Using a Sniff Controller to Self-Trigger Abdominal Functional Electrical Stimulation for Assisted Coughing Following Cervical Spinal Cord Lesions

Discernment on assistive technology for the care and support requirements of older adults and differently-abled individuals

Assistive technology for the differently abled and older adults has made remarkable achievements in providing rehabilitative, adaptive, and assistive devices. It provides huge assistance for people with physical impairments to lead a better self-reliant daily life, in terms of mobility, education, rehabilitation, etc. This technology ranges from simple hand-held devices to complex robotic accessories which promote the individual's independence. This study aimed at identifying the assistance required by differently-abled individuals, and the solutions proposed by different researchers, and reviewed their merits and demerits. It provides a detailed discussion on the state of art assistive technologies, their applications, challenges, types, and their usage for rehabilitation. The study also identifies different unexplored research areas related to assistive technology that can improve the daily life of individuals and advance the field. Despite their high usage, assistive technologies have some limitations which have been briefly described in the study. This review, therefore, can help understand the utilization, and pros and cons of assistive devices in rehabilitation engineering and assistive technologies.

Soft Exoskeleton Mimics Human Cough for Assisting the Expectoration Capability of SCI Patients

OBJECTIVE

This paper describes the design of a bionic soft exoskeleton and demonstrates its feasibility for assisting the expectoration function rehabilitation of patients with spinal cord injury (SCI).

METHODS

A human-robot coupling respiratory mechanic model is established to mimic human cough, and a synergic inspire-expire assistance strategy is proposed to maximize the peak expiratory flow (PEF), the key metric for promoting cough intensity. The negative pressure module of the exoskeleton is a soft "iron lung" using layer-jamming actuation. It assists inspiration by increasing insufflation to mimic diaphragm and intercostal muscle contraction. The positive pressure module exploits soft origami actuators for assistive expiration; it pressures human abdomen and bionically "pushes" the diaphragm upward.

RESULTS

The maximum increase in PEF ratios for mannequins, healthy participants, and patients with SCI with robotic assistance were 57.67%, 278.10%, and 124.47%, respectively. The soft exoskeleton assisted one tetraplegic SCI patient to cough up phlegm successfully.

CONCLUSION

The experimental results suggest that the proposed soft exoskeleton is promising for assisting the expectoration ability of SCI patients in everyday life scenarios.

SIGNIFICANCE

The proposed soft exoskeleton is promising for advancing the application field of rehabilitation exoskeletons from motor functions to respiratory functions.

Olfactory sniffing signals consciousness in unresponsive patients with brain injuries

After severe brain injury, it can be difficult to determine the state of consciousness of a patient, to determine whether the patient is unresponsive or perhaps minimally conscious¹, and to predict whether they will recover. These diagnoses and prognoses are crucial, as they determine therapeutic strategies such as pain management, and can underlie end-of-life decisions^2,3. Nevertheless, there is an error rate of up to 40% in determining the state of consciousness in patients with brain injuries^4,5. Olfaction relies on brain structures that are involved in the basic mechanisms of arousal⁶, and we therefore hypothesized that it may serve as a biomarker for consciousness⁷. Here we use a non-verbal non-task-dependent measure known as the sniff response^8-11 to determine consciousness in patients with brain injuries. By measuring odorant-dependent sniffing, we gain a sensitive measure of olfactory function^10-15. We measured the sniff response repeatedly over time in patients with severe brain injuries and found that sniff responses significantly discriminated between unresponsive and minimally conscious states at the group level. Notably, at the single-patient level, if an unresponsive patient had a sniff response, this assured future regaining of consciousness. In addition, olfactory sniff responses were associated with long-term survival rates. These results highlight the importance of olfaction in human brain function, and provide an accessible tool that signals consciousness and recovery in patients with brain injuries.