B. B. Bhakta

Engaging children in healthcare technology design: developing rehabilitation technology for children with cerebral palsy

This paper presents a case study of users’ involvement in the design and evaluation of two devices for upper limb rehabilitation for children with cerebral palsy to use in their homes. The devices comprise a computer game and a force feedback interface, designed to stimulate children with cerebral palsy to undertake fun arm exercises that are beneficial in terms of improving overall functional use of their impaired arm. This device was developed for children using a combination of informal and formal user-centred design methods. The methods used include standard questionnaires, interviews, a modified peer tutoring process and a comparative method, and have been applied to the iterative design of both the hardware and software components of the rehabilitation systems. Thirty-seven non-disabled children and 15 children with cerebral palsy in the 5–12-year-old age group were involved in the evaluation, held at six local primary schools. Prototypes of the final design were used by 18 patients with cerebral palsy for approximately 4 weeks as a therapeutic intervention. To evaluate the designs, qualitative and questionnaire-based opinion was sought from these children, and their parents, at the end of the intervention. An evaluation of the methodologies employed is presented.

The engagement of children with disabilities in health-related technology design processes: identifying methodology.

Purpose. This review aims to identify research methodology that is suitable for involving children with disabilities in the design of healthcare technology, such as assistive technology and rehabilitation equipment. Method. A review of the literature included the identification of methodology that is available from domains outside of healthcare and suggested a selection of available methods. Results. The need to involve end users within the design of healthcare technology was highlighted, with particular attention to the need for greater levels of participation from children with disabilities within all healthcare research. Issues that may arise when trying to increase such involvement included the need to consider communication via feedback and tailored information, the need to measure levels of participation occurring in current research, and caution regarding the use of proxy information. Additionally, five suitable methods were highlighted that are available for use with children with disabilities in the design of healthcare technology. Conclusion. The methods identified in the review need to be put into practice to establish effective and, if necessary, novel ways of designing healthcare technology when end users are children with disabilities.

Pharmacotherapy for treatment of attention deficits after non-progressive acquired brain injury. A systematic review

Objective: To systematically review the effectiveness of medications used to improve attention in people with non-progressive acquired brain injury. Design: A systematic review. Methods: MEDLINE, EMBASE, CINALH, PUBMED and PsychINFO databases were used to identify studies published between 1987 and 2008 meeting the following criteria: studies with subjects older than 18 years; diagnosis of new onset or previous acquired brain injury; medication given to improve attention and use of outcome to measure attention. Studies involving subjects in low arousal states or with neurogenerative conditions were excluded. The studies were categorized into three evidence levels: I — Randomized controlled trials; II — Prospective studies, controlled trials with methodological limitations; and III — Retrospective studies, clinical case series. Results: Forty-seven articles were identified on initial search. Twenty-six met the pre-specified criteria. Five articles were assessed as meeting the level I evidence criteria, 12 were level II studies and 9 were level III studies. Methylphenidate can improve information processing speed but not all attention aspects in some people after traumatic brain injury. There is weak evidence for use of dopamine agonists to improve neglect/inattention after stroke. There is little evidence on the frequency of adverse effects and long-term functional benefits. Conclusion: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

A novel robotic system for quantifying arm kinematics and kinetics: description and evaluation in therapist-assisted passive arm movements post-stroke.

We developed a system for quantitatively measuring arm movement. Our approach provides a method to simultaneously capture upper limb kinetic and kinematic data during assisted passive arm movements. Data are analysed with respect to Cartesian and upper limb coordinate systems to obtain upper limb joint angles and torques. We undertook an evaluation of the system in participants with stroke to show the feasibility of this approach. During rehabilitation after stroke, one aspect of treatment includes the physiotherapist applying assistive forces to move the impaired arm of the patient who remains passive. There is a dearth of published data on the relationship between upper limb kinematics and the underlying forces (kinetics) in this mode of physiotherapy treatment. Such quantitative data are crucial in facilitating research into therapy practice, for example by measuring variation in practice and determining dosage. An experienced therapist prescribed passive movements tailored to the needs of 16 participants with stroke (41-81 years) with a range of anthropometric sizes and motor impairments. Our novel measurement tool recorded kinematic and kinetic data at 100 Hz for 6-11 movements per participant. The kinetic data show that the majority of movements fall within upper limits of 36.7 N in shoulder elevation, 22.4N in shoulder protraction, 4.6 Nm in shoulder abduction, 12.8 Nm in shoulder flexion, 2.4 Nm in shoulder rotation and 5.5 Nm in elbow flexion. These data show the potential of this system to better understand arm movement, in particular to objectively evaluate physical therapy treatments and support development of robotic devices to facilitate upper limb rehabilitation.

Involving children in the development of assistive technology devices

Purpose. To investigate the implementation of a web-based survey for involving children in the design of assistive technology devices within the primary school environment. Method. Children were recruited within their normal school environment. They completed tasks within the survey that sought to gather their personal preferences about assistive technology devices. From six primary schools, 257 children (mean age = 9 years and 8 months, SD = 1.51; 123 males, 134 females) including children with cerebral palsy (N = 11), varying levels of deafness (N = 7), global developmental delay (N = 2) and Downs syndrome (N = 1) participated. Observations were taken whilst the children completed the survey tasks. Results. All children were able to complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters. Conclusions. The use of the web-based survey provided a novel means with which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. In order for the survey to be utilised more widely, issues that arose when involving children with disabilities need to be addressed.

Effector force requirements to enable robotic systems to provide assisted exercise in people with upper limb impairment after stroke

iPAM (intelligent Pneumatic Arm Movement) is a dual robotic system that aims to assist in the recovery of upper-limb movement in people with all severities of motor impairment after stroke. This paper presents effector force data gathered during the course of a pilot clinical study. It identifies the forces and workspace required to facilitate reach-retrieve exercises in a range of patients as part of rehabilitation treatments. These findings have been used in further refinements of the iPAM system.

Feasibility of school-based computer-assisted robotic gaming technology for upper limb rehabilitation of children with cerebral palsy

Abstract Introduction: We investigated the feasibility of using computer-assisted arm rehabilitation (CAAR) computer games in schools. Outcomes were childrens preference for single player or dual player mode, and changes in arm activity and kinematics. Method: Nine boys and two girls with cerebral palsy (6–12 years, mean 9 years) played assistive technology computer games in single-user mode or with school friends in an AB–BA design. Preference was determined by recording the time spent playing each mode and by qualitative feedback. We used the ABILHAND-kids and Canadian Occupational Performance Measure to evaluate activity limitation, and a portable laptop-based device to capture arm kinematics. Results: No difference was recorded between single-user and dual-user modes (median daily use 9.27 versus 11.2 min, p = 0.214). Children reported dual-user mode was preferable. There were no changes in activity limitation (ABILHAND-kids, p = 0.424; COPM, p = 0.484) but we found significant improvements in hand speed (p = 0.028), smoothness (p = 0.005) and accuracy (p = 0.007). Conclusion: School timetables prohibit extensive use of rehabilitation technology but there is potential for its short-term use to supplement a rehabilitation program. The restricted access to the rehabilitation games was sufficient to improve arm kinematics but not arm activity. Implications for Rehabilitation School premises and teaching staff present no obstacles to the installation of rehabilitation gaming technology. Twelve minutes per day is the average amount of time that the school time table permits children to use rehabilitation gaming equipment (without disruption to academic attendance). The use of rehabilitation gaming technology for an average of 12 minutes daily does not appear to benefit childrens functional performance, but there are improvements in the kinematics of childrens upper limb.

Development of the iPAM MkII system and description of a randomized control trial with acute stroke patients

iPAM (intelligent Pneumatic Arm Movement) is a dual robot system for providing assistive upper-limb exercise to people with arm weakness as a result of stroke. This paper highlights refinements made to the system in the development of iPAM MkII. The rationale of an on-going random control trial using the iPAM MkII is also presented.

Acceptability of robot assisted active arm exercise as part of rehabilitation after stroke

In this paper, a solution is proposed to render both rough and detailed images information using only audio-range sound. The procedure is implemented in consecutive stages with stage-dependent parameters selected by the user. The first stage consists of edge detection and tracking of the boundaries of the objects to obtain the sketch of the image. In the second stage, the user can selectively access the details of the image, such as brightness, texture and spatial position of the objects. Practical methods are proposed and tested which accelerate the training process. As a particular application, an educational module is presented which assists students of a special school for the blind by vocalization and description of geographical maps.

The Involvement of Primary Schools in the Design of Healthcare Technology for Children

There has been an increased emphasis on user involvement within healthcare technology development (Ram et al., 2007). Within the healthcare domain the term “user” can describe a range of different people across all ages; from patients and their families to healthcare professionals, NHS providers and commissioners of services. Within rehabilitation engineering, a “user” of technology is often characterised by the presence of a physical, cognitive, sensory or communication impairment. Although research has focused on the considerations of involving disabled adults in healthcare technology design (e.g. Orpwood, 1990) there has been little research directed towards the design and development of rehabilitation technologies with disabled children. Engaging children in the development of rehabilitation technologies has been reported (Hwang et al., 2004; Weightman et al., 2010), but there are still considerable gaps in our knowledge of the most efficient approaches to engage children in the design process of such technology.