PRE2019 3 Group1
Group 1
| Group members | Student number | Study | |
|---|---|---|---|
| C.C. Vreezen | 1011476 | Medical science and technology | c.c.vreezen@student.tue.nl |
| J. Voet | 1386794 | Psychology and Technology | j.voet@student.tue.nl |
| F.W.H.M. Ligtenberg | 1237054 | Biomedical engineering | f.w.h.m.ligtenberg@student.tue.nl |
| J.A. van Leeuwen | 1261401 | Applied Physics | j.a.v.leeuwen@student.tue.nl |
| P. Gort | 1253042 | Applied Physics | p.gort@student.tue.nl |
Introduction
Parkinson’s disease (PD) is a neurodegenerative disorder that is the second most prevalent in America today, only surpassed by Alzheimer disease. (Marshall & Hale, 2020) 500.000 people have been diagnosed with PD in the United States, but it is believed that this number would be nearing a million if we allowed for misdiagnosed on undiagnosed cases. It is considered a disease that comes with old age. Costs for treatment are high, around $14 billion, and there is no cure as of now. Both incidence and cost are expected to double as of 2040.
PD is caused by a malfunction in the neurons in the part of the brain that produces dopamine. Because of this, it becomes harder to control movement. The cause for this degeneration is still unknown. The greatest risks for PD are old age, genetics or prolonged exposure to toxins such as pesticides. PD can come with both motor and nonmotor symptoms, however motor symptoms are most common. These symptoms can affect one side of the body and then later also affect the other side. Tremors occur at rest and subside when the patient performs purposeful movements. They worsen because of stress or anxiety. It can also cause Bradykinesia; slowed movements, which can cause feelings of tiredness and weakness. This causes a shuffling way of walking and falling since they cannot adjust their footing quickly enough. Moreover, this causes difficulty when buttoning clothes, brushing their teeth or typing something. They can suffer from decreased movement and range of motion due to muscle stiffness, which causes discomfort. Later in the disease, PD patients can lack balance and stability of posture, so they can sway from side to side or remain seated for long periods of time. This can cause them to be in need of a wheelchair or require assistance to move. Other motor symptoms include: freezing, sudden stopping, slurred speech and stammering.
Parkinson’s disease is a serious concern for the future. (Darweesh et al., 2018) A recent report of the Public Health England shows trends in death numbers of neurological diseases in England between 2001-2014. Mortality associated with PD and other similar disorders has increased substantially between 2001-2014. Since PD is a disease that can significantly decrease the quality of life and the incidence is high and still rising, helping these patients becomes of increasing importance for our society.
From the beginning of arising PD until further developing stages of the disease, one of the main occurring symptoms are the tremors. Since tremors are very disturbing and can really hinder the patient in daily life activities, they can become quite nerve-racking for the patiënt. Causing even more stress and anxiety to the patient, which in turn strengthens the tremors as well. Therefore PD patients could benefit from a personalized mechanic soft sleeve that would help correct the movements which the tremors create. By these corrections, the sleeve makes it possible again to regain stability and makes it possible again to execute easy daily life activities like reading a newspaper or holding a cup of coffee without tremors. The soft sleeve will improve the autonomy of the patient and reduces the patient’s stress level, which in turn reduces the tremors the brain creates. The soft sleeve can reach out to the needs of the patient through a developed computational model of the arm, taking into account it’s biomechanics and physical interaction. (Velandia, Tibaduiza, & Vejar, 2017)
The problem we want to address is that Parkinson’s disease is hard to distinguish from other diseases with tremor symptoms in the beginning stadia. For Parkinson’s disease, a correct diagnosis is important, since Parkinson’s disease can come with other health problems. (Nederlandse Huisartsen Genootschap, 2020) The model is able to differentiate between tremor diseases such as essential tremors, Parkinson’s disease, Paraneoplastic syndrome, Extrapyramidal syndrome and Idiopathic Parkinson based on the amplitude and frequencies of tremors.
Problem statement
"Diagnose similar diseases where tremors occur, by distinguishing the different kinds of tremors based on the amplitude and frequency of these tremors. A doctor can prescribe a patient to wear a sleeve that uses sensors and the model we produced to store data for the doctor to read. Based on this data, a diagnosis can be determined without going to specialists."
Objectives
- Help family medicine doctors diagnose a patient correctly without the help of specialists
- User-friendly
- Design should be appealing to age demographic (50+)
Users
The primary users are the primary family medicine doctors. The problem that they face is that there aren’t any medical tests to identify tremor-related diseases. As such it is not always as clear what disease a patient may have when they are in the beginning stages. They have to work with symptom-based judgment. Even though the main symptom that we are looking at is the same: Involuntary limb movements, the types of medication differ from each other. That is why it is of great importance to come to the right diagnosis right away. With the help of the sleeve, the family medicine doctors have an additional measuring tool to help to conclude the right diagnosis.
The secondary users are the patients that suffer from an early stage tremor-related disease. As said previously, the sleeve is useful in getting to the right conclusion. This prevents cases of misdiagnosis which would result in taking the wrong medication. Taking the wrong medication can be very bad for someone’s general health and it can also cause tedious side effects. Furthermore, the sleeve prevents having to go to a specialist. This can save a lot of money and can also save time.
Product
The product will be a sleeve. This sleeve will consist of a gyroscope, an accelerometer, and an Arduino. The sleeve uses a model to process the data of the tremors and converts it into a frequency spectrum.
Requirements
- Accurate
- Easy to use
- Can use sensor data to compute the model
- Needs to be able to measure the amplitude of the tremors
- Needs to be able to measure the frequency of the tremors
Approach
- Going to users
- Literature studies
Milestones/Planning
- Week 3: Finish literature study
- Week 4: Finish the description of the users and of the relevance of the project
- Week 4, 5 & 6: Work on the model
- Week 7: Organize & finish the wiki page
- Week 8: Presentation
Deliverables
- Wiki page
- Model
- A prototype sleeve
- Presentation
Marketing
Medical
It is challenging to distinguish between Parkinson’s disease and other diseases with tremor symptoms like essential tremor, both in the beginning and progressing stages of the diseases. (Thenganatt & Louis, 2012) Both essential tremor and Parkinson’s disease show tremor types like rest, postural, kinetic an intention tremors. Both diseases could even coexist in the same patient. Now, the diagnosis is determined by looking at things like tremor frequency and amplitude and associated neurological findings. Laboratory testing may also aid in differentiating these two diseases. Tests like this include: “accelerometry and surface electromyography, spiral analysis, dopamine transporter imaging, olfactory testing and, eventually, postmortem histopathology. These tests have limitations and their diagnostic utility requires additional study.” (Thenganatt & Louis, 2012) This difficulty with diagnosis shows the practicality of a model that could acquire data from which the doctor could determined the correct diagnosis, thus bypassing extensive clinical testing.
Frustration
PD patients get frustrated when they are dependent on partners or carers for performing daily tasks. (National Tremor Foundation, 2020) They often lack necessary confidence when these helpers are not there. Simple household tasks like cleaning and cooking are really difficult or even impossible. Carrying lightly weighted objects makes these tremors even worse. (Robakis & Louis, 2014) An early and correct diagnosis is thus very important to improve the quality of life of patients with tremor symptoms.
Ethical considerations
It is of utmost importance to pay attention to the balance between benefiting the patients’ quality of life, and avoiding damage, risk or injury. (Bulboacă, Bolboacă, & Bulboacă, 2017)
Most concerns around electronic health records (EHRs) like the data the model will calculate and store are around privacy, confidentiality and the jeopardization of autonomy. (Ozair, Jamshed, Sharma, & Aggarwal, 2015) EHRs are massively being implemented because of their several advantages over paper records, since they increase healthcare access, decrease costs and improve care quality. Autonomy can be taken away from patients if their data is shared without their knowledge. Because of this, a patient might choose to withhold important information in fear of their data being leaked. This can cause suboptimal treatment plans with undesired outcomes. Following privacy and confidentiality guidelines, information about a patient can only be shared with third parties with the patients’ consent. Clinical data is confidential and must always be safeguarded. When this patient cannot give informed consent because of mental capacity or old age, this decision falls upon their guardian or legal representative. Data leaks violate a patients’ privacy and thus damage trust in the health care system as a whole. The fact that the privacy and autonomy of patients can be compromised when collecting data from them in a clinical setting is an ethical question that needs to be at the forefront of the development of this sleeve.
Moreover, when can a doctor decide if this sleeve should be worn by a patient? Under which conditions should the sleeve be applied? What should a patient expect from the sleeve? These conditions should be determined before usage to avoid conflict. Little guidance exists in health care, which results in competing pressures and affects the way that the sleeve is put into practice. (Foye et al, 2002)
Beyond conflicts also the clinical reasoning process is being affected by reimbursement or money issues and this raises significant concerns about the way in which we assess the quality of the provided services of the sleeve. If the sleeve is not in the family medicine budget, it will not see the light of day. If the patient needs to buy it to own it and be able to use it, they will only do so if the symptoms become severe. By this time, treatment could have been started way earlier, combating these symptoms.
Another closely related issue that arises is that the patient will get less attention from health care professionals compared to now. This can feel less personal, so patients might not feel like they get the care they deserve, even though this model makes the diagnosis more accurate and faster.
Essential tremor (ET):
ET is a progressive neurological disorder, which causes an involuntary rhythmic pure action tremor, and as such no tremors are experienced while in rest. ET can affect the whole body but it occurs most often in the hands. Due to the lack of medical tests for this disease the diagnosis is at first based on the symptoms. When one has the symptoms of ET then the medical history and family history of the patient is reviewed.
Essential tremor signs and symptoms: • Begin gradually, usually more prominently on one side of the body • Worsen with movement • Usually occur in the hands first, affecting one hand or both hands • Can include a "yes-yes" or "no-no" motion of the head • May be aggravated by emotional stress, fatigue, caffeine or temperature extremes
A patient with ET can be prescribed of multiple types of medication. Firstly Betablockers, these normally are used for treating high blood pressure but also tend to reduce the tremors of patients. Secondly, anti-seizure medication, these often are a replacement for people who don’t respond to betablockers. Lastly, tranquilizers. These are anti-anxiety medications for patients whose ET is affected by their emotional state. These are addictive.
Parkinson’s disease
Parkinson’s disease (PD) is a neurodegenerative disorder that is the second most prevalent in America today, only surpassed by Alzheimer disease. (Marshall & Hale, 2020) 500.000 people have been diagnosed with PD in the United States, but it is believed that this number would be nearing a million if we allowed for misdiagnosed on undiagnosed cases. It is considered a disease that comes with old age. Costs for treatment are high, around $14 billion, and there is no cure as of now.
PD is caused by a malfunction in the neurons in the part of the brain that produces dopamine. Because of this, it becomes harder to control movement. The cause for this degeneration is still unknown. The greatest risks for PD are old age, genetics or prolonged exposure to toxins such as pesticides. PD can come with both motor and nonmotor symptoms, however motor symptoms are most common. These symptoms can affect one side of the body and then later also affect the other side. Tremors most often occur at rest and subside when the patient performs purposeful movements. They worsen because of stress or anxiety. It can also cause Bradykinesia; slowed movements, which can cause feelings of tiredness and weakness. This causes a shuffling way of walking and falling since they cannot adjust their footing quickly enough. Other motor symptoms include: freezing, sudden stopping, slurred speech and stammering.
The most commonly prescribed medication for PD is Levodopa. Levodopa is changed in the brain into dopamine. As PD affects the dopamine production it is the best medication to help control the symptoms slow movements and stiff body parts. Levodopa is often taken along with Carbidopa as Carbidopa increases the effectiveness of Levodopa. This results in smaller doses of Levodopa which reduces the negative side effects. Other types of medication are dopamine agonists. These mimic the effects of dopamine however, they aren’t as effective as dopamine. Furthermore, anticholinergics have often been used in the past. These block involuntary movements to some degree however, it is not often used anymore due to its sideeffects. Amantadine is also used for PD. This increased the availability of dopamine. Lastly, both MAO B inhibitors and COMT inhibitors block the enzyme which is responsible for the breaking down of dopamine in the brain.
Essential tremor vs Parkinson’s disease
ET is occasionally confused with Parkinson’s disease however, there are some key differences. ET is only involved with tremors, there are no other health issues whereas PD may shorten a patient’s lifespan as it causes issues with the brain. Also the tremor affected parts of the body differ. ET involves the hand, head and the voice, while PD cannot be involved with the voice but can be involved with other body parts. Furthermore, ET is a pure action tremor whereas PD is more often a (pure) resting tremor. Lastly, there are difference with the timing of the tremors. ET tremors tend to be of a lower magnitude and with a higher frequency than PD tremors are
Current state of art
Purpose
There are multiple designs made for a flexoskeleton functioning in rehabilitation, supporting physical actions of the impaired, disorders and functioning in normal every day life usage. At this moment there are many kinds of research into flexoskeletons. The one that is investigated mostly is the soft sleeve for the hand, a glove, and therefore there is already a lot of data and knowledge available to take into account for a soft sleeve. Though there are already proposals for the design and functionality tests of an elbow sleeve. Elbow sleeves were made by elastomeric and fabric-based pneumatic actuators to get a soft and lightweight feeling. Yet the elbow sleeve is capable of carrying out continuous passive and intent-based assisted movements, but finetuning is still needed. Therefore. Further investigation of the clinical implementation of the elbow sleeve for the neuromuscular training of neurologically-impaired persons, such as stroke survivors, is needed. (Koh, et al. 2017) Materials versus the ability to intent Traditional flexoskeletons still include systems that interfere with the natural movement of joints, and thus reduce portability and cause discomfort to the user. For improving this disadvantage there are ongoing researches about skeletons with varying the components of the flexoskeleton to improve the usage of the material. For example silicone rubber with an elastic modulus of human tissue using air pressure for the support of the finger area for example. By this, the patient’s grip improved with the presence of the glove so there is an ability for soft portable and lightweight exoskeletons used for everyday life. (Yap et Lim et al. 2017) Or for example fabric and latex bladder to use for a zero volume concept. (Yap et Kai et al., 2017) So far the ability to detect a user’s intent to engage movement is only about 30%. (Chu et al., 2018) Most devices are made assistive devices and so detecting user intent is not necessarily a priority. There is less interest in incorporating feedback modalities to detect user intent accompanied by robotic augmentation of that intent. At the moment it is find more important to reduce the weight of the flexoskleton as much as possible to reduce any unnecessary weight for rehabilitation with usage of the flexoskeleton..
Design, safety, and implementation Soft robotics are also already used for neurologic disorders due to their inherent safety, less complex designs, and increased potential for portability and efficacy. While several groups have begun designing devices, there are few devices that have progressed enough to provide clinical evidence of their design's therapeutic abilities. More work needs to be done in actuator design, safety, and implementation in order for these devices to progress to clinical trials. (Chu et al., 2018)
Portability A lot of flexoskeleton devices were designed with portability in mind. Several devices were mobile due to compact control units that were battery powered. However, a portable device is not necessarily mobile even though it is called mobile, since some portable devices are still powered by wall outlets, but could still be used in a patient’s home. Mobility enabled users to power the device while freely moving about their environment, which permitted more assistance with their every day life compared to if they were tethered to a wall outlet. This allowed devices to have further applications as assistive devices. Currently, it is unclear what the benefit having this mobility grants in terms of rehabilitative success and so it should be elucidated to determine whether it is a desirable trait in these rehabilitative devices. (Chu et al., 2018)
Safety In terms of safety measures, only 12 of the 44 devices of a hand flexoskeleton(27%) had implemented clear forms of safety mechanisms. (Chu et al., 2018) This indicates that there is still a lot to investigate into the safety input of the design of a flexoskeleton. Though it is hard to incorporate safety mechanisms due to its disadvantages. Table 1 describes the advantages and disadvantages of a couple of safety mechanisms in a flexoskeleton. It is likely that the lack of safety is also due to the premature stages of many devices. Since safety is not yet a major concern within the design and only a few have been tested on human subjects. There is still a desire to reduce components for the mobility and weight of the exoskeleton, but inclusion of effective safety mechanisms are an absolute necessity for future iterations of these devices. Table 1) Advantages and disadvantages of safety mechanisms
Literature study
Femke
Breen, J. S. (2015). The exoskeleton generation – disability redux. Disability & Society, 30(10), 1568–1572. https://doi.org/10.1080/09687599.2015.1085200 https://www-tandfonline-com.dianus.libr.tue.nl/doi/full/10.1080/09687599.2015.1085200
This article talks about the implications with on the one side the increasing acceptance of disability, and on the other side the rapid scientific developments in the medical field. If you could just function as a non-disabled person again with the help of an exoskeleton, would you still be able to choose to not use this medical advancement? Would you still have a free choice in this, or are you frowned upon when you do not want to “fix” your disability?
Association for Computing Machinery (ACM). (2020, 02 04). code-of-ethics. Opgehaald van https://www.acm.org/: https://www.acm.org/code-of-ethics
This website states the ethical codes for computing machinery. Exoskeletons would violate some of these codes, such as 1.1 "Be fair and take action not to discriminate" and 1.4 "Contribute to society and human well-being"
1. Greenbaum, Dov., 'Ethical, Legal and Social Concerns Relating to Exoskeletons.' ACM SIGCAS Computers and Society 45, no. 3 (2015): 234-239. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2843109
This article talks about ethical implications such as financial availability (with exoskeletons costing as much as a luxury car), and the dehumanization of soldiers or workers using these exoskeletons (overworking employees and dehumanizing warfare and the humans that fight in that war)
Pauline Maurice, Ludivine Allienne, Adrien Malaisé, Serena Ivaldi. Ethical and Social Considerations for the Introduction of Human-Centered Technologies at Work. IEEE Workshop on Advanced Robotics and its Social Impacts (ARSO), 2018, Genova, Italy. hal-01826487 https://hal.archives-ouvertes.fr/hal-01826487/document
This research paper talks about the importance of, aside from existing ethical guidelines, complementing this with an analysis of the social impact of this exoskeleton technology. They studied the opinions of factory workers (so people who are more at risk of physical injuries) and people outside this environment
Bissolotti, L., Nicoli, F., & Picozzi, M. (2018). Domestic Use of the Exoskeleton for Gait Training in Patients with Spinal Cord Injuries: Ethical Dilemmas in Clinical Practice . Frontiers in Neuroscience , Vol. 12, p. 78. Retrieved from https://www.frontiersin.org/article/10.3389/fnins.2018.00078 https://www.frontiersin.org/articles/10.3389/fnins.2018.00078/full
This research paper evaluates some ethical questions about the domestic use of a robotic exoskeleton (ReWalk Robotics) for gait assistance in patients with a spinal cord injury. “This device is presently FDA and EC market approved and it is now available”. It talks about ethical concerns like financial coverage because of personal resources, but learning to walk again is of high priority for patients
(Handig boek over “lower limb wearable robotics” en welke onderdelen het allemaal nodig heeft en wat daar de challenges van zijn: https://app.knovel.com/web/toc.v/cid:kpWESDCA03/viewerType:toc//root_slug:wearable-exoskeleton-systems?kpromoter=marc)
Pim
One yet existing exoskeleton is the RUPERT (Robotic upper extremity repetitive trainer). This device has 5 actuated degrees of freedom which are driven by compliant and safe pneumatic (operated by air or gas under pressure.) muscle actuators. This helps with shoulder elevation, elbow extension, forearm supination (turning your arm outwards) and humeral external rotation. There is no gravity compensation for this exoskelet. The system is lightweight and uses a PID-based controller combined with an ILC (iterative learning controller) controller. (Balasubramanian, 2008) https://ieeexplore.ieee.org/document/4625154
The state of the art of currently available lower limb assistive exoskeletons is presented in this paper. The functional abilities and the mechanism designs are described. In conclusion, there is still a lot to improve on assistive exoskeletons like choosing the proper and effective tools methods, developing user friendly interfaces and making the devices more affordable. (Kapsalyamov, 2019) https://ieeexplore.ieee.org/abstract/document/8759880
To operate a robotic exoskeleton a control system is needed to monitor an output of electrical activity sensors which are disposed on the human operator. The control system reacts automatically an the step the human makes, choosing from a plurality of different modes. Eventually the operating mode selected will determine the response the system will have to make. (Wilkinson, 2014) https://patents.google.com/patent/US9339396B2/en
The lower-limb exoskeleton is designed to provide weight-bearing assistance for strength and endurance augmentation. It has 10 degrees of freedom. A trajectory learning scheme based on RL (reinforcement learning) and DMP (dynamic movement principles) is present to give assistance to human walking. A two-level plan is presented, the first one concerns the ZMP (zero-moment-point) within the ankle joint for the supported leg. For this purpose the inverted pendulum approximation is utilized, this is done with the so called locomotion parameters. The second level models the joint trajectories learned by the DMP. The RL is now adopted to learn these trajectories so that it can eliminate all the uncertainties in the joint space. The experiments show that it is an effective method for minimizing disturbances and uncertainties. (Yuan, 2019) https://dr.ntu.edu.sg/handle/10356/88973
The robots used for physical rehabilitation allow the patient a compliance and a quantitative, more accurate monitoring of the performance of the patient. However when the patients go back home, it is logistically not possible to keep this same kind of support. Recent research in soft materials for designing robotic devices can make this possible. These are made of fabric and elastomers, is a promising way of delivering power and being ergonomic. Features like assisting the elbow joint and compensating the gravitational forces with a controller are developed and evaluated. It is tested on both the kinetics and kinematics of healthy people. (Xiloyannis, 2019) https://ieeexplore.ieee.org/abstract/document/8718029
bibliography
Balasubramanian, S. (2008). RUPERT: An exoskeleton robot for assisting rehabilitation of arm functions. Vancouver, BC, Canada: IEEE.
Kapsalyamov, A. (2019). State of the Art Lower Limb Robotic Exoskeletons for Elderly Assistance. Nazarbayev: IEEE.
Wilkinson, L. J. (2014). Robotic exoskeleton multi-modal control system . US: Harris Corp.
Xiloyannis, M. (2019). Development and validation of a soft robotic exosuit for assistance of the upper limbs. Singapore: Nanyang Technological University.
Yuan, Y. (2019). DMP-based Motion Generation for a Walking Exoskeleton Robot Using Reinforcement Learning. Liverpool: IEEE.
Jan
The IHMC exoskeleton is a suit that can be used to gain more strength. The first prototypes were targeted for walking assistance for persons with lower paralysis. The goal is to successfully enable a person to walk a straight line of a distance of 15 feet without human assistance. https://ieeexplore.ieee.org/abstract/document/5152394
In this paper the development of a lower limb exoskeleton is described. These twin legs are powered by pneumatic muscle actuators. These are low mass high power to weight and volume actuation system. These “muscles” being pneumatic means that a more natural muscle like feeling is achieved. This exoskeleton is mostly used for rehabilitation. https://ieeexplore.ieee.org/abstract/document/1639137
CRUX: compliant robotic upper-extermity exosuit. This exosuit is a lightweight (1.3 kg), has flexible multi-joitn design for portable augmentation. The CRUX also maintains the ability to freely move why wearing it. Mostly used for physical therapy and in extreme environments. It is mostly used for people suffering from stroke. It can help these people with the rehabilitation. Most of these rehabiliations now a days succeed. CRUX can provide a solution for this. https://ieeexplore.ieee.org/abstract/document/8009482
In this article a exosuit is talked about that can help people with hip problems. It uses a backpack frame to connect to the torso. Beneftis of using this method is that exosuits eliminate the problem regarding the alignment of a rigid frame to the biological joints, furthermore the inertia of the joints can be extremely low, meaning less muscle power has to be used. A spooled-webbing of actuators is attached onto the back of the user. These actuators can assist the user. Due to this mechanics more torque is achieved which means that for the same movement 30% less power is needed. https://www.sciencedirect.com/science/article/abs/pii/S0921889014002103
In this article the biomechanical and physiological effects of a multi-joint soft exosuit are assessed. This exosuit can apply a assisting torque to the hip and ankle joints during walking. This study has looked at the effects of the exosuit on the characteristics of the movement of humans. It appeared that the suit is able to support most of the power that is needed to walk. However there is a decline in kinematic performance with this suit on. This is technical limitation. https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0150-9
bibliography
Hian Kai Kwa (2009), Development of IHMC Mobility Assist Exoskeleton, IEEE
Costa, N. (2006), Control of a Biomimetic "Soft-actuated" 10DoF Lower Body Exoskeleton, Pisa, Italy, IEEE
Lessard, S (2017), CRUX: A compliant robotic upper-extremity exosuit for lightweight, portable, multi-joint muscular augmentation, Londen, UK, 2017
Asbeck, Alan T. (2015), Soft exosuit for hip assistance, Robotcs and Autonomous Systems
Panizzolo, Fausto A. (2016), A biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking, Journal of NeuroEngineering and Rehabilitation
Jorn
Chen, B (2017) A wearable exoskeleton suit for motion assistance to paralysed patients, Journal of Orthopaedic Translation, https://doi.org/10.1016/j.jot.2017.02.007
This is a study performed in order to help, the ever increasing amount of, paralysed patients to regain control over their limbs using a wearable exoskeleton
H. Kobayashi, H. Suzuki, H. Nozaki and T. Tsuji, "Development of Power Assist System for Manual Worker by Muscle Suit," RO-MAN 2007 - The 16th IEEE International Symposium on Robot and Human Interactive Communication, Jeju, 2007, pp. 332-337. https://ieeexplore.ieee.org/document/4415104
This paper researches the application of a ‘muscle suit’ that will provide muscular support for manual workers. If the application in this scene will succeed then the muscle suit can be taken further to help the elderly or paralysed patients. But as these categories inquire more risks it is necessary to test it on manual workers beforehand.
R. Auberger, C. Breuer-Ruesch, F. Fuchs, N. Wismer and R. Riener, "Smart Passive Exoskeleton for Everyday Use with Lower Limb Paralysis: Design and First Results of Knee Joint Kinetics," 2018 7th IEEE International Conference on Biomedical Robotics and Biomechatronics (Biorob), Enschede, 2018, pp. 1109-1114. https://ieeexplore.ieee.org/abstract/document/8488119
This paper introduces a new orthotic system that supports people with lower limb paralysis in their everyday life.
B. Dellon and Y. Matsuoka, "Prosthetics, exoskeletons, and rehabilitation [Grand Challenges of Robotics]," in IEEE Robotics & Automation Magazine, vol. 14, no. 1, pp. 30-34, March 2007. https://ieeexplore.ieee.org/abstract/document/4141030
The paper briefly discusses the history of artificial limbs and describes present prosthetics, exoskeletons and robotic rehabilitation and the challenges in prosthetics and exoskeletons
M. Aach, O. Cruciger, M. Sczesny-Kaiser, O. Höffken, R. Ch. Meindl, M. Tegenthoff, P. Schwenkreis, Y. Sankai, T. A. Schildhauer, Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study, The Spine Journal, Volume 14, Issue 12, 2014, Pages 2847-2853, ISSN 1529-9430, https://doi.org/10.1016/j.spinee.2014.03.042.
This research tested if the HAL exoskeleton is safe and whether it improves functional mobility. The patient sample consisted of eight patients with chronic spinal cord injury. The results showed highly significant improvements to the functional mobility without the exoskeleton in the end.
Chantal
Lee, R. C. H., Hasnan, N., & Engkasan, J. P. (2017). Characteristics of persons with spinal cord injury who drive in Malaysia and its barriers: a cross sectional study. Spinal Cord, 56(4), 341–346. https://doi.org/10.1038/s41393-017-0034-2 In this article the importance of the availability to drive after obtaining a physical impairment for SCI is described. Also it is stated that driving is a very important factor for rehabilitation. It is explained that there are various reasons not for driving with a physical impairment.
Zuk, M. (2019). Autonomy - a way for loneliness. analysis of the experience of loneliness of people with physical disabilities. Autonomy, 1633-1640. https://www.ncbi.nlm.nih.gov/pubmed/31586975 This article talks about the importance of autonomy as valuable asset in the lives of societies and individuals and causing the problem of loneliness. The aim of the article is the characteristics of psychological mechanisms accompanying the experience of loneliness by people with mobility disabilities.
Plus, M. (2020). Disabilities. Geraadpleegd op 13 februari 2020, van https://medlineplus.gov/disabilities.html This article talks about the difficulties and limits of the impaired in normal daily lifestyle activities. It also explains the capabilities of Mobility impaired.
Bray, N., Edwards, R. T., Squires, L., & Morrison, V. (2019). Perceptions of the impact of disability and impairment on health, quality of life and capability. BMC Research Notes, 12(1). https://doi.org/10.1186/s13104-019-4324-y This article describes a research project that examines student perceptions of what it would be like to live with a physical or sensory impairment, and how adaptation influences health and quality of life. Mobility impairment is perceived to have the largest impact on health status.
Toro-Hernandez, M. L., Villa-Torres, L., Mondragón-Barrera, M. A., & Camelo-Castillo, W. (2020). Factors that influence the use of community assets by people with physical disabilities: results of participatory mapping in Envigado, Colombia. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-8285-9 This article is about a research to identify the factors at the levels of the socio-ecological framework, and their interaction, that influence the use of community assets among people with physical disabilities and community stakeholders. It calls for stronger enforcement of the existing legal framework through articulated work between different stakeholders, so that people with disabilities can enjoy community assets.
Planning
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References
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