plantean la importancia de que aquélla se efectúe por el exterior. A tal respecto, la falta de disponibilidad de espesor suficiente para implantar sistemas tipo SATE deriva en que, frecuentemente, la única solución viable sea la de aislar por el interior perdiendo con ello la capacidad de acumulación térmica del muro y con el asociado riesgo de condensaciones. La amplia tradición en el empleo de revestimientos, especialmente en base de cal, permiten que éstos sean utilizados no sólo como elemento estético o de protección de la obra de fábrica antigua sino también para la mejora del comportamiento térmico del soporte, si se aprovecha el mecanismo de transmisión térmica por radiación. Éste es el objetivo de la presente Tesis Doctoral en la que se estudia la modificación de las propiedades radiantes de los morteros de revestimiento para la mejora de la eficiencia energética de las construcciones históricas, principalmente las constituidas por muros monolíticos, aunque podría ser de aplicación a otro tipo de construcciones compuestas por diversas capas. Como punto de partida, se estudió y revisó la documentación disponible sobre las investigaciones de las tres áreas científico-tecnológicas que convergen en la Tesis Doctoral: rehabilitación, material y comportamiento térmico, a partir de lo cual se comprobó la inexistencia de estudios similares al objeto de la presente Tesis Doctoral. Complementariamente, se analizaron los revestimientos en lo concerniente a los materiales que los constituyen, la composición de las mezclas y características de cada una de las capas así como al enfoque que, desde el punto de vista térmico, se estimaba más adecuado para la obtención de los objetivos propuestos. Basándonos en dichos análisis, se preseleccionaron ochenta materiales que fueron ensayados en términos de reflectancia y emisividad para elegir cuatro con los que se continuó la investigación. Éstos, junto con la cal elegida para la investigación y el árido marmóreo característico de la última capa de revestimiento, fueron caracterizados térmicamente, de forma pormenorizada, así como química y físicamente. Los fundamentos teóricos y los estudios preliminares desarrollados con distintos materiales, en estado fresco y endurecido, fueron empleados en la dosificación de componentes de las mezclas, en dos proporciones distintas, para el estudio del efecto del agregado. Éstas se ensayaron en estado fresco, para comprobar su adecuación de puesta en obra y prever su VI adherencia al soporte, así como en estado endurecido a 28 y 90 días de curado, para conocer las propiedades que permitieran prever su compatibilidad con aquél y estimar el alcance de la reducción de transferencias térmicas lograda. Además, se estudiaron las características generales de las mezclas que sirvieron para establecer correlaciones entre distintas propiedades y entender los resultados mecánicos, físicos (comportamiento frente al agua) y energéticos. Del estudio conjunto de las distintas propiedades analizadas se propusieron dos mezclas, una blanca y otra coloreada, cuyas características permiten garantizar la compatibilidad con la obra de fábrica antigua, desde el punto de vista físico y mecánico, y preservar la autenticidad de los revestimientos, en cuanto a la técnica de aplicación tradicional en sistemas multicapa. El comportamiento térmico de las mismas, sobre una obra de fábrica de 40 cm de espesor, se estimó, en estado estacionario y pseudo-transitorio, demostrándose reducciones del flujo térmico entre 16-48%, en condiciones de verano, y entre el 6-11%, en invierno, en función de la coloración y de la rugosidad de la superficie, en comparación con el empleo de la mezcla tradicional. Por lo que, se constata la viabilidad de los materiales compuestos propuestos y su adecuación al objetivo de la investigación. VII ABSTRACT The envelope is responsible for balancing the energy exchange between the inside and outside in buildings. For this reason, any action aimed at reducing energy consumption must establish, as one of its key priorities, its improvement. In rural areas and urban centers, most of the constructions were built before 1940. In them, the impact of the façade on the global transmittance highlights the need for intervention. However, its high thermal inertia and fluctuation of temperatures in the majority of Spain bring up that it should be placed outside the insulation. In this regard, the lack of availability of enough thickness to implement systems such as ETICS results in that often the only viable solution is to isolate the interior, losing thereby the wall’s heat storage capacity with the associated risk of condensation. The tradition in the use of renders, especially lime-based, allows us to use them not only as an aesthetic element or to protect the ancient masonry, but also for improved thermal performance of the support by taking advantage of the heat transfer mechanism by radiation. This is the aim of this Doctoral Thesis in which the modification of the radiative properties of lime mortars for renders to improve the energy efficiency of historic buildings, mainly composed of monolithic walls, is studied, although it could be applied to other structures composed of several layers. As a starting point, the available literature in the three scientific-technological areas that converge at the Doctoral Thesis: rehabilitation, material and thermal behaviour, was reviewed, and confirmed the absence of researches similar to this Doctoral Thesis. Additionally, the renders were studied with regard to the materials that constitute them, the composition of the mixtures and the characteristics of each layer, as well as to the approach which, from a thermal point of view, was deemed the most suitable for achieving the objectives sets. Based on thre aforementioned analysis, eighty materials tested in terms of reflectance and emissivity were pre-selected, to choose four with which the research was continued. Common marble sand, used in the last layer of the renders, together with the appointed materials and hydrated lime were characterized thermally, in detail, as well as chemically and physically. The theoretical bases and preliminary studies with different materials, in fresh and hardened state, were used in the dosage of the composition of the mixtures. In order to study their effect they were used in two different proportions, that is, ten mixtures in total. These were tested in their fresh state to evaluate their setting-up suitability and foresee their adhesion to the support, as well as in their hardened state, at 28 and 90 days of curing, to establish the properties which enabled us to anticipate their compatibility with the old masonry walls and estimate the scope of the reduction of heat transfers achieved. In addition, the general characteristics of the mixtures used to establish correlations and to understand the mechanical, physical and energy results were studied. Two mixtures, one white and one colored, were proposed as the result of the different properties analysed, whose characteristics allow the guarantee of mechanical and physical compatibility VIII with the old masonry and preserve the authenticity of the renders. The thermal behavior of both, applied on a masonry wall 40 cm thick, was estimated at a steady and pseudo-transient state, with heat flow reductions between 16-48% during summertime and 6-11% during wintertime, depending on the color and surface roughness, compared to the use of the traditional mixture. So, the viability of the proposed composite materials and their fitness to the aim of the research are established.

2D-Tasks for Cognitive Rehabilitation

Neuropsychological Rehabilitation is a complex clinic process which tries to restore or compensate cognitive and behavioral disorders in people suffering from a central nervous system injury. Information and Communication Technologies (ICTs) in Biomedical Engineering play an essential role in this field, allowing improvement and expansion of present rehabilitation programs. This paper presents a set of cognitive rehabilitation 2D-Tasks for patients with Acquired Brain Injury (ABI). These tasks allow a high degree of personalization and individualization in therapies, based on the opportunities offered by new technologies.

PREVIRNEC A new platform for cognitive tele-rehabilitation

Acquired Brain Injury (ABI), either caused by vascular or traumatic nature, is one of the most important causes for neurological disabilities. People who suffer ABI see how their quality of life decreases, due to the affection of one or some of the cognitive functions (memory, attention, language or executive functions). The traditional cognitive rehabilitation protocols are too expensive, so every help carried out in this area is justified. PREVIRNEC is a new platform for cognitive tele-rehabilitation that allows the neuropsychologist to schedule rehabilitation sessions consisted of specifically designed tasks, plus offering an additional way of communication between neuropsychologists and patients. Besides, the platform offers a knowledge management module that allows the optimization of the cognitive rehabilitation to this kind of patients.

Innovative self management system for guided cardiac rehabilitation

This paper describes the design and development of a system for cardio rehabilitation of patients that suffered a myocardial infarction. The proposed solution focuses on exercise prescriptions and the encouragement of healthy behaviors. The innovative strategy of the design takes into account health promotion models to provide safe, assistive exercise training sessions, personalized feedbacks, and educational contents.

ROAD: Domestic Assistant and Rehabilitation Robot

This study introduces the concept design and analysis of a robotic system for the assistance and rehabilitation of disabled people. Based on the statistical data of the most common types of disabilities in Spain and other industrialized countries, the different tasks that the device must be able to perform have been determined. In this study, different robots for rehabilitation and assistance previously introduced have been reviewed. This survey is focused on those robots that assist with gait, balance and standing up. The structure of the ROAD robot presents various advantages over these robots, we discuss some of them. The performance of the proposed architecture is analyzed when it performs the sit to stand activity.

Handmade Task Tracking Applied to Cognitive Rehabilitation

This article presents research focused on tracking manual tasks that are applied in cognitive rehabilitation so as to analyze the movements of patients who suffer from Apraxia and Action Disorganization Syndrome (AADS). This kind of patients find executing Activities of Daily Living (ADL) too difficult due to the loss of memory and capacity to carry out sequential tasks or the impossibility of associating different objects with their functions. This contribution is developed from the work of Universidad Politécnica de Madrid and Technical University of Munich in collaboration with The University of Birmingham. The KinectTM for Windows© device is used for this purpose. The data collected is compared to an ultrasonic motion capture system. The results indicate a moderate to strong correlation between signals. They also verify that KinectTM is very suitable and inexpensive. Moreover, it turns out to be a motion-capture system quite easy to implement for kinematics analysis in ADL.

Data mining applied to the cognitive rehabilitation of patients with acquired brain injury

Acquired brain injury (ABI) is one of the leading causes of death and disability in the world and is associated with high health care costs as a result of the acute treatment and long term rehabilitation involved. Different algorithms and methods have been proposed to predict the effectiveness of rehabilitation programs. In general, research has focused on predicting the overall improvement of patients with ABI. The purpose of this study is the novel application of data mining (DM) techniques to predict the outcomes of cognitive rehabilitation in patients with ABI. We generate three predictive models that allow us to obtain new knowledge to evaluate and improve the effectiveness of the cognitive rehabilitation process. Decision tree (DT), multilayer perceptron (MLP) and general regression neural network (GRNN) have been used to construct the prediction models. 10-fold cross validation was carried out in order to test the algorithms, using the Institut Guttmann Neurorehabilitation Hospital (IG) patients database. Performance of the models was tested through specificity, sensitivity and accuracy analysis and confusion matrix analysis. The experimental results obtained by DT are clearly superior with a prediction average accuracy of 90.38%, while MLP and GRRN obtained a 78.7% and 75.96%, respectively. This study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients.

Strengthening and rehabilitation of two damaged bridges in the motorway M-410 in Madrid (Spain)

The new highway M-410 in Madrid was constructed in the year 2007. This motorway near to Parla city crosses the road from Madrid to Toledo. To solve this crossing it was needed to constructed three bridges, the central with two spans over the existing motorway and the other two with one span at each side of the previous one.

Rehabilitation of two bridges in construction in the motorway M-410 in Madrid (Spain)

Rehabilitation of two bridges in construction in the motorway M-410 in Madrid (Spain)

Artificial metaplasticity prediction model for cognitive rehabilitation outcome in acquired brain injury patients

Objective The main purpose of this research is the novel use of artificial metaplasticity on multilayer perceptron (AMMLP) as a data mining tool for prediction the outcome of patients with acquired brain injury (ABI) after cognitive rehabilitation. The final goal aims at increasing knowledge in the field of rehabilitation theory based on cognitive affectation. Methods and materials The data set used in this study contains records belonging to 123 ABI patients with moderate to severe cognitive affectation (according to Glasgow Coma Scale) that underwent rehabilitation at Institut Guttmann Neurorehabilitation Hospital (IG) using the tele-rehabilitation platform PREVIRNEC©. The variables included in the analysis comprise the neuropsychological initial evaluation of the patient (cognitive affectation profile), the results of the rehabilitation tasks performed by the patient in PREVIRNEC© and the outcome of the patient after a 3–5 months treatment. To achieve the treatment outcome prediction, we apply and compare three different data mining techniques: the AMMLP model, a backpropagation neural network (BPNN) and a C4.5 decision tree. Results The prediction performance of the models was measured by ten-fold cross validation and several architectures were tested. The results obtained by the AMMLP model are clearly superior, with an average predictive performance of 91.56%. BPNN and C4.5 models have a prediction average accuracy of 80.18% and 89.91% respectively. The best single AMMLP model provided a specificity of 92.38%, a sensitivity of 91.76% and a prediction accuracy of 92.07%. Conclusions The proposed prediction model presented in this study allows to increase the knowledge about the contributing factors of an ABI patient recovery and to estimate treatment efficacy in individual patients. The ability to predict treatment outcomes may provide new insights toward improving effectiveness and creating personalized therapeutic interventions based on clinical evidence.

Video-based tasks for emotional processing rehabilitation in schizophrenia

Schizophrenia is a mental disorder characterized by a breakdown of cognitive processes and by a deficit of typi-cal emotional responses. Effectiveness of computerized task has been demonstrated in the field of cognitive rehabilitation. However, current rehabilitation programs based on virtual environments normally focus on higher cognitive functions, not covering social cognition training. This paper presents a set of video-based tasks specifically designed for the rehabilita-tion of emotional processing deficits in patients in early stages of schizophrenia or schizoaffective disorders. These tasks are part of the Mental Health program of Guttmann NeuroPer-sonalTrainer® cognitive tele-rehabilitation platform, and entail innovation both from a clinical and technological per-spective in relation with former traditional therapeutic con-tents.

A graphical tool for designing interactive video cognitive rehabilitation therapies

Acquired Brain Injury (ABI) has become one of the most common causes of neurological disability in developed countries. Cognitive disorders result in a loss of independence and therefore patients? quality of life. Cognitive rehabilitation aims to promote patients? skills to achieve their highest degree of personal autonomy. New technologies such as interactive video, whereby real situations of daily living are reproduced within a controlled virtual environment, enable the design of personalized therapies with a high level of generalization and a great ecological validity. This paper presents a graphical tool that allows neuropsychologists to design, modify, and configure interactive video therapeutic activities, through the combination of graphic and natural language. The tool has been validated creating several Activities of Daily Living and a preliminary usability evaluation has been performed showing a good clinical acceptance in the definition of complex interactive video therapies for cognitive rehabilitation.

Thermal evolution of lower limbs during a rehabilitation process after anterior cruciate ligament surgery

Infrared thermography (IRT) is a safe and non-invasive tool used for examining physiological functions based on skin temperature (Tsk) control. The aim of this paper was to establish the probable thermal difference between the beginning and the end of the anterior cruciate ligament (ACL) rehabilitation process after surgery. For this purpose thermograms from 25 ACL surgically operated patients (2 women, 23 men) were taken on the first and last day of a six-week rehabilitation program. A FLIR infrared camera according to the protocol established by the International Academy of Clinical Thermology (IACT). The results showed significant temperature increases in the posterior thigh area between the first and the last week of the rehabilitation process probably due to a compensatory mechanism. According to this, we can conclude that temperature of the posterior area of the injured and non-injured leg has increased from the first to the last day of the rehabilitation process.