Fiscal Year 2018 National Defense Authorization Act, Section 734, Weapon Systems Line of Inquiry: Overview and Blast Overpressure Tool-A Module for Human Body Blast Wave Exposure for Safer Weapons Training.

Introduction: Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section 734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study's goal is to improve DoD's understanding of the impact of BOP exposure from weapon systems on service members' brain health and inform policy for risk mitigation, unit readiness, and health care decisions.

Recommendations for a Military Health System Auditory Blast Injury Prevention Standard.

Introduction: Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members.

Use of wearable physiological sensors to predict cognitive workload in a visuospatial learning task.

Background: Increased cognitive workload, sometimes known as mental strain or mental effort, has been associated with reduced performance.

Objective: The use of physiological monitoring was investigated to predict cognitive workload and performance.

Methods: Twenty-one participants completed a 10-minute seated rest, a visuospatial learning task modeled after crane operation, and the Stroop test, an assessment that measures cognitive interference.

Continuous Assessment of Levodopa Response in Parkinson's Disease Using Wearable Motion Sensors.

Objective: Fluctuations in response to levodopa in Parkinson's disease (PD) are difficult to treat as tools to monitor temporal patterns of symptoms are hampered by several challenges. The objective was to use wearable sensors to quantify the dose response of tremor, bradykinesia, and dyskinesia in individuals with PD.

Methods: Thirteen individuals with PD and fluctuating motor benefit were instrumented with wrist and ankle motion sensors and recorded by video.

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME).

In previous work, we developed a lightweight wearable hand exoskeleton (Hand Spring Operated Movement Enhancer) that improves range of motion and function in laboratory testing. In this pilot study, we added the ability to log movement data for extended periods and recruited ten chronic stroke subjects to use the device during reach and grasp task practice at home for 1.5 h/day, five days per week, and for four weeks.

Dynamic motor tracking is sensitive to subacute mTBI.

Effective screening for mild traumatic brain injury (mTBI) is critical to accurate diagnosis, intervention, and improving outcomes. However, detecting mTBI using conventional clinical techniques is difficult, time intensive, and subject to observer bias. We examine the use of a simple visuomotor tracking task as a screening tool for mTBI.

Development of a clinician worn device for the evaluation of abnormal muscle tone.

Neurological disorders such as cerebral palsy commonly result in abnormal muscle hyperactivity that negatively effects functional use of the affected limbs. Individuals with cerebral palsy often present with a mix of spasticity and dystonia, and it can be difficult to distinguish between the effects of these types of abnormal tone. Different types of abnormal tone respond differently to treatments such as deep brain stimulation and baclofen.

Usability evaluation of a kinematics focused Kinect therapy program for individuals with stroke.

Background: Continued and frequent use of the affected arm can result in increased function after stroke. However, long-term access to therapy is often limited, and home exercise compliance is low. While rehabilitation gaming is becoming increasingly prevalent, concerns about therapeutic method, safety, and usability for independent home use remain largely unaddressed.

Robotic therapy provides a stimulus for upper limb motor recovery after stroke that is complementary to and distinct from conventional therapy.

Background: Individuals with chronic stroke often have long-lasting upper extremity impairments that impede function during activities of daily living. Rehabilitation robotics have shown promise in improving arm function, but current systems do not allow realistic training of activities of daily living. We have incorporated the ARMin III and HandSOME device into a novel robotic therapy modality that provides functional training of reach and grasp tasks.

Using the Kinect to limit abnormal kinematics and compensation strategies during therapy with end effector robots.

Abnormal kinematics and the use of compensation strategies during training limit functional improvement from therapy. The Kinect is a low cost ($100) sensor that does not require any markers to be placed on the user. Integration of this sensor into currently used therapy systems can provide feedback about the user's movement quality, and the use of compensatory strategies to complete tasks.

Comparison of joint space and end point space robotic training modalities for rehabilitation of interjoint coordination in individuals with moderate to severe impairment from chronic stroke.

We have developed a novel robotic modality called Time Independent Functional Training (TIFT) that provides focused retraining of interjoint coordination after stroke. TIFT was implemented on the ARMin III exoskeleton and provides joint space walls that resist movement patterns that are inconsistent with the targeted interjoint coordination pattern. In a single test session, ten moderate to severely impaired individuals with chronic stroke practiced synchronous shoulder abduction and elbow extension in TIFT and also in a comparison mode commonly used in robotic therapy called end point tunnel training (EPTT).

Robotic approaches for rehabilitation of hand function after stroke.

The goal of this review was to discuss the impairments in hand function after stroke and present previous work on robot-assisted approaches to movement neurorehabilitation. Robotic devices offer a unique training environment that may enhance outcomes beyond what is possible with conventional means. Robots apply forces to the hand, allowing completion of movements while preventing inappropriate movement patterns.

Time Independent Functional task Training: a case study on the effect of inter-joint coordination driven haptic guidance in stroke therapy.

After a stroke abnormal joint coordination of the arm may limit functional movement and recovery. To aid in training inter-joint movement coordination a haptic guidance method for functional driven rehabilitation after stroke called Time Independent Functional Training (TIFT) has been developed for the ARMin III robot. The mode helps retraining inter-joint coordination during functional movements, such as putting an object on a shelf, pouring from a pitcher, and sorting objects into bins.

Retraining of interjoint arm coordination after stroke using robot-assisted time-independent functional training.

We have developed a haptic-based approach for retraining of interjoint coordination following stroke called time-independent functional training (TIFT) and implemented this mode in the ARMin III robotic exoskeleton. The ARMin III robot was developed by Drs. Robert Riener and Tobias Nef at the Swiss Federal Institute of Technology Zurich (Eidgenossische Technische Hochschule Zurich, or ETH Zurich), in Zurich, Switzerland.

Hand Spring Operated Movement Enhancer (HandSOME): a portable, passive hand exoskeleton for stroke rehabilitation.

Stroke patients often have flexor hypertonia and finger extensor weakness, which makes it difficult to open their affected hand for functional grasp. Because of this impairment, hand rehabilitation after stroke is essential for restoring functional independent lifestyles. The goal of this study is to develop a passive, lightweight, wearable device to assist with hand function during performance of activities of daily living.

Hand spring operated movement enhancer (HandSOME) device for hand rehabilitation after stroke.

Hand rehabilitation after stroke is essential for restoring functional independent lifestyles. After stroke, patients often have flexor hypertonia, making it difficult to open their hand for functional grasp. The development and initial testing of a passive hand rehabilitation device is discussed.