Design and development of the first exoskeletal garment to enhance arm mobility for children with movement impairments

Development and Initial Evaluation of a Soft Ankle Support for Children With Ankle Impairments

PURPOSE

Develop and initially evaluate a soft ankle support (SAS) garment for children with ankle impairments.

DESCRIPTION OF CASES

Two participants were evaluated at baseline and interviews with their parent(s) to identify wants and needs for the SAS. The SAS was developed and evaluated via participant report and functional measures in barefoot, ankle-foot orthosis (AFO), and SAS conditions.

OUTCOMES

Children and parents expressed dissatisfaction with AFOs' dimensions, weight, adjustability, comfort, and ease of use. Gait and gross motor function were similar for SAS and AFOs' conditions; however, participants rated the SAS better for weight and bulk, integration with shoes, adjustability, comfort, cost, and washability.

DISCUSSION

The SAS and AFOs performed similarly in this initial testing, yet the SAS also met participants' needs across key metrics not well addressed by AFOs. Ankle support devices that meet users' broad needs may support improved adherence and user satisfaction.

Users' Perceptions About Lower Extremity Orthotic Devices: A Systematic Review

OBJECTIVE

To systematically review perceptions from adults, children, and caregivers in scientific and open sources to determine how well lower extremity orthotic devices (LEODs) meet users' functional, expressive, aesthetic, and accessibility (FEA2) needs.

DATA SOURCES

Scientific source searches were conducted in the National Library of Medicine (PubMed/MEDLINE) and Web of Science; open source searches were conducted in Google Search Engine in April 2020.

STUDY SELECTION

Inclusion criteria were reporting of users' perceptions about a LEOD, experimental or observational study design, including qualitative studies, and full text in English. Studies were excluded if the device only provided compression or perception data could not be extracted. One hundred seventy three scientific sources of 3440 screened were included (total of 1108 perceptions); 36 open sources of 150 screened were included (total of 508 perceptions).

DATA EXTRACTION

Users' perceptions were independently coded by 2 trained, reliable coders.

DATA SYNTHESIS

Across both source types, there were more perceptions about functional needs, and perceptions were more likely to be positive related to functional than expressive, aesthetic, or accessibility needs. Perceptions about expression, aesthetics, and accessibility were more frequently reported and more negative in open vs scientific sources. Users' perceptions varied depending on users' diagnosis and device type.

CONCLUSIONS

There is significant room for improvement in how LEODs meet users' FEA2 needs, even in the area of function, which is often the primary focus when designing rehabilitation devices. Satisfaction with LEODs may be improved by addressing users' unmet needs. Individuals often choose not to use prescribed LEODs even when LEODs improve their function. This systematic review identifies needs for LEODs that are most important to users and highlights how well existing LEODs address those needs. Attention to these needs in the design, prescription, and implementation of LEODs may increase device utilization.

A model for using developmental science to create effective early intervention programs and technologies to improve children's developmental outcomes

Children born with a variety of environmental or medical risk factors may exhibit delays in global development. Very often, such delays are identified at preschool or school age, when children are severely overdue for effective early interventions that can alleviate the delays. This chapter proposes a conceptual model of child development to inform the creation of interventions and rehabilitative technologies that can be provided very early in development, throughout the first year of life, to optimize children's future developmental outcomes. The model suggests that early sensorimotor skills are antecedent and foundational for future motor, cognitive, language, and social development. As an example, this chapter describes how children's early postural control and exploratory movements facilitate the development of future object exploration behaviors that provide enhanced opportunities for learning and advance children's motor, cognitive, language, and social development. An understanding of the developmental pathways in the model can enable the design of effective intervention programs and rehabilitative technologies that target sensorimotor skills in the first year of life with the goal of minimizing or ameliorating the delays that are typically identified at preschool or school age. Specific examples of early interventions and rehabilitative technologies that have effectively advanced children's motor and cognitive development by targeting early sensorimotor skills and behaviors are provided.

Robotic devices for paediatric rehabilitation: a review of design features

Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.

Current Trends and Challenges in Pediatric Access to Sensorless and Sensor-Based Upper Limb Exoskeletons

Sensorless and sensor-based upper limb exoskeletons that enhance or support daily motor function are limited for children. This review presents the different needs in pediatrics and the latest trends when developing an upper limb exoskeleton and discusses future prospects to improve accessibility. First, the principal diagnoses in pediatrics and their respective challenge are presented. A total of 14 upper limb exoskeletons aimed for pediatric use were identified in the literature. The exoskeletons were then classified as sensorless or sensor-based, and categorized with respect to the application domain, the motorization solution, the targeted population(s), and the supported movement(s). The relative absence of upper limb exoskeleton in pediatrics is mainly due to the additional complexity required in order to adapt to children's growth and answer their specific needs and usage. This review highlights that research should focus on sensor-based exoskeletons, which would benefit the majority of children by allowing easier adjustment to the children's needs. Sensor-based exoskeletons are often the best solution for children to improve their participation in activities of daily living and limit cognitive, social, and motor impairments during their development.

Design and validation of a smart garment to measure positioning practices of parents with young infants

The aim of this cross-sectional study was to evaluate the feasibility, construct validity, and reliability of a smart garment to characterize parent-child positioning practices in infants less than six months old. The smart garment (Get Around Garment, GG) was developed through feedback from seven infants and their parents. The final system was then tested with sixteen infants (M = 3.1 ± 1.1 months) assessed in their homes during one visit that consisted of a: 1) Structured Play Assessment (2.5 min): infant was placed in each of five positions (prone, supine, reclined/inclined, and upright) for 30 s, 2) Free Play Assessment (40-60 min): parents were asked to engage in typical daily activities, and 3) second Structured Play Assessment. Infants' body position was both coded from video and identified from sensor data using a custom program. Feasibility was measured by data from a Daily Wearing Log and Garment Perception Questionnaire. Validity was evaluated by comparing the coding and sensor data. Reliability was measured by comparing the sensor data between the two Structured Play Assessments. The GG was considered feasible for use. The smart wearable system showed high levels of accuracy for classifying body position secondby- second and when comparing cumulative duration across time. Reliability of the smart garment was excellent. Young infants spent more time in supine and supported upright positions relative to prone, reclined, or inclined positions. The results suggest that accelerometers can be integrated into garments in a manner that is feasible to provide accurate and consistent data about positioning practices of parents with young infants. Monitoring early positioning practices is important because these practices impact future motor and cognitive developmental trajectories.

A survey on the attitudes of parents with young children on in-home monitoring technologies and study designs for infant research

Remote in-home infant monitoring technologies hold great promise for increasing the scalability and safety of infant research (including in regard to the current Covid-19 pandemic), but remain rarely employed. These technologies hold a number of fundamental challenges and ethical concerns that need addressing to aid the success of this fast-growing field. In particular, the responsible development of such technologies requires caregiver input. We conducted a survey of the opinions of 410 caregivers on the viability, privacy and data access of remote in-home monitoring technologies and study designs. Infant-friendly wearable devices (such as sensing body suits) were viewed favourably. Caregivers were marginally more likely to accept video and audio recording in the home if data was anonymised (through automated processing) at point of collection, particularly when observations were lengthy. Caregivers were more open to international data sharing for anonymous data. Caregivers were interested in viewing all types of data, but were particularly keen to access video and audio recordings for censoring purposes (i.e., to delete data segments). Taken together, our results indicate generally positive attitudes to remote in-home monitoring technologies and studies for infant research but highlight specific considerations such as safety, privacy and family practicalities (e.g. multiple caregivers, visitors and varying schedules) that must be taken into account when developing future studies.

Lower limb rehabilitation robotics: The current understanding and technology

BACKGROUND

With the increasing rate of ambulatory disabilities and rise in the elderly population, advance methods to deliver the rehabilitation and assistive services to patients have become important. Lower limb robotic therapeutic and assistive aids have been found to improve the rehabilitation outcome.

OBJECTIVE

The article aims to present the updated understanding in the field of lower limb rehabilitation robotics and identify future research avenues.

METHODS

Groups of keywords relating to assistive technology, rehabilitation robotics, and lower limb were combined and searched in EMBASE, IEEE Xplore Digital Library, Scopus, Web of Science and Google Scholar database.

RESULTS

Based on the literature collected from the databases we provide an overview of the understanding of robotics in rehabilitation and state of the art devices for lower limb rehabilitation. Technological advancements in rehabilitation robotic architecture (sensing, actuation and control) and biomechanical considerations in design have been discussed. Finally, a discussion on the major advances, research directions, and challenges is presented.

CONCLUSIONS

Although the use of robotics has shown a promising approach to rehabilitation and reducing the burden on caregivers, extensive and innovative research is still required in both cognitive and physical human-robot interaction to achieve treatment efficacy and efficiency.

Wearables for Pediatric Rehabilitation: How to Optimally Design and Use Products to Meet the Needs of Users

This article will define "wearables" as objects that interface and move with users, spanning clothing through smart devices. A novel design approach merging information from across disciplines and considering users' broad needs will be presented as the optimal approach for designing wearables that maximize usage. Three categories of wearables applicable to rehabilitation and habilitation will be explored: (1) inclusive clothing (eg, altered fit, fasteners); (2) supportive wearables (eg, orthotics, exoskeletons); and (3) smart wearables (eg, with sensors for tracking activity or controlling external devices). For each category, we will provide examples of existing and emerging wearables and potential applications for assessment and intervention with a focus on pediatric populations. We will discuss how these wearables might change task requirements and assist users for immediate effects and how they might be used with intervention activities to change users' abilities across time. It is important for rehabilitation clinicians and researchers to be engaged with the design and use of wearables so they can advocate and create better wearables for their clients and determine how to most effectively use wearables to enhance their assessment, intervention, and research practices.