Musical instrument classifier for early childhood percussion instruments

While the musical instrument classification task is well-studied, there remains a gap in identifying non-pitched percussion instruments which have greater overlaps in frequency bands and variation in sound quality and play style than pitched instruments. In this paper, we present a musical instrument classifier for detecting tambourines, maracas and castanets, instruments that are often used in early childhood music education. We generated a dataset with diverse instruments (e.g., brand, materials, construction) played in different locations with varying background noise and play styles. We conducted sensitivity analyses to optimize feature selection, windowing time, and model selection. We deployed and evaluated our best model in a mixed reality music application with 12 families in a home setting. Our dataset was comprised of over 369,000 samples recorded in-lab and 35,361 samples recorded with families in a home setting. We observed the Light Gradient Boosting Machine (LGBM) model to perform best using an approximate 93 ms window with only 12 mel-frequency cepstral coefficients (MFCCs) and signal entropy. Our best LGBM model was observed to perform with over 84% accuracy across all three instrument families in-lab and over 73% accuracy when deployed to the home. To our knowledge, the dataset compiled of 369,000 samples of non-pitched instruments is first of its kind. This work also suggests that a low feature space is sufficient for the recognition of non-pitched instruments. Lastly, real-world deployment and testing of the algorithms created with participants of diverse physical and cognitive abilities was also an important contribution towards more inclusive design practices. This paper lays the technological groundwork for a mixed reality music application that can detect children's use of non-pitched, percussion instruments to support early childhood music education and play.

Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments

INTRODUCTION

Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.

METHODS AND ANALYSIS

In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.

TRIAL REGISTRATION NUMBER

NCT05998239; pre-results.

Measuring functional hand use in children with unilateral cerebral palsy using accelerometry and machine learning

AIM

To investigate wearable sensors for measuring functional hand use in children with unilateral cerebral palsy (CP).

METHOD

Dual wrist-worn accelerometry data were collected from three females and seven males with unilateral CP (mean age = 10 years 2 months [SD 3 years]) while performing hand tasks during video-recorded play sessions. Video observers labelled instances of functional and non-functional hand use. Machine learning was compared to the conventional activity count approach for identifying unilateral hand movements as functional or non-functional. Correlation and agreement analyses compared the functional usage metrics derived from each method.

RESULTS

The best-performing machine learning approach had high precision and recall when trained on an individual basis (F1  = 0.896 [SD 0.043]). On an individual basis, the best-performing classifier showed a significant correlation (r = 0.990, p < 0.001) and strong agreement (bias = 0.57%, 95% confidence interval = -4.98 to 6.13) with video observations. When validated in a leave-one-subject-out scenario, performance decreased significantly (F1  = 0.584 [SD 0.076]). The activity count approach failed to detect significant differences in non-functional or functional hand activity and showed no significant correlation or agreement with the video observations.

INTERPRETATION

With further development, wearable accelerometry combined with machine learning may enable quantitative monitoring of everyday functional hand use in children with unilateral CP.

Development of the Preferred Components for Co-Design in Research Guideline and Checklist: Protocol for a Scoping Review and a Modified Delphi Process

BACKGROUND

There is increasing evidence that co-design can lead to more engaging, acceptable, relevant, feasible, and even effective interventions. However, no guidance is provided on the specific designs and associated methods or methodologies involved in the process. We propose the development of the Preferred Components for Co-design in Research (PRECISE) guideline to enhance the consistency, transparency, and quality of reporting co-design studies used to develop complex health interventions.

OBJECTIVE

The aim is to develop the first iteration of the PRECISE guideline. The purpose of the PRECISE guideline is to improve the consistency, transparency, and quality of reporting on studies that use co-design to develop complex health interventions.

METHODS

The aim will be achieved by addressing the following objectives: to review and synthesize the literature on the models, theories, and frameworks used in the co-design of complex health interventions to identify their common elements (components, values or principles, associated methods and methodologies, and outcomes); and by using the results of the scoping review, prioritize the co-design components, values or principles, associated methods and methodologies, and outcomes to be included in the PRECISE guideline.

RESULTS

The project has been funded by the Canadian Institutes of Health Research.

CONCLUSIONS

The collective results of this project will lead to a ready-to-implement PRECISE guideline that outlines a minimum set of items to include when reporting the co-design of complex health interventions. The PRECISE guideline will improve the consistency, transparency, and quality of reports of studies. Additionally, it will include guidance on how to enact or enable the values or principles of co-design for meaningful and collaborative solutions (interventions). PRECISE might also be used by peer reviewers and editors to improve the review of manuscripts involving co-design. Ultimately, the PRECISE guideline will facilitate more efficient use of new results about complex health intervention development and bring better returns on research investments.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50463.

Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study

Introduction

Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can be used at home to encourage upper limb (UL) functional exercise tailored to each child's abilities and therapy goals. The study objectives were to: 1) Establish the extent to which children achieve their self-directed play-time goal over a 12-week intervention, 2) Measure changes in UL motor outcomes, and 3) Explore participants' experiences of using Bootle Blast at home.

Methods

Mixed methods case series study of four children with hemiplegic cerebral palsy (HCP), each with a participating parent. Participants played Bootle Blast at home for 12 weeks. Study assessments occurred at baseline, post-intervention and four week follow up. A post-intervention interview explored participants' experiences. Game-logs provided play time and progress data.

Results

Three of four participants (8-13 yrs., Manual Ability Classification Level I-II) completed the intervention. One dropped out at week 6. Play-time goals were achieved in most weeks, with two of four children surpassing their overall intervention goals. Outcomes varied across the three participants, however consistent improvements were observed on the Canadian Occupational Performance Measure and the Box and Blocks Test. Inductive analysis generated four main themes: 1) Intrinsic motivators fostered play engagement, 2) Virtual play for real-world gains, 3) Therapy on demand (at home), and 4) Shifting the onus from the parent to the game. Integration of qualitative and quantitative data was important for interpreting play patterns/usage and clinical outcomes.

Discussion

This mixed methods study describes a novel videogaming intervention designed for home-rehabilitation for children with HCP and provides preliminary evidence to guide future study design and research.

Clinical Trial Registration

[https://clinicaltrials.gov/ct2/show/NCT04009031?recrs=h&cond=Cerebral+Palsy&cntry=CA&city=Toronto&draw=2&rank=1], identifier [NCT04009031].

Multi-domain assessment of sports-related and military concussion recovery: A scoping review

OBJECTIVE

This review explores the literature on multi-domain assessments used in concussion recovery, to inform evidence-based and ecologically valid return-to-play. It asks: What simultaneous, dynamic multi-domain paradigms are used to assess recovery of youth and adults following concussion?

METHODS

Five databases were searched (CINAHL, EMBASE, MEDLINE, PsycInfo, SPORTDiscus) until September 30, 2021. Records were limited to those published in peer-reviewed journals, in English, between 2002 and 2021. Included studies were required to describe the assessment of concussion recovery using dynamic paradigms (i.e., requiring sport-like coordination) spanning multiple domains (i.e., physical, cognitive, socio-emotional functioning) simultaneously.

RESULTS

7098 unique articles were identified. 64 were included for analysis, describing 36 unique assessments of 1938 concussed participants. These assessments were deconstructed into their constituent tasks: 13 physical, 17 cognitive, and one socio-emotional. Combinations of these "building blocks" formed the multi-domain assessments. Forty-six studies implemented level walking with a concurrent cognitive task. The most frequently implemented cognitive tasks were 'Q&A' paradigms requiring participants to answer questions aloud during a physical task.

CONCLUSIONS

A preference emerged for dual-task assessments, specifically combinations of level walking and Q&A tasks. Future research should balance ecological validity and clinical feasibility in multi-domain assessments, and work to validate these assessments for practice.

R2Play development: Fostering user-driven technology that supports return-to-play decision-making following pediatric concussion

Objective

To design a multi-domain return-to-play assessment system (R2Play) for youth athletes with concussion.

Methods

The R2Play system was developed using an overarching user-centered approach, the Design Thinking Framework, and research activities included: 1) structured brainstorming within our research team, 2) interviews with clinician and youth sports coaches, 3) building a testable prototype, and 4) interface testing through cognitive walkthroughs with clinician partners.

Results

Clinician and coach participants provided feedback on the R2Play concept, which was integrated into the design process and provided future directions for research. Examples of feedback-driven design choices included reducing assessment time, increasing ecological validity by adding in background noise, and developing youth-friendly graphical results screens. Following refinement based on stakeholder feedback, the R2Play system was outlined in detail and a testable prototype was developed. It is made up of two parts: a clinician tablet, and a series of tablet "buttons" that display numbers and letters. Youth athletes run between the buttons to connect a "trail" in ascending alphanumeric order, 1-A-2-B, etc. Their performance across a series of levels of increasing difficulty is logged on the clinician tablet. Initial testing with five clinicians showed the system's interface to have excellent usability with a score of 81% (SD = 8.02) on the System Usability Scale.

Conclusion

Through this research, a prototype of the R2Play system was innovated and evaluated by clinician and coach stakeholders. Initial usability was excellent and directions for future iterations were highlighted. Outcomes suggest the potential benefits of using technologies to assist in complex clinical assessment, as well as utilizing a user-centered approach to design.

Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study

OBJECTIVE

To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation.

METHODS

Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians' responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified.

RESULTS

Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles.

CONCLUSIONS

This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.

A Classification and Calibration Procedure for Gesture Specific Home-Based Therapy Exercise in Young People With Cerebral Palsy

Movement-based video games can provide engaging practice for repetitive therapeutic gestures towards improving manual ability in youth with cerebral palsy (CP). However, home-based gesture calibration and classification is needed to personalize therapy and ensure an optimal challenge point. Nineteen youth with CP controlled a video game during a 4-week home-based intervention using therapeutic hand gestures detected via electromyography and inertial sensors. The in-game calibration and classification procedure selects the most discriminating, person-specific features using random forest classification. Then, a support vector machine is trained with this feature subset for in-game interaction. The procedure uses features intended to be sensitive to signs of CP and leverages directional statistics to characterize muscle activity around the forearm. Home-based calibration showed good agreement with video verified ground truths (0.86 ± 0.11, 95%CI = 0.93-0.97). Across participants, classifier performance (F1-score) for the primary therapeutic gesture was 0.90 ± 0.05 (95%CI = 0.87-0.92) and, for the secondary gesture, 0.82 ± 0.09 (95%CI = 0.77-0.86). Features sensitive to signs of CP were significant contributors to classification and correlated to wrist extension improvement and increased practice time. This study contributes insights for classifying gestures in people with CP and demonstrates a new gesture controller to facilitate home-based therapy gaming.

A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: A randomized single-case experimental design feasibility study

Importance/Background

Movement-controlled video games have potential to promote home-based practice of therapy activities. The success of therapy gaming interventions depends on the quality of the technology used and the presence of effective support structures.

Aim

This study assesses the feasibility of a novel intervention that combines a co-created gaming technology integrating evidence-based biofeedback and solution-focused coaching (SFC) strategies to support therapy engagement and efficacy at home.

Methods

Following feasibility and single-case reporting standards (CONSORT and SCRIBE), this was a non-blind, randomized, multiple-baseline, AB, design. Nineteen (19) young people with cerebral palsy (8–18 years old) completed the 4-week home-based intervention in France and Canada.

Participant motivations, personalized practice goals, and relevance of the intervention to daily activities were discussed in a Solution Focused Coaching-style conversation pre-, post-intervention and during weekly check-ins. Participants controlled a video game by completing therapeutic gestures (wrist extension, pinching) detected via electromyography and inertial sensors on the forearm (Myo Armband and custom software).

Process feasibility success criteria for recruitment response, completion and adherence rates, and frequency of technical issues were established a priori. Scientific feasibility, effect size estimates and variance were determined for Body Function outcome measures: active wrist extension, grip strength and Box and Blocks Test; and for Activities and Participation measures: Assisting Hand Assessment (AHA), Canadian Occupational Performance Measure (COPM) and Self-Reported Experiences of Activity Settings (SEAS).

Results

Recruitment response (31%) and assessment completion (84%) rates were good and 74% of participants reached self-identified practice goals. As 17% of technical issues required external support to resolve, the intervention was graded as feasible with modifications. No adverse events were reported.

Moderate effects were observed in Body Function measures (active wrist extension: SMD = 1.82, 95%CI = 0.85–2.78; Grip Strength: SMD = 0.63, 95%CI = 0.65–1.91; Box and Blocks: Hedge’s g = 0.58, 95%CI = -0.11–1.27) and small-moderate effects in Activities and Participation measures (AHA: Hedge’s g = 0.29, 95%CI = -0.39–0.97, COPM: r = 0.60, 95%CI = 0.13–0.82, SEAS: r = 0.24, 95%CI = -0.25–0.61).

Conclusion

A definitive RCT to investigate the effectiveness of this novel intervention is warranted. Combining SFC-style coaching with high-quality biofeedback may positively engage youth in home rehabilitation to complement traditional therapy.

Trial registration

ClinicalTrials.gov, U.S. National Library of Medicine: NCT03677193.

The design and evaluation of electromyography and inertial biofeedback in hand motor therapy gaming

This article details the design of a co-created, evidence-based biofeedback therapy game addressing the research question: is the biofeedback implementation efficient, effective, and engaging for promoting quality movement during a therapy game focused on hand gestures? First, we engaged nine young people with Cerebral Palsy (CP) as design partners to co-create the biofeedback implementation. A commercially available, tap-controlled game was converted into a gesture-controlled game with added biofeedback. The game is controlled by forearm electromyography and inertial sensors. Changes required to integrate biofeedback are described in detail and highlight the importance of closely linking movement quality to short- and long-term game rewards. After development, 19 participants (8-17 years old) with CP played the game at home for 4 weeks. Participants played 17 ± 9 min/day, 4 ± 1 day/week. The biofeedback implementation proved efficient (i.e. participants reduced compensatory arm movements by 10.2 ± 4.0%), effective (i.e. participants made higher quality gestures over time), and engaging (i.e. participants consistently chose to review biofeedback). Participants found the game usable and enjoyable. Biofeedback design in therapy games should consider principles of motor learning, best practices in video game design, and user perspectives. Design recommendations for integrating biofeedback into therapy games are compiled in an infographic to support interdisciplinary knowledge sharing.

Positive Distraction in Pediatric Healthcare Waiting Spaces: Sharing Play Not Germs through Inclusive, Hands-Free Interactive Media

Purpose: To investigate the value of shared opportunities for positive distraction in pediatric healthcare environments. Methods: Self-selected activities of 271 young people (5-19 years) with diverse neurodevelopmental conditions were observed in an ambulatory pediatric rehabilitation clinic. Shared opportunities included hands-free media (nature video or interactive media) and an aquarium. Anxiety was self-reported on the State Trait Anxiety Scale upon arrival and after 10 minutes in the waiting space. Results: Young people engaged more with shared opportunities for distraction (n = 170/271) than personal items brought from home (n = 119/271), p = 0.02. Personal electronic devices were used by 67 young people, but did not positively impact anxiety. Interactive media and the aquarium significantly reduced anxiety (p < 0.04) while the nature video appeared to increase anxiety (p = 0.036). Age influenced activity preference and anxiety. Shared, hands-free interactive media engaged individuals of diverse age and mobility. Conclusion: Shared opportunities for positive distraction in healthcare facilities are valuable, particularly hands-free interactive media.

Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives

PURPOSE

To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings.

METHODS

A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis.

RESULTS

Features of the technology and the intervention influence feelings of autonomy (e.g., personalization), competence (e.g., calibration), and relatedness (e.g., social play, virtual therapist/coach). There may be multiple and differently valued goals in interactive computer play-based interventions (e.g., game- and therapy-focused) that, if disconnected or unmet, negatively impact engagement. Multiplayer interactions, real-time feedback and progress tracking provide information that influences self-regulation and engagement over time.

CONCLUSIONS

Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy. Implications for rehabilitation The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies. Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization) and the intervention (e.g., interactions with therapists, social play). Increased effort should be directed towards ensuring that interactive computer play-based interventions and technologies reward and reinforce efforts towards therapy goals.

Children and Teens in Charge of their Health (CATCH): A protocol for a feasibility randomised controlled trial of solution-focused coaching to foster healthy lifestyles in childhood disability

INTRODUCTION

Children with physical disabilities are rarely included in interventions to promote healthy lifestyles, despite being at higher risk for suboptimal dietary and physical activity behaviours. The Children and Teens in Charge of their Health study explores the feasibility and acceptability of conducting a randomised controlled trial (RCT) of a strengths-based, solution-focused coaching intervention for improving and sustaining physical activity and healthy dietary habits in children and young people with physical disabilities.

METHODS AND ANALYSIS

Thirty children aged 10-18 years with a diagnosis of spina bifida or cerebral palsy who are able to set healthy lifestyle goals will be recruited from two children's rehabilitation hospitals in Ontario, Canada. Participants will be enrolled in the study for twelve months. All participants will receive standard care and printed information about healthy lifestyles. Of the 30 participants, 15 will be randomised to receive a coaching intervention for the first 6 months. Health indicators and psychosocial outcomes will be assessed by blinded assessors four times: at the start of the trial, immediately postintervention (6 months after randomisation), and at 3 and 6 months postintervention (9 and 12 months after randomisation, respectively). Predefined success criteria will be used to assess the feasibility of trial processes such as recruitment, attrition, stratification and intervention fidelity. Acceptability and perceived impact of the intervention will be explored qualitatively.

ETHICS AND DISSEMINATION

The study has been approved by Holland Bloorview Kids Rehabilitation Hospital's Research Ethics Board (Ref: 17-752). A knowledge translation planning template will be used to ensure our findings have maximum reach.

TRIAL REGISTRATION NUMBER

NCT03523806.

Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller

OBJECTIVE

To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play.

METHODS

The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM).

RESULTS

The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.

"It's all about incentive": Social technology as a potential facilitator for self-determined physical activity participation for young people with physical disabilities

PURPOSE

To investigate the perceived role of social technologies in promoting physical activity participation for young people with physical disabilities and to identify design considerations that should be addressed when creating social technologies to promote physical activity.

METHOD

Interactive design workshops for young people with physical disabilities aged 12-18 (n = 8) were held. Data were analyzed using interpretive thematic analysis.

RESULTS

Young people perceived significant benefit for social technologies to promote physical activity as they have the potential to overcome many barriers to physical activity participation. Design features recommended by the participants included (1) options for diverse interests and preferences, (2) provision of informational support, (3) support through equitable technology design, (4) incentive through competition and play, and (5) opportunities to develop community.

CONCLUSIONS

Social technology has potential to provide tailored, equitable opportunities for social engagement and physical activity participation for young people with physical disabilities through needs- and preference-specific design.

Interactive media as a tool for reducing waiting anxiety at paediatric rehabilitation hospitals: a randomized controlled trial

AIM

To investigate the efficacy of waiting room media for reducing anxiety and increasing satisfaction at a paediatric rehabilitation hospital.

METHOD

In this clustered, parallel, randomized controlled trial, 310 young people with disabilities (age range 5-19y) and their parents attending outpatient clinics were assigned to interactive media (n=113), a silent nature video (n=97), or media-free comparison (n=100) groups. Young person and parent anxiety was reported using the State-Trait Anxiety Inventory (STAI) on arrival and after 10 minutes in the waiting space. Questionnaires measured young person, parent, and staff satisfaction.

RESULTS

Young people exposed to interactive media reported a postexposure state anxiety that was 1.1 raw points (2.7 standardized points) lower on the STAI than the comparison group (95% confidence interval [CI] -1.9 to -0.22). There was no difference in postexposure state anxiety between the passive media and comparison groups (95% CI -0.64 to 1.1). Parents' state anxiety did not differ between conditions, but interactive media were associated with greater satisfaction (p=0.009). Of 120 staff, 119 reported that interactive media improved the clinic experience for families.

INTERPRETATION

Interactive media designed for accessible, hands-free play mitigate waiting anxiety and increases satisfaction. This paper provides evidence to guide design and decision-making around the use of interactive media in health care spaces.

WHAT THIS PAPER ADDS

Interactive media reduced preclinic waiting anxiety for young people with disabilities. Interactive media were accessible to young people with a range of mobility. Interactive media increased parental and staff satisfaction in the clinic. Guidelines for the design of hands-free, inclusive interactive media for health care facilities are presented.

Biofeedback interventions for individuals with cerebral palsy: a systematic review

Purpose: The purpose of this study is to evaluate the quality of evidence of biofeedback interventions aimed at improving motor activities in people with Cerebral Palsy (CP). Second, to describe the relationship between intervention outcomes and biofeedback characteristics. Methods: Eight databases were searched for rehabilitation interventions that provided external feedback and addressed motor activities. Two reviewers independently assessed and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to evaluate quality of evidence for outcome measures related to two International Classification of Functioning, Disability and Health (ICF) chapters. Results: Fifty-seven studies were included. There were 53 measures related Activities and Participation and 39 measures related to Body Functions. Strength of evidence was "Positive, Very-Low" due to the high proportion of non-controlled studies and heterogeneity of measures. Overall, 79% of studies and 63% of measures showed improvement post-intervention. Counter to motor learning theory recommendations, most studies provided feedback consistently and concurrently throughout the intervention regardless of the individual's desire or progress. Conclusion: Heterogeneous interventions and poor study design limit the strength of biofeedback evidence. A thoughtful biofeedback paradigm and standardized outcome toolbox can strengthen the confidence in the effect of biofeedback interventions for improving motor rehabilitation for people with CP. Implications for Rehabilitation Biofeedback can improve motor outcomes for people with Cerebral Palsy. If given too frequently, biofeedback may prevent the client from learning autonomously. Use consistent and concurrent feedback to improve simple/specific motor activities. Use terminal feedback and client-directed feedback to improve more complex/general motor activities.

A feasibility study using solution-focused coaching for health promotion in children and young people with Duchenne muscular dystrophy

PURPOSE

To evaluate the feasibility and acceptability of a coaching intervention (Solution-Focused Coaching in pediatric rehabilitation [SFC-Peds]) related to physical activity and diet in males with Duchenne muscular dystrophy.

METHODS

A pre-post design was employed. Participants had five coaching sessions over 8 weeks. The first session was face-to-face, followed by four virtual sessions. Feasibility criteria included recruitment rates, attrition, and intervention fidelity. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were employed to look at outcome trends. The acceptability was assessed using a survey.

RESULTS

Five males (11-19 years) participated. All feasibility criteria were met. Clinically significant increases were observed for GAS and COPM scores. Participants reported SFC-Peds to be acceptable. Broad barriers and facilitators to coaching success were identified.

CONCLUSIONS

A SFC-Peds intervention for health promotion is feasible and acceptable in children with DMD and their families. A rigorous efficacy study assessing SFC-Peds intervention is warranted.

Characterizing socially supportive environments relating to physical activity participation for young people with physical disabilities

PURPOSE

To explore the experiences of young people with physical disabilities relating to social inclusion and physical activity, in order to describe the characteristics of social environments that support participation in physical activity.

METHOD

An iterative, qualitative design employed in-depth, semi-structured interviews with young people with physical disabilities aged 12-18 (n = 11). Data were analyzed using interpretive thematic analysis.

RESULTS

Young people described several ways that their social environments help motivate and support them in their physical activity participation. These include providing: fair and equitable participation beyond physical accommodations; belonging through teamwork; and socially supported independence.

CONCLUSIONS

Supportive social environments characterized by equitable participation, a sense of belonging, and opportunities for interdependence, play a critical role in promoting the health and well-being of young people with physical disabilities. These characteristics are important to consider in the design of both integrated and dedicated physical activity programs.

Musical Stairs: A motivational therapy tool for children with disabilities featuring automated detection of stair-climbing gait events via inertial sensors

Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed of two foot-mounted inertial sensors, a step detection algorithm, and an auditory feedback response. In Phase 1, we establish its clinical feasibility via a Wizard-of-Oz AB/BA cross-over design with 17 children, aged 4-6 years, having diverse diagnoses and gait abilities. Self-, therapist- and blinded-observer reports indicated increased motivation with auditory feedback. Phase 2 describes the construction of a database comprised of synchronized video and inertial data associated with 1568 steps up and down stairs completed by 26 children aged 4-6 years with diverse diagnoses and gait. Lastly, in Phase 3, data from 18 children in the database were used to train a rule-based step detection algorithm based on local minima in the acceleration profile and the foot's swing angle. A step detection rate of 96% [SD=3%] and false positive rate of 6% [SD=5%] were achieved with an independent test set (n=8). Recommendations for future development and evaluation are discussed.

Biofeedback interventions for people with cerebral palsy: a systematic review protocol

BACKGROUND

Cerebral palsy is a life-long disability that affects motor control and activities of daily living. Depending on the type of cerebral palsy, some individuals may have trouble performing tasks with one or both of their arms and/or legs. Different strategies exist to help develop motor capacity. Biofeedback therapy is a commonly applied rehabilitation strategy. In biofeedback therapy, information about the motor behavior while completing a task is given back to the individual to help improve their performance. This can provide valuable information that would otherwise be unknown to the individual. Biofeedback may also have a unique method of operation in clinical populations, such as people with cerebral palsy. Therefore, it is important to identify the most effective mechanisms for specific populations. This review aims to evaluate the effects of biofeedback interventions that have been used towards improving motor performance and motor learning in people with cerebral palsy.

METHODS

Using a customized strategy, MEDLINE, CINAHL, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, SCOPUS, SPORTDiscus, and PEDro databases will be searched. Two independent reviewers will screen titles and abstracts, review full texts for inclusion criteria, and extract data from relevant articles using a standardized template. Quality of evidence and risk of bias will be assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

DISCUSSION

Several studies have investigated biofeedback-based interventions for people with cerebral palsy. However, there is a great variety and limited consensus regarding how to implement biofeedback mechanisms. This systematic review will consolidate the current evidence to direct future study and develop effective biofeedback rehabilitation strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO ID: CRD42016047612.

Biomusic: An Auditory Interface for Detecting Physiological Indicators of Anxiety in Children

For children with profound disabilities affecting communication, it can be extremely challenging to identify salient emotions such as anxiety. If left unmanaged, anxiety can lead to hypertension, cardiovascular disease, and other psychological diagnoses. Physiological signals of the autonomic nervous system are indicative of anxiety, but can be difficult to interpret for non-specialist caregivers. This paper evaluates an auditory interface for intuitive detection of anxiety from physiological signals. The interface, called "Biomusic," maps physiological signals to music (i.e., electrodermal activity to melody; skin temperature to musical key; heart rate to drum beat; respiration to a "whooshing" embellishment resembling the sound of an exhalation). The Biomusic interface was tested in two experiments. Biomusic samples were generated from physiological recordings of typically developing children (n = 10) and children with autism spectrum disorders (n = 5) during relaxing and anxiety-provoking conditions. Adult participants (n = 16) were then asked to identify "anxious" or "relaxed" states by listening to the samples. In a classification task with 30 Biomusic samples (1 relaxed state, 1 anxious state per child), classification accuracy, sensitivity, and specificity were 80.8% [standard error (SE) = 2.3], 84.9% (SE = 3.0), and 76.8% (SE = 3.9), respectively. Participants were able to form an early and accurate impression of the anxiety state within 12.1 (SE = 0.7) seconds of hearing the Biomusic with very little training (i.e., < 10 min) and no contextual information. Biomusic holds promise for monitoring, communication, and biofeedback systems for anxiety management.

Evaluation of an instrument-assisted dynamic prosthetic alignment technique for individuals with transtibial amputation

BACKGROUND

A prosthesis that is not optimally aligned can adversely influence the rehabilitation and health of the amputee. Very few studies to date evaluate the effectiveness and utility of instrument-assisted alignment techniques in clinical practice.

OBJECTIVES

To compare an instrument-assisted dynamic alignment technique (Compas(™)) to conventional methods.

STUDY DESIGN

In a crossover study design, dynamic prosthetic alignments were provided to nine individuals with unilateral transtibial amputations to compare conventional and instrument-assisted alignment techniques.

METHODS

The instrument-assisted technique involved a commercially available force and torque sensing dynamic alignment system (Compas). Cadence, pelvic accelerations, and socket moments were assessed. A custom questionnaire was used to gather user perceptions.

RESULTS

No differences between alignment techniques were found in global gait measures including cadence and pelvic accelerations. No significant alignment differences were achieved by examination of angular changes between the socket and foot; however, significantly higher below-the-socket moments were found with the instrument-assisted technique. From the questionnaire, six amputees had no preference, while three preferred the conventional alignment.

CONCLUSION

The use of Compas appears to produce similar alignment results as conventional techniques, although with slightly higher moments at the socket.

CLINICAL RELEVANCE

This study provides new information about the clinical utilization of instrument-assisted prosthetic alignment techniques for individuals with transtibial amputation.

The design and testing of interactive hospital spaces to meet the needs of waiting children

OBJECTIVE

To design an innovative interactive media display in a pediatric hospital clinic waiting space that addresses the growing demand for accessible, contact-surface-free options for play.

BACKGROUND

In healthcare settings, waiting can be anxiety provoking for children and their accompanying family members. Opportunities for positive distraction have been shown to reduce waiting anxiety, leading to positive health outcomes.

METHODS

An interactive media display, ScreenPlay, was created and evaluated using a participatory design approach and a combination of techniques including quality function deployment and mixed data elicitation methods (questionnaires, focus groups, and observations). The user and organizational design requirements were established and used to review contemporary strategies for positive distraction in healthcare waiting spaces and to conceptualize and test ScreenPlay. Ten staff members, 11 children/youths, and 6 parents participated in the design and evaluation of ScreenPlay.

RESULTS

ScreenPlay provided a positive, engaging experience without the use of contact surfaces through which infections can be spread. It was accessible to children, youth, and adults of all motor abilities. All participants strongly agreed that the interactive media display would improve the healthcare waiting experience.

CONCLUSIONS

ScreenPlay is an interactive display that is the result of a successful model for the design of healthcare waiting spaces that is collaborative, interdisciplinary, and responsive to the needs of its community.

KEYWORDS

Design process, healing environments, hospital, interdisciplinary, pediatric.

Design and Evaluation of Virtual Reality-Based Therapy Games with Dual Focus on Therapeutic Relevance and User Experience for Children with Cerebral Palsy

OBJECTIVE

Virtual reality (VR)-based therapy for motor rehabilitation of children with cerebral palsy (CP) is growing in prevalence. Although mainstream active videogames typically offer children an appealing user experience, they are not designed for therapeutic relevance. Conversely, rehabilitation-specific games often struggle to provide an immersive experience that sustains interest. This study aims to design and evaluate two VR-based therapy games for upper and lower limb rehabilitation and to evaluate their efficacy with dual focus on therapeutic relevance and user experience.

MATERIALS AND METHODS

Three occupational therapists, three physiotherapists, and eight children (8-12 years old), with CP Level I-III on the Gross Motor Function Classification System, evaluated two games for the Microsoft(®) (Redmond, WA) Kinect™ for Windows and completed the System Usability Scale (SUS), Physical Activity Enjoyment Scale (PACES), and custom feedback questionnaires.

RESULTS

Children and therapists unanimously agreed on the enjoyment and therapeutic value of the games. Median scores on the PACES were high (6.24±0.95 on the 7-point scale). Therapists considered the system to be of average usability (50th percentile on the SUS). The most prevalent usability issue was detection errors distinguishing the child's movements from the supporting therapist's. The ability to adjust difficulty settings and to focus on targeted goals (e.g., elbow/shoulder extension, weight shifting) was highly valued by therapists.

CONCLUSIONS

Engaging both therapists and children in a user-centered design approach enabled the development of two VR-based therapy games for upper and lower limb rehabilitation that are dually (a) engaging to the child and (b) therapeutically relevant.

Musical stairs: the impact of audio feedback during stair-climbing physical therapies for children

PURPOSE

Enhanced biofeedback during rehabilitation therapies has the potential to provide a therapeutic environment optimally designed for neuroplasticity. This study investigates the impact of audio feedback on the achievement of a targeted therapeutic goal, namely, use of reciprocal steps.

METHODS

Stair-climbing therapy sessions conducted with and without audio feedback were compared in a randomized AB/BA cross-over study design. Seventeen children, aged 4-7 years, with various diagnoses participated. Reports from the participants, therapists, and a blinded observer were collected to evaluate achievement of the therapeutic goal, motivation and enjoyment during the therapy sessions.

RESULTS

Audio feedback resulted in a 5.7% increase (p = 0.007) in reciprocal steps. Levels of participant enjoyment increased significantly (p = 0.031) and motivation was reported by child participants and therapists to be greater when audio feedback was provided.

DISCUSSION

These positive results indicate that audio feedback may influence the achievement of therapeutic goals and promote enjoyment and motivation in young patients engaged in rehabilitation therapies. This study lays the groundwork for future research to determine the long term effects of audio feedback on functional outcomes of therapy.

IMPLICATIONS FOR REHABILITATION

Stair-climbing is an important mobility skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. Provision of audio feedback during stair-climbing therapies for young children may increase their achievement of a targeted therapeutic goal (i.e., use of reciprocal steps). Children's motivation and enjoyment of the stair-climbing therapy was enhanced when audio feedback was provided.

Biomusic: a novel technology for revealing the personhood of people with profound multiple disabilities

It is often difficult for family members and caregivers to interact with persons with profound multiple disabilities (PMD) because of the severely compromised communicative repertoire of this population. The resulting communication challenges may limit the ability of others to perceive personhood in individuals with PMD. This preliminary study investigated the effects of music generated in real time from physiological signals (biomusic) on caregiver perceptions of their interactions with persons with PMD. Caregivers (n = 10; parents and clinical staff) engaged in four, 10-min interactions with a person with PMD (n = 3; diagnoses = traumatic brain injury, pervasive developmental disorder, hypoxic brain injury), whose biomusic was projected throughout. Caregivers participated in two open-ended, semi-structured interviews to explore the effect of biomusic on these interactions. Most caregiver responses to biomusic were very positive, and many reported that biomusic caused an improvement in their interaction with and perceptions of the person with PMD. By providing audible evidence of the changing physiological state of persons with PMD, biomusic may enhance the perceived personhood of these individuals and enrich interactions with their family members and caregivers.

A Comparison of Solo and Multiplayer Active Videogame Play in Children with Unilateral Cerebral Palsy

OBJECTIVE

Active videogames (AVGs) have potential in terms of physical activity and therapy for children with cerebral palsy. However, the effect of social interaction on AVG play has not yet been assessed. The objective of this study is to determine if multiplayer AVG versus solo affects levels of energy expenditure and movement patterns.

SUBJECTS AND METHODS

Fifteen children (9.77 [standard deviation (SD) 1.78] years old) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) participated in solo and multiplayer Nintendo(®) "Wii™ Boxing" (Nintendo, Inc., Redmond, WA) AVG play while energy expenditure and punching frequency were monitored.

RESULTS

Moderate levels of physical activity were achieved with no significant differences in energy measures during multiplayer and solo play. Dominant arm punching frequency increased during the multiplayer session from 95.75 (SD 37.93) punches/minute to 107.77 (SD 36.99) punches/minute. Conversely, hemiplegic arm punching frequency decreased from 39.05 (SD 29.57) punches/minutes to 30.73 (SD 24.74) punches/minutes during multiplayer game play. Children enjoyed multiplayer more than solo play.

CONCLUSIONS

Opportunities to play AVGs with friends and family may translate to more frequent participation in this moderate physical activity. Conversely, increased hemiplegic limb use during solo play may have therapeutic advantages. As such, new strategies are recommended to promote use of the hemiplegic hand during multiplayer AVG play and to optimize commercial AVG systems for applications in virtual reality therapy.

Wearable wrist activity monitor as an indicator of functional hand use in children with cerebral palsy

AIM

New tools that capture hand function in everyday activities and contexts are needed for assessing children with hemiplegic cerebral palsy. This study evaluates a wearable wrist monitor and tests the hypothesis that wrist extension frequency (FreqE) is an appropriate indicator of functional hand use.

METHOD

Fifteen children (four females, 11 males; age range 6-12y; mean age 10y [SD 2y]) with hemiplegia (seven at level I and eight at level II on the Manual Ability Classification System) participated in the Assisting Hand Assessment (AHA) while wearing the wrist monitor. FreqEs were captured via the wrist monitor and validated using video analysis. Correlations between FreqE and AHA scores were calculated and a multivariate linear regression was conducted to explore other measures of wrist activity.

RESULTS

Wrist extensions observed in video analyses were reliably detected by the wrist monitor (intraclass correlation coefficient, r=0.88; p<0.001) and were strongly correlated with the AHA scores (r=0.93; p<0.001). AHA scores were significantly correlated with FreqE (r=0.80; p=0.001) and the range of wrist extensions/flexions (r=0.70; p=0.008). The multivariate linear regression combining the FreqE and range of wrist extensions/flexions yielded a strong correlation with AHA scores (r=0.84; p=0.0043).

INTERPRETATION

The wearable wrist monitor may offer a convenient, valid alternative to observer reports for functional assessments of the hemiplegic hand in everyday contexts.

Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence

BACKGROUND

While sparsely researched, funding structures may play an important role in use of and satisfaction with prostheses and related health services.

OBJECTIVES

The objectives of this study were to (1) quantify the direct costs of prosthesis wear, (2) explore variations in funding distribution, and (3) describe the role of affordability in prosthesis selection and wear.

STUDY DESIGN

An anonymous, online cross-sectional descriptive survey was administered.

METHODS

Analyses were conducted of qualitative and quantitative data extracted from an international sample of 242 individuals with upper limb absence.

RESULTS

Access to prosthesis funding was variable and fluctuated with age, level of limb absence and country of care. Of individuals who gave details on prosthetic costs, 63% (n = 69) were fully reimbursed for their prosthetic expenses, while 37% (n = 40) were financially disadvantaged by the cost of components (mean [SD] US$9,574 [$9,986]) and their ongoing maintenance (US$1,936 [$3,179]). Of the 71 non-wearers in this study, 48% considered cost an influential factor in their decision not to adopt prosthesis use.

CONCLUSIONS

Prosthesis funding is neither homogeneous nor transparent and can be influential in both the selection and use of a prosthetic device.

CLINICAL RELEVANCE

Inequitable access to prosthesis funding is evident in industrialized nations and may lead to prosthesis abandonment and/or diminished quality of life for individuals with upper limb absences. Increased efforts are required to ensure equitable access to upper limb prosthetics and related services in line with individuals' needs.

Active video games to promote physical activity in children and youth: a systematic review

OBJECTIVES

To systematically review levels of metabolic expenditure and changes in activity patterns associated with active video game (AVG) play in children and to provide directions for future research efforts.

DATA SOURCES

A review of the English-language literature (January 1, 1998, to January 1, 2010) via ISI Web of Knowledge, PubMed, and Scholars Portal using the following keywords: video game, exergame, physical activity, fitness, exercise, energy metabolism, energy expenditure, heart rate, disability, injury, musculoskeletal, enjoyment, adherence, and motivation.

STUDY SELECTION

Only studies involving youth (< or = 21 years) and reporting measures of energy expenditure, activity patterns, physiological risks and benefits, and enjoyment and motivation associated with mainstream AVGs were included. Eighteen studies met the inclusion criteria. Articles were reviewed and data were extracted and synthesized by 2 independent reviewers. MAIN OUTCOME EXPOSURES: Energy expenditure during AVG play compared with rest (12 studies) and activity associated with AVG exposure (6 studies).

MAIN OUTCOME MEASURES

Percentage increase in energy expenditure and heart rate (from rest).

RESULTS

Activity levels during AVG play were highly variable, with mean (SD) percentage increases of 222% (100%) in energy expenditure and 64% (20%) in heart rate. Energy expenditure was significantly lower for games played primarily through upper body movements compared with those that engaged the lower body (difference, -148%; 95% confidence interval, -231% to -66%; P = .001).

CONCLUSIONS

The AVGs enable light to moderate physical activity. Limited evidence is available to draw conclusions on the long-term efficacy of AVGs for physical activity promotion.

Predicting need for intervention in individuals with congestive heart failure using a home-based telecare system

We have studied how well the need for a medical intervention can be predicted by a telecare monitoring system. During a study period of about 18 months, 45 elderly individuals with congestive heart failure used a home health monitor to enter daily information pertaining to their symptoms and health status. A total of 8576 alerts were generated by the monitoring system, although in most cases, patient and service provider interaction was not required. When system alerts were considered to be serious, or if symptoms persisted, the patient was contacted. A total of 171 key medical events (6 deaths; 28 hospital admissions; 59 changes in medication; 54 cases of advice given; 24 instances where immediate medical attention was recommended) were recorded in the monitoring logs. A multivariate logistic regression model was developed to predict these medical interventions/events. The model correctly predicted key medical events in 75% of cases with a specificity of 74% and an overall cross-validated accuracy of 74% (95% CI, 68–80%). Key predictors included the number of system alerts, self-rated mobility, self-rated health and self-rated anxiety. This suggests that subjective measures are useful in addition to physiological ones for predicting health status. A multivariate decision support model has potential to supplement practitioners and current telecare systems in identifying heart failure patients in need of medical intervention.

Consumer design priorities for upper limb prosthetics

PURPOSE

To measure consumer satisfaction with upper limb prosthetics and provide an enumerated list of design priorities for future developments.

METHODS

A self-administered, anonymous survey collected information on participant demographics, history of and goals for prosthesis use, satisfaction, and design priorities. The questionnaire was available online and in paper format and was distributed through healthcare providers, community support groups, and one prosthesis manufacturer; 242 participants of all ages and levels of upper limb absence completed the survey.

RESULTS

Rates of rejection for myoelectric hands, passive hands, and body-powered hooks were 39%, 53%, and 50%, respectively. Prosthesis wearers were generally satisfied with their devices while prosthesis rejecters were dissatisfied. Reduced prosthesis weight emerged as the highest priority design concern of consumers. Lower cost ranked within the top five design priorities for adult wearers of all device types. Life-like appearance is a priority for passive/cosmetic prostheses, while improved harness comfort, wrist movement, grip control and strength are required for body-powered devices. Glove durability, lack of sensory feedback, and poor dexterity were also identified as design priorities for electric devices.

CONCLUSIONS

Design priorities reflect consumer goals for prosthesis use and vary depending on the type of prosthesis used and age. Future design efforts should focus on the development of more light-weight, comfortable prostheses.

The roles of predisposing characteristics, established need, and enabling resources on upper extremity prosthesis use and abandonment

PURPOSE

Prosthesis use and abandonment is a complex function of variables defining the contextualized individual. This review presents a comprehensive panoramic of these factors as related to the management of upper limb deficiency. Me

METHOD

nderson's model for health service utilization was used to frame prosthesis use and abandonment as a function of (1) predisposing characteristics of the individual (e.g. gender or level of limb loss); (2) established need, as characterized by lifestyle- and age-related demands; and (3) enabling resources (e.g. clinical and social). English-language articles pertaining to these components were identified in a search of Ovid, PubMed, ISI Web of Science and www.scholar.google.com (1980-November 2006) for key words upper limb and prosthesis. Approximately 90 articles were included as evidence in this review. Re

RESULTS

ersonal and contextual factors are critical determinants of prosthesis acceptance. While the influence of some factors (i.e. lifestyle, level of limb loss), is strongly supported in the literature, the impact of others, (i.e. age of fitting, efficacy of training protocols), remain controversial. Co

CONCLUSIONS

nhanced understanding of these factors is required to optimize clinical practices, guide design efforts, and satiate demand for evidence-based measures of intervention. Future research should comprise of controlled, multifactor studies adopting standardized outcome measures and providing comprehensive descriptions of population characteristics.

Dielectric elastomers as actuators for upper limb prosthetics: challenges and opportunities

Recent research has indicated that consumers of upper limb prostheses desire lighter-weight, anthropomorphic devices. The potential of dielectric elastomer (DE) actuators to better meet the design priorities of prosthesis users is explored. Current challenges are critically reviewed with respect to (1) durability, (2) precision control, (3) energy consumption, and (4) anthropomorphic implementation. The key points arising from the literature review are illustrated with empirical examples of the strain performance and durability of one of the most popular DEs, VHB 4910. Practical application of DE actuators in powered upper extremity prosthetics is at present impeded by poor durability and susceptibility to air-borne contaminants, unreliable control owing to viscoelasticity, hysteresis, stress relaxation and creep mechanisms, high voltage requirements, and insufficient stress and strain performance within the confines of anthropomorphic size, weight, and function. Our review suggests that the implementation of DE actuators in powered upper extremity prosthetics is not feasible at present but worthy of reevaluation as the materials advance.

Electroactive polymeric sensors in hand prostheses: bending response of an ionic polymer metal composite

In stark contrast to the inspiring functionality of the natural hand, limitations of current upper limb prostheses stemming from marginal feedback control, challenges of mechanical design, and lack of sensory capacity, are well-established. This paper provides a critical review of current sensory systems and the potential of a selection of electroactive polymers for sensory applications in hand prostheses. Candidate electroactive polymers are reviewed in terms of their relevant advantages and disadvantages, together with their current implementation in related applications. Empirical analysis of one of the most novel electroactive polymers, ionic polymer metal composites (IPMC), was conducted to demonstrate its potential for prosthetic applications. With linear responses within the operating range typical of hand prostheses, bending angles, and bending rates were accurately measured with 4.4+/-2.5 and 4.8+/-3.5% error, respectively, using the IPMC sensors. With these comparable error rates to traditional resistive bend sensors and a wide range of sensitivities and responses, electroactive polymers offer a promising alternative to more traditional sensory approaches. Their potential role in prosthetics is further heightened by their flexible and formable structure, and their ability to act as both sensors and actuators.

Electrokinetic generation of temporally and spatially stable concentration gradients in microchannels

Generating stable microscale concentration gradients is key to numerous biological and chemical analyses. Microfluidic systems offer the ability to maintain laminar fluid diffusion interfaces ideal for the production of temporally stable concentration gradients. Previous efforts have focused on pressure driven flows and have relied on networks of branching channels to create streams of varying concentrations which can subsequently be combined to form the desired gradients. In this study, we numerically and experimentally demonstrate a novel electrokinetic technique which utilizes applied voltages and surface charge heterogeneity in simpler channel geometries to control and manipulate microscale concentration gradients without the need for parallel lamination. Flow rates ranged from 30 to 460 nl min(-1) for Peclet numbers between 70 and 1100. Spatial stability of 0.6 mm or greater was obtained for a wide range of gradient shapes and magnitudes over lateral dimensions of 400-450 microm. Sensitivity analysis determined that this technique is largely independent of channel depth and species electrophoretic mobility, however channel width and the diffusion coefficient of the analyte are critical. It was concluded that by adjusting applied voltages and/or channel width, this approach to concentration gradient generation can be adapted to a wide range of applications.

Heterogeneous Surface Charge Enhanced Micromixing for Electrokinetic Flows

Enhancing the species mixing in microfluidic applications is key to reducing analysis time and increasing device portability. The mixing in electroosmotic flow is usually diffusion-dominated. Recent numerical studies have indicated that the introduction of electrically charged surface heterogeneities may augment mixing efficiencies by creating localized regions of flow circulation. In this study, we experimentally visualized the effects of surface charge patterning and developed an optimized electrokinetic micromixer applicable to the low Reynolds number regime. Using the optimized micromixer, mixing efficiencies were improved between 22 and 68% for the applied potentials ranging from 70 to 555 V/cm when compared with the negatively charged homogeneous case. For producing a 95% mixture, this equates to a potential decrease in the required mixing channel length of up to 88% for flows with Péclet numbers between 190 and 1500.