Metodologías de modelado, monitorización y asistencia robótica en neurorrehabilitación funcional de extremidad superior

La Organización Mundial de la Salud (OMS) prevé que para el año 2020, el Daño Cerebral Adquirido (DCA) estará entre las 10 causas más comunes de discapacidad. Estas lesiones, dadas sus consecuencias físicas, sensoriales, cognitivas, emocionales y socioeconómicas, cambian dramáticamente la vida de los pacientes y sus familias. Las nuevas técnicas de intervención precoz y el desarrollo de la medicina intensiva en la atención al DCA han mejorado notablemente la probabilidad de supervivencia. Sin embargo, hoy por hoy, las lesiones cerebrales no tienen ningún tratamiento quirúrgico que tenga por objetivo restablecer la funcionalidad perdida, sino que las terapias rehabilitadoras se dirigen hacia la compensación de los déficits producidos. Uno de los objetivos principales de la neurorrehabilitación es, por tanto, dotar al paciente de la capacidad necesaria para ejecutar las Actividades de Vida Diaria (AVDs) necesarias para desarrollar una vida independiente, siendo fundamentales aquellas en las que la Extremidad Superior (ES) está directamente implicada, dada su gran importancia a la hora de la manipulación de objetos. Con la incorporación de nuevas soluciones tecnológicas al proceso de neurorrehabilitación se pretende alcanzar un nuevo paradigma centrado en ofrecer una práctica personalizada, monitorizada y ubicua con una valoración continua de la eficacia y de la eficiencia de los procedimientos y con capacidad de generar conocimientos que impulsen la ruptura del paradigma de actual. Los nuevos objetivos consistirán en minimizar el impacto de las enfermedades que afectan a la capacidad funcional de las personas, disminuir el tiempo de incapacidad y permitir una gestión más eficiente de los recursos. Estos objetivos clínicos, de gran impacto socio-económico, sólo pueden alcanzarse desde una apuesta decidida en nuevas tecnologías, metodologías y algoritmos capaces de ocasionar la ruptura tecnológica necesaria que permita superar las barreras que hasta el momento han impedido la penetración tecnológica en el campo de la rehabilitación de manera universal. De esta forma, los trabajos y resultados alcanzados en la Tesis son los siguientes: 1. Modelado de AVDs: como paso previo a la incorporación de ayudas tecnológicas al proceso rehabilitador, se hace necesaria una primera fase de modelado y formalización del conocimiento asociado a la ejecución de las actividades que se realizan como parte de la terapia. En particular, las tareas más complejas y a su vez con mayor repercusión terapéutica son las AVDs, cuya formalización permitirá disponer de modelos de movimiento sanos que actuarán de referencia para futuros desarrollos tecnológicos dirigidos a personas con DCA. Siguiendo una metodología basada en diagramas de estados UML se han modelado las AVDs 'servir agua de una jarra' y 'coger un botella' 2. Monitorización ubícua del movimiento de la ES: se ha diseñado, desarrollado y validado un sistema de adquisición de movimiento basado en tecnología inercial que mejora las limitaciones de los dispositivos comerciales actuales (coste muy elevado e incapacidad para trabajar en entornos no controlados); los altos coeficientes de correlación y los bajos niveles de error obtenidos en los corregistros llevados a cabo con el sistema comercial BTS SMART-D demuestran la alta precisión del sistema. También se ha realizado un trabajo de investigación exploratorio de un sistema de captura de movimiento de coste muy reducido basado en visión estereoscópica, habiéndose detectado los puntos clave donde se hace necesario incidir desde un punto de vista tecnológico para su incorporación en un entorno real 3. Resolución del Problema Cinemático Inverso (PCI): se ha diseñado, desarrollado y validado una solución al PCI cuando el manipulador se corresponde con una ES humana estudiándose 2 posibles alternativas, una basada en la utilización de un Perceptrón Multicapa (PMC) y otra basada en sistemas Artificial Neuro-Fuzzy Inference Systems (ANFIS). La validación, llevada a cabo utilizando información relativa a los modelos disponibles de AVDs, indica que una solución basada en un PMC con 3 neuronas en la capa de entrada, una capa oculta también de 3 neuronas y una capa de salida con tantas neuronas como Grados de Libertad (GdLs) tenga el modelo de la ES, proporciona resultados, tanto de precisión como de tiempo de cálculo, que la hacen idónea para trabajar en sistemas con requisitos de tiempo real 4. Control inteligente assisted-as-needed: se ha diseñado, desarrollado y validado un algoritmo de control assisted-as-needed para una ortesis robótica con capacidades de actuación anticipatoria de la que existe un prototipo implementado en la actualidad. Los resultados obtenidos demuestran cómo el sistema es capaz de adaptarse al perfil disfuncional del paciente activando la ayuda en instantes anteriores a la ocurrencia de movimientos incorrectos. Esta estrategia implica un aumento en la participación del paciente y, por tanto, en su actividad muscular, fomentándose los procesos la plasticidad cerebral responsables del reaprendizaje o readaptación motora 5. Simuladores robóticos para planificación: se propone la utilización de un simulador robótico assisted-as-needed como herramienta de planificación de sesiones de rehabilitación personalizadas y con un objetivo clínico marcado en las que interviene una ortesis robotizada. Los resultados obtenidos evidencian como, tras la ejecución de ciertos algoritmos sencillos, es posible seleccionar automáticamente una configuración para el algoritmo de control assisted-as-needed que consigue que la ortesis se adapte a los criterios establecidos desde un punto de vista clínico en función del paciente estudiado. Estos resultados invitan a profundizar en el desarrollo de algoritmos más avanzados de selección de parámetros a partir de baterías de simulaciones Estos trabajos han servido para corroborar las hipótesis de investigación planteadas al inicio de la misma, permitiendo, asimismo, la apertura de nuevas líneas de investigación. Summary The World Health Organization (WHO) predicts that by the year 2020, Acquired Brain Injury (ABI) will be among the ten most common ailments. These injuries dramatically change the life of the patients and their families due to their physical, sensory, cognitive, emotional and socio-economic consequences. New techniques of early intervention and the development of intensive ABI care have noticeably improved the survival rate. However, in spite of these advances, brain injuries still have no surgical or pharmacological treatment to re-establish the lost functions. Neurorehabilitation therapies address this problem by restoring, minimizing or compensating the functional alterations in a person disabled because of a nervous system injury. One of the main objectives of Neurorehabilitation is to provide patients with the capacity to perform specific Activities of the Daily Life (ADL) required for an independent life, especially those in which the Upper Limb (UL) is directly involved due to its great importance in manipulating objects within the patients' environment. The incorporation of new technological aids to the neurorehabilitation process tries to reach a new paradigm focused on offering a personalized, monitored and ubiquitous practise with continuous assessment of both the efficacy and the efficiency of the procedures and with the capacity of generating new knowledge. New targets will be to minimize the impact of the sicknesses affecting the functional capabilitiies of the subjects, to decrease the time of the physical handicap and to allow a more efficient resources handling. These targets, of a great socio-economic impact, can only be achieved by means of new technologies and algorithms able to provoke the technological break needed to beat the barriers that are stopping the universal penetration of the technology in the field of rehabilitation. In this way, this PhD Thesis has achieved the following results: 1. ADL Modeling: as a previous step to the incorporation of technological aids to the neurorehabilitation process, it is necessary a first modelling and formalization phase of the knowledge associated to the execution of the activities that are performed as a part of the therapy. In particular, the most complex and therapeutically relevant tasks are the ADLs, whose formalization will produce healthy motion models to be used as a reference for future technological developments. Following a methodology based on UML state-chart diagrams, the ADLs 'serving water from a jar' and 'picking up a bottle' have been modelled 2. Ubiquitous monitoring of the UL movement: it has been designed, developed and validated a motion acquisition system based on inertial technology that improves the limitations of the current devices (high monetary cost and inability of working within uncontrolled environments); the high correlation coefficients and the low error levels obtained throughout several co-registration sessions with the commercial sys- tem BTS SMART-D show the high precision of the system. Besides an exploration of a very low cost stereoscopic vision-based motion capture system has been carried out and the key points where it is necessary to insist from a technological point of view have been detected 3. Inverse Kinematics (IK) problem solving: a solution to the IK problem has been proposed for a manipulator that corresponds to a human UL. This solution has been faced by means of two different alternatives, one based on a Mulilayer Perceptron (MLP) and another based on Artificial Neuro-Fuzzy Inference Systems (ANFIS). The validation of these solutions, carried out using the information regarding the previously generated motion models, indicate that a MLP-based solution, with an architecture consisting in 3 neurons in the input layer, one hidden layer of 3 neurons and an output layer with as many neurons as the number of Degrees of Freedom (DoFs) that the UL model has, is the one that provides the best results both in terms of precission and in terms of processing time, making in idoneous to be integrated within a system with real time restrictions 4. Assisted-as-needed intelligent control: an assisted-as-needed control algorithm with anticipatory actuation capabilities has been designed, developed and validated for a robotic orthosis of which there is an already implemented prototype. Obtained results demonstrate that the control system is able to adapt to the dysfunctional profile of the patient by triggering the assistance right before an incorrect movement is going to take place. This strategy implies an increase in the participation of the patients and in his or her muscle activity, encouraging the neural plasticity processes in charge of the motor learning 5. Planification with a robotic simulator: in this work a robotic simulator is proposed as a planification tool for personalized rehabilitation sessions under a certain clinical criterium. Obtained results indicate that, after the execution of simple parameter selection algorithms, it is possible to automatically choose a specific configuration that makes the assisted-as-needed control algorithm to adapt both to the clinical criteria and to the patient. These results invite researchers to work in the development of more complex parameter selection algorithms departing from simulation batteries Obtained results have been useful to corroborate the hypotheses set out at the beginning of this PhD Thesis. Besides, they have allowed the creation of new research lines in all the studied application fields.

Dysfunctional profile for patients in physical neurorehabilitation of upper limb

This paper proposes a first approach to Objective Motor Assessment (OMA) methodology. Also, it introduces the Dysfunctional profile (DP) concept. DP consists of a data matrix characterizing the Upper Limb (UL) physical alterations of a patient with Acquired Brain Injury (ABI) during the rehabilitation process. This research is based on the comparison methology of UL movement between subjects with ABI and healthy subjects as part of OMA. The purpose of this comparison is to classify subjects according to their motor control and subsequently issue a functional assessment of the movement. For this purpose Artificial Neural Networks (ANN) have been used to classify patients. Different network structures are tested. The obtained classification accuracy was 95.65%. This result allows the use of ANNs as a viable option for dysfunctional assessment. This work can be considered a pilot study for further research to corroborate these results.

Obtención y Uso de Patrones para la Implementación de Funcionalidades de Usabilidad en Aplicaciones Web

La usabilidad es un atributo de calidad de un sistema software que llega a ser crítico en sistemas altamente interactivos. Desde el campo de la Interacción Persona-Ordenador se proponen recomendaciones que permiten alcanzar un nivel adecuado de usabilidad en un sistema. En la disciplina de la Ingeniería de Software se ha establecido que algunas de estas recomendaciones afectan a la funcionalidad principal de los sistemas y no solo a la interfaz de usuario. Este tipo de recomendaciones de usabilidad se deben tener en cuenta desde las primeras actividades y durante todo el proceso de desarrollo, así como se hace con atributos tales como la seguridad, la facilidad de mantenimiento o el rendimiento. Desde la Ingeniería de Software se han hecho estudios y propuestas para abordar la usabilidad en las primeras actividades del desarrollo. En particular en la educción de requisitos y diseño de la arquitectura. Estas propuestas son de un alto nivel de abstracción. En esta investigación se aborda la usabilidad en actividades avanzadas del proceso de desarrollo: el diseño detallado y la programación. El objetivo de este trabajo es obtener, formalizar y validar soluciones reutilizables para la usabilidad en estas actividades. En este estudio se seleccionan tres funcionalidades de usabilidad identificadas como de alto impacto en el diseño: Abortar Operación, Retroalimentación de Progreso y Preferencias. Para la obtención de elementos reutilizables se utiliza un método inductivo. Se parte de la construcción de aplicaciones web particulares y se induce una solución general. Durante la construcción de las aplicaciones se mantiene la trazabilidad de los elementos relacionados con cada funcionalidad de usabilidad. Al finalizar se realiza un análisis de elementos comunes, y los hallazgos se formalizan como patrones de diseño orientados a la implementación y patrones de programación en cada uno de los lenguajes utilizados: PHP, VB .NET y Java. Las soluciones formalizadas como patrones se validan usando la metodología de estudio de casos. Desarrolladores independientes utilizan los patrones para la inclusión de las tres funcionalidades de usabilidad en dos nuevas aplicaciones web. Como resultado, los desarrolladores pueden usar con éxito las soluciones propuestas para dos de las funcionalidades: Abortar Operación y Preferencias. La funcionalidad Retroalimentación de Progreso no puede ser implementada completamente. Se concluye que es posible obtener elementos reutilizables para la implementación de cada funcionalidad de usabilidad. Estos elementos incluyen: escenarios de aplicación, que son la combinación de casuísticas que generan las funcionalidades de usabilidad, responsabilidades comunes necesarias para cubrir los escenarios, componentes comunes para cumplir con las responsabilidades, elementos de diseño asociados a los componentes y el código que implementa el diseño. Formalizar las soluciones como patrones resulta útil para comunicar los hallazgos a otros desarrolladores y los patrones se mejoran a través de su utilización en nuevos desarrollos. La implementación de funcionalidades de usabilidad presenta características que condicionan su reutilización, en particular, el nivel de acoplamiento de la funcionalidad de usabilidad con las funcionalidades de la aplicación, y la complejidad interna de la solución. ABSTRACT Usability is a critical quality attribute of highly interactive software systems. The humancomputer interaction field proposes recommendations for achieving an acceptable system usability level. The discipline of software engineering has established that some of these recommendations affect not only the user interface but also the core system functionality. This type of usability recommendations must be taken into account as of the early activities and throughout the software development process as in the case of attributes like security, ease of maintenance or performance. Software engineering has conducted studies and put forward proposals for tackling usability in the early development activities, particularly requirements elicitation and architecture design. These proposals have a high level of abstraction. This research addresses usability in later activities of the development process: detailed design and programming. The goal of this research is to discover, specify and validate reusable usability solutions for detailed design and programming. Abort Operation, Feedback and Preferences, three usability functionalities identified as having a high impact on design, are selected for the study. An inductive method, whereby a general solution is induced from particular web applications built for the purpose, is used to discover reusable elements. During the construction of the applications, the traceability of the elements related to each usability functionality is maintained. At the end of the process, the common and possibly reusable elements are analysed. The findings are specified as implementation-oriented design patterns and programming patterns for each of the languages used: PHP, VB .NET and Java. The solutions specified as patterns are validated using the case study methodology. Independent developers use the patterns in order to build the three usability functionalities into two new web applications. As a result, the developers successfully use the proposed solutions for two of the functionalities: Abort Operation and Preferences. The Progress Feedback functionality cannot be fully implemented. We conclude that it is possible to discover reusable elements for implementing each usability functionality. These elements include: application scenarios, which are combinations of cases that generate usability functionalities, common responsibilities to cover the scenarios, common components to fulfil the responsibilities, design elements associated with the components and code implementing the design. It is useful to specify solutions as patterns in order to communicate findings to other developers, and patterns improve through further use in other development projects. Reusability depends on the features of usability functionality implementation, particularly the level of coupling of the usability functionality with the application functionalities and the internal complexity of the solution.

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of “learning strategy”. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper

Training project management complexity in postgraduate and continuing education programs: a learning strategy in the eshe (European Space of Higher Education) framework

The objective of this paper is to address the methodological process of a teaching strategy for training project management complexity in postgraduate programs. The proposal is made up of different methods —intuitive, comparative, deductive, case study, problem-solving Project-Based Learning— and different activities inside and outside the classroom. This integration of methods motivated the current use of the concept of ―learning strategy‖. The strategy has two phases: firstly, the integration of the competences —technical, behavioral and contextual—in real projects; and secondly, the learning activity was oriented in upper level of knowledge, the evaluating the complexity for projects management in real situations. Both the competences in the learning strategy and the Project Complexity Evaluation are based on the ICB of IPMA. The learning strategy is applied in an international Postgraduate Program —Erasmus Mundus Master of Science— with the participation of five Universities of the European Union. This master program is fruit of a cooperative experience from one Educative Innovation Group of the UPM -GIE-Project-, two Research Groups of the UPM and the collaboration with other external agents to the university. Some reflections on the experience and the main success factors in the learning strategy were presented in the paper.

Cartography for cooperative manoeuvres with autonomous land vehicles

This article presents a cartographic system to facilitate cooperative manoeuvres among autonomous vehicles in a well-known environment. The main objective is to design an extended cartographic system to help in the navigation of autonomous vehicles. This system has to allow the vehicles not only to access the reference points needed for navigation, but also noticeable information such as the location and type of traffic signals, the proximity to a crossing, the streets en route, etc. To do this, a hierarchical representation of the information has been chosen, where the information has been stored in two levels. The lower level contains the archives with the Universal Traverse Mercator (UTM) coordinates of the points that define the reference segments to follow. The upper level contains a directed graph with the relational database in which streets, crossings, roundabouts and other points of interest are represented. Using this new system it is possible to know when the vehicle approaches a crossing, what other paths arrive at that crossing, and, should there be other vehicles circulating on those paths and arriving at the crossing, which one has the highest priority. The data obtained from the cartographic system is used by the autonomous vehicles for cooperative manoeuvres.