Patient Motion Research Articles

Variable Admittance Control of a Hand Exoskeleton for Virtual Reality-Based Rehabilitation Tasks.

Robot-based rehabilitation is consolidated as a viable and efficient practice to speed up and improve the recovery of lost functions. Several studies highlight that patients are encouraged to undergo their therapies and feel more involved in the process when collaborating with a user-friendly robotic environment. Object manipulation is a crucial element of hand rehabilitation treatments; however, as a standalone process may result in being repetitive and unstimulating in the long run. In this view, robotic devices, like hand exoskeletons, do arise as an excellent tool to boost both therapy's outcome and patient participation, especially when paired with the advantages offered by interacting with virtual reality (VR). Indeed, virtual environments can simulate real-life manipulation tasks and real-time assign a score to the patient's performance, thus providing challenging exercises while promoting training with a reward-based system. Besides, they can be easily reconfigured to match the patient's needs by manipulating exercise intensity, e.g., Assistance-As-Needed (AAN) and the required tasks. Modern VR can also render interaction forces when paired to wearable devices to give the user some sort of proprioceptive force or tactile feedback. Motivated by these considerations, a Hand Exoskeleton System (HES) has been designed to be interfaced with a variable admittance control to achieve VR-based rehabilitation tasks. The exoskeleton assists the patient's movements according to force feedback and following a reference value calculated inside the VR. Whenever the patient grasps a virtual object, the HES provides the user with a force feedback sensation. In this paper, the virtual environment, developed within the Webots framework and rendering a HES digital-twin mapping and mimicking the actual HES motion, will be described in detail. Furthermore, the admittance control strategy, which continuously varies the control parameters to best render the force sensation and adapt to the user's motion intentions, will be investigated. The proposed approach has been tested on a single subject in the framework of a pilot study.

DyNeuMo Mk-1: Design and pilot validation of an investigational motion-adaptive neurostimulator with integrated chronotherapy

There is growing interest in using adaptive neuromodulation to provide a more personalized therapy experience that might improve patient outcomes. Current implant technology, however, can be limited in its adaptive algorithm capability. To enable exploration of adaptive algorithms with chronic implants, we designed and validated the ‘Picostim DyNeuMo Mk-1’ (DyNeuMo Mk-1 for short), a fully-implantable, adaptive research stimulator that titrates stimulation based on circadian rhythms (e.g. sleep, wake) and the patient's movement state (e.g. posture, activity, shock, free-fall). The design leverages off-the-shelf consumer technology that provides inertial sensing with low-power, high reliability, and relatively modest cost. The DyNeuMo Mk-1 system was designed, manufactured and verified using ISO 13485 design controls, including ISO 14971 risk management techniques to ensure patient safety, while enabling novel algorithms. The system was validated for an intended use case in movement disorders under an emergency-device authorization from the Medicines and Healthcare Products Regulatory Agency (MHRA). The algorithm configurability and expanded stimulation parameter space allows for a number of applications to be explored in both central and peripheral applications. Intended applications include adaptive stimulation for movement disorders, synchronizing stimulation with circadian patterns, and reacting to transient inertial events such as posture changes, general activity, and walking. With appropriate design controls in place, first-in-human research trials are now being prepared to explore the utility of automated motion-adaptive algorithms.

Wearable Supernumerary Robotic Limb System Using a Hybrid Control Approach Based on Motor Imagery and Object Detection

Motor disorder of upper limbs has seriously affected the daily life of the patients with hemiplegia after stroke. We developed a wearable supernumerary robotic limb (SRL) system using a hybrid control approach based on motor imagery (MI) and object detection for upper-limb motion assistance. SRL system included an SRL hardware subsystem and a hybrid control software subsystem. The system obtained the patient's motion intention through MI electroencephalogram (EEG) recognition method based on graph convolutional network (GCN) and gated recurrent unit network (GRU) to control the left and right movements of SRL, and the object detection technology was used together for a quick grasp of target objects to compensate for the disadvantages when using MI EEG alone like fewer control instructions and lower control efficiency. Offline training experiment was designed to obtain subjects' MI recognition models and evaluate the feasibility of the MI EEG recognition method; online control experiment was designed to verify the effectiveness of our wearable SRL system. The results showed that the proposed MI EEG recognition method (GCN+GRU) could effectively improve the MI classification accuracy (90.04% ± 2.36 %) compared with traditional methods; all subjects were able to complete the target object grasping tasks within 23 seconds by controlling the SRL, and the highest average grasping success rate achieved 90.67% in bag grasping task. The SRL system can effectively assist people with upper-limb motor disorder to perform upper-limb tasks in daily life by natural human-robot interaction, and improve their ability of self-help and enhance their confidence of life.

Guide to physiotherapy and rehabilitation of cats

Background: Veterinary physiotherapy involves restoring a patient's movement and function following an injury, illness or trauma. In recent years, there has been increasing interest in the application of physiotherapy to small animals; however, it is still often overlooked for cats. Cats are not accustomed to regular handling or restraint and tend to become impatient and bored quickly, which means they are perceived as poor candidates for physiotherapy referral. However, many feline conditions do benefit from rehabilitation.Aim of the article: This article explores the application of physiotherapy techniques to feline patients, highlighting how rehabilitative exercises can be adapted so that they are suitable for cats.

Design of a seniors and Alzheimer's disease caring service platform

BackgroundTo meet the needs of aging and dementia patients in Taiwan, this study designed a nursing system that includes communication, location tracking, and fall detection, and early warning services. The main purpose of this research is to provide timely services to the elderly and patients and hope to reduce the burden when the number of nursing staff decreases. This article is a remote disease care service platform with the Internet of Things (IoT) devices to monitor the location of the elderly and whether they have dropped warning alerts.ResultsThe device is connected to the patient's waist and chest, monitors the patient's movement and behavior, and transmits messages to the back-end system, and informs caregivers through mobile phone applications when unexpected or shocking events occur. The system can identify whether the patient has fallen, accidentally, or long-term inactivity. The device is equipped with sensors that enable it to monitor the patient's location and behavior data through Bluetooth and GPS technology. Finally, we proposed a basic model and an integrated model that will industrialize the system and is expected to play a role in a larger patient population.ConclusionsThe system developed in this research has passed the Activities of Daily Living (ADL) test and verification, and is expected to provide appropriate safety care services for nursing homes and elderly residences.

Supervised Skeleton-Based Reference Movement Adjustment

Abstract In Medical Training Therapy (MTT) the exact execution of training exercises developed by the therapist is crucial for the success of the therapy. Currently, a therapist has to treat up to 15 patients at the same time on an outpatient basis. The aim of this paper is to provide an assistance system that can evaluate both the quantity and the quality of the movement performed using a goal-oriented model which gives the patient direct recommendations for action through automated, machine-monitored feedback. To implement the therapeutic measures in a targeted manner, it is advantageous to transfer their knowledge to the patients. This would be possible by transferring the therapist's movement into a patient's movement. Under this assumption a movement sequence of the therapist is recorded and a movement reference frame is extracted with the help of a smart sensor, which is made available to the patient as a target movement. The assistance system records the patient's movement in real time, extracts the its skeleton and compares this movement with the reference. Due to anatomical body differences, the reference skeleton must be adapted to the current patient skeleton, otherwise no movement evaluation can take place. By adjusting the bone lengths and angles in the individual frames of the patient's movement the selected sequence can be compared and any movement deviations that occur can be projected in directly in real time onto the patient's 3D avatar as an error image. The patient tries to reduce the errors and in doing so comes closer and closer to the ideal movement of the therapist which guarantees the best possible therapy success.

Detection of Mandibular Canal in Human Dry Mandibles with Cone Beam Computed Tomography using 270° and 360° Protocols under Continuous and Pulse Modes – A Comparative Study

Background: Cone beam computed tomography (CBCT) enables practitioner to accurately localize and mark the nerve canal. The rotation of the X-ray tube and the detector around the patient's head produces multiple projection images. A high number of projections is associated with increased radiation dose to the patient, higher spatial and contrast resolution. Shorter scan arc results in reduced scan time, reduced dose and smaller file sizes. The pulsed X-ray beam reduces the actual exposure time than the scanning time and the patient radiation exposure. Aim: (1) To assess and compare the diagnostic efficacy between pulse mode and continuous mode (2) To assess and compare the diagnostic efficacy between 270° and 360° CBCT rotational protocols Subjects and Methods: A total of 30 Intact Dentate or Partially dentate dry human mandibles consisting first, second, and third molars were subjected to a total of 4 CBCT scans: 270° rotation scans under continuous and pulse mode, 360° rotation scans under continuous and pulse mode using two CBCT units. Distance from the inferior cortical border of mandible (ICBM) to the roof of the inferior alveolar nerve canal (IANC) was measured at four locations: mental foramen, first, second and third molar. The results were then compared. Results: Comparison of the IANC length measurements for the two modes revealed no significant difference. Conclusion: Shorter scan arc and pulse mode can be adopted in patients finding it difficult to remain stable for prolonged periods of time, while maintaining appreciable clarity and quality of image. This could apply to geriatric patients, children, mentally challenged, in patients with trauma, neurological diseases, anxiety, claustrophobia, wherein the patient's movements might need re-scanning, which would lead to an extra radiation dose to the patient.

Utilization of Big Data Analysis Through Public Video, Virus Data Cooperation, and Social Media as the Surveillance to COVID-19 in Indonesia

This article discusses Big Data's use as a surveillance tool for the spread of Corona Virus Disease 2019 (COVID-19), both in Indonesia and the world. In Indonesia, the range of COVID-19 is increasingly sporadic, causing mass panic and Indonesia's geographical characteristics, which will be difficult when this spread could not control quickly. Researchers are conducting several studies to overcome this pandemic, including supervision, features, handling, mobility, patient interaction, treatment evaluation, and the biological structure. These studies become data and lead to Big Data. This article explores how to use Big Data analysis to monitor the spread of COVID-19 as a communication process that reflects mediated communication as a form of mobility and spatial relationships in communication practices. The method used in this article is a literature review and uses meta-synthesis techniques as its analysis. The literature sources used are articles in highly reputable international journals. Based on the reports, various ways to monitor the virus's spread, through public video data, GPS, and social media tracking, trace the patient's movement. Big Data can also provide data collaboration for viruses and pathogens for further research as digital mediated communication is anchored by the diversity of places and the mobility of people, data, and objects.

Modified algorithms for signal nonlinear trend detection

There is a problem of nonlinear (abrupt) signal trend detection in many digital signals processing practical applications. In particular, in the field of biomedical signals processing, the actual task is the elimination of abrupt signal baseline distortions caused by the patient's movements. For processing such signals containing edges and other discontinues, linear filtering based on discrete Fourier or cosine transforms leads to significant smoothing of a signal. Median type algorithms related to nonlinear stable (robust) filters are successfully applied for filtering such signals, in particular, high efficiency is provided by median hybrid filters with finite impulse response (FIR). The article considers simple algorithms of the class of FIR-median hybrid filters used for signal nonlinear trend detection. It is proposed to modify these algorithms by replacing the operation of finding the median of the data in the sliding filter window with the calculation of their myriad, as well as adding weights (number of duplications) to certain window elements. Statistical estimates of filter efficiency according to the mean square error (MSE) criterion for test signals like “step” and “ramp” edges, and triangular peak and parabola have been obtained. The high efficiency of the investigated nonlinear filters for the listed test signals types and the improvements achieved as a result of the proposed filter modifications are shown based on the analysis of the filter output signals and statistical estimates of their quality. Some examples of processing biomedical signals of electroencephalograms which illustrate good quality of noise suppression and signal abrupt changes preservation, and motion artifacts removal without large signal distortions are given.

Caregiver-Reported Burden in RE-KINECT: Data From a Prospective Real-World Tardive Dyskinesia Screening Study.

RE-KINECT (NCT03062033), a real-world study of possible tardive dyskinesia (TD) in antipsychotic-treated patients, included a questionnaire to assess the effects of patients' abnormal involuntary movements on caregivers. To capture the experiences of caregivers who assisted individuals with abnormal involuntary movements that were confirmed by clinicians as being consistent with TD. Qualified (nonpaid) caregivers were invited to complete a questionnaire that included the following: caregivers' sociodemographic characteristics, their perceptions about the impact of abnormal involuntary movements on patients, and the impact of these movements on themselves (caregivers). Of the 41 participating caregivers, 25 (61.0%) were women, 20 (48.8%) were employed full time or part time, and 35 (85.4%) were family members or friends. Based on responses from caregivers who noticed patients' abnormal involuntary movements and were caring for individuals who also noticed those movements, 48.0% of patients had "a lot" of severity in ≥1 body region and 76.0% had abnormal involuntary movements in ≥2 regions. Caregiver ratings were significantly correlated with patient ratings (but not with clinician ratings) for maximum severity of abnormal involuntary movements and the number of affected regions (both p <.05). Based on their own judgments and perceptions, caregivers reported that the patient's movements had "some" or "a lot" of impact on their (caregiver's) ability to continue usual activities (50.0%), be productive (58.3%), socialize (55.6%), or take care of self (50.0%). Caregivers as well as patients are negatively affected by TD, and the impact of TD on caregivers' lives should be considered when determining treatment options.

Method for estimating tensiomyography parameters from motion capture data

Tensiomyography is a muscle performance assessment technique that measures its mechanical responses. In this study, we explore a possibility to replace traditional tensiomyography measurement system with motion capture. The proposed method allows for measurement of multiple muscle's points simultaneously, while achieving measurements during a patient's movements. The results show that approximately 5 mm error is achieved when estimating maximal muscle displacement, while time delay in muscle contraction and contraction time are assessed with upto 20 ms error. As confirmed by physicians, the introduced errors are with the acceptable margin and, thus, the obtained results are medically valid.

Dysphagia bedside evaluatation in adults with nasogastric tube

The theoretical analysis of scientific literature sources and practice show that standardized adult assessment tools for the evaluation of adult swallowing disorders and readiness for withdrawal of the nasogastric tube (NGZ) are not uniformly used in Lithuanian health care institutions. The theoretical analysis of the assessment of swallowing disorders in adults fed by NGZ in the article showed that in the early stage of the disorder, examinations that are performed in the patient's ward and do not require radiological evaluation are sufficiently accurate. The aim of the study is to reveal the tools and methodologies for the evaluation of swallowing disorders in adults fed by NGZ in the patient's ward during the acute period of the disease. After the theoretical analysis of scientific literature sources, it can be stated that: enteral feeding improves feeding quality, but it restricts patient's movements, complicates communication, induces isolation; accurate assessment of dysphagia can be made by performing a swallowing sample in the patient’s ward; assessment of swallowing function takes into account masticatory muscle function, movements of lips, tongue and soft palate, swallowing, cough and gag reflex, oral control, oral residue, voice quality after swallowing and aspiration risk.

Teaching Video NeuroImage: Choreoathetosis and Focal Dystonia in Vitamin B12 Deficiency.

An 87-year-old man presented with involuntary movements of his fingers for 3 months. Clinical examination showed dystonia with choreoathetosis of his hands and fingers (Video 1). Pinprick sensation was reduced to ankles and vibration sense was absent up to shoulders and costal margin bilaterally. Investigations revealed hemoglobin of 10.1 g/dL, mean corpuscular volume of 94.6 fL, vitamin B12 level of <92 pmol/L, and the presence of antiparietal cell antibody. He was diagnosed with pernicious anemia and treated with intramuscular cyanocobalamin (1,000 μg weekly for 4 weeks then monthly). Reassessment 2 months later showed significant clinical improvement and normalized vitamin B12 level of 534 pmol/L. Pseudoathetosis—a slow, writhing movement of the distal extremities seen in severe sensory neuropathy—was also considered. However, the patient's movements did not worsen with eye closure. Severe vitamin B12 deficiency may result in chorea, myoclonus, tremor, and dystonia.1 These manifestations, possibly a result of basal ganglia dysfunction, are rare but important to recognize as they are largely reversible with supplementation.2

Tracking Bedridden Patient Positions Using Micro-Doppler Signatures

Hospital patients who are bedridden for prolonged periods of time require routine repositioning to aid in the prevention of pressure ulcers. This necessitates repositioning the patient at various laterally inclined angles. Readjustments of a patient's position must be performed over prescribed time intervals. Keeping track of a patient's position history throughout a given day is difficult without supervising the patient. A camera may be used to monitor the patient, but this can be detrimental to his or her privacy. In this letter, we propose applying Doppler radar to monitoring a bedridden patient's movements. This approach enables a patient's repositioning to be monitored at a low cost and with better privacy than monitoring with cameras. Doppler radar was applied to a human subject emulating typical movements that a bedridden patient may exhibit. It was observed that each movement resulted in unique micro-Doppler signatures and tracking a patient's rotation using Doppler radar is feasible.

Her İstemsiz Hareket Epileptik midir?

Paroxysmal nonepileptic events are episodic changes in behavior, sensation, or consciousness that are similar to epileptic seizures but not associated with abnormal ictal brain electrophysiological discharges. Here, a case treated as epileptic seizure was presented in order to draw attention to paroxysmal nonepileptic events in differential diagnosis.&#x0D; A 4 years old girl sent to our hospital with the diagnose of status epilepticus due to change in her consciousness, contractions and abnormal movements in her body, arms and legs those started after taking 6 spoonfull syrup of Peditus® (Containing 120 mg paracetamol, 50 mg guaifenesin, 6.25 mg pyrilamine maleate, 5 mg phenylephrine hcl in 5 ml scale) and 5 Medikinet® 10 mg capsules (10 mg methylphenidate hydrochloride in 1 capsule). She was conscious and cooperate and has involuntary snake-like movements throughout her body on admission. The patient's movement disturbances thought as methylphenidate-induced choreoathetosis responded to given haloperidol treatment and any sign of poisoning were not observed in the patient's follow up.&#x0D; Chorea side effects were observed in our patient but not any poisoning symptoms, who received a toxic dose of methylphenidate for her age. This suggests that methylphenidate, a central nervous system stimulant, may have therapeutic, toxic dose limits and side effects profile those associated with individual pharmacogenetic variations. Accurate distinction of chorea from drug-related paroxysmal nonepileptic events will ensure early effective treatment of patients and to protect patients from unnecessary drug risks.

Determining the Efficiency of Ergonomic Belt During Patient Handling and its Effect on Reducing Musculoskeletal Disorders in Nurses.

IntroductionNursing personnel are always at risk for work-related musculoskeletal disorders, and patient transportation is one of the major risk factor for these disorders.ObjectiveThe aim of this study was to evaluate the ergonomic belt to improve patient transferring conditions.MethodsThe subjects included 60 health care workers (HCW) of a hospital with patient transfer experience. The ergonomic belt was examined to help move the patient from one bed to another. The prevalence of musculoskeletal disorders was assessed through the Nordic questionnaire, the degree of perceived exertion through the Borg criterion, and the patient's movement through the MAPO index before and after the intervention.ResultsThe results showed a significant decrease in Borg scale scores and MAPO index in two factors of education and auxiliary tools and overall scores of this index. We also saw a significant reduction in musculoskeletal disorders in the neck, shoulders and arms, waist, hands and wrists, thighs, knees and legs. There were no significant differences in the elbow and forearm before and after using the ergonomic belt.ConclusionIn general, it can be concluded that the use of ergonomic belt had helped to reduce the risk of musculoskeletal disorders, as well as reducing the perceived exertion of nurses and other relevant personnel.

Performance Evaluation of Waist Guiding Control Method for Self-Standing-Up Training Support Robot

This paper proposed a self-standing-up training support robot that supports the patient's movements instead of the therapist for hemiplegic stroke patients. The robot consists of two passive robots with ER fluid brakes. We proposed a waist guiding control method that allows the patient to stand up and sit down. Two robots attached to the patient’s waist guide the patient’s waist in the left-right, roll, and yaw directions as the therapist. Moreover, the effectiveness of the proposed control method was evaluated from the view point of the maximum constraint force required at the end-effector and the virtual spring characteristics of the end-effector.

ExoNet Database: Wearable Camera Images of Human Locomotion Environments.

ExoNet Database: Wearable Camera Images of Human Locomotion Environments.

An implementation study on Hazard Identification and Risk Assessment (HIRA) technique in the Critical Care Unit of a Tertiary Care Hospital

In the studied hospital an increased number of adverse events were noted in the critical care unit (CCU)department of the tertiary care hospital in the last three months. Hence, a risk management technique, HazardIdentification and Risk Assessment (HIRA) is applied to identify the hazards and to reduce the risk of theidentified hazards by administering suitable mitigation and the control programs. The study was carriedout for three months i.e from May 2019 to July 2019 and all the staff’s responses of the CCU departmentwere captured to prepare the list of the perceived hazards. Moreover, the risk matrix is prepared for theidentified hazards by the responses of the CCU staff captured under the categories probability and severity.The findings of the study conclude that the risk associated with hazards H12 (Hindrance in the movementof patients, staff and utilities due to obstructed corridors), H2 (Malfunctioning of Life-saving equipmentor patient monitoring Biomedical Equipment) and H3 ( The broken cable of equipment results in powerleakage, short circuit and the trip of electricity supply in the department). The suitable interventions for thesecan be increased frequency of safety rounds, widening of the corridors and restricting access to the patientmovement areas, and buffer stock for the life-saving devices.

Encapsulating enzyme into metal-organic framework during in-situ growth on cellulose acetate nanofibers as self-powered glucose biosensor

Development of reliable Enzymatic Biofuel Cells (EBFC)-based self-powered glucose biosensor for continuous, noninvasive monitoring without restriction on patient's movement is highly recommendable. However, its application to a large extent is limited by the relatively poor stability. Herein, we synthesized a highly flexible electrode for effective enzyme immobilization by encapsulating enzyme into the metal-organic frameworks (MOFs) and robustly anchored to the cellulose acetate (CA) nanofiber membrane. As is well-known, such nanostructured fiber materials are the first time to be synthesized for glucose biosensor, which encapsulated biomolecules in MOFs platform during the MOFs in-situ growth on the nanofiber membranes. The as-proposed biosensor demonstrated excellent stability over 15 h of continuous long-term monitoring. The remarkable stability of assembled self-powered glucose biosensor in this work could inspire the application of enzymatic biosensors in biometrics, chronic disease management and clinical diagnosis.