Mobile Rehabilitation Research Articles

Hardware Development and Safety Control Strategy Design for a Mobile Rehabilitation Robot

The use of bodyweight unloading force control on a treadmill with therapist manual assistance for gait training imposes constraints on natural walking. It influences the patient’s training effect for a full range of natural walks. This study presents a prototype and a safety controller for a mobile rehabilitation robot (MRR). The prototype integrates an autonomous mobile bodyweight support system (AMBSS) with a lower-limb exoskeleton system (LES) to simultaneously achieve natural over-ground gait training and motion relearning. Human-centered rehabilitation robots must guarantee the safety of patients in the presence of significant tracking errors. It is difficult for traditional stiff controllers to ensure safety and excellent tracking accuracy concurrently, because they cannot explicitly guarantee smooth, safe, and overdamped motions without overshoot. This paper integrated a linear extended state observer (LESO) into proxy-based sliding mode control (ILESO-PSMC) to overcome this problem. The LESO was used to observe the system’s unknown states and total disturbance simultaneously, ensuring that the “proxy” tracks the reference target accurately and avoids the unsafe control of the MRR. Based on the Lyapunov theorem to prove the closed-loop system stability, the proposed safety control strategy has three advantages: (1) it provides an accurate and safe control without worsening tracking performance during regular operation, (2) it guarantees safe recoveries and overdamped properties after abnormal events, and (3) it need not identify the system model and measure unknown system states as well as external disturbance, which is quite difficult for human–robot interaction (HRI) systems. The results demonstrate the feasibility of the proposed ILESO-PSMC for MRR. The experimental comparison also indicates better safety performance for the ILESO-PSMC than for the conventional proportional–integral–derivative (PID) control.

Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies in Community Mobility Rehabilitation: Protocol for Evaluation and Rehabilitation of Mobility Across Continuums of Care.

BackgroundRapid advances in technologies over the past 10 years have enabled large-scale biomedical and psychosocial rehabilitation research to improve the function and social integration of persons with physical impairments across the lifespan. The Biomedical Research and Informatics Living Laboratory for Innovative Advances of New Technologies (BRILLIANT) in community mobility rehabilitation aims to generate evidence-based research to improve rehabilitation for individuals with acquired brain injury (ABI).ObjectiveThis study aims to (1) identify the factors limiting or enhancing mobility in real-world community environments (public spaces, including the mall, home, and outdoors) and understand their complex interplay in individuals of all ages with ABI and (2) customize community environment mobility training by identifying, on a continuous basis, the specific rehabilitation strategies and interventions that patient subgroups benefit from most. Here, we present the research and technology plan for the BRILLIANT initiative.MethodsA cohort of individuals, adults and children, with ABI (N=1500) will be recruited. Patients will be recruited from the acute care and rehabilitation partner centers within 4 health regions (living labs) and followed throughout the continuum of rehabilitation. Participants will also be recruited from the community. Biomedical, clinician-reported, patient-reported, and brain imaging data will be collected. Theme 1 will implement and evaluate the feasibility of collecting data across BRILLIANT living labs and conduct predictive analyses and artificial intelligence (AI) to identify mobility subgroups. Theme 2 will implement, evaluate, and identify community mobility interventions that optimize outcomes for mobility subgroups of patients with ABI.ResultsThe biomedical infrastructure and equipment have been established across the living labs, and development of the clinician- and patient-reported outcome digital solutions is underway. Recruitment is expected to begin in May 2022.ConclusionsThe program will develop and deploy a comprehensive clinical and community-based mobility-monitoring system to evaluate the factors that result in poor mobility, and develop personalized mobility interventions that are optimized for specific patient subgroups. Technology solutions will be designed to support clinicians and patients to deliver cost-effective care and the right intervention to the right person at the right time to optimize long-term functional potential and meaningful participation in the community.International Registered Report Identifier (IRRID)PRR1-10.2196/12506

Personalized Virtual Reality Environments for Intervention with People with Disability

Background: Virtual reality (VR) is a technological resource that allows the generation of an environment of great realism while achieving user immersion. The purpose of this project is to use VR as a complementary tool in the rehabilitation process of people with physical and cognitive disabilities. An approach based on performing activities of daily living is proposed. Methods: Through joint work between health and IT professionals, the VR scenarios and skills to be trained are defined. We organized discussion groups in which health professionals and users with spinal injury, stroke, or cognitive impairment participated. A testing phase was carried out, followed by a qualitative perspective. As materials, Unity was used as a development platform, HTC VIVE as a VR system, and Leap Motion as a hand tracking device and as a means of interacting with the scenarios. Results: A VR application was developed, consisting of four scenarios that allow for practicing different activities of daily living. Three scenarios are focused on hand mobility rehabilitation, while the remaining scenario is intended to work on a cognitive skill related to the identification of elements to perform a task. Conclusions: Performing activities of daily living using VR environments provides an enjoyable, motivating, and safe means of rehabilitation in the daily living process of people with disabilities and is a valuable source of information for healthcare professionals to assess a patient’s evolution.

Effects of mental practice on mobility of individuals in the early subacute post-stroke phase: A randomized controlled clinical trial

IntroductionOnly a small number of clinical trials were designed to investigate Mental Practice (MP)'s use for gait rehabilitation in individuals in the early subacute post-stroke phase. This trial aims to investigate the effect of mental practice on mobility rehabilitation in the early subacute phase after a stroke in comparison to a control group. MethodsRandomized controlled clinical trial with 16 individuals diagnosed with a stroke between 50 and 80 years of age. Mobility was evaluated using Timed Up and Go and the Five-Minute Walk Test. In addition, lower extremity muscular strength, Timed Up and Go Assessment of Biomechanical Strategies, quality of life, and depression were evaluated. ResultsBefore and after intervention (within-subjects), mental practice group showed improved mobility in Timed Up and Go (p = 0.01,r = 0.59), muscular strength for bending the right hip (p = 0.04, r = 0.50), for right knee bending (p = 0.03,r = 0.53), and in biomechanical performance of Timed Up and Go Assessment of Biomechanical Strategies(p = 0.01,r = 0.63). Control group showed improvement in neither mobility nor in muscular strength after intervention. Comparing the scores between the groups after intervention (between-subjects), no differences were found for any of the study's outcomes. In the analysis of deltas (gains), it was observed that mental practice group volunteers had a reduction in Timed Up and Go (p = 0.27,r = 0.29) and an increase in total Timed Up and Go Assessment of Biomechanical Strategies scores (p = 0.14,r = 0.36). ConclusionMental Practice was not associated with mobility, muscular strength, mental health, and quality of life improvement for patients in the early subacute post-stroke phase as compared to a control group.

Outcome of early control of infection using antibiotics impregnated cement beads in early surgical site infection in operated case of intra articular comminuted fracture (AO C3) of distal femur with ORIF: case report and review of literature

<p class="abstract">Surgical site infection is the most deleterious complication for any surgery and it's quite a daunting task for the surgeon to manage such post op events which also takes a great toll on patients' health physically as well as financially. Here we are presenting one such case report of early SSI effectively managed with antibiotic cement beads incorporation locally. We report a 65 year old male patient case of left sided comminuted distal femur fracture who was managed operatively with open reduction and internal fixation with 8 holes distal femur plate. Patient developed early SSI and was managed with debridement and antibiotic cement beads which was removed 6 weeks later. Here, we bring to the fore relevant findings to conclude the advantages of antibiotic cement beads for infected surgical wounds. In our case, early intervention resulted in full recovery of the patient from surgical site infection, early rehabilitation of joint mobility, decreased hospital stay and expenses. Looking at the advantages it is concluded from our study that locally impregnated antibiotic beads confers higher effectivity, compliance and cost benefits to the patient. </p>

Effect of proprioceptive neuromuscular facilitation technique on the treatment of frozen shoulder: a pilot randomized controlled trial

Background and objectivesFrozen shoulder is a common painful disease of the shoulder joint characterized by structural changes in the shoulder joint, restricting both active and passive shoulder joint activities. Proprioceptive neuromuscular facilitation (PNF) effectively improved and maintained the range of motion; however, it is not clear whether it can improve the shoulder joint structure in patients with frozen shoulder. This pilot study used magnetic resonance imaging (MRI) observation to assess the improvement of the local structure of the shoulder joint upon PNF treatment to elucidate a target based on structure for the treatment of frozen shoulder.Materials and methodsForty-eight patients with frozen shoulder were randomly divided into the traditional manual therapy group and the PNF technique group. Changes in the thicknesses of the coracohumeral ligament (CHL) and capsule in axillary recess (CAR) of the shoulder joint were observed via MRI upon admission and at 4 weeks after treatment. A visual analog scale (VAS) and passive shoulder range of motion (ROM) at abduction, anteflexion and external rotation position were used to evaluate the improvement of shoulder joint pain and function in the initial, mid-term, and discharge of the two groups of patients.ResultsThe primary outcome results shown that the PNF joint mobilization significantly reduced the thickness of the CHL (p = 0.0217) and CAR (p = 0.0133). Compared with simple joint mobilization, The mid-term and discharge rehabilitation assessment results showed that PNF has a better effect on shoulder pain. At the mid-term evaluation, the ROM of the PNF group was significantly better than that of the Control group in the three directions (p < 0.05).ConclusionAs an adjunctive therapy, PNF can improve the shoulder joint structure of patients with frozen shoulder and is an effective treatment strategy for frozen shoulder.

Cost–benefit analysis of orientation and mobility programs for adults with vision disability: a contingent valuation study

Purpose The purpose of this study is to conduct a cost–benefit analysis of orientation and mobility (O&M) programs from three perspectives: the general public, the experienced, and the potential users of O&M programs. Methods Willingness-to-pay (WTP) for O&M programs was collected via a contingent valuation survey using a double-bound dichotomous choice approach. WTP was estimated using interval regression analyses, accounting for study arm, sex, occupation, income, and self-rated health. The cost data were estimated from a service provider’s perspective. The net present value (NPV), variation if delivered by tele-O&M, was investigated. Results The adjusted mean NPV of O&M programs was $3857 (95% CI: $3760–$3954) per client, with highest NPV from the general public ($4289, 95% CI: $4185–$4392), followed by the experienced users ($3158, 95% CI: $2897–$3419) and the potential users ($2867, 95% CI: $2680–$3054). The NPV reached break-even for tele-O&M. Conclusions There was strong community support for investment into O&M programs considering benefits for clients over and above the cost of providing the services. Implications for rehabilitation This study demonstrates the feasibility of using cost–benefit analysis with a contingent valuation approach to economically assess a rehabilitation intervention, where its multi-dimensional benefits cannot be fully captured by a conventional appraisal technique such as cost-effectiveness analysis. The high willingness-to-pay (WTP) values amongst the general public suggests that Australians perceive government’s investment in orientation and mobility (O&M) rehabilitation as value for money and that individuals would be prepared to contribute to its costs. The lower WTP for O&M partially delivered via tele-practice (tele-O&M) indicates a lower acceptance of this innovation in comparison with the traditional face-to-face O&M. The estimated net present values of O&M programs, positive for traditional O&M and break-even for tele-O&M, can be of assistance to service planning and investment decisions within the Australian context.

Mobile Health to Support Community-Integration of Individuals With Disabilities Using iMHere 2.0: Focus Group Study.

BackgroundMobile health (mHealth) systems that support self-management can improve medical, functional, and psychosocial outcomes for individuals with disabilities and chronic conditions. The mHealth systems can potentially be expanded to support community integration.ObjectiveThe purposes of this study were to (1) partner with a community-based organization that supports community integration of individuals with disabilities; (2) identify software requirements needed to support community participation; and (3) iteratively refine an existing mHealth application to include new requirements.MethodsCommunity Living and Support Services (CLASS), a nonprofit organization that serves individuals with disabilities in Pittsburgh, Pennsylvania, was identified as the focus group for this study. Key stakeholders within the Community Partners Program at CLASS proposed design requirements for an existing mHealth application, Interactive Mobile Health and Rehabilitation (iMHere) 2.0, that has been used to support self-management.ResultsWe gathered qualitative data from a focus group composed of CLASS members to develop and iteratively revise iMHere 2.0 to include new modules and features to support community integration. A caregiver app was also developed. The new system contains features to support finance, transportation, client and caregiver communication, calendar and checklist management, upcoming medical and nonmedical appointments, social engagement, pain management, and access to a personal profile. Modifications were made to the following existing modules: education, mood, personal health record, goals, medications, and nutrition.ConclusionsA successful partnership with a community-based organization that supports individuals with disabilities resulted in a newly designed mHealth system with features to support community integration.

A progressive prediction model towards home-based stroke rehabilitation programs

More than 795,000 people suffer from stroke each year in the United States. Rehabilitation is crucial to help restore mobility function in activities of daily life. Many research works manifest that effective prediction of rehabilitation outcomes can significantly improve personalized rehabilitation strategies and maximize health outcomes. Existing studies on predicting stroke rehabilitation outcomes are primarily based on clinical or inpatient data, and there are few in-depth investigations in home-based rehabilitation prediction. In this work, we perform a retrospective study on mRehab (mobile rehabilitation), a six-week home-based rehabilitation program, where we investigated the in-program user data across 12 different rehabilitation activities performed by 16 stroke survivors. We proposed a new progressive prediction framework that constructs the multiple linear regression (MLR) and the random forest (RF) models, and found that combining the clinical and demographic data of stroke survivors with movement phenotyping data will significantly improve the prediction model’s performance. Specifically, our proposed model can accurately predict the outcome only with the first two weeks’ data with the root mean square error (RMSE) of 0.1050 in the MLR model and 0.0011 in the RF model. Moreover, we identify the features that significantly contribute to the prediction outcomes in home-based rehabilitation programs through feature correlation analyses. To the best of our knowledge, this work is the first study towards the rehabilitation outcome prediction in a home-based program.

Infographic: Four training modalities to improve functional mobility in people with Parkinson’s disease

Impairment of functional mobility is one of the most disabling symptoms in people with Parkinson’s disease (PwPD). Limitations in mobility lead to sedentarism, which may decrease the quality of life in PwPD. Several studies demonstrated that the combination of exercise with the traditional pharmacological treatment (i.e., levodopa) is effective to improve mobility in PwPD 1-5. Although the effects of traditional modalities (e.g., walking overground and cycling) are well documented, other stimuli may also induce positive responses on mobility in PwPD. However, such studies demonstrated trivial results or effectiveness in terms of functional mobility, indicating that the exercise – mainly using non-traditional stimuli – should be carefully prescribed. To avoid practical mistakes and ensure a high probability of success in mobility rehabilitation in PwPD, rehabilitation professionals must apply up-to-date and high-quality knowledge about mobility. Also, they must recognize the effects of different exercise modalities to improve functional mobility and the motivators and barriers to exercise in PwPD 1. This infographic aims to present (1) the motiving factors and barriers of training in PwPD, (2) the main effects of four exercise modalities on functional mobility (considering its underlining mechanisms), and (3) demonstrate the training evidence to improve the functional mobility. The exercise modalities were selected from the four recent meta-analyses (searched on PUBMED) that tested the exercise effects on functional mobility and presented data related to exercise prescription for PwPD. The encouragement of other persons is the most motivating factor for PwPD during exercise. The lacking of encouragement, fatigue and depression are related to exercise barriers in PwPD 1. Suárez-Iglesias et al. 2 demonstrated that Pilates was effective to improve functional mobility, improving Timed Up and Go (TUG) performances. Interventions using hydrotherapy, with or without land-based therapy, also showed positive effects on TUG values 3. Dance modality, associated with auditory cues, promoted positive effects on gait velocity, TUG, and freezing of gait 4. Finally, Robinson et al. 5 observed that treadmill training, when compared to no-exercise ones, improved the gait velocity and step length in PwPD regardless of use or not body weight support. Overall these results were observed in patients with early to moderate stages of disease (Hoehn and Yahr &lt; 3). These main effects and the mechanism related to the positive responses were presented in the infographic. Despite the noteworthy positive effects of exercise using these modalities in PwPD, recommendations for training prescriptions are still debatable. The characteristics of the modalities were poorly described in most of the studies. For example, even with the availability of acceptable and practical tools, the exercise intensity or its increment throughout the training was not properly reported. Therefore, it is difficult to determine a specific guideline to improve functional mobility in PwPD. The discussion about prescriptions (hydrotherapy) and the program with the highest weight in the meta-analysis (dance, pilates and treadmill) were presented in the infographic. Future studies should detail, as many as, possible training characteristics, increasing the reproducibility and applicability of the results.

User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study.

BackgroundMobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly.ObjectiveIn this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app.MethodsWe evaluated the original and redesigned iMHere modules—MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants’ dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred.ResultsIn total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules.ConclusionsThis study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles.

Factors Affecting Uptake of Orientation and Mobility Rehabilitation Training among Blind Older People in Nigeria

he study investigated the factors affecting the low uptake of Orientation and Mobility Rehabilitation Training (O&amp;M RT) among 350 legally blind (VA ≤ LogMAR -1.00 and/or visual field loss to less than 10°) older adults aged ≥ 60 years who had never gone for O&amp;M RT.

Wearable inertial sensors for human movement analysis: a five-year update

ABSTRACT Introduction The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory-based ambulatory settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings. Areas covered Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings. Expert Opinion IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.

The effect of an early mobilization rehabilitation protocol on outcomes after reverse shoulder arthroplasty

BackgroundGiven the continued growth of reverse shoulder arthroplasty (RSA), it is important to optimize factors that contribute to successful outcomes. Rehabilitation after RSA is critical to achieve successful outcomes including patient function and satisfaction; however, the ideal rehabilitation program has not been established. The purpose of this study was to evaluate the effect of early mobilization (EM) compared with delayed mobilization (DM) on outcomes and function after RSA. MethodsA retrospective study of prospectively collected data was performed comparing 67 patients who underwent RSA in two groups: the EM group began a rehabilitation program immediately after surgery, and the DM group began after 4-6 weeks postoperatively. Preoperative and postoperative Constant shoulder score, American Shoulder and Elbow Surgeons (ASES) score, Penn Shoulder Score (PSS), shoulder satisfaction value as well as demographics, opioid usage, range of motion, 90-day complications, reoperation, and readmission rates were collected. Statistical analysis was performed between each group’s outcomes and for the change (delta) of outcomes from baseline to each postoperative time point. ResultsAt 6 weeks postoperatively, the EM group showed significantly higher scores in ASES function, PSS, active forward elevation, passive forward elevation, active external rotation, and passive external rotation. There was significantly lower narcotic usage in the EM group at 6 weeks. At 3 months postoperatively, the EM group showed a lower numerical rating score for pain and higher active forward elevation. At the last follow-up, there was a lower numerical rating score and greater degree for all ranges of motion for the EM group than that for the DM group. A greater change from baseline to 6 weeks postoperatively was seen for the EM group in shoulder satisfaction value, ASES function, PSS, active forward elevation, passive forward elevation, and internal rotation. From baseline to 3 months postoperatively, ASES pain, PSS, active forward elevation, and passive forward elevation improved significantly in the EM group. At the final follow-up, active forward elevation increased greater for the EM group. There were 3 complications (2 hematomas and 1 infection) in the DM group and none in the EM group. ConclusionThe EM rehabilitation protocol after RSA achieved lower opioid usage at 6 weeks, lower pain scores at each time point, and better range of motion during the final follow-up than DM protocol. There were no complications reported with the EM protocol, suggesting it is a safe alternative for postoperative recovery. Orthopedic surgeons should consider the EM rehabilitation protocol after RSA.

Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial.

Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic.Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure.Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.

Biomechanical analysis of an unpowered hip flexion orthosis on individuals with and without multiple sclerosis

BackgroundGait impairment is a common complication of multiple sclerosis (MS). Gait limitations such as limited hip flexion, foot drop, and knee hyperextension often require external devices like crutches, canes, and orthoses. The effects of mobility-assistive technologies (MATs) prescribed to people with MS are not well understood, and current devices do not cater to the specific needs of these individuals. To address this, a passive unilateral hip flexion-assisting orthosis (HFO) was developed that uses resistance bands spanning the hip joint to redirect energy in the gait cycle. The purpose of this study was to investigate the short-term effects of the HFO on gait mechanics and muscle activation for people with and without MS. We hypothesized that (1) hip flexion would increase in the limb wearing the device, and (2) that muscle activity would increase in hip extensors, and decrease in hip flexors and plantar flexors.MethodsFive healthy subjects and five subjects with MS walked for minute-long sessions with the device using three different levels of band stiffness. We analyzed peak hip flexion and extension angles, lower limb joint work, and muscle activity in eight muscles on the lower limbs and trunk. Single-subjects analysis was used due to inter-subject variability.ResultsFor subjects with MS, the HFO caused an increase in peak hip flexion angle and a decrease in peak hip extension angle, confirming our first hypothesis. Healthy subjects showed less pronounced kinematic changes when using the device. Power generated at the hip was increased in most subjects while using the HFO. The second hypothesis was not confirmed, as muscle activity showed inconsistent results, however several subjects demonstrated increased hip extensor and trunk muscle activity with the HFO.ConclusionsThis exploratory study showed that the HFO was well-tolerated by healthy subjects and subjects with MS, and that it promoted more normative kinematics at the hip for those with MS. Future studies with longer exposure to the HFO and personalized assistance parameters are needed to understand the efficacy of the HFO for mobility assistance and rehabilitation for people with MS.

Multi-Component Design of a Mobile Rehabilitation Application for Remote Monitoring of Patients

This paper a will provide background and research outcomes for a student-led multi-University motion capture design project with the FDA Human Device Interaction Lab. This research project spawned from the FDA’s interest in studying mobile Apps used to collect information about a rehabilitation patient’s function outside of a laboratory setting. This is particularly important from a research perspective as it allows knowledge to be gathered about the reliability, safety, and efficacy of such devices, which can later inform human factors guidelines and regulatory oversight. While there is a wide range of applications for remote monitoring of patient function, this project focuses specifically on wearables used to track rehabilitative progress of individuals suffering from upper or lower limb impairment. These wearables may also be used to assess the efficacy of a new assistive technology intended to restore or augment function. The interdisciplinary student teams applied human-centered design principles to develop and prototype hardware and software components for a rotatable body-worn mobile device holder to remotely track rehabilitation progress. The design process and outcomes are presented along with insights on further development of system components.

Performance-based physical function correlates with walking speed and distance at 3 months post unilateral total knee arthroplasty.

After total knee arthroplasty (TKA), walking speed and distance are main concerns of patients. Which physical functions affect walking speed and distance after TKA? Cross-sectional data from 149 patients who underwent unilateral primary TKA and completed performance-based physical function tests. Instrumental gait evaluation for spatiotemporal parameters, isometric knee extensor and flexor strength of both knees, 6-minute walk test (6MWT), timed up-and-go (TUG) test, timed stair climbing test (SCT), and knee flexion and extension range of motion (ROM) of surgical knee were examined. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQol five dimensions (EQ-5D) questionnaires were also performed. Univariate analyses revealed that post-operative walking speed showed significant positive correlations with cadence, stride length, propulsion index of surgical and non-surgical knee, peak torque (PT) of the extensor of surgical and non-surgical knee and flexor of surgical and non-surgical knee, 6MWT, EQ-5D, and significant negative correlations with gait cycle duration, TUG, SCT-ascent and descent, and WOMAC-pain scores. Post-operative walking distance had significant positive correlations with walking speed, cadence, stride length, swing phase duration, propulsion index of surgical and non-surgical knee, PT of the extensor of surgical and non-surgical knee, EQ-5D, and significant negative correlation with gait cycle duration, double support duration, TUG, SCT-ascent and descent. In the multivariate linear regression analyses, TUG, cadence, stride length and propulsion index of non-surgical knee were factor correlated with post-operative walking speed. The SCT-ascent and descent, TUG and propulsion index of surgical knee were factor correlated with post-operative walking distance. Physical performance factors correlated with walking speed and distance at 3 months after surgery. Based on these observations, rehabilitation of bilateral muscle strength and functional mobility would be important for functional recovery after unilateral TKA.

Comparison of neuromuscular and cardiovascular exercise intensity and enjoyment between standard of care, off-the-shelf and custom active video games for promotion of physical activity of persons post-stroke

BackgroundActive video games have been embraced for the rehabilitation of mobility and promotion of physical activity for persons post-stroke. This study seeks to compare carefully matched standard of care stepping activities, off-the-shelf (non-custom) active video games and custom active video games that are either self-paced or game-paced for promoting neuromuscular intensity and accuracy, cardiovascular intensity, enjoyment and perceived effort.MethodsFifteen persons (ages 38–72) with mild to moderate severity in the chronic phase post-stroke (average 8 years) participated in a single group counter balanced repeated measures study. Participants were included if they were greater than 6 months post-stroke, who could walk 100 feet without assistance and stand unsupported for three continuous minutes. They were excluded if they had cardiac, musculoskeletal or neurologic conditions that could interfere with repeated stepping and follow instructions. In a single session located in a laboratory setting, participants executed for 8.5 min each: repeated stepping, the Kinect-light race game, two custom stepping games for the Kinect, one was repeated and self-paced and the other was random and game paced. Custom video games were adjusted to the participants stepping volume. Ten-minute rest periods followed the exercise during which time participants rested and completed the PACES an enjoyment questionnaire. Participants were instrumented with a metabolic cart and heart rate sensor for collection of cardiovascular intensity (METs and % of max HR) data. Stepping frequency, accuracy and pattern were acquired via video. Data were analyzed using a RMANOVA and post-hoc comparison with a Holm's/Sidak correction.ResultsNeuromuscular intensity (repetitions) was significantly greater for the off-the-shelf and self-paced custom game, however accuracy was greater for the custom games. Cardiovascular intensity for all activities took place in the moderate intensity exercise band. Enjoyment (measured with a questionnaire and rankings) was greater for the custom active video games and rate of perceived exertion was lower for the custom active video games.ConclusionsCustom active video games provided comparable intensity but better accuracy, greater enjoyment and less perceived exertion than standard of care stepping activities and a carefully matched off-the-shelf (non-custom) video game. There were no differences between the game-paced and self-paced custom active video games.Trial registration: NCT04538326.

Mobile Pulmonary Rehabilitation: Feasibility of Delivery by a Mobile Phone-Based Program

Background: Pulmonary rehabilitation (PR) has been proven effective but is not well accessed due to transport, time, cost, and physical limitations of patients. We have developed a mobile phone-based PR program (mPR) that could be offered as an alternative for those unable to attend in-person. This was developed following formative research with patients, their families and clinicians. mPR has a core text message program plus an app that includes an action plan, exercise videos, lung visualization, symptom score questionnaire and 1-min sit-to-stand test.Aims: To determine the feasibility of delivering pulmonary rehabilitation by mobile phone.Methods: A 9-week non-randomized (1-arm) pilot study was conducted. Participants were 26 adults with chronic obstructive pulmonary disease plus four family members, who were offered participation at first assessment or during group PR sessions. Outcomes included satisfaction, engagement with the program, and perceived impacts.Results: Eight people (31%) opted for text messages only, and 18 (69%) chose text messages plus the app. Three people stopped the program early, 20 said they would recommend it to others, 19 said it helped them to feel more supported, 17 said it helped them to change their behavior.Conclusion: It is feasible to deliver PR support via mobile phone, including exercise prescription and support. Our mPR program was appreciated by a small number of people with chronic respiratory disorders and family members. Suggestions for improvements are being used to inform the further development of the program, which will then be tested for effectiveness. Registered with the Australia New Zealand Clinical Trials Registry ACTRN12619000884101 (www.anzctr.org.au).