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Jarvis K, Cook J, Bavikatte G, Branscombe N, Donovan S, Haworth J, Lawrence C, Morland C, Stockley RC. A pilot exploration of staff and service-user perceptions of a novel digital health technology (Virtual Engagement Rehabilitation Assistant) in complex inpatient rehabilitation. Disabil Rehabil Assist Technol 2024:1-11. [PMID: 38743465 DOI: 10.1080/17483107.2024.2351499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Digital health technologies have the potential to advance rehabilitation. The Virtual Engagement Rehabilitation Assistant (VERA) is a digital technology, co-designed to increase service-user engagement and promote self-management. This qualitative study explored staff and service-user perceptions of implementing VERA on a UK complex inpatient rehabilitation ward. METHODS Purposively sampled service-users were allocated to VERA for up to six weeks. The Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework underpinned service-user post-intervention interviews and staff focus groups, and structured analysis of the data. Seven service-users were interviewed. Nine staff contributed to focus groups. RESULTS A framework analysis identified themes (and subthemes) structured by the NASSS framework domains: 1. Nature of Clinical Condition, 2. Technology (Ease of Use, Holding Information/Resources in a single Digital Location, Appointments), 3. Value Proposition (Structuring Time, Feedback, Unexpected Benefits) 4. Adopters (Confidence in using Technology, Usefulness), 5. Wider Organisation. Ease of use and storage of key information in a single location were beneficial. Reliability, and provision of accurate and timely feedback to staff and service-users, were identified as essential. CONCLUSIONS A blended approach is required to meet staff and service-user needs. The potential for VERA in a community setting was identified and requires further investigation. Learning from VERA will support development of other digital technologies and their implementation.
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Affiliation(s)
- Kathryn Jarvis
- Stroke Research Team, University of Central Lancashire (UCLan), Preston, UK
| | - Julie Cook
- Applied Health Research Hub, University of Central Lancashire (UCLan), Preston, UK
| | | | | | | | - Jo Haworth
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Rachel C Stockley
- Stroke Research Team, University of Central Lancashire (UCLan), Preston, UK
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Jarvis K, Thetford C, Turck E, Ogley K, Stockley RC. Understanding the Barriers and Facilitators of Digital Health Technology (DHT) Implementation in Neurological Rehabilitation: An Integrative Systematic Review. Health Serv Insights 2024; 17:11786329241229917. [PMID: 38690403 PMCID: PMC11060031 DOI: 10.1177/11786329241229917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/16/2024] [Indexed: 05/02/2024] Open
Abstract
Background Digital Health technologies (DHT) have potential to deliver intensive, novel and engaging rehabilitation for people with neurological conditions, yet health services lack a strong track record in embedding DHT into practice. The aim of this review was to synthesise factors that have been shown to influence implementation of DHT into neurological rehabilitation. Method An integrative review was undertaken. An extensive search of MEDLINE, CINAHL, AMED, EMBASE was undertaken. The title and abstract of all retrieved sources were screened against pre-defined criteria. Retained sources underwent full text review. The quality of all included sources was assessed. A meta-ethnographic synthesis explored commonalities and contradictions of the included studies. Results Fourteen studies (1 quantitative, 8 qualitative and 5 mixed methods) were included. Eleven implementation theories/models/frameworks were used across the 14 studies. Five themes were identified: (i) individual factors; (ii) user experience of the technology; (iii) the content of the intervention; (iv) access to the technology and (v) supporting use. Conclusions Key factors which appear to influence the implementation of DHT into clinical settings are highlighted. Implementation theories, models and frameworks are under-utilised in DHT rehabilitation research. This needs to be addressed if DHT are to realise their potential in neurological rehabilitation. Registration The protocol was registered and is available from PROSPERO (CRD42021268984).
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Affiliation(s)
- Kathryn Jarvis
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Clare Thetford
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Edward Turck
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Kelly Ogley
- School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Rachel C Stockley
- Stroke Research Team, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Herold L, Bosques G, Sulzer J. Clinical Uptake of Pediatric Exoskeletons: Pilot Study Using the Consolidated Framework for Implementation Research. Am J Phys Med Rehabil 2024; 103:302-309. [PMID: 38063305 DOI: 10.1097/phm.0000000000002371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
OBJECTIVE While the design and clinical evidence base of robot-assisted gait training devices has been advancing, few studies investigate user experiences with accessing and using such devices in pediatric rehabilitation. This pilot study aims to further the understanding of barriers encountered by clinicians and caregivers when implementing a robot-assisted gait training device. DESIGN A qualitative descriptive study was conducted at a local outpatient pediatric therapy center with a robot-assisted gait training exoskeleton. Six caregivers and six clinicians participated in semistructured interviews with brief surveys. The surveys were summarized with descriptive statistics. The interviews were analyzed using directed content analysis guided by the Consolidated Framework for Implementation Research. RESULTS The five most mentioned Consolidated Framework for Implementation Research constructs were knowledge and beliefs, relative advantage, child attributes, complexity, and access to knowledge and information. Caregivers experienced obstacles to accessing and trialing robot-assisted gait training devices. Clinicians expressed concerns regarding the feasibility of incorporating robot-assisted gait training into their clinic and preferred lower-tech gait training techniques. CONCLUSIONS While some aspects of access and usability may be addressed by device design and technological advancements, overcoming other barriers will require a deeper understanding of the roles of scientific evidence, personal beliefs, and current therapy workflows in the uptake of robotic interventions.
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Affiliation(s)
- Larissa Herold
- From the Walker Department of Mechanical Engineering, University of Texas at Austin, Austin, Texas (LH); Department of Neurology, Dell Medical School, Austin, Texas (GB); Pediatric Rehabilitation Medicine, Dell Children's Medical Center, Austin, Texas (GB); and Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio (JS)
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Celian C, Redd H, Smaller K, Ryali P, Patton JL, Reinkensmeyer DJ, Rafferty MR. Uncovering clinical rehabilitation technology trends: field observations, mixed methods analysis, and data visualization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.05.24303809. [PMID: 38496469 PMCID: PMC10942504 DOI: 10.1101/2024.03.05.24303809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objective To analyze real-world rehabilitation technology (RT) use, with a view toward enhancing RT development and adoption. Design A convergent, mixed-methods study using direct field observations, semi-structured templates, and summative content analysis. Setting Ten neurorehabilitation units in a single health system. Participants 3 research clinicians (1OT, 2PTs) observed ∼60 OTs and 70 PTs in inpatient; ∼18 OTs and 30 PTs in outpatient. Interventions Not applicable. Main Outcome Measures Characteristics of RT, time spent setting up and using RT, and clinician behaviors. Results 90 distinct devices across 15 different focus areas were inventoried. 329 RT-uses were documented over 44 hours with 42% of inventoried devices used. RT was used more during interventions (72%) than measurement (28%). Intervention devices used frequently were balance/gait (39%), strength/endurance (30%), and transfer/mobility training (16%). Measurement devices were frequently used to measure vitals (83%), followed by grip strength (7%), and upper extremity function (5%). Device characteristics were predominately AC-powered (56%), actuated (57%), monitor-less (53%), multi-use (68%), and required little familiarization (57%). Set-up times were brief (mean ± SD = 3.8±4.21 and 0.8±1.3 for intervention and measurement, respectively); more time was spent with intervention RT (25.6±15) than measurement RT (7.3±11.2). RT nearly always involved verbal instructions (72%) with clinicians providing more feedback on performance (59.7%) than on results (30%). Therapists' attention was split evenly between direct attention towards the patient during clinician treatment (49.7%) and completing other tasks such as documentation (50%). Conclusions Even in a tech-friendly hospital, majority of available RT were observed un-used, but identifying these usage patterns is crucial to predict eventual adoption of new designs from earlier stages of RT development. An interactive data visualization page supplement is provided to facilitate this study.
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Alt Murphy M, Pradhan S, Levin MF, Hancock NJ. Uptake of Technology for Neurorehabilitation in Clinical Practice: A Scoping Review. Phys Ther 2024; 104:pzad140. [PMID: 37856528 PMCID: PMC10851848 DOI: 10.1093/ptj/pzad140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Technology-based interventions offer many opportunities to enhance neurorehabilitation, with associated research activity gathering pace. Despite this fact, translation for use in clinical practice has lagged research innovation. An overview of the current "state of play" regarding the extent of clinical uptake and factors that might influence use of technologies is required. This scoping review explored the uptake of technologies as neurorehabilitation interventions in clinical practice and factors that are reported to influence their uptake. METHODS This systematic scoping review was conducted with narrative synthesis and evidence mapping. Studies of any design reporting uptake or implementation of technology (wearable devices, virtual reality, robotics, and exergaming) for movement neurorehabilitation after stroke and other neurological conditions were sought via a formal search strategy in MEDLINE (Ovid), CINAHL, AMED, and Embase. Full-text screening and data extraction were completed independently by 2 reviewers. RESULTS Of 609 studies returned, 25 studies were included after title, abstract, and full-text screening. Studies investigated a range of technologies at various stages of development. Only 4 of the included studies explored the sustained use of technology in practice. The following 5 themes representing experiences of technology use emerged: perceived usefulness, technology design, social interaction, integration with services, and suggested improvements to enhance uptake. CONCLUSION Reporting of uptake and use of neurorehabilitation technologies in clinical practice is limited. The synthesis provided comprehensive knowledge of barriers to and facilitators of uptake to be considered in future protocols, including a steep learning curve required to engage with technology, a need for a supportive organizational culture, and a need for user involvement in both design and development. IMPACT This scoping review has provided indicators from current evidence of important factors to consider in the planning of research into and clinical implementation of technologies for neurorehabilitation. It serves to support an evidence-based, user-centered platform for improved research on and translation of technologies in neurorehabilitation clinical practice.
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Affiliation(s)
- Margit Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sujata Pradhan
- Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | - Nicola J Hancock
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Curtis S, Sheehan L, Buchman E, Bhattacharjya S. Clinicians' perspectives and usage of rehabilitation technology: a survey. Disabil Rehabil Assist Technol 2023:1-8. [PMID: 37987735 DOI: 10.1080/17483107.2023.2284365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE The aim of this study was to investigate clinicians' perspectives regarding their usage of rehabilitation technology in their day-to-day practice and uncover the factors that impact clinicians' use of rehabilitation technology in their daily practice. MATERIALS AND METHODS An online survey was used to gather cross-sectional data from American occupational therapists, occupational therapy assistants, physical therapists, physical therapy assistants, and speech language pathologists. This survey used Likert-scale, multiple choice, and free-response questions. RESULTS Approximately half (n = 56/105, 53.3%) of our clinicians reported using rehabilitation in their daily practice. Less than 20% (n = 18/105, 17.1%) of the respondents strongly agreed that they felt comfortable implementing new rehabilitation technology, and few reported that their workplace encouraged (n = 16/85, 18.8%) or strongly encouraged (n = 14/85, 16.5%) the use of rehabilitation technology in practice. Additionally, excluding the 2011-2020 graduate clinicians that reported that they had not learned about rehabilitation technology in school or fieldwork, few reported feeling prepared (n = 14/97, 14.4%) or very prepared (n = 4/97, 4.1%) to use rehabilitation technology after graduation. CONCLUSIONS Our findings have revealed a sizable knowledge-to-practice gap in regard to clinicians' preparedness to engage with and advocate for rehabilitation technology in their day-to-day practice.
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Affiliation(s)
- Sarah Curtis
- Department of Occupational Therapy, GA State University, Atlanta, GA, USA
| | | | - Emily Buchman
- Department of Occupational Therapy, GA State University, Atlanta, GA, USA
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Shirota C, Mitchell J, Clanchy K. End-User Perspectives of the Importance of Rehabilitation Technologies and Related Values for Implementation. IEEE Int Conf Rehabil Robot 2023; 2023:1-4. [PMID: 37941202 DOI: 10.1109/icorr58425.2023.10304808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Despite the increased availability of rehabilitation technologies (such as robotics) and evidence to support their use, their adoption is still limited in practice. To begin to address this issue, we sought to better understand the perspectives of end-users regarding the implementation of rehabilitation technologies through an online survey. Fifty unique responses across Client (e.g., people with disability and carers), Allied Health (e.g., occupational and physical therapists, podiatrists, psychologists, dieticians, audiologists, exercise physiologists), and Medical (i.e., physicians and nurses) groups were analyzed. Respondents considered rehabilitation technologies to be important (median across groups of 9 out of 10). Across groups, value statements related to the implementation of rehabilitation technologies ranked from most to least important related to: benefits of technology to its intended end-user with disability, practical use of technologies, the technologies themselves (e.g., innovative, established, stand-alone), and their impact on health professionals or the health system as a whole. There were similarities and differences in ranking within and across end-user groups. The prioritization of statements indicates where development efforts can be focused to address end-user goals, and disparity in results across groups supports rich stakeholder engagement during rehabilitation technology development.
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Sommerhalder M, Kurth N, Song J, Riener R. ARMStick - An Intuitive Therapist Interface for Upper-Limb Rehabilitation Robots. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176161 DOI: 10.1109/icorr55369.2022.9896409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Currently, therapists struggle with interaction of rehabilitation robots due to non-intuitive interfaces. Therefore their acceptance of these robots are limited. This paper presents the development of ARMStick, a lightweight and small robotic interface in the shape of a human arm with 4 actuated and 3 unactuated joints, to facilitate the interaction between therapists and rehabilitation robots. It allows therapists to intuitively perceive joint-dependent data as recorded by rehabilitation robots, and teach poses and trajectories to individualize therapy to the patient. It's range of motion (RoM) covers the RoM of a healthy human. The device's measuring accuracy of CI 95% $ \lt \pm 0.322^{\circ}$ and movement accuracy of CI 70% $ \lt \pm 5.23^{\circ}$ lie within the confidence interval of average visual perception. A demonstration of the device to 5 therapists indicated that it could indeed improve efficiency and efficacy bottlenecks in current robot-assisted therapy. Comparison of ARMStick to two visual user interfaces showed a decrease in mean adaptation time from 15s to 5s for three arm configurations presented to the therapists.
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Christensen KB, Rindom HK, Jensen DR, Fabricius J, Spaich EG. Evaluation of the implementation of Armeo®Spring in a specialized neurorehabilitation center. IEEE Int Conf Rehabil Robot 2022; 2022:1-5. [PMID: 36176131 DOI: 10.1109/icorr55369.2022.9896403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rehabilitation of the upper extremity (UE) is an essential part of the process following an acquired brain injury, where robot technologies have the potential of making the rehabilitation more intensive and effective. However, the implementation of robot technologies in a clinical setting can be complicated and not always successful. The aim of this study was to evaluate the implementation of the robot technology Armeo®Spring (Hocoma, Volketswil, Switzerland) at a specialized neurorehabilitation center, and to propose a list of actions for further implementation of the technology.The Study, Act and Plan phases of the Plan-Do-Study-Act (PDSA) model for structuring technology implementations was applied as the methodological framework in this study. In the Study-phase, nine semi-structured interviews with therapists, using Armeo®Spring, were conducted to evaluate the current implementation. In the Act-phase, a workshop was held with 13 participants to discuss the findings of the Study-phase and to find possible solutions to the identified problems. The results were incorporated into a list of actions (Plan-phase) for further implementation of Armeo®Spring.Facilitating and inhibiting factors for the implementation of Armeo®Spring were identified. Facilitating factors were the practical "hands-on" approach during training, support from the management, support and sparring with colleagues as well as a positive work culture. The inhibiting factors were related to the retention of the therapists' acquired competencies, the identification of the type of patient that can benefit from this form of training, challenges due to the technical use of Armeo®Spring, and prioritization of the rehabilitation needs of the patients.Several solutions were proposed in the Act-phase, which subsequently resulted in eight concrete actions to facilitate the further implementation of Armeo®Spring. It is expected that these actions will contribute to the further implementation of Armeo®Spring at the neurorehabilitation center. As a first step, an Armeo®Spring group with therapists from all relevant wards was established.
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Swanson VA, Chan V, Cruz-Coble B, Alcantara CM, Scott D, Jones M, Zondervan DK, Khan N, Ichimura J, Reinkensmeyer DJ. A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10186. [PMID: 34639494 PMCID: PMC8508164 DOI: 10.3390/ijerph181910186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 11/21/2022]
Abstract
Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.
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Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
| | - Vicky Chan
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Betsaida Cruz-Coble
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Celeste M. Alcantara
- Department of Outpatient Physical Therapy, University of California, Irvine, CA 92868, USA; (V.C.); (B.C.-C.); (C.M.A.)
| | - Douglas Scott
- Division of Rehabilitative Services, University of California, Irvine, CA 92868, USA;
| | - Mike Jones
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA 30309, USA;
| | | | | | - Jan Ichimura
- Department of Physical Therapy, Acute Rehabilitation Unit, University of California, Irvine, CA 92868, USA;
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Henry Samueli School of Engineering, University of California, Irvine, CA 92697, USA;
- Department of Anatomy and Neurobiology, UC Irvine School of Medicine, University of California, Irvine, CA 92697, USA
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