Amrish O. Chourasia

Effect of Touch Screen Button Size and Spacing on Touch Characteristics of Users With and Without Disabilities

Objective: The aim of this study was to investigate the effect of button size and spacing on touch characteristics (forces, impulses, and dwell times) during a digit entry touch screen task. A secondary objective was to investigate the effect of disability on touch characteristics. Background: Touch screens are common in public settings and workplaces. Although research has examined the effect of button size and spacing on performance, the effect on touch characteristics is unknown. Method: A total of 52 participants (n = 23, fine motor control disability; n = 14, gross motor control disability; n = 15, no disability) completed a digit entry task. Button sizes varied from 10 mm to 30 mm, and button spacing was 1 mm or 3 mm. Results: Touch characteristics were significantly affected by button size. The exerted peak forces increased 17% between the largest and the smallest buttons, whereas impulses decreased 28%. Compared with the fine motor and nondisabled groups, the gross motor group had greater impulses (98% and 167%, respectively) and dwell times (60% and 129%, respectively). Peak forces were similar for all groups. Conclusion: Button size but not spacing influenced touch characteristics during a digit entry task. The gross motor group had significantly greater dwell times and impulses than did the fine motor and nondisabled groups. Application: Research on touch characteristics, in conjunction with that on user performance, can be used to guide human computer interface design strategies to improve accessibility of touch screen interfaces. Further research is needed to evaluate the effect of the exerted peak forces and impulses on user performance and fatigue.

Hypertonic Dextrose and Morrhuate Sodium Injections (Prolotherapy) for Lateral Epicondylosis (Tennis Elbow). Results of a Single-blind, Pilot-Level, Randomized Controlled Trial

Objective Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated. Design This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral epicondylosis for 3 mos or longer were randomized to ultrasound-guided PrT with dextrose solution, ultrasound-guided PrT with dextrose-morrhuate sodium solution, or watchful waiting (“wait and see”). The primary outcome was the Patient-Rated Tennis Elbow Evaluation (100 points) at 4, 8, and 16 wks (all groups) and at 32 wks (PrT groups). The secondary outcomes included pain-free grip strength and magnetic resonance imaging severity score. Results The participants receiving PrT with dextrose and PrT with dextrose-morrhuate reported improved Patient-Rated Tennis Elbow Evaluation composite and subscale scores at 4, 8, and/or 16 wks compared with those in the wait-and-see group (P < 0.05). At 16 wks, compared with baseline, the PrT with dextrose and PrT with dextrose-morrhuate groups reported improved composite Patient-Rated Tennis Elbow Evaluation scores by a mean (SE) of 18.7 (9.6; 41.1%) and 17.5 (11.6; 53.5%) points, respectively. The grip strength of the participants receiving PrT with dextrose exceeded that of the PrT with dextrose-morrhuate and the wait and see at 8 and 16 wks (P < 0.05). There were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events. Conclusions PrT resulted in safe, significant improvement of elbow pain and function compared with baseline status and follow-up data and the wait-and-see control group. This pilot study suggests the need for a definitive trial.

Effect of sitting or standing on touch screen performance and touch characteristics.

Objective: The aim of this study was to evaluate the effect of sitting and standing on performance and touch characteristics during a digit entry touch screen task in individuals with and without motor-control disabilities. Background: Previously, researchers of touch screen design have not considered the effect of posture (sitting vs. standing) on touch screen performance (accuracy and timing) and touch characteristics (force and impulse). Method: Participants with motor-control disabilities (n = 15) and without (n = 15) completed a four-digit touch screen number entry task in both sitting and standing postures. Button sizes varied from 10 mm to 30 mm (5-mm increments), and button gap was 3 mm or 5 mm. Results: Participants had more misses and took longer to complete the task during standing for smaller button sizes (<20 mm). At larger button sizes, performance was similar for both sitting and standing. In general, misses, time to complete task, and touch characteristics were increased for standing. Although disability affected performance (misses and timing), similar trends were observed for both groups across posture and button size. Conclusion: Standing affects performance at smaller button sizes (<20 mm). For participants with and without motor-control disabilities, standing led to greater exerted force and impulse. Application: Along with interface design considerations, environmental conditions should also be considered to improve touch screen accessibility and usability.

Relationships Between Biomechanics, Tendon Pathology, and Function in Individuals With Lateral Epicondylosis

STUDY DESIGN Single-cohort descriptive and correlational study. OBJECTIVES To investigate the relationships between tendon pathology, biomechanical measures, and self-reported pain and function in individuals with chronic lateral epicondylosis. BACKGROUND Lateral epicondylosis has a multifactorial etiology and its pathophysiology is not well understood. Consequently, treatment remains challenging, and lateral epicondylosis is prone to recurrence. While tendon pathology, pain system changes, and motor impairments due to lateral epicondylosis are considered related, their relationships have not been thoroughly investigated. METHODS Twenty-six participants with either unilateral (n = 11) or bilateral (n = 15) chronic lateral epicondylosis participated in this study. Biomechanical measures (grip strength, rate of force development, and electromechanical delay) and measures of tendon pathology (magnetic resonance imaging and ultrasound) and self-reported pain and function (Patient-Rated Tennis Elbow Evaluation) were performed. Partial Spearman correlations, adjusting for covariates (age, gender, weight, and height), were used to evaluate the relationship between self-reported pain, function, and biomechanical and tendon pathology measures. RESULTS Statistically significant correlations between biomechanical measures and the Patient-Rated Tennis Elbow Evaluation ranged in magnitude from 0.44 to 0.68 (P<.05); however, no significant correlation was observed between tendon pathology (magnetic resonance imaging and ultrasound) measures and the Patient-Rated Tennis Elbow Evaluation (r = -0.02 to 0.31, P>.05). Rate of force development had a stronger correlation (r = 0.54-0.68, P<.05) with self-reported function score than with grip strength (r = 0.35-0.47, P<.05) or electromechanical delay (r = 0.5, P<.05). CONCLUSION Biomechanical measures (pain-free grip strength, rate of force development, electromechanical delay) have the potential to be used as outcome measures to monitor progress in lateral epicondylosis. In comparison, the imaging measures (magnetic resonance imaging and ultrasound) were useful for visualizing the pathophysiology of lateral epicondylosis. However, the severity of the pathophysiology was not related to pain and function, indicating that imaging measures may not provide the best clinical assessment.

Effect of Lateral Epicondylosis on Grip Force Development

STUDY DESIGN Case-Control. INTRODUCTION Although it is well known that grip strength is adversely affected by lateral epicondylosis (LE), the effect of LE on rapid grip force generation is unclear. PURPOSE OF THE STUDY To evaluate the effect of LE on the ability to rapidly generate grip force. METHODS Twenty-eight participants with LE (13 unilateral and 15 bilateral LE) and 13 healthy controls participated in this study. A multiaxis profile dynamometer was used to evaluate grip strength and rapid grip force generation. The ability to rapidly produce force is composed of the electromechanical delay and rate of force development. Electromechanical delay is defined as the time between the onset of electrical activity and the onset of muscle force production. The Patient-rated Tennis Elbow Evaluation (PRTEE) questionnaire was used to assess pain and functional disability. Magnetic resonance imaging was used to evaluate tendon degeneration. RESULTS LE-injured upper extremities had lower rate of force development (50 lb/sec, confidence interval [CI]: 17, 84) and less grip strength (7.8 lb, CI: 3.3, 12.4) than nonnjured extremities. Participants in the LE group had a longer electromechanical delay (- 59% , CI: 29, 97) than controls. Peak rate of force development had a higher correlation (r = 0.56; p<0.05) with PRTEE function than grip strength (r = 0.47; p<0.05) and electromechanical delay (r = 0.30; p>0.05) for participants with LE. In addition to a reduction in grip strength, those with LE had a reduction in rate of force development and an increase in electromechanical delay. CONCLUSIONS Collectively, these changes may contribute to an increase in reaction time, which may affect risk for recurrent symptoms. These findings suggest that therapists may need to address both strength and rapid force development deficits in patients with LE. LEVEL OF EVIDENCE 3B.

Mechanical and Magnetic Resonance Imaging Changes Following Eccentric or Concentric Exertions

BACKGROUND Prior work has shown that changes in mechanical parameters and magnetic resonance imaging parameters occur following submaximal eccentric activity but it is unclear whether similar changes occur following submaximal concentric activity. This study compared mechanical response parameters and MRI relaxation parameters following submaximal concentric or eccentric exertions. METHODS This single site, randomized study investigated in vivo changes in human upper limb dynamic mechanical properties following exposure to short term repetitive submaximal eccentric or concentric exertions. Eighteen subjects were assigned to either an eccentric or concentric group and exercised for 30 min at 50% of isometric forearm maximum voluntary contraction. Changes in strength, symptom intensity, magnetic resonance imaging T2 relaxation measurements, which are indicative of edema, and dynamic mechanical parameters (stiffness, effective mass, and damping) were ascertained prior to exercise, 1h after, and 24h later. FINDINGS Strength decreased following exercise (P<0.01), however only the eccentric exercise group exhibited a reduction in mechanical stiffness (55%, P<0.01) and damping (31%, P<0.05), and an increase (17%, P<0.05) in magnetic resonance imaging T2 relaxation time. INTERPRETATION The changes in mechanical parameters and magnetic resonance imaging findings following repetitive submaximal eccentric activity could negatively impact the ability of the arm to react to rapid forceful loading during repetitive industrial work activities and may result in increased strain on the upper limb. Similar changes were not observed following concentric exercise.

The global public inclusive infrastructure (GPII)

The incidence of disabilities is increasing as our population ages and we find that access to ICT is becoming mandatory for meaningful participation, independence, and self-sustenance. However we are not only nowhere near providing access to everyone who needs it, but we are actually losing ground due to reasons such as technical proliferation across platforms, increasing product churn (breaking existing solutions), decreasing social resources to address it, and an inability to effectively serve the tails of these populations because of the higher cost to do so. This poster describes the Cloud4all and Prosperity4All projects and progress in building the Global Public Inclusive Infrastructure (GPII), an infrastructure based on cloud, web and platform technologies that can increase dissemination and international localization while lowering the cost to develop, deploy, market, and support a broad range of access solutions.

Prolonged mechanical and physiological changes in the upper extremity following short-term simulated power hand tool use

This study investigated in-vivo changes in upper limb dynamic mechanical properties and magnetic resonance imaging (MRI) parameters following short-term power hand tool operation. Previous studies have found reduction in mechanical properties following short-term power tool usage at long build-up times. This study advances that work by having participants operate a simulated pistol grip power hand tool and evaluating changes in mechanical properties, strength, discomfort level and MRI prior to tool operation and daily for 3 d after tool operation. Twenty-four participants were randomly assigned to operate a simulated power hand tool for either a high peak reaction force of 123 N (peak torque = 8 Nm, build-up time = 250 ms) or at a low peak reaction force of 5 N (peak torque = 2 Nm, build-up time = 50 ms). Subjects operated the tool for 60 min at the rate of six times per min. A reduction in stiffness (27%, p < 0.05) was observed 24 h after tool operation for the high force group and this change persisted (26%, p < 0.05) up to 72 h after tool operation. Similar changes were not observed for the low force group. No changes were observed in mass moment of inertia, damping, isometric strength and damping for either group (p > 0.05). There was a signal intensity increase (12%, CI 19%, 5.06%) in the supinator muscle MRI for both groups 24 h after tool operation but only the high force group remained elevated (10%, CI 13.7%, 0.06%) 72 h after tool operation. Persistent short-term changes in mechanical and MRI parameters at high force levels could indicate increased strain on the upper limb and may negatively affect ability to react during rapid forceful loading of the upper limb. This research can ultimately lead to better ergonomic interventions through quantitative power hand tool design guidelines and work practices based on understanding the damaging effects of exposure to specific levels of reaction force, build-up time and repetition, as well as providing new outcome measures for epidemiological studies.

The effect of lateral epicondylosis on upper limb mechanical parameters

BACKGROUND Lateral epicondylosis is a prevalent and costly musculoskeletal disorder characterized by degeneration of the common extensor tendon origin at the lateral epicondyle. Grip strength is commonly affected due to lateral epicondylosis. However, less is known about the effect of lateral epicondylosis on other functional parameters such as ability to react to rapid loading. METHODS Twenty-nine lateral epicondylosis participants and ten controls participated in a case-control study comparing mechanical parameters (mass, stiffness and damping), magnetic resonance imaging signal intensity and grip strength of injured and uninjured limbs. A mixed effects model was used to assess the effect of dominance and injury on mechanical parameters and grip strength. FINDINGS Significant effect of injury and dominance was observed on stiffness, damping and grip strength. An injured upper limb had, on average, 18% less stiffness (P<0.01, 95% CI [9.8%, 26%]), 21% less damping (P<0.01, 95% CI [11%, 31%]) and 50% less grip strength (P<0.01, 95% CI [37%, 61%]) than an uninjured upper limb. The dominant limb had on average 15% more stiffness (P<0.01, 95% CI [8.0%, 23%], 33% more damping (P<0.01, 95% CI [22%, 45%]), and 24% more grip strength (P<0.01, 95% CI [6.6%, 44%]) than the non-dominant limb. INTERPRETATION Lower mechanical parameters are indicative of a lower capacity to oppose rapidly rising forces and quantify an important aspect of upper limb function. For individuals engaged in manual or repetitive activities involving the upper limb, a reduction in ability to oppose these forces may result in increased risk for injury or recurrence.

Auto-Personalization: Theory, Practice and Cross-Platform Implementation

In an increasing digital society, access to information and communication technologies (ICT) is no longer just helpful but has become a necessity. However, the human interfaces appearing on these ICT (and increasingly, even common household products) are beyond of the abilities of many people with disability, digital literacy, or aging related limitations. Access to these ICT is essential to these individuals yet it is not possible to create an interface that is usable by all. This paper introduces a new approach to auto-personalization that is based on the development of the Global Public Inclusive Infrastructure (GPII). The GPII is a new international collaborative effort between users, developers and industry to build a sustainable infrastructure to make access to all digital technologies technically and economically possible, including access by users who are unable to use or understand today’s technologies. Based on a one-size-fits-one approach, the GPII uses auto-adapting mainstream interfaces, and ubiquitous access to assistive technologies when mainstream interfaces cannot adapt enough, to provide each user with the interface they need. The GPII has three main components: a mechanism to allow individuals to easily discover which interface variations they need and then store it in a secure way on a token or in the cloud; a mechanism to allow them to use these stored needs and preferences to automatically adapt the interfaces on the digital technologies they encounter, anywhere and anytime; and a resource for developers (mainstream and assistive technology) providing the information and tools required to develop, disseminate, and support new access solutions more simply, more quickly, and at lower cost.