Rehabilitation Assistive Devices Research Articles

Design and testing of fabric-based portable soft exoskeleton glove for hand grasping assistance in daily activity

Hand exoskeleton robots have been developed as rehabilitation robots and assistive devices. Based on the material used, they can be soft or hard exoskeletons. Soft materials such as fabric can be used as a component of the wearable robot to increase comfortability. In this paper, we proposed an affordable soft hand exoskeleton based on fabric and motor-tendon actuation for hand flexion/extension motion assistance in daily activities. On-off control and PI compensator were implemented to regulate finger flexion and extension of the soft exoskeleton. The controllers were embedded into a microcontroller using Simulink software. The input signal command comes from the potentiometer and electromyography (EMG) sensor to drive the flexion/extension movement. Based on the experiments, the proposed controller successfully controlled the exoskeleton hand to facilitate a user in grasping various objects. The proposed soft hand exoskeleton is lightweight, comfortable, portable, and affordable, making it easily manufactured using available hardware and open-source code. The developed soft exoskeleton is a potential assistive device for a person who lost the ability to grasp objects.

Selective load control of lumbar muscles in robot-assisted isometric lumbar stabilization exercise

AbstractLumbar stabilization exercises are commonly employed in the rehabilitation of patients with low back pain. However, many patients discontinue these exercises, generally calisthenics using various postures or tools, due to the difficulty of providing an appropriate exercise load intensity. This challenge results in an inability to apply the desired strength to the target lumbar muscles and sometimes leads to an excessive load on unintended areas during calisthenics. Consequently, a method that enables patients to exercise continuously and progressively recover is required, specifically one that can target the lumbar muscles with a desired load. To address this issue, we propose a rehabilitation assistive device that quantitatively controls the lumbar spine load. In isometric lumbar stabilization exercises, our method involves precise compensation for gravity. The device, equipped with a series elastic actuator, is positioned beneath the patient in a lying posture. It applies an assistive force in the direction opposite to gravity, enabling precise control of the load on the lumbar region and reducing the vertical load on the spine. To validate the effectiveness of our proposed method, we conducted experiments with 20 healthy subjects across three exercises and analyzed the electromyography signal using nonparametric statistical methods. Our objective was to determine whether the load on the target lumbar muscles could be precisely and gradually controlled. The statistical results indicate that exercises performed using the proposed device produce statistically significant load changes in the target lumbar muscles.

Leber Optic Neuropathy and Low Vision Rehabilitation: A Case Report

Leber’s Hereditary Optic Neuropathy (LHON) is a maternally inherited mitochondrial disease, characterized by point mutations in mitochondrial DNA and subsequent mitochondrial dysfunction; which leads to a bilateral and painless loss of central vision. Unfortunately at this time, there is no proven treatment to prevent or reverse this optic neuropathy. Therefore, individualized low vision rehabilitation services and assistive devices are essential to help people with LHON regain their independence and quality of life. We highlight through a case study the importance of psychic support as well as the impact of low vision rehabilitation on a young man with LHON.

Characterizing postural balance on 2-dimensional compliant surfaces with directional virtual time-to-contact

BackgroundThis study aimed to (1) investigate postural balance control on 2-Dimensional (2D) compliant surfaces using directional virtual time-to-contact (d-VTC), a novel method for VTC calculation; and (2) compare d-VTC with conventional balance measures in this context. MethodsA dual-axis robotic platform was used to simulate 2D surfaces/grounds with varying compliance levels. Twenty healthy young adults stood on the platform with either open or closed eyes. Balance was evaluated using d-VTC in multiple aspects, including temporal (VTC mean), spatial (boundary contact - BC), and control aspects (switching rate – SR). Additionally, conventional balance measures, namely center-of-pressure (COP) area and COP root-mean-square (RMS), were employed for further comparisons with d-VTC measures. Normality checks were performed using Shapiro-Wilk tests. Two-way repeated measures ANOVA tests were used to examine the effects of surface compliance and vision on postural balance, followed by post-hoc pairwise comparisons across conditions with Bonferroni correction. ResultsThe results showed that increasing surface compliance and/or absence of vision caused a significant decrease in VTC mean (all p-values <0.001; all ηp2 > 0.816). Interaction effects between surface compliance and vision on 2D and ML VTC mean were also significant (all p-values <0.019; all ηp2 > 0.355). The AP and ML BC values indicated a converging trend to 50%. No vision effect was observed (p = 0.458), but both surface compliance (p = 0.001; ηp2 = 0.522) and interaction (p = 0.002; ηp2 = 0.492) effects were significant. Decreases in SR were significant due to the compliance of the standing surface (p = 0.01; ηp2 = 0.401) but not vision (p = 0.109). COP area increased due to both surface and vision conditions (all p-values <0.001; all ηp2 > 0.872). AP and ML RMS were altered by vision (all p-values <0.001; all ηp2 > 0.741), but not by surface condition (all p-values >0.06). No interaction effect was observed in the conventional measures (all p-values >0.07). ConclusionBalance control is compromised by 2D compliant surfaces, which is exacerbated when vision is absent. Among all balance measures, VTC mean measures demonstrated particularly high sensitivity in identifying decreased balance capabilities, while BC and SR provided new insights into fall risks and balance control mechanisms. These insights may facilitate the development of rehabilitation training or assistive devices for fall prevention.

Decoupling brain activations of muscle-caused activations and mental intention-cause activations using the general linear model: A functional near-infrared spectroscopy study.

Integrating a brain-computer interface into a lower-limb medical rehabilitation assistive device can enhance rehabilitation efficiency. The latest research in the field focuses on the decoding performance of different motions. However, the difference between muscle-caused primitive activation and mental intention-caused activation has not been fully investigated. Thus, our study tried to decouple these two kinds of cerebral activation using a general linear model (GLM). Nine healthy and right-handed subjects were recruited for a two-section experiment. They were asked to extend or flex their knees while seated in the first section of the experiment or standing in the second section. Functional near-infrared spectroscopy (fNIR) was adopted to monitor their hemodynamic changes. Two groups of paradigms (one for circle-wise analysis, the other for full-section analysis) were constructed from the experimental paradigm. Each group consisted of three (the first intention, the second intention, and the muscle activation). The constructed paradigms were fed to the Balloon model for six desired hemodynamic responses (dHRFs). The regressor of GLM consisted of three dHRFs and the corresponding motion artifacts and drifts. The simulated physiological noises were included in the structured background matrix. The results showed that all subjects had similar cerebral activation patterns for the intention to extend or flex knees. The activation during musclecaused activation was less intense than that caused by both intentions. This finding can help further research on more efficient motion intention detection and the possibility of multiple motions decoding.

Discussion on Sustainable Development Strategy of China’s Rehabilitation Assistive Device Industry Based on Diamond Model

The rehabilitation assistive device industry is an important field of innovative development in the health industry and occupies a huge consumer market share worldwide. The rehabilitation assistive device industry in China has developed rapidly in recent years, but there is still a gap between China and developed countries. How to improve the industrial competitiveness and promote the sustainable development of this industry is therefore the subject of this study. This study uses the “diamond model” to analyze the development status and competitiveness of China’s rehabilitation assistive device industry from six aspects: “production factors”, “demand conditions”, “related and supporting industries”, “market strategy and peer competition”, “opportunities” and “government”. It concludes that the industry chain is not perfect, the ability of independent innovation is weak, the vitality of market factors is not mobilized, and that there is a lack of systematic industrial policy support. Additionally, it puts forward the development countermeasures of integrating industrial resources, improving the industrial production chain, stimulating market demand, cultivating industrial talents, improving technological innovation, seizing opportunities, and improving industrial policies, laws and regulations. In this study, through the linkage analysis between the elements, it is believed that the elements affect each other. Therefore, in order to achieve sustainable development of the rehabilitation assistive device industry, all of the elements must be strengthened.

Implementation and Evaluation of a Dynamic Neck Brace Rehabilitation Device Prototype

Rehabilitation assistive devices for head/neck pain treatment cannot allow dynamic changes in position and orientation of the head/neck. Moreover, such devices can neither be used simultaneously nor can they assess the patients' head/neck conditions. This paper aims at designing and implementing a novel dynamic head/neck brace that provides static and dynamic support and/or traction at symmetric and asymmetric positions. This device also provides assessments of the head/neck stiffness for the purpose of fulfilling diagnoses of the head/neck disorders. The device was used and evaluated for its range of motion and its symmetric traction capability using two control modalities. In addition, it was also evaluated in determining the stiffness of the head/neck throughout a simulating mechanical model involved in a set of springs. The device could apply right/left lateral bending to the head/neck ranged -6.97 ± 0.01° to 7.02 ± 0.01° with accuracies of 99.89% and 99.48%, and flexion/extension ranged -8.10 ± 0.02° to 8.12 ± 0.01° with accuracies of 99.57% and 99.42%, respectively, throughout a traction phase of 20 mm. The practical measurements through the symmetric traction tests showed some deviations as compared to that being calculated. Such deviations were greater in flexion/extension rather than the right/left lateral bending. The mean of the obtained error was less than 0.34° for all situations of tests. The accuracies of stiffness measurement of the mechanical model were 99.78% and 99.96%, respectively, throughout performing stair and step tests. The paper presented a novel design of a dynamic head/neck brace that provides support and/or traction to any head/neck positions and capable of evaluating the head/neck stiffness during cervical traction.

Knowledge, attitude and perception towards lower limb amputation amongst persons living with diabetes in rural South Africa: A qualitative study.

South Africa has a high prevalence of diabetes mellitus (DM), a leading risk factor for lower limb amputation (LLA). Lower limb amputation is associated with significant morbidity and mortality. Lower limb amputation incidence can be mitigated through prompt identification and treatment of individuals at risk and engagement in self-management practices. Also, when LLA is inevitable, outcomes or prognosis can be improved with timely surgery. This study explored the knowledge, attitude and perception of persons living with diabetes towards LLA and its prevention. Nqamakwe, a rural community in the Eastern Cape province of South Africa. This was a descriptive, qualitative study involving persons living with DM, with and without LLA, and community leaders. Fifteen participants were recruited purposively and conveniently from a rural community in the Eastern Cape, South Africa. Data collection took place through semistructured interviews, in English and a local language, Xhosa. Interviews were transcribed and translated, and an inductive approach was used for thematic analysis. A total of 15 individual interviews were conducted. Of those, 13 were persons with DM, five with LLA, including one with bilateral LLA. There was a gap in knowledge on foot self-examination as a measure of preventing LLA amongst persons with DM. The attitude of persons without LLA was mostly fearful and their fears centred around perioperative death, risk for contralateral amputation, loss of limb and independence. Consent to LLA procedure was a last resort and only when pain levels were unbearable. Family support and information on rehabilitation services and assistive devices also fostered consent to LLA surgery. There is a need for awareness creation and adequate health education for persons living with DM on LLA and its prevention measures, especially foot care practices. Also, health education programmes for persons living with DM in rural areas should address the various misperceptions of LLA to reduce delays.Contribution: The article revealed gaps in knowledge on LLA and its prevention among individuals living with diabetes as well as areas of concerns that may potentially delay acceptance when LLA is inevitable. Findings from our study may assist primary health care providers to determine important issues to be addressed during routine and pre-operative patient education.

Relating Underlying Performance Objectives of Overground Walking to Observable Walking Mechanics using Predictive Musculoskeletal Simulations.

There exists motor redundancy during human gait that allows individuals to perform the same task in different observable ways (i.e., with varied styles). However, how differences in observable walking mechanics depend on unique and underlying biomechanical objectives is unclear. As an example, these objectives could include metabolic energy consumption, sum of muscle activations, limb mechanical loading, balance and combinations thereof. In this study, we develop predictive neuromuscular simulations to investigate the relationships between these biomechanical objectives and observable mechanics during level walking. We simulated 3D normal walking of five healthy subjects, while optimizing each of the aforementioned objectives-resulting in 25 forward dynamics simulations for analysis. We compared the resulting joint kinematics and moments of different simulations. One of main findings suggests that decreased hip abduction angle is tightly related to when the regulation of dynamic balance (computed as whole-body angular momentum) is included in a movement cost function. We also find that increased joint moments are related to including metabolic cost (i.e., objectives associated with improving the energy economy of movement). Further, the timing of joint kinematics is adjusted for different performance objectives. These findings could guide the development of rehabilitation training and assistive devices that target specific individuals, tasks, and specific styles of movement.

A design method for an intelligent manufacturing and service system for rehabilitation assistive devices and special groups

The maturity of Industrial 4.0 technologies (smart wearable sensors, Internet of things [IoT], cloud computing, etc.) has facilitated the iteration and digitization of rehabilitation assistive devices (RADs) and the innovative development of intelligent manufacturing systems of RADs, expanding the value-added component of smart healthcare services. The intelligent manufacturing service mode, based on the concept of the product life cycle, completes the multi-source data production process analysis and the optimization of manufacturing, operation, and maintenance through intelligent industrial Internet of things and other means and improves the product life cycle management and operation mechanism. The smart product-service system (PSS) realizes the value-added of products by providing users with personalized products and value-added services, service efficiency, and sustainable development and gradually forms an Internet-product-service ecosystem. However, research on the PSS of RADs for special populations is relatively limited. Thus, this paper provides an overview of an IoT-based production model for RADs and a smart PSS-based development method of multimodal healthcare value-added services for special people. Taking the hand rehabilitation training devices for autistic children as a case, this paper verifies the effectiveness and availability of the proposed method. Compared with the traditional framework, the method used in this paper primarily helps evaluate rehabilitation efficacy, personalizes schemes for patients, provides auxiliary intelligent manufacturing service data and digital rehabilitation data for RAD manufacturers, and optimizes the product iteration development procedures by combining user-centered product interaction, multimodal evaluation, and value-added design. This study incorporates the iterative design of RADs into the process of smart PSS to provide some guidance to the RADs design manufacturers.

People with spinal cord injury in Morocco: results from the very first systematic data collection

Purpose To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco. Materials and methods We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL. Results The most frequently reported environmental barriers were “lack of public services” (92.5%), “financial strain” (93.0%), restricted access to “public transportation” (85.5%), “public places” (83.9%) and “private places” (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL. Conclusions This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population. IMPLICATIONS FOR REHABILITATION Public policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society. The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers. Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers. Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.

Wireless Manipulation Mechanism and Analysis for Actively Assistive Pinch Movements.

Pinching motions are important for holding and retaining objects with precision. Therefore, training exercises for the thumb and index finger are extremely important in the field of hand rehabilitation. Considering the need for training convenience, we developed a device and a driving system to assist pinching motions actively via a lightweight, simple, and wireless mechanism driven by the magnetic forces and torques generated by magnets attached to the tip of these two fingers. This device provides accurate pinching motions through the linking structures connecting the two magnets. The fabricated device has minimal mechanical elements with an ultralightweight of 57.2 g. The magnetic field, the intensity of which is based on the time variant, generates a pinching motion between the thumb and index finger, thus rendering it possible to achieve repetitive training. To verify the generation of an active pinching motion, we fabricated a finger model using a 3D printer and a rubber sheet and observed the active motions generated by the newly developed device. We also verified the performance of the proposed mechanism and driving method via various experiments and magnetic simulations. The proposed mechanism represents an important breakthrough for patients requiring hand rehabilitation and wearable assistive motion devices.

Wearable Sensor-Based Real-Time Gait Detection: A Systematic Review.

Gait analysis has traditionally been carried out in a laboratory environment using expensive equipment, but, recently, reliable, affordable, and wearable sensors have enabled integration into clinical applications as well as use during activities of daily living. Real-time gait analysis is key to the development of gait rehabilitation techniques and assistive devices such as neuroprostheses. This article presents a systematic review of wearable sensors and techniques used in real-time gait analysis, and their application to pathological gait. From four major scientific databases, we identified 1262 articles of which 113 were analyzed in full-text. We found that heel strike and toe off are the most sought-after gait events. Inertial measurement units (IMU) are the most widely used wearable sensors and the shank and foot are the preferred placements. Insole pressure sensors are the most common sensors for ground-truth validation for IMU-based gait detection. Rule-based techniques relying on threshold or peak detection are the most widely used gait detection method. The heterogeneity of evaluation criteria prevented quantitative performance comparison of all methods. Although most studies predicted that the proposed methods would work on pathological gait, less than one third were validated on such data. Clinical applications of gait detection algorithms were considered, and we recommend a combination of IMU and rule-based methods as an optimal solution.

A synthetical development approach for rehabilitation assistive smart product–service systems: A case study

Digital transformation (DT), the combination of information, computing, communication and connectivity technologies, which has triggered an effective upgrade of different aspects of market strategy, customer experience etc. Nowadays, rehabilitation assistive devices (RADs) are evolving to be more digital, intelligent and personalized. Digitalization and servitization have fostered to an emerging business model—the smart product–service system (Smart PSS). Therefore, DT of the RADs’ industry advocates not only the design of products and functions, the more important is the management of service processes and resource integration. With the increase in the elderly and disabled population, the requirement for RADs is becoming more urgent. However, research on Smart PSS for RAD is still limited. The rehabilitation assistive smart product–service systems (RASPSS) was introduced into the development of RADs based on the “Design and Management of DT” strategy through the service design of assistive devices and user requirements analysis. Further, an integrated design of RAD and Smart PSS has been created, a development method of RASPSS proposed, the theoretical model of the Smart PSS based on RADs built. To specify the service framework, this case study discusses the development of a home rehabilitation assistive system for femoral stem fracture patients. This paper evaluates the usability of the system, the results of which prove usability and effectiveness of the RASPSS development method. The RASPSS development model is designed to meet needs of stakeholders, improve the user rehabilitation experience, promote the service innovation of Smart PSS, bring certain market benefits of rehabilitation aids and create social value.

The Use of Wearable Sensors for the Classification of Electromyographic Signal Patterns based on Changes in the Elbow Joint Angle

Upper limb elbow movement in terms of flexion-relaxation is a complex physical phenomenon in human daily life, particularly during synchronized activities, such as exercising, reaching, pointing, and manipulating. Improper elbow movement might cause musculoskeletal injury, fatigue, pain, or disorders in the upper limb muscles. This study aimed to identify subject-specific electromyographic (EMG) signal patterns based on changes in five elbow joint angles (at 0°, 30°, 60°, 90° and 120°) during maximum (100%) voluntary isometric (static) contraction. Surface electromyographic (sEMG) signals were recorded from the upper arm biceps brachii muscle using a three-channel wearable sensor. A non-parametric machine learning algorithm called k-nearest neighbors (k-NN) was used to build a model that can determine the EMG characteristics and thus discriminate between elbow joint angles. Fifteen time domain features were extracted from the recorded EMG signal and those were used for classification purposes. Two cross validation (CV) methods, namely, leave-one-out (LOO) and k-fold, were used to examine and validate the model. The results showed that k-fold CV showed higher mean classification accuracies (89.68%) than the LOO method (82.49%). Our classification-based results from sEMG signals acquired with five elbow joint angles could aid the development of more advanced rehabilitation assistive devices and further improve the neuromuscular activities of the upper arms. Additionally, this result showed that wearable technology has potential application for remotely monitoring and controlling motor rehabilitation exercises.

In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice?

Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.

The efficacy of appropriate paper-based technology for Kenyan children with cerebral palsy

Purpose Appropriate paper-based technology (APT) is used to provide postural support for children with cerebral palsy (CP) in low-resourced settings. This pilot study aimed to evaluate the impact of APT on the children’s and families’ lives. Materials and methods A convenience sample of children with CP and their families participated. Inclusion was based on the Gross Motor Function Classification System levels IV and V. APT seating or standing frames were provided for six months. A mixed methods impact of APT devices on the children and families included the Family Impact Assistive Technology Scale for Adaptive Seating (FIATS-AS); the Child Engagement in Daily Life (CEDL) questionnaire; and a qualitative assessment from diary/log and semi-structured interviews. Results Ten children (median 3 years, range 9 months to 7 years). Baseline to follow-up median (IQR) FIATS-AS were: 22.7 (9.3) and 30.3 (10.2), respectively (p=.002). Similarly mean (SD) CEDL scores for “frequency” changed from 30.5 (13.2) to 42.08 (5.96) (p=.021) and children’s enjoyment scores from 2.23 (0.93) to 2.91 (0.79) (p=.019). CEDL questionnaire for self-care was not discriminatory; seven families scored zero at both baseline and 6 months. Qualitative interviews revealed three key findings; that APT improved functional ability, involvement/interaction in daily-life situations, and a reduced family burden of care. Conclusions APT devices used in Kenyan children with non-ambulant CP had a meaningful positive effect on both the children’s and their families’ lives. Implications for rehabilitation Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries. APT is a low cost and sustainable solution to make seating and standing devices for disabled children in Kenya. The regular use of a postural support device enhanced the children’s motor skills, ability to function and participate in everyday activities, reduced the burden of care for the families and promoted the children’s social interaction. The postural support devices were highly valued and utilised by the children and families in this study.

Motor learning in hemi-Parkinson using VR-manipulated sensory feedback

Aims Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation. Methods We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training. Results Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity. Discussion Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia. Implications for rehabilitation Assistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel – constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.

Analysis of type and frequency dynamics of rehabilitation assistive devices in children with cerebral palsy

Background. Currently, cerebral palsy is the most common neuromuscular disease in the pediatric population. Spastic forms of cerebral palsy are characterized by secondary musculoskeletal complications. They are corrected by the use of assistive devices and, especially, orthoses, along with surgical treatment, botulinum toxin, and others.&#x0D; Aim. The aim of this study was to assess the type and frequency dynamics of rehabilitation assistive devices in children with spastic forms of cerebral palsy, depending on the level of the gross motor function of the patient.&#x0D; Materials and methods. A prospective analysis was conducted by questioning 214 parents of children with spastic forms of cerebral palsy who were treated for the period from 2017 to 2019. The patients were divided into five groups according to the gross motor function classification (GMFCS). The statistical processing was performed using the application package Statistica 10 and Microsoft Excel.&#x0D; Results. Statistically significant differences in variances (p 0.05) were obtained between the number of rehabilitation assistive devices used in the anamnesis in the year before the questionnaire (period I) and assistive devices used in the last six months before the questionnaire (period II). Repeatedly, patients used orthopedic shoes the most often, and the trunk-hip-knee-ankle-foot orthoses the most rarely. We found five main causes groups of assistive device use failure for children with cerebral palsy.&#x0D; Conclusion. Statistically significant differences in variances were obtained between the frequency of rehabilitation assistive devices used in the anamnesis and during the last six months before the questionnaire was obtained. It has been confirmed that patients used orthopedic shoes most regularly; of all functional orthoses, hip adductor orthosis was used most often repeatedly, whereas the trunk-hip-knee-foot orthoses were the least common. Factors such as a negative attitude of the child towards the orthosis, uncomfortable in life, the presence of construction errors of the product, the absence of appropriate appointments in the individual rehabilitation and habilitation programs for the patient, have led to the most frequent rejection of the reuse of the technical device for rehabilitation. At the same time, positive or negative dynamics on the condition of the patient affected the regularity of the use of a technical device for rehabilitation in only one in six patients.

Experiences accessing and using rehabilitation services for people with physical disabilities in Sierra Leone

Purpose To explore the experiences of persons with physical disabilities accessing and using rehabilitation services in Sierra Leone. Materials and methods Interviews of 38 individuals with differing physical disabilities in three locations across Sierra Leone. An inductive approach was applied, and qualitative content analysis used. Results Participants faced several barriers to accessing and using rehabilitation services. Six themes emerged: The initial and ongoing need for rehabilitation throughout life; challenges with the cost of rehabilitation and transportation to reach rehabilitation services; varied experiences with rehabilitation staff; coming to terms with disability and encountering stigma; the struggles without and opportunities with rehabilitation services; and limited knowledge and availability of rehabilitation services. Conclusions There is a continued need to address the barriers associated with the affordability of rehabilitation through the financing of rehabilitation and transportation and exploring low-cost care delivery models. Rehabilitation services, assistive devices, and materials need to be available in existing rehabilitation centres. A national priority list is recommended to improve the availability and coordination of rehabilitation services. Improved knowledge about disability and rehabilitation services in the wider community is needed. Addressing discriminatory health beliefs and the stigma affecting people with disabilities through community interventions and health promotion is recommended. Implications for Rehabilitation Financing for rehabilitation, transportation to services and low-cost delivery models of care areneeded to reduce financial barriers and increase affordability of access and use. Community interventions and health promotion can provide information about the utility and availability of rehabilitation services, while addressing health beliefs and stigma towards persons with disabilities. The availability of both rehabilitation services and information, that is relevant and accessible is required to facilitate improved access and use of rehabilitation services.