Mobility Issues Research Articles

Design, Control, and Assessment of a Synergy-Based Exosuit for Patients with Gait-Associated Pathologies

With ever-rising population comes a corresponding rise in people with mobility issues who have difficulty handling tasks in their daily lives. Such persons could benefit significantly from an active movement assistance device. This paper presents the design of a lower-limb exosuit designed to provide the wearer with useful gait assistance. While exoskeletons have existed for a while, soft exoskeletons or exosuits are relatively new. One challenge in the design of a gait-assistance device is the reduction of device weight. In order to facilitate this, the concept of kinematic synergies is implemented to reduce the number of actuators. In this prototype, the exosuit can actuate the hip, ankle, and knee of both legs using just one single motor, and a transmission system consisting of gears and clutches. The implementation of these synergies and their advantages are detailed in this paper, as well as preliminary tests to assess performance. This was performed by testing the exosuit worn by a subject on a treadmill while taking EMG readings and measuring cable tension produced. Significant reductions by up to 35% in certain muscle activations were observed, demonstrating the validity of this prototype for gait assistance.

Recursive Self-feedback Improved Speech Fluency in Two Patients with Chronic Nonfluent Aphasia

ABSTRACT Background Previous studies have demonstrated that people with nonfluent aphasia (PWNA) improve their language production after repeating personalized scripts, modeled by speech-language pathologists (SLPs). If PWNA could improve by using their own self-feedback, relying less on external feedback, barriers to aphasia treatment, such as a dearth of clinicians and mobility issues, can be overcome. Here we examine whether PWNA improve their language production through an automated procedure that exposes them to playbacks of their own speech, which are updated recursively, without any feedback from SLPs. Method We tested if recursive self-feedback could improve speech fluency in two persons with chronic nonfluent aphasia. We compared two treatments: script production with recursive self-feedback (a new technique) and a non-self-feedback training. We administered the treatments remotely to the participants through their smartphones using two versions of a mobile app we developed. Each participant engaged in each treatment for about three weeks. We estimated clinical improvements of script production through a quantitative trend analysis and nonoverlap of all pairs. Results Recursive self-feedback improved speaking rate and speech initiation latency of trained and untrained scripts in both participants. The control (non-self-feedback) training was also effective, but it induced a somewhat weaker improvement in speaking rate, and improved speech initiation latency in only one participant. Conclusion Our findings provide preliminary evidence that PWNA can improve their speaking rate and speech initiation latency during production of scripts via fully automated recursive self-feedback. The beneficial effects of recursive self-feedback training suggest that speech unison and repeated exposures to written scripts may be optional ingredients of script-based treatments for aphasia.

Barriers and facilitators of physical activity in adults with severe haemophilia: A qualitative study.

People with haemophilia (PWH) tend to be less physically active than the general population, but there is a lack of research on the specific barriers and facilitators affecting their participation in physical activities. This study aims to explore perceived barriers and facilitators to physical activity in severe PWH. An explorative qualitative study based on focus groups. Four focus groups including 16 participants (severe haemophilia A patients) were conducted to examine the factors perceived as facilitators or barriers to haemophiliacs engaging in physical activity. One researcher conducted a thematic analysis of all data. Three themes were identified: body function, personal factors, and environmental factors. Key facilitators identified were access to prophylaxis treatment to reduce the risk of bleeding(s), the enjoyability of physical activity, fitness and health motives, social interaction, support, and low cost. PWH faced additional barriers to being physically active including hurtful joints, mobility issues, haemophilic arthropathy, dislike or disinterest, lack of motivation, fear of injury, tiredness, lack of time, lack of guidance, negative social influence, restriction, and lack of coordination of prophylaxis treatment. This exploratory study demonstrated that participation in physical activity in PWH is influenced not only by their own abilities and attitudes, but also by external variables, including family, friends, healthcare professionals, structures, and communities. The results of this study may be used to assist caregivers and health professionals, inform programs, interventions, and policies to promote physical activity and health in severe PWH.

A Single Case Study on the Management of Vipadika

Kushtha is an encompassing phrase that refers to all skin conditions mentioned in Ayurvedic writings. One of the illnesses covered under the category of Kshudra Kushtha is Vipadika. It is distinguished by Teevra vedana (with excruciating agony) and Pani-pada Sphutan (fissure in the palms and soles). The individual is impacted as a result of erratic eating habits, stressed lifestyle. Its manifestation is mostly caused by vitiation of Vata, Kapha, and Pitta/Rakta. In this case, the patient has been complaining for six months about discomfort and bleeding along with the dryness, scaling, itching, and cracking of both hands. Vipadika patients experience higher negative effects on their personal and social lives because they have severe difficulties with daily tasks, mobility issues, and self-care challenges.

Real-Time Wi-Fi Signal Monitoring from a User Perspective in a Wireless Environment Using the Internet of Things

Mobility issues, such as handover, should be considered in a wireless environment. Real-time Wi-Fi monitoring from a user perspective is important because it is used to keep track of the Wi-Fi performance and status. Thus, improving network efficiency allows users to work more efficiently. The monitoring currently being held on the Wi-Fi is not in a real-time perspective. The monitoring is only focused on the connection between the controller and the Access Point (AP) and the AP to the user devices. We proposed a way to monitor the Wi-Fi from a real-time user perspective in a wireless environment. This project will use the Raspberry Pi as a device (RP). This is because RP has an operating system that can replace personal computers in terms of monitoring the access point from the user’s point of view. This device will make monitoring tasks more efficient and faster for the user to identify the problems occurring at the Wi-Fi network. This research will also enable the usage of the existing Internet of Things (IoT) to develop new things. To conclude, monitoring using an IoT device can project the view of the Wi-Fi performance from a user perspective.

The advantages of artificial intelligence-based gait assessment in detecting, predicting, and managing Parkinson's disease.

Parkinson's disease is a neurological disorder that can cause gait disturbance, leading to mobility issues and falls. Early diagnosis and prediction of freeze episodes are essential for mitigating symptoms and monitoring the disease. This review aims to evaluate the use of artificial intelligence (AI)-based gait evaluation in diagnosing and managing Parkinson's disease, and to explore the potential benefits of this technology for clinical decision-making and treatment support. A thorough review of published literature was conducted to identify studies, articles, and research related to AI-based gait evaluation in Parkinson's disease. AI-based gait evaluation has shown promise in preventing freeze episodes, improving diagnosis, and increasing motor independence in patients with Parkinson's disease. Its advantages include higher diagnostic accuracy, continuous monitoring, and personalized therapeutic interventions. AI-based gait evaluation systems hold great promise for managing Parkinson's disease and improving patient outcomes. They offer the potential to transform clinical decision-making and inform personalized therapies, but further research is needed to determine their effectiveness and refine their use.

Communication and mobility issues of visually impaired pedestrians with connected autonomous vehicles

ABSTRACT This paper presents an econometric modelling framework to unravel the communication and mobility issues of visually impaired pedestrians in the context of connected autonomous vehicles (CAVs). The research uses a dataset collected through a tailor-made stated-preference survey given to visually impaired pedestrians and provides evidence-based recommendations on communication techniques. The recommendations are based on the findings of a structural equation model (SEM) estimated using the survey data. The latent factors ‘safety and security’ and ‘importance of hearing’ are generated using a confirmatory factor analysis embedded in the SEM. The results from the model show that these two factors have negative influences on how much a visually impaired pedestrian trusts the use of CAVs.

Prevalence and correlates of metabolic syndrome among women living in urban slums, Mysore, India.

Metabolic Syndrome (MetSyn) is a predictor of cardiovascular disease (CVD). About a third of urban Indians suffer from MetSyn. This study examined the prevalence of MetSyn among women living in urban slums. A cross-sectional survey was carried out between October 2017 and May 2018 among a non-probability sample of slum-dwelling women, 40-64 years of age, in six government-designated slums in Mysore, India. Data were collected on demographics, diet, behavioral risks, anthropometry, blood pressure, serum glucose, hemoglobin A1c, and serum lipids. The study used a definition of MetSyn from the International Diabetes Federation Task Force on Epidemiology and Prevention with an HbA1c measure for average blood glucose. About two-fifths of the 607 participants had MetSyn (41.5%; 95% CI: 37.7-45.5). Of those, 40.9% met three criteria, 38.1% four, and 25.0%, all five criteria. Elevated BP was the most prevalent MetSyn factor (79.6%), followed by increased waist circumference (54.5%), low HDL (50.1%), elevated Hb A1c (37.1%), and elevated triglycerides (36.1%). Odds for MetSyn were 1.52 times greater for those who were 50-59 years of age compared with those 40-49 years of age (adjusted odds ratio[AOR]:1.52; 95% CI:0.96-2.40). Women with mobility issues had 1.29 times higher odds of MetSyn than those without it (AOR: 0.76, 95% CI: 0.96, 1.75). Housewives had 1.29 times greater odds of MetSyn (AOR: 1.29, 95% CI: 1.00, 1.67). There is a high prevalence of MetSyn among urban slum-dwelling women in Mysore. There is a need for interventions aimed at reducing CVD risk factors in this population.

Does joint impedance improve dynamic leg simulations with explicit and implicit solvers?

The nervous system predicts and executes complex motion of body segments actuated by the coordinated action of muscles. When a stroke or other traumatic injury disrupts neural processing, the impeded behavior has not only kinematic but also kinetic attributes that require interpretation. Biomechanical models could allow medical specialists to observe these dynamic variables and instantaneously diagnose mobility issues that may otherwise remain unnoticed. However, the real-time and subject-specific dynamic computations necessitate the optimization these simulations. In this study, we explored the effects of intrinsic viscoelasticity, choice of numerical integration method, and decrease in sampling frequency on the accuracy and stability of the simulation. The bipedal model with 17 rotational degrees of freedom (DOF)-describing hip, knee, ankle, and standing foot contact-was instrumented with viscoelastic elements with a resting length in the middle of the DOF range of motion. The accumulation of numerical errors was evaluated in dynamic simulations using swing-phase experimental kinematics. The relationship between viscoelasticity, sampling rates, and the integrator type was evaluated. The optimal selection of these three factors resulted in an accurate reconstruction of joint kinematics (err < 1%) and kinetics (err < 5%) with increased simulation time steps. Notably, joint viscoelasticity reduced the integration errors of explicit methods and had minimal to no additional benefit for implicit methods. Gained insights have the potential to improve diagnostic tools and accurize real-time feedback simulations used in the functional recovery of neuromuscular diseases and intuitive control of modern prosthetic solutions.

Quality of Life of Patients with Stiff Person Syndrome

Aim: This study aimed to identify the factors that significantly affect the quality of life (QoL) of patients with Stiff-Person syndrome (SPS) by examining their physical, psychological, and social aspects using questionnaires. Methods: This cross-sectional study included 23 patients with SPS. Data were collected using several questionnaires. Patient QoL was quantified using the EuroQoL-5-Dimention 5-Level; sociodemographic characteristics and other relevant variables were examined. Results: QoL was poorer for patients with SPS than those with moderate to severe Alzheimer’s disease. Several important factors for patients’ QoL have been identified, including difficulty in breathing, pain, mobility issues leading to difficulty performing daily activities, depressive symptoms inherent to SPS, and insufficient social support. Conclusion: Factors that significantly influenced the QoL of patients with SPS were related to multiple aspects of their lives. We evaluated all previously used methods. A disease-specific evaluation form is required to assess these patients thoroughly.

Pressure sore at an unusual site: the bilateral knee - a case report.

The authors reported a case of a 66-year-old male, last seen 5 days ago by his son, who was found on the floor (with the knee on the ground) and was brought to the hospital. The patient had no history of mobility issue. On initial assessment his vitals were unstable but Glasgow Coma Scale 15/15 and CT head and ECG were unremarkable. On knee examination, there was bilateral grazing and bruising diagnosed as grade 3 and grade 4 pressure sore in the right and left knee, respectively. The pressure ulcer was managed adhering to the principles to remove all pressure, keep the ulcer clean, prevent further injury, and regular dressing by tissue viability nurses. On 17 March 2023, the patient was discharged from the hospital to a care home after his condition improved. A comprehensive review of the medical literature found no other reports of pressure sore at knee. A few published articles showed pressure sore as a complication of prone positioning. It is postulated that fall and long-term lie on the knees have developed this pressure ulcer. The Clinicians should be vigilant to check for pressure ulcers especially in all the bony prominences in any patients having an unwitnessed fall.

CLASSIFICATION OF PARKINSON'S DISEASE IN BRAIN MRI IMAGES USING DEEP RESIDUAL CONVOLUTIONAL NEURAL NETWORK

In our aging culture, neurodegenerative disorders like Parkinson's disease (PD) are among the most serious health issues. It is a neurological condition that has social and economic effects on individuals. It happens because the brain's dopamine-producing cells are unable to produce enough of the chemical to support the body's motor functions. The main symptoms of this illness are eyesight, excretion activity, speech, and mobility issues, followed by depression, anxiety, sleep issues, and panic attacks. The main aim of this research is to develop a workable clinical decision-making framework that aids the physician in diagnosing patients with PD influence. In this research, we proposed a technique to classify Parkinson’s disease by MRI brain images. Initially, normalize the input data using the min-max normalization method and then remove noise from input images using a median filter. Then utilizing the Binary Dragonfly Algorithm to select the features. Furthermore, to segment the diseased part from MRI brain images using the technique Dense-UNet. Then, classify the disease as if it’s Parkinson’s disease or health control using the Deep Residual Convolutional Neural Network (DRCNN) technique along with Enhanced Whale Optimization Algorithm (EWOA) to get better classification accuracy. Here, we use the public Parkinson’s Progression Marker Initiative (PPMI) dataset for Parkinson’s MRI images. The accuracy, sensitivity, specificity, and precision metrics will be utilized with manually gathered data to assess the efficacy of the proposed methodology.

SOME ASPECTS OF THE LEGAL REGULATION OF SOCIAL SECURITY FOR THE DISABLED

Social protection of persons with disabilities is part of the internal policy of the Republic of Kazakhstan, which is fully reflected in national legislation. The need for close attention to this category of citizens on the part of the state is equally due to their high number, objective limitations of their opportunities for full participation in the life of society, to work and to self-service. The author defines the basic principles of the formation of state policy in relation to this category of citizens. The ratification by the Republic of Kazakhstan of the Convention on the Rights of Persons with Disabilities makes it possible to fully guarantee the protection and development of socio-economic and other rights of persons with disabilities. The adoption of this Convention served as a basis for further improvement of legislative and practice-oriented activities in the field of socio-economic protection of persons with disabilities. The author analyzes the normative and legal support of the modern system of social protection of persons with disabilities and provides some of its contradictions with the International Convention on the Rights of Persons with Disabilities. The author focuses on the gaps and contradictions existing in the normative legal acts regulating the issues of social security of persons with disabilities. The gaps relate to the issues of individual mobility of persons with disabilities, drug provision, sanatorium treatment and technical equipment. Based on the results of the analysis and research, the author proposes to make amendments and additions to the Law of the Republic of Kazakhstan «On Social Protection of disabled people in the Republic of Kazakhstan», the Code of the Republic of Kazakhstan «On the health of the people and the health system» and the Order of the Minister of Health and Social Development of the Republic of Kazakhstan «On some issues of rehabilitation of disabled people».

Food insecurity during the COVID-19 pandemic who use drugs in Vancouver, Canada.

To examine prevalence and factors associated with food insecurity among people who use drugs (PWUD) during the first year of the COVID-19 pandemic and the overdose crisis. This cross-sectional study employs multivariable logistic regression to identify factors associated with self-reported food insecurity. PWUD who are part of three community-recruited cohorts. Interviews conducted in Vancouver, Canada, via phone between July and November 2020 in adherence to COVID-19 safety procedures. Among 765 participants, including 433 (56·6 %) men, eligible for this study, 146 (19·1 %; 95 % CI: 16·3 %, 21·9 %) reported food insecurity in the past month. Of the participants reporting food insecurity, 114 (78·1 %) reported that their hunger levels had increased since the beginning of the pandemic. In multivariable analyses, factors independently and positively associated with food insecurity included: difficulty accessing health or social services (adjusted OR (AOR) = 2·59; 95 % CI: 1·60, 4·17); having mobility difficulties (AOR = 1·59; 95 % CI: 1·02, 2·45) and engaging in street-based income generation (e.g. panhandling and informal recycling) (AOR = 2·31; 95 % CI: 1·45, 3·65). Approximately one in five PWUD reported food insecurity during this time. PWUD with mobility issues, who experienced difficulty accessing services and/or those engaged in precarious street-based income generation were more likely to report food insecurity. Food security is paramount to the success of interventions to prevent COVID-19 and drug toxicity deaths. These findings suggest a need for a more unified state response to food insecurity that prioritises and incorporates accessibility and autonomy of the communities they serve.

Exploring the potential benefits of an online music-based meditation programme for family carers of people with dementia

This study explores the potential psychosocial benefits of an online music-based meditation programme for family carers of people with dementia. Previous literature identifies the benefits of music and mindfulness in separate capacities for the promotion of wellbeing, positive mood and reducing isolation for family carers of people with dementia. No known literature currently exists combining meditation and music online specifically for this demographic. Thirteen family carers were recruited and participated in the study, attending a 30-minute session each week over four weeks. Additional music-based meditation resources were provided to be accessed outside the intervention at a time convenient to the participants. Data was collected through eight in-depth semi-structured interviews post intervention and analysed using Interpretive Phenomenological Analysis (IPA). There was an overall positive response from participants as the majority noted that participation in the programme had a positive impact on their mood, provided an opportunity to relax and practice self-care, process difficult emotions, and reduce feelings of social isolation. The facilitation of the programme in an online format allowed participants to access the intervention from the comfort of their home environment and negated potential barriers such as organising care, geographical location, mobility issues or access to transport. Findings from this study can be used as a base on which to develop further research in this area.

Design for new perspectives in urban mobility

Urban mobility is an important property of the people that promotes access to the city. However, the current model of urban mobility generates social and environmental issues, reducing inclusivity, accessibility and health, delaying humane development of cities, resulting in urban crisis. Considering design as a tool to improve people's interaction with the environment, as it can initiate and materialise social innovations. How can design provide new urban mobility perspectives? From the empirical analysis of urban mobility issues in the Brazilian cities of São Paulo and Campinas, between 2017 and 2022, accessing definitions of mobility and questions from sustainable development and revision of literature, the work presented summarises five main aspects for the appliance of design at new urban mobility perspectives improving life quality to people, and enlist five case studies from design-mobility projects, addressing the way designers contribute in such projects.

Design Analysis of Prosthetic Unilateral Transtibial Lower Limb with Gait Coordination

People with lower limb amputations struggle through difficulties during locomotion in their daily activities. People with transtibial amputations take support from prosthetic legs for systematic movement. During motion, they experience some mobility issues while using general prosthetic limbs regarding gait pattern. The design of a prosthetic-controlled lower limb with gait synchronization for physically disabled persons is the main goal of the present research work, which can provide an improved walking experience. The design and performance analysis of prosthetic lower limbs for people with transtibial amputations is performed in the present paper. The designed rehabilitation system shows synchronization between the normal and the prosthetic limbs achieved with gait coordination. The dynamics of the lower extremities in different postural activities are used for design purpose utilizing Euler–Lagrange motion theory. The artificial motion of the knee and the ankle joints function through the angular movement of the servo motors according to the movements of the rotary encoders placed on the sound limb joints. The range of motion of both the sound and prosthetic limbs are compared for different steps during a gait cycle. The prosthetic electronic system design of the artificial lower limb is able to show the gait style of human being with body kinesics. The nonlinear domain stability analysis of the designed prosthetic limb is presented through the Lyapunov method. A PIDF2 controller tuning process is implemented for the designed limb’s performance improvement. The designed prosthetic system is beneficial for people with unilateral transtibial amputations with a great societal impact.

Implementing Machine Learning-based Autonomic Cyber Defense for IoT-enabled Healthcare Devices

Smart homes present a serious challenge for the aged and those with mobility issues due to the environment's inherent danger. Unwary people have the propensity to fall over when bending over in these settings. Here, they show two time-based reasoning models to identify incidents of potentially fatal falls that have not been accounted for (CM-I and CM-II). The ubiquitous use of IoT altimeter watches among the elderly provides a wealth of data that can be used by these algorithms to predict the likelihood of a fall based on categorization criteria. They compared actual and simulated data involving missteps, mishaps, and crashes to gauge the programmers’ performance. Results suggest that using such logic models to help healthcare providers determine if senior people living in smart homes have fallen is a potential field for future study. The CM-II model had the highest prediction accuracy of any model identified in the literature, at 0.98 when compared to the test parameter. Since the number of devices linked to the IoT can be quickly extended in contrast to the number of devices connected to conventional computers, the number of hacks aimed at the IoT has grown dramatically. There is no way to fix the issue that hacked IoT devices create until they figure out how to track down the source of the attacks. Pursuing a deeper understanding of the technologies, protocols, and architecture of IoT systems, as well as the potential consequences of using infected IoT devices, is the overarching goal of this study. There are many Internet of Things (IoT) systems vulnerable to cybercriminal manipulation, so this study also explores a range of machine learning and deep learning-based methods that can be used to detect such compromise.

Multi-Level Participatory GIS Framework to Assess Mobility Needs and Transport Barriers in Rural Areas: A Case Study of Rural Mumias East, a Sub-County of Kakamega, Kenya

In recent decades, there has been a growing interest in the application of GIS to community empowerment or new policy development through participatory design, information gathering and implementation. This study, therefore, aims to apply a multi-level participatory GIS (PGIS) framework to assess mobility needs and barriers in rural areas from different available transport modes. This assessment was applied to three sub-locations (Lusheya, Khaunga and Mahola) located in the sub-county of Mumias East, Kakamega, Kenya. The study brings two main contributions: (1) an overview of mobility needs and barriers in Sub-Saharan Africa (SSA) and (2) an introduction of a PGIS framework that integrates in-depth local knowledge of rural mobility needs and mobility barriers. This PGIS framework was applied to mobility issues based on three main dimensions: context, process and content. The context in the PGIS framework focuses on identifying the right stakeholders and putting on suitable structures for their training as well as the collection of data. The process considers the collection, analysis and visualization of rural mobility data. The content of the data collected are validated for accuracy in the form of maps and are evaluated for relevance by stakeholders. Local youths with GIS knowledge and digital tools were mobilized along with community people having a solid understanding of the local geographical contexts to collect geographically referenced data related to community resources, transport networks, and mobility barriers. The application of the multi-level PGIS framework has brought to the mainstream daily mobility challenges faced by rural communities in Sub-Saharan Africa. Community members, even those from remote areas, also have access to decision making, reversing the previous structure that strongly relied on often-irrelevant, top-down decision making.

Effects of Engaging Older Adults in Technology-Based Dance Programs

Functionality is a crucial aspect of aging that is vital to one’s health and well-being. Older adults often struggle with mobility issues, which increases their risk of injury from falls and other problems. Dancing has the potential to be a physically stimulating activity that may be tailored to older individuals’ ages, physical conditions, and cultural preferences. The study aimed to determine whether dancing programs can improve older adults’ physical and mental health by using technology. Sixty women were divided into two groups at random: a dance group (N = 33; mean age 62.24) and a dance group using technology (N = 27, mean age 67.37). The intervention lasted six months and was performed twice a week for 75-min sessions. Dances were chosen from all over Greece. Participants’ physical and cognitive status was evaluated before and after the intervention. The results show that the dance group improved balance (p = 0.001), lower body strength (p = 0.006) and aerobic capacity (p = 0.006), while the dance group with the use of technology shower greater improvement in the same tests (p = 0.002, p &lt; 0.0001 and p &lt; 0.0001). Both groups improved on walking balance and danger of falling (p &lt; 0.0001). Depression (p = 0.007) and sociability (p = 0.001) significantly improved in the dance group. Dance, an enjoyable activity, contributes to the well-being of older adults by maintaining their physical status and functional capacity at acceptable levels.