Considering Propulsion Pattern in Therapeutic Outcomes for Children Who Use Manual Wheelchairs.

Purpose: Children who use manual wheelchairs encounter pain and injury risks to the upper body. Current literature does not describe how propulsion pattern and physiotherapeutic training methodologies impact response to treatment.

Methods: This study assesses the effect of community-based intensive physical and occupational therapy on functional outcomes over a 7-week period in pediatric manual wheelchair users.

Assessment of a markerless motion analysis system for manual wheelchair application.

Background: Wheelchair biomechanics research advances accessibility and clinical care for manual wheelchair users. Standardized outcome assessments are vital tools for tracking progress, but there is a strong need for more quantitative methods. A system offering kinematic, quantitative detection, with the ease of use of a standardized outcome assessment, would be optimal for repeated, longitudinal assessment of manual wheelchair users' therapeutic progress, but has yet to be offered.

Validation of the Patient Global Impression of Improvement for Penile Prosthesis.

Background: No consensus on the preferred means of evaluating patients after surgical placement of an inflatable penile prosthesis (IPP) currently exists. Many self-assessment questionnaires are available, but none specifically targets patients with IPPs. The purpose of this study was to assess the construct validity of the Patient Global Impression of Improvement (PGI-I) for evaluating patient satisfaction after placement of an IPP.

Patient perception of transvaginal mesh and the media.

Objective: To assess the penetration of media-based information on transvaginal mesh (TVM) in our patient population and to determine whether exposure affects patient opinion. Since the 2011 Federal Drug Administration communication on TVM, many advertisements from legal practices have been directed toward patients.

Materials And Methods: An 18-item survey was administered to female patients at 2 sites from August 2012 to April 2013.

Functional classification of skeletal muscle networks. I. Normal physiology.

Extensive measurements of the parts list of human skeletal muscle through transcriptomics and other phenotypic assays offer the opportunity to reconstruct detailed functional models. Through integration of vast amounts of data present in databases and extant knowledge of muscle function combined with robust analyses that include a clustering approach, we present both a protein parts list and network models for skeletal muscle function. The model comprises the four key functional family networks that coexist within a functional space; namely, excitation-activation family (forward pathways that transmit a motoneuronal command signal into the spatial volume of the cell and then use Ca(2+) fluxes to bind Ca(2+) to troponin C sites on F-actin filaments, plus transmembrane pumps that maintain transmission capacity); mechanical transmission family (a sophisticated three-dimensional mechanical apparatus that bidirectionally couples the millions of actin-myosin nanomotors with external axial tensile forces at insertion sites); metabolic and bioenergetics family (pathways that supply energy for the skeletal muscle function under widely varying demands and provide for other cellular processes); and signaling-production family (which represents various sensing, signal transduction, and nuclear infrastructure that controls the turn over and structural integrity and regulates the maintenance, regeneration, and remodeling of the muscle).

Functional classification of skeletal muscle networks. II. Applications to pathophysiology.

In our preceding companion paper (Wang Y, Winters J, Subramaniam S. J Appl Physiol. doi: 10.

Multivariate nonlinear regression analysis of trajectory tracking performance using force reflecting joystick in chronic stroke-induced hemiparesis.

Individualizing a neurorehabilitation training protocol requires understanding the performance of subjects with various capabilities under different task settings. We use multivariate regression to evaluate the performance of subjects with stroke-induced hemiparesis in trajectory tracking tasks using a force-reflecting joystick. A nonlinear effect was consistently shown in both dimensions of force field strength and impairment level for selected kinematic performance measures, with greatest sensitivity at lower force fields.

Modeling the adaptive pathophysiology of essential hypertension.

This paper proposes an adaptive neuro-fuzzy model to study the pathophysiology of essential hypertension. Using diverse inputs such as risk factors, physical relations and medical interventions, and states that include both transient and resting states for key physiological variables (blood pressure, total peripheral resistance), it can roughly predict both real-time and long-term blood pressure change for a robust range of inputs. Although it was tuned using published population data, it can be applied to specific individuals to estimate the risks of hypertension with different life experience.

A framework for mapping between "living" muscle model parameters and systems biology data for muscle tissue.

Striated muscle represents a unique type of actuator in that it depends on living tissue. Models of muscle have historically focused on the role of actuator, using properties that do not adapt over time. This paper extends the foundation of Hill-based muscle models by considering muscle as a tissue composed of well-mixed composite materials (at the level of fascicle), and identifies three specific classes of protein families that occupy functional space functional space: excitation → activation; mechanical attachment/transmission, and myo-energy supply.

Development of a method for evaluating accessibility of medical equipment for patients with disabilities.

Objective: The purpose of this study was to develop a method for evaluating accessibility of medical equipment for patients with disabilities.

Methods: The researchers reviewed videotapes of patient-participants with various physical and sensory disabilities using different types of medical equipment. For each of 11 videotapes, four observers independently identified and documented access and safety barriers, such as physical, sensory, cognitive, and environmental barriers.

Evaluation of applied forces and EMG of the young, aged & stroke population in a 3D arm workspace.

The objectives of this study were to evaluate 11 muscle electromyograms (EMGs) while performing force application tasks in a 3D workspace, and to identify challenging regions within the workspace in which subjects had difficultly generating forces in desired directions. Each subject (4 young healthy adults, 4 older with stroke-induced disability, 4 age-matched older) applied forces (8 lbs desired) in 6 directions at 19 locations spatially distributed in the workspace. The normals could meet the force threshold levels except for the 2 female aged participants for the Right force direction.

A pilot study evaluating use of a computer-assisted neurorehabilitation platform for upper-extremity stroke assessment.

Background: There is a need to develop cost-effective, sensitive stroke assessment instruments. One approach is examining kinematic measures derived from goal-directed tasks, which can potentially be sensitive to the subtle changes in the stroke rehabilitation process. This paper presents the findings from a pilot study that uses a computer-assisted neurorehabilitation platform, interfaced with a conventional force-reflecting joystick, to examine the assessment capability of the system by various types of goal-directed tasks.

Evaluating automatically generated personalized interfaces on an ergometer for people with diverse abilities.

The MedURC (Medical Universal Remote Console) technology uses a collection of standards to create universal interfaces for various medical equipment, including user information on preferences and capabilities to create a personalized accessible interface. This project significantly extends MedURC by supporting an ad hoc fitness industry communication standard for that makes it possible for MedURC to operate any other supported exercise equipment. A variety of alternative interfaces (default, universally designed, personalized) were evaluated by subjects that included persons with disabilities and older adults, using performance data while executing specific tasks and subject interviews.

A multisegmental foot model with bone-based referencing: sensitivity to radiographic input parameters.

We present a new kinematic model measuring the three-dimensional orientation of multiple segments of the foot and ankle. The model defines neutral alignments based on the alignments of the underlying bony segments, and indexes the orientation of skin-mounted markers to the bony anatomy using measures from weightbearing x-rays. The sensitivity of the model to these radiographic input parameters was analyzed using data from walking trials.

An interactive framework for personalized computer-assisted neurorehabilitation.

This paper presents the implementation of a framework for computer-assisted neurorehabilitation that intends to address the need for more personalized healthcare technologies. This framework called UniTherapy is applied to home neurorehabilitation for individuals with stroke-induced disability. It supports interactive upper limb assessment and therapy that makes use of mass-marketed force-reflecting joysticks and wheels, as well as some customized therapeutic devices.

Potential of a suite of robot/computer-assisted motivating systems for personalized, home-based, stroke rehabilitation.

Background: There is a need to improve semi-autonomous stroke therapy in home environments often characterized by low supervision of clinical experts and low extrinsic motivation. Our distributed device approach to this problem consists of an integrated suite of low-cost robotic/computer-assistive technologies driven by a novel universal access software framework called UniTherapy. Our design strategy for personalizing the therapy, providing extrinsic motivation and outcome assessment is presented and evaluated.

Enhanced TheraJoy technology for use in upper-extremity stroke rehabilitation.

Due to rising costs of health care and decreasing length of conventional therapy, it has become imperative to develop affordable, motivating devices that can be used in the home for upper-extremity stroke rehabilitation. In the TheraJoy project, a commercial joystick has been modified to enlarge the range of arm movement used during therapeutic movement tasks, and to support the application of light passive and actuated forces. The enhanced version presented here allows for motion in both the horizontal and vertical planes, uses a dynamic linkage model to map joystick-hand position and force data, uses motivating gaming technology, and can be used in both therapy and in home settings.

A mobile tool for accessibility and usability testing of medical instrumentation.

The Mobile Usability Lab (MU-Lab) is a tool developed by the Rehabilitation Engineering Research Center on Accessible Medical Instrumentation (RERC-AMI) to study the accessibility and usability of medical devices by people with diverse abilities. The system includes a suite of data collection hardware components and a custom software interface to help coordinate problem identification and planning as well as data collection and analysis for usability and accessibility research of medical devices. Hardware components include a laptop computer, data acquisition card, video cameras, quad video processor and wireless microphones.

Progress toward universal interface technologies for telerehabilitation.

One of the overriding needs in the field of telerehabilitation is for user-centered interfaces that provide individuals with differing abilities with access to effective remote communication. This paper provides a foundation for developing and evaluating interfaces that move towards the aim of universal accessibility, and reports on progress for four types of interfaces: multimedia conferencing technologies involving persons with different roles and disabilities participating in goal-directed tasks; physical devices for therapy and assessment; communication/control for computer-assisted teletherapy; and an intelligent telerehabilitation assistant that supports the dynamic rehabilitative process.

An input classification scheme for use in evidence-based dynamic recurrent neuro-fuzzy prognosis.

This paper presents an input classification scheme used in an evidence-based dynamic recurrent neuro-fuzzy system for prognosis in rehabilitation. All external variables which may have an effect on the outcome of the rehabilitative process are classified into facts, contexts and interventions. Their effects on patients' physical and/or physiological states, which are estimated based on available evidence, are represented by fuzzy rules and/or non-linear models of physiologic processes.

Videoconferencing and telehealth technologies can provide a reliable approach to remote assessment and teaching without compromising quality.

Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists.

A dynamic neuro-fuzzy model providing bio-state estimation and prognosis prediction for wearable intelligent assistants.

Background: Intelligent management of wearable applications in rehabilitation requires an understanding of the current context, which is constantly changing over the rehabilitation process because of changes in the person's status and environment. This paper presents a dynamic recurrent neuro-fuzzy system that implements expert-and evidence-based reasoning. It is intended to provide context-awareness for wearable intelligent agents/assistants (WIAs).

A telehomecare model for optimizing rehabilitation outcomes.

For telehealth to become an accepted component of rehabilitation, a scientific base verifying that telehealth improves outcomes must be developed. A conceptual framework based on theory and empirical findings is necessary for this area of inquiry to flourish. Most academic curricula possess such an educational pillar, which serves to help prepare professionals to practice in the new arena, and scholars to perform quality research.