Edmund F. LoPresti

Assistive technology for cognitive rehabilitation: State of the art

For close to 20 years, clinicians and researchers have been developing and assessing technological interventions for individuals with either acquired impairments or developmental disorders. This paper offers a comprehensive review of literature in that field, which we refer to collectively as assistive technology for cognition (ATC). ATC interventions address a range of functional activities requiring cognitive skills as diverse as complex attention, executive reasoning, prospective memory, self-monitoring for either the enhancement or inhibition of specific behaviours and sequential processing. ATC interventions have also been developed to address the needs of individuals with information processing impairments that may affect visual, auditory and language ability, or the understanding of social cues. The literature reviewed indicates that ATC interventions can increase the efficiency of traditional rehabilitation practices by enhancing a persons ability to engage in therapeutic tasks independently and by broadening the range of contexts in which those tasks can be exercised. More importantly, for many types of impairments, ATC interventions represent entirely new methods of treatment that can reinforce a persons residual intrinsic abilities, provide alternative means by which activities can be completed or provide extrinsic supports so that functional activities can be performed that might otherwise not be possible. Although the major focus of research in this field will continue to be the development of new ATC interventions, over the coming years it will also be critical for researchers, clinicians, and developers to examine the multi-system factors that affect usability over time, generalisability across home and community settings, and the impact of sustained, patterned technological interventions on recovery of function.

How many people would benefit from a smart wheelchair

Independent mobility is important, but some wheelchair users find operating existing manual or powered wheelchairs difficult or impossible. Challenges to safe, independent wheelchair use can result from various overlapping physical, perceptual, or cognitive symptoms of diagnoses such as spinal cord injury, cerebrovascular accident, multiple sclerosis, amyotrophic lateral sclerosis, and cerebral palsy. Persons with different symptom combinations can benefit from different types of assistance from a smart wheelchair and different wheelchair form factors. The sizes of these user populations have been estimated based on published estimates of the number of individuals with each of several diseases who (1) also need a wheeled mobility device and (2) have specific symptoms that could interfere with mobility device use.

Participatory design in the development of the wheelchair convoy system

BackgroundIn long-term care environments, residents who have severe mobility deficits are typically transported by having another person push the individual in a manual wheelchair. This practice is inefficient and encourages staff to hurry to complete the process, thereby setting the stage for unsafe practices. Furthermore, the time involved in assembling multiple individuals with disabilities often deters their participation in group activities.MethodsThe Wheelchair Convoy System (WCS) is being developed to allow a single caregiver to move multiple individuals without removing them from their wheelchairs. The WCS will consist of a processor, and a flexible cord linking each wheelchair to the wheelchair in front of it. A Participatory Design approach – in which several iterations of design, fabrication and evaluation are used to elicit feedback from users – was used.ResultsAn iterative cycle of development and evaluation was followed through five prototypes of the device. The third and fourth prototypes were evaluated in unmanned field trials at J. Iverson Riddle Development Center. The prototypes were used to form a convoy of three wheelchairs that successfully completed a series of navigation tasks.ConclusionA Participatory Design approach to the project allowed the design of the WCS to quickly evolve towards a viable solution. The design that emerged by the end of the fifth development cycle bore little resemblance to the initial design, but successfully met the projects design criteria. Additional development and testing is planned to further refine the system.

A perspective on intelligent devices and environments in medical rehabilitation

Globally, the number of people older than 65 years is anticipated to double between 1997 and 2025, while at the same time the number of people with disabilities is growing at a similar rate, which makes technical advances and social policies critical to attain, prolong, and preserve quality of life. Recent advancements in technology, including computation, robotics, machine learning, communication, and miniaturization of sensors have been used primarily in manufacturing, military, space exploration, and entertainment. However, few efforts have been made to utilize these technologies to enhance the quality of life of people with disabilities. This article offers a perspective of future development in seven emerging areas: translation of research into clinical practice, pervasive assistive technology, cognitive assistive technologies, rehabilitation monitoring and coaching technologies, robotic assisted therapy, and personal mobility and manipulation technology.

iWalker: Toward a Rollator-Mounted Wayfinding System for the Elderly

Research on intelligent walkers aims at helping elderly individuals to maintain their independence in familiar and unfamiliar environments. Several walkers have been developed by researchers at Carnegie Mellon University and the University of Pittsburgh. This article contributes to this research venue by describing the design and initial evaluations of iWalker, a multi-sensor rollator-mounted wayfinding system for the elderly. The primary difference of the proposed navigation aid from other intelligent walkers is that iWalker is assumed to operate in a smart world (SW), a physical space equipped with embedded sensors. By integrating inexpensive sensors into the environment, the cost and complexity of the walker can be reduced.

A prototype power assist wheelchair that provides for obstacle detection and avoidance for those with visual impairments

BackgroundAlmost 10% of all individuals who are legally blind also have a mobility impairment. The majority of these individuals are dependent on others for mobility. The Smart Power Assistance Module (SPAM) for manual wheelchairs is being developed to provide independent mobility for this population.MethodsA prototype of the SPAM has been developed using Yamaha JWII power assist hubs, sonar and infrared rangefinders, and a microprocessor. The prototype limits the user to moving straight forward, straight backward, or turning in place, and increases the resistance of the wheels based on the proximity of obstacles. The result is haptic feedback to the user regarding the environment surrounding the wheelchair.ResultsThe prototype has been evaluated with four blindfolded able-bodied users and one individual who is blind but not mobility impaired. For all individuals, the prototype reduced the number of collisions on a simple navigation task.ConclusionThe prototype demonstrates the feasibility of providing navigation assistance to manual wheelchair users, but several shortcomings of the system were identified to be addressed in a second generation prototype.

Neck range of motion and use of computer head controls

Head controls provide an alternative means of computer access. This study determined whether neck movement limitations are associated with reduced performance with such head controls. This study also identified features of the cursor movement path that could aid in assessing computer access limitations. Fifteen subjects without disabilities and ten subjects with disabilities received neck range of motion evaluations and performed computer exercises using head controls. Reduced neck range of motion was correlated with reduced accuracy (R2 = 93.5%) and speed (R2 = 79.5%) in icon selection. A model was developed with the use of cursor positioning time and number of velocity peaks to identify when a person was having difficulty with target acquisition (kappa = 0.81). Models such as this may allow head controls to adapt to a users needs, accommodating difficulties resulting from neck range of motion limitations.

Adaptive software for head-operated computer controls

Head-operated computer controls provide an alternative means of computer access for people with disabilities who are unable to use a standard mouse. However, a persons disability may limit his or her neck movements as well as upper extremity movements. Software was developed which automatically adjusts the interface sensitivity to the needs of a particular user. This adaptive software was evaluated in two stages. First, 16 novice head-control users with spinal-cord injury or multiple sclerosis used head controls with and without the adaptive software. The adaptive software was associated with increased speed in standardized icon selection exercises (p<0.05). A small increase in accuracy was also observed. In addition, five current head-control users evaluated the software in a real-world setting. One of these five subjects perceived an improvement in comparison to his current head-control system.

Plans and planning in smart homes

In this chapter, we review the use (and uses) of plans and planning in Smart Homes. Plans have several applications within Smart Homes, including: sharing task execution with the homes inhabitants, providing task guidance to inhabitants, and to identifying emergencies. These plans are not necessarily generated automatically, nor are they always represented in a human-readable form. The chapter ends with a discussion of the research issues surrounding the integration of plans and planning into Smart Homes.

Head-operated computer controls: effect of control method on performance for subjects with and without disability

Head-operated computer controls provide an alternative means of computer access for people with physical disabilities. A persons ability to use such head controls may be reduced if he or she experiences neck movement limitations. Five experimental methods of compensating for neck movement limitations were evaluated in comparison to a standard head control interface. Twenty-two subjects without disabilities and three subjects with multiple sclerosis performed icon acquisition exercises using the standard interface and each of the five experimental compensation methods. Subjects without disabilities had less tendency to overshoot the target icons when using an interface with decreased sensitivity or one in which head movements controlled cursor velocity rather than cursor position (p<0.05). Subjects with multiple sclerosis tended to be more accurate when using an interface with increased sensitivity, and had less tendency to overshoot icons when using head movements to control cursor velocity rather than cursor position. Overall, subjects tended to demonstrate faster performance when using an interface with reduced sensitivity.