T. Claire Davies

Effectiveness of robot-assisted therapy on ankle rehabilitation - a systematic review

ObjectiveThe aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries.MethodsThirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle*’, ‘robot*’, ‘rehabilitat*’ or ‘treat*’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation.ResultsTwenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II.ConclusionAll the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies.

Enabling Self-Directed Computer Use for Individuals with Cerebral Palsy: A Systematic Review of Assistive Devices and Technologies

Aim  The purpose of this study was to systematically review published evidence on the development, use, and effectiveness of devices and technologies that enable or enhance self‐directed computer access by individuals with cerebral palsy (CP).

Using ecological interface design to develop an auditory interface for visually impaired travellers

This paper discusses the development of a prototype design of an auditory interface for the visually impaired based on the work domain analysis of ecological interface design. Secondary mobility devices have been developed to increase preview distances in addition to a long cane, but these have gained limited acceptance. These devices lack an easily interpreted interface. An interface design that provides the user with sufficient preview to avoid obstacles and plan a path among obstacles is presented

Reviewing effectiveness of ankle assessment techniques for use in robot- assisted therapy

This article provides a comprehensive review of studies that investigated ankle assessment techniques to better understand those that can be used in the real-time monitoring of rehabilitation progress for implementation in conjunction with robot-assisted therapy. Seventy-six publications published between January 1980 and August 2013 were selected based on eight databases. They were divided into two main categories (16 qualitative and 60 quantitative studies): 13 goniometer studies, 18 dynamometer studies, and 29 studies about innovative techniques. A total of 465 subjects participated in the 29 quantitative studies of innovative measurement techniques that may potentially be integrated in a real-time monitoring device, of which 19 studies included less than 10 participants. Results show that qualitative ankle assessment methods are not suitable for real-time monitoring in robot-assisted therapy, though they are reliable for certain patients, while the quantitative methods show great potential. The majority of quantitative techniques are reliable in measuring ankle kinematics and kinetics but are usually available only for use in the sagittal plane. Limited studies determine kinematics and kinetics in all three planes (sagittal, transverse, and frontal) where motions of the ankle joint and the subtalar joint actually occur.

Youth with cerebral palsy with differing upper limb abilities: How do they access computers?

OBJECTIVE To identify the current level of awareness of different computer access technologies and the choices made regarding mode of access by youth with cerebral palsy (CP) and their families. DESIGN Survey. SETTING Two tertiary-level rehabilitation centers in New Zealand and Canada. PARTICIPANTS Youth (N=60) with CP, Manual Ability Classification Scale (MACS) levels I to V, age 13 to 25 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Questionnaire. RESULTS Fifty (83%) of the 60 youth were aware of at least 1 available assistive technology (AT), such as touch screens and joysticks. However, only 34 youth (57%) were familiar with the accessibility options currently available in the most common operating systems. Thirty-three (94%) of 35 youth who were MACS I and II used a standard mouse and keyboard, while few chose to use assistive technology or accessibility options. In contrast, 10 (40%) of 25 youth who were MACS III to V used a variety of assistive technologies such as touch screens, joysticks, trackballs, and scanning technologies. This group also had the highest use of accessibility options, although only 15 (60%) of the 25 were aware of them. CONCLUSION Most youth with CP were aware of, and used, assistive technologies to enhance their computer access but were less knowledgeable about accessibility options. Accessibility options allow users to modify their own computer interface and can thus enhance computer access for youth with CP. Clinicians should be knowledgeable enough to give informed advice in this area of computer access, thus ensuring that all youth with CP can benefit from both AT and accessibility options, as required.

The effect of hydrotherapy treatment on gait characteristics of hereditary spastic paraparesis patients

BACKGROUND Hereditary spastic paraparesis (HSP) is a group of neurological disorders characterised by slowly progressive increasing muscle tone, predominantly in the lower limbs, with relatively preserved power. This leads to progressive difficulties in motor control and walking. OBJECTIVE The purpose of this study was to evaluate the effectiveness of hydrotherapy treatment when used as a means to increase locomotor function in individuals with late onset HSP. This paper discusses the analysis of the effect on gait characteristics. METHODS Nine people with HSP were asked to participate in pre- and post-hydrotherapy gait analyses. Ground reaction force and motion trajectories were recorded and used to calculate spatiotemporal gait parameters, joint angles and moments. RESULTS The normalised joint kinematics and kinetics profile revealed that the biomechanics of people with HSP were similar to that of controls for most of the joints, but with lower range of motion. Walking speed increased significantly (11%) after the course of hydrotherapy. Though part of this was achieved through increased ROM there was also a further increase in hip internal rotation and in peak hip extension moment. CONCLUSIONS Although participants had increased walking speed and step length, it appears that hydrotherapy increases the ability to perform compensatory strategies rather than resulting in a more typical kinematic and kinetic approach.

Mobility interfaces for the visually impaired: what's missing?

Individuals with visual impairments must rely on information from their other senses to provide them with obstacle preview. Although the long cane has become the most common primary device for detecting obstacles on the ground, other systems have gained acceptance by cane users who already have a high degree of travel ability as secondary mobility devices to detect obstacles that are not ground-based. Echolocation, on the other hand, has been a method of localisation in the past that enables a traveller to orient themselves relative to obstacles in a room and successfully avoid them. Echolocation has recently been rejected due to environmental influences that make it more difficult in noisy environments and social restrictions imposed by orientation and mobility instructors. Localisation could be attained through downconverted ultrasound echoes in the auditory domain, thus echolocation by ultrasound. This paper examines the interfaces that are currently used to display information to visually impaired individuals.

A cross‐sectional study examining computer task completion by adolescents with cerebral palsy across the Manual Ability Classification System levels

The aim of this study was to analyze the cursor trajectories of adolescents with cerebral palsy (CP) when using a mouse for point‐and‐click computer tasks. By identifying some of the factors limiting cursor movement and gaining a better understanding of human movement, it will be possible to design more accessible computer interfaces.

A Robot-Driven Computational Model for Estimating Passive Ankle Torque With Subject-Specific Adaptation

Background: Robot-assisted ankle assessment could potentially be conducted using sensor-based and model-based methods. Existing ankle rehabilitation robots usually use torquemeters and multiaxis load cells for measuring joint dynamics. These measurements are accurate, but the contribution as a result of muscles and ligaments is not taken into account. Some computational ankle models have been developed to evaluate ligament strain and joint torque. These models do not include muscles and, thus, are not suitable for an overall ankle assessment in robot-assisted therapy. Methods: This study proposed a computational ankle model for use in robot-assisted therapy with three rotational degrees of freedom, 12 muscles, and seven ligaments. This model is driven by robotics, uses three independent position variables as inputs, and outputs an overall ankle assessment. Subject-specific adaptations by geometric and strength scaling were also made to allow for a universal model. Results: This model was evaluated using published results and experimental data from 11 participants. Results show a high accuracy in the evaluation of ligament neutral length and passive joint torque. The subject-specific adaptation performance is high, with each normalized root-mean-square deviation value less than 10%. Conclusion: This model could be used for ankle assessment, especially in evaluating passive ankle torque, for a specific individual. The characteristic that is unique to this model is the use of three independent position variables that can be measured in real time as inputs, which makes it advantageous over other models when combined with robot-assisted therapy.

Testing a Novel Auditory Interface Display to Enable Visually Impaired Travelers to Use Sonar Mobility Devices Effectively

This paper discusses the pilot testing of an auditory interface designed to increase navigational ability of visually impaired individuals. Sonar devices have been developed to increase preview distances, but these have gained limited acceptance as they lack an easily interpreted interface. This paper presents usability testing of an auditory prototype interface developed using the work domain analysis of ecological interface design (EID). An interface design that provides the user with sufficient preview to avoid obstacles may offer more environmental information than the single tones of the current designs.