Sonya Allin

Measuring just noticeable differences for haptic force feedback: implications for rehabilitation

Describes preliminary work in the use of a virtual environment to derive just noticeable differences (JNDs) for force. Specifically, we look for thresholds of force sensitivity so that we may ultimately construct therapeutic force feedback distortions that stay below these thresholds. Initially, we have concentrated on JNDs as they are applied to the index finger; preliminary data in healthy individuals shows an average JND of approximately 100%. More significantly, the data indicate that visual feedback distortions in a virtual environment can be created to encourage increased force productions by up to 100%, and that this can be done without a patients awareness.

Recent Trends in the Development and Evaluation of Assistive Robotic Manipulation Devices

This review explores recent trends in the development and evaluation of assistive robotic arms, both prosthetic and externally mounted. Evaluations have been organized according to the CATOR taxonomy of assistive device outcomes, which takes into consideration device effectiveness, social significance, and impact on subjective well-being. Questions that have informed the review include: (1) Are robotic arms being comprehensively evaluated along axes of the CATOR taxonomy? (2) Are definitions of effectiveness in accordance with the priorities of users? (3) What gaps in robotic arm evaluation exist, and how might these best be addressed? (4) What further advances can be expected in the next 15 years? Results highlight the need for increased standardization of evaluation methods, increased emphasis on the social significance (i.e., social cost) of devices, and increased emphasis on device impact on quality of life. Several open areas for future research, in terms of both device evaluation and device development, are also discussed.

Enhanced snake based segmentation of vocal folds

We present a system to segment the medial edges of the vocal folds from stroboscopic video. The system has two components. The first learns a color transformation that optimally discriminates, according to the Fisher linear criterion, between the trachea and vocal folds. Using this transformation, it is able to make a coarse segmentation of vocal fold boundaries. The second component uses an active contour formulation recently developed for the Insight Toolkit to refine detected contours. Rather than tune the internal energy of our active contours to bias for specific shapes, we optimize image energy so as to highlight boundaries of interest. This transformation of image energy simplifies the contour extraction process and suppresses noisy artifacts, which may confound standard implementations. We evaluate our system on stroboscopic video of sustained phonation. Our evaluation compares points on automatically extracted contours with manually supplied points at perceived vocal fold edges. Mean deviations for points located on the minor axes of the vocal folds averaged 2.2 pixels across all subjects, with a standard deviation of 3.6.

Robust Tracking of the Upper Limb for Functional Stroke Assessment

We present a robust 3-D parts-based (PB) tracking system designed to follow the upper limb of stroke survivors during desktop activities. This system fits a probabilistic model of the arm to sequences of images taken from multiple angles. The arm model defines shapes and colors of limbs and limb configurations that are more or less likely. We demonstrate that the system is 1) robust to cluttered scenes and temporary occlusions, 2) accurate relative to a commercial motion capture device, and 3) capable of capturing kinematics that correlate with concurrent measures of post-stroke limb function. To evaluate the PB system, the functional motion of seven stroke survivors was measured concurrently with the PB system and a commercial motion capture system. In addition, functional motion was assessed by an expert using the Fugl-Meyer Assessment (FMA) and related to recorded kinematics. Standard deviation of differences in measured elbow angles between systems was 5.7^; deviation in hand velocity estimates was 2.6 cm/s. Several statistics, moreover, correlated strongly with FMA scores. Standard deviation in shoulder velocity had a significant correlation coefficient with FMA score below -0.75 when measured with all systems.

Video based analysis of standing balance in a community center

Postural sway is a well known measure of postural stability in the elderly. Sway measurements, however, are typically made using expensive equipment in a laboratory. We report on efforts to make clinically significant and quantitative measurements of postural sway in a community center with a single un-calibrated video camera. Results indicate that simple tracking technologies can capture some aspects of sway in a community center in a way that is perceptually accurate and capable of distinguishing expert-assigned levels of balance performance in an elderly, balance impaired cohort.

Fracture risk assessment after BMD examination: whose job is it, anyway?

SummaryFracture risk assessments on bone mineral density reports guide family physicians’ treatment decisions but are subject to inaccuracy. Qualitative analysis of interviews with 22 family physicians illustrates their pervasive questioning of reported assessment accuracy and independent assumption of responsibility for assessment. Assumption of responsibility is common despite duplicating specialists’ work.IntroductionFracture risk is the basis for recommendations of treatment for osteoporosis, but assessments on bone mineral density (BMD) reports are subject to known inaccuracies. This creates a complex situation for referring physicians, who must rely on assessments to inform treatment decisions. This study was designed to broadly understand physicians’ current experiences with and preferences for BMD reporting; the present analysis focuses on their interpretation and use of the fracture risk assessments on reports, specificallyMethodsA qualitative, thematic analysis of one-on-one interviews with 22 family physicians in Ontario, Canada was performed.ResultsThe first major theme identified in interview data reflects questioning by family physicians of reported fracture risk assessments’ accuracy. Several major subthemes related to this included questioning of: 1) accuracy in raw bone mineral density measures (e.g., g/cm2); 2) accurate inclusion of modifying risk factors; and 3) the fracture risk assessment methodology employed. A second major theme identified was family physicians’ independent assumption of responsibility for risk assessment and its interpretation. Many participants reported that they computed risk assessments in their practice to ensure accuracy, even when provided with assessments on reports.ConclusionsResults indicate family physicians question accuracy of risk assessments on BMD reports and often assume responsibility both for revising and relating assessments to treatment recommendations. This assumption of responsibility is common despite the fact that it may duplicate the efforts of reading physicians. Better capture of risk information on BMD referrals, quality control standards for images and standardization of risk reporting may help attenuate some inefficiency.

Low-cost, Automated Assessment of Sit-To-Stand Movement in “Natural” Environments

The ability to rise from a chair is a prerequisite for upright mobility and independent living. We are developing an inexpensive stereo based system capable of cheaply and automatically assessing the quality of “sit-tostand” movements in environments outside of clinics. Automated assessments have been designed to translate perceived kinematics onto assessment scores that are consistent with expert opinion on the Berg Balance Scale (BBS). In addition, automated assessments reveal movement strategies associated with age and disability, like the use of the arms while rising or excess extension at the knees. In this paper, we present preliminary work to translate perceived movement kinematics from community dwelling balance impaired elders onto expert assessments of sit-to-stand health. Our ultimate goal is to create automated tools to identify falls risk, quantify real-world movement changes that result from therapeutic interventions, and perform ergonomic analyses of elders’ seating arrangements in the home.

Understanding Referral Patterns for Bone Mineral Density Testing among Family Physicians: A Qualitative Descriptive Study

Introduction. Evidence of inappropriate bone mineral density (BMD) testing has been identified in terms of overtesting in low risk women and undertesting among patients at high risk. In light of these phenomena, the objective of this study was to understand the referral patterns for BMD testing among Ontarios family physicians (FPs). Methods. A qualitative descriptive approach was adopted. Twenty-two FPs took part in a semi-structured interview lasting approximately 30 minutes. An inductive thematic analysis was performed on the transcribed data in order to understand the referral patterns for BMD testing. Results. We identified a lack of clarity about screening for osteoporosis with a tendency for baseline BMD testing in healthy, postmenopausal women and a lack of clarity on the appropriate age for screening for men in particular. A lack of clarity on appropriate intervals for follow-up testing was also described. Conclusions. These findings lend support to what has been documented at the population level suggesting a tendency among FPs to refer menopausal women (at low risk). Emphasis on referral of high-risk groups as well as men and further clarification and education on the appropriate intervals for follow-up testing is warranted.

Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study

Background Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. Objective The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. Methods Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages. Results A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section. Conclusions A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools’ impact on self-efficacy and health.

Using the theoretical domains framework to guide the development of a self-management program for individuals with spinal cord injury: Results from a national stakeholder advisory group

Objective: To determine the implementation considerations for a targeted self-management program for individuals with spinal cord injury (SCI) from the perspective of a national stakeholder advisory group using the Theoretical Domains Framework (TDF) as a guide. Design: Qualitative descriptive approach. Setting: Two focus groups held at the 6th National Spinal Cord Injury Conference (October 2–4th, 2014) in Toronto, Ontario, Canada. Participants: A total of 25 stakeholders from across Canada participated in focus groups or “brainstorming sessions”. The stakeholders included 5 clinicians, 14 researchers, 3 policy makers, and 3 individuals with SCI. Interventions: Not applicable. Outcome Measures: Not applicable. Results: All 14 theoretical domains were identified in the brainstorming sessions. No new themes or domains were identified. The need to consider the theoretical domains of Knowledge, Skills, Reinforcement, Intentions, Goals (e.g. the readiness of the individual with SCI), Environmental Context and Resources (e.g. considerations for governance and ownership of the program and a business model for sustainability), as well as Social Influences (e.g. issues of privacy and security in the context of on-line delivery) was identified. Conclusions: The current study provides complementary results to our previous series of studies on the implementation considerations for the development of a targeted self-management program for individuals with SCI by emphasizing the health care professional/health policy perspective. It is anticipated that such a program could not only reduce secondary complications and subsequent inappropriate health care use but it may also improve the quality of life for individuals with SCI and their caregivers.