Major trends in mobility technology research and development: overview of the results of the NSF-WTEC European study

Bibliometric study on scientific productivity in the use of smart bracelets

In recent years, wearable sensors and mHealth applications are becoming an important part for recording and monitoring health parameters. The aim is to characterize bibli-ometric indicators on scientific productivity in the use of smart bracelets according to scientific journal, study topic and publication trend. A bibliometric study was per-formed. The data extracted from the articles were: year of publication, name of the journal, language of publication, country, type of study and subject matter. A total of 45 studies were identified (21 cross-sectional and 24 experimental), of which 43 were published in English, one in Spanish and one in German. A total of 32 scientific journals published eight research topics related to smartwatch use [active living with 17 studies (37.8%), followed by stress and anxiety with 7 studies (15.6%), nanogenerators (batteries) with 6 studies (13.3%), computing with 5 studies (11.1%), chronic diseases 4 studies (8.9%), COVID propagation 3 studies (6.7%), energy expenditure 2 studies (4.4%) and occupational health 1 study (2.2%)]. The journal Sensors (Basel) published the most articles in the last 6 years (n=7, 16%). The scientific productivity of both study types reflects a positive trend (cross-sectional studies R2= 0.82 and in experimental studies R2= 0.76). A total of 45 cross-sectional and experimental studies using smart-watches were verified in eight different study topics. The most investigated category was active living and the journal that published the highest number of articles was the journal Sensors (Basel).

Past, Present and Future of Research on Wearable Technologies for Healthcare: A Bibliometric Analysis Using Scopus

Currently, wearable technology is present in different fields that aim to satisfy our needs in daily life, including the improvement of our health in general, the monitoring of patient health, ensuring the safety of people in the workplace or supporting athlete training. The objective of this bibliometric analysis is to examine and map the scientific advances in wearable technologies in healthcare, as well as to identify future challenges within this field and put forward some proposals to address them. In order to achieve this objective, a search of the most recent related literature was carried out in the Scopus database. Our results show that the research can be divided into two periods: before 2013, it focused on design and development of sensors and wearable systems from an engineering perspective and, since 2013, it has focused on the application of this technology to monitoring health and well-being in general, and in alignment with the Sustainable Development Goals wherever feasible. Our results reveal that the United States has been the country with the highest publication rates, with 208 articles (34.7%). The University of California, Los Angeles, is the institution with the most studies on this topic, 19 (3.1%). Sensors journal (Switzerland) is the platform with the most studies on the subject, 51 (8.5%), and has one of the highest citation rates, 1461. We put forward an analysis of keywords and, more specifically, a pennant chart to illustrate the trends in this field of research, prioritizing the area of data collection through wearable sensors, smart clothing and other forms of discrete collection of physiological data.

Assistive Technology for the Upper Extremities After Stroke: Systematic Review of Users' Needs

BACKGROUND

Technical innovations have the potential to compensate for loss of upper-limb motor functions after stroke. However, majority of the designs do not completely meet the needs and preferences of the end users. User-centered design methods have shown that the attention to user perspectives during development of assistive technology leads to devices that better suit the needs of the users.

OBJECTIVE

To get more insight into the factors that can bring the design of assistive technology to higher levels of satisfaction and acceptance, studies about user perspectives on assistive technology for the upper limb after stroke are systematically reviewed.

METHODS

A database search was conducted in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus from inception to August 2017, supplemented with a search of reference lists. Methodological quality of the included studies was appraised. User perspectives of stroke survivors, carers, and health care professionals were extracted. A total of 35 descriptive themes were identified, from which 5 overarching themes were derived.

RESULTS

In total, 9 studies with information gathered from focus groups, questionnaires, and interviews were included. Barriers and enablers influencing the adoption of assistive technology for the upper limb after stroke emerged within 5 overarching but highly interdependent themes: (1) promoting hand and arm performance; (2) attitude toward technology; (3) decision process; (4) usability; and (5) practical applicability.

CONCLUSIONS

Expected use of an assistive technology is facilitated when it has a clear therapeutic base (expected benefit in enhancing function), its users (patients and health care professionals) have a positive attitude toward technology, sufficient information about the assistive technology is available, and usability and practical applicability have been addressed successfully in its design. The interdependency of the identified themes implies that all aspects influencing user perspectives of assistive technology need to be considered when developing assistive technology to enhance its chance of acceptance. The importance of each factor may vary depending on personal factors and the use context, either at home as an assistive aid or for rehabilitation at a clinic.

Exerciser for rehabilitation of the Arm (ERA): Development and unique features of a 3D end-effector robot

Stroke is one of the leading causes of disability worldwide. Consequently, many stroke survivors exhibit difficulties undergoing voluntary movement in their affected upper limb, compromising their functional performance and level of independence. To minimize the negative impact of stroke disabilities, exercises are recognized as a key element in post-stroke rehabilitation. In order to provide the practice of exercises in a uniform and controlled manner as well as increasing the efficiency of therapists' interventions, robotic training has been found, and continues to prove itself, as an innovative intervention for post-stroke rehabilitation. However, the complexity as well as the limited degrees of freedom and workspace of currently commercially available robots can limit their use in clinical settings. Up to now, user-friendly robots covering a sufficiently large workspace for training of the upper limb in its full range of motion are lacking. This paper presents the design and implementation of ERA, an upper-limb 3-DOF force-controlled exerciser robot, which presents a workspace covering the entire range of motion of the upper limb. The ERA robot provides 3D reaching movements in a haptic virtual environment. A description of the hardware and software components of the ERA robot is also presented along with a demonstration of its capabilities in one of the three operational modes that were developed.

Accuracy and Precision of an Accelerometer-Based Smartphone App Designed to Monitor and Record Angular Movement over Time

BACKGROUND

Therapeutic exercise is a central component in the management of many common conditions. It is imperative, therefore, that clinicians monitor and correct patient performance to facilitate the use of proper form both in the clinic and during home exercise programs. Although clinicians are trained to prescribe exercise and analyze form, there are many subtleties that may be missed by relying on visual assessment. This study investigated the accuracy and precision of a novel, exercise-training smartphone application (app), running on an iPhone(®) (Apple, Cupertino, CA) 4 and using its LIS331DLH accelerometer to dynamically measure and record movement during exercise.

MATERIALS AND METHODS

The iPhone, running the app, was mounted to the movement arm of a Biodex™ isokinetic dynamometer System 4 (Biodex Corp., Shirley, NY). Angle and time measurements taken by the app were compared with the dynamometer (gold standard) while rotating at 30°/s, 60°/s, 90°/s, 120°/s, and 150°/s. Accuracy was assessed using limits of agreement and fast Fourier transform analyses. Precision was assessed using the coefficient of variation.

RESULTS

The mean difference between the app and the Biodex recordings was less than 1°/s for all test velocities. The coefficient of variation was less than 3% at velocities from 30°/s to 120°/s and less than 7% at 150°/s.

CONCLUSIONS

The app was highly accurate and precise. The validation of apps designed for motion tracking is a vital prerequisite to clinical implementation. The app described in this article is clinically identical to the Biodex dynamometer in its ability to accurately and precisely read angular movement over time.

Translation of evidence-based Assistive Technologies into stroke rehabilitation: users' perceptions of the barriers and opportunities

BACKGROUND

Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems.

METHODS

Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development.

RESULTS

292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly.

CONCLUSION

Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.

On the role of auditory feedback in robot-assisted movement training after stroke: review of the literature

The goal of this paper is to address a topic that is rarely investigated in the literature of technology-assisted motor rehabilitation, that is, the integration of auditory feedback in the rehabilitation device. After a brief introduction on rehabilitation robotics, the main concepts of auditory feedback are presented, together with relevant approaches, techniques, and technologies available in this domain. Current uses of auditory feedback in the context of technology-assisted rehabilitation are then reviewed. In particular, a comparative quantitative analysis over a large corpus of the recent literature suggests that the potential of auditory feedback in rehabilitation systems is currently and largely underexploited. Finally, several scenarios are proposed in which the use of auditory feedback may contribute to overcome some of the main limitations of current rehabilitation systems, in terms of user engagement, development of acute-phase and home rehabilitation devices, learning of more complex motor tasks, and improving activities of daily living.

Concept proposal for a detachable exoskeleton-wheelchair to improve mobility and health

Wheelchair use has consequences to quality of life in at least two areas: 1) health issues such as pressure sores and chronic overuse injury; and 2) access problems due to the inaccessible nature of the built and natural environments that are most amenable to upright postures. Even with these concerns, wheelchairs are still the best form of mobility for many people (e.g. they are relatively easy to transfer into and propel). However, wheelchairs are simply not transformative, i.e. they do not allow a person with a disability to attain a level of mobility performance that approaches that of their non-disabled peers, nor do they typically allow for face to face interactions and full participation in the community. Wheelchairs also do not typically support ongoing therapeutic benefits for the user. To address the inadequacy of existing wheelchairs, we are merging two evolving technologies into a coherent new mobility device. The first is dynamic wheeled mobility, which adds significant functionality to conventional wheelchairs through the use of on-the-fly adjustable positioning. The second is powered walking exoskeletons, which enable highly desired standing and walking functions, as well as therapeutic benefits associated with rehabilitation gait training. Unfortunately, exoskeletons have significant usability concerns such as slow speed, limited range, potential to cause skin issues, and difficult transfers. A new concept of docking a detachable exoskeleton to a wheeled frame has been developed to address these issues. The design goal is a single mobility device that not only optimizes daily activities (i.e. wheelchair seating and propulsion with dynamic positioning), but also serves as an easy-to-use rehabilitation tool for therapeutic benefits (i.e. a detachable powered exoskeleton for walking sojourns). This has significant potential benefits for the lives of people with mobility impairments.

Body sensor network-based strapdown orientation estimation: application to human locomotion

In this contribution, inertial and magnetic sensors are considered for real-time strapdown orientation tracking of human limb or robotic segment orientation. By using body sensor network integrated triaxial gyrometer, accelerometer, and magnetometer measurements, two orientation estimation filters are presented and subsequently designed for bias insensitive tracking of human gait. Both filters use quaternions for rotation representation, where preprocessing accelerometer and magnetometer data is conducted with the quaternion based estimation algorithm (QUEST) as a reference filter input. This results in a significant reduction of the complexity and calculation cost on the body sensor network. QUEST-based preprocessed attitude data is used for the designed extended Kalman filter (EKF) and a new complementary sliding mode observer. EKF-QUEST and complementary sliding mode observer are designed and tested in simulations and subsequently validated with a reference motion tracking system in treadmill tests.

A review of wearable sensors and systems with application in rehabilitation

The aim of this review paper is to summarize recent developments in the field of wearable sensors and systems that are relevant to the field of rehabilitation. The growing body of work focused on the application of wearable technology to monitor older adults and subjects with chronic conditions in the home and community settings justifies the emphasis of this review paper on summarizing clinical applications of wearable technology currently undergoing assessment rather than describing the development of new wearable sensors and systems. A short description of key enabling technologies (i.e. sensor technology, communication technology, and data analysis techniques) that have allowed researchers to implement wearable systems is followed by a detailed description of major areas of application of wearable technology. Applications described in this review paper include those that focus on health and wellness, safety, home rehabilitation, assessment of treatment efficacy, and early detection of disorders. The integration of wearable and ambient sensors is discussed in the context of achieving home monitoring of older adults and subjects with chronic conditions. Future work required to advance the field toward clinical deployment of wearable sensors and systems is discussed.