PARTICIPATORY DESIGN OF PEDIATRIC UPPER LIMB PROSTHESES: QUALITATIVE METHODS AND PROTOTYPING.

OBJECTIVES: The study aims to develop an understanding of the views of children and adolescents, parents, and professionals on upper limb prosthetic devices to develop and improve device design. Previous research has found that children are dissatisfied with prostheses but has relied heavily on parent proxy reports and quantitative measures (such as questionnaires) to explore their views. METHODS: Thirty-four participants (eight children aged 8-15 years with upper limb difference, nine parents, eight prosthetists, and nine occupational therapists) contributed to the development of new devices through the BRIDGE methodology of participatory design, using focus groups and interviews. RESULTS: The study identified areas for improving prostheses from the perspective of children and adolescents, developed prototypes based on these and gained feedback on the prototypes from the children and other stakeholders (parents and professionals) of paediatric upper limb prostheses. Future device development needs to focus on ease of use, versatility, appearance, and safety. CONCLUSIONS: This study has demonstrated that children and adolescents can and should be involved as equal partners in the development of daily living equipment and that rapid prototyping (three-dimensional printing or additive manufacturing), used within a participatory design framework, can be a useful tool for facilitating this.

Detecting Elementary Arm Movements by Tracking Upper Limb Joint Angles With MARG Sensors.

This paper reports an algorithm for the detection of three elementary upper limb movements, i.e., reach and retrieve, bend the arm at the elbow and rotation of the arm about the long axis. We employ two MARG sensors, attached at the elbow and wrist, from which the kinematic properties (joint angles, position) of the upper arm and forearm are calculated through data fusion using a quaternion-based gradient-descent method and a two-link model of the upper limb. By studying the kinematic patterns of the three movements on a small dataset, we derive discriminative features that are indicative of each movement; these are then used to formulate the proposed detection algorithm. Our novel approach of employing the joint angles and position to discriminate the three fundamental movements was evaluated in a series of experiments with 22 volunteers who participated in the study: 18 healthy subjects and four stroke survivors. In a controlled experiment, each volunteer was instructed to perform each movement a number of times. This was complimented by a seminaturalistic experiment where the volunteers performed the same movements as subtasks of an activity that emulated the preparation of a cup of tea. In the stroke survivors group, the overall detection accuracy for all three movements was 93.75% and 83.00%, for the controlled and seminaturalistic experiment, respectively. The performance was higher in the healthy group where 96.85% of the tasks in the controlled experiment and 89.69% in the seminaturalistic were detected correctly. Finally, the detection ratio remains close ( ±6%) to the average value, for different task durations further attesting to the algorithms robustness.

Effect of Trunk Support on Upper Extremity Function in People With Chronic Stroke and People Who Are Healthy.

BACKGROUND: Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption in neurorehabilitation has not been validated in clinical trials. OBJECTIVE: The study objectives were to investigate the effect of providing external trunk support on trunk control and UE function and to examine the relationship between trunk control and UE function in people with chronic stroke and people who were healthy. DESIGN: A cross-sectional study was conducted. METHODS: Twenty-five people with chronic stroke and 34 people who were healthy and matched for age and sex were recruited. Trunk control was assessed with the Trunk Impairment Scale (TIS), and UE impairment and UE function were assessed with the UE subsection of the Fugl-Meyer Assessment (FMA-UE) and the Streamlined Wolf Motor Function Test (SWMFT), respectively. The TIS and SWMFT were evaluated, with and without external trunk support; the FMA-UE was evaluated without trunk support. RESULTS: With trunk support, people with stroke showed improvement from 18 to 20 points on the TIS, a reduction in SWMFT performance times from 37.20 seconds to 35.37 seconds for the affected UE, and improvement from 3.3 points to 3.4 points on the SWMFT Functional Ability Scale for the function of the affected UE. With trunk support, the SWMFT performance time for people who were healthy was reduced from 1.61 seconds to 1.48 seconds for the dominant UE and from 1.71 seconds to 1.59 seconds for the nondominant UE. A significant moderate correlation was found between the TIS and the FMA-UE (r=.53) for people with stroke. LIMITATIONS: The limitations included a nonmasked assessor and a standardized height of the external trunk support. CONCLUSIONS: External trunk support improved trunk control in people with chronic stroke and had a statistically significant effect on UE function in both people with chronic stroke and people who were healthy. The findings suggest an association between trunk control and the UE when external trunk support was provided and support the hypothesis that lower trunk and lumbar stabilization provided by external support enables an improvement in the ability to use the UE for functional activities.

Surface texture detection with artificial fingers.

This paper highlights the potential of using prosthetic devices to sense surface textures; an important characteristic of a lower arm that is often neglected. An artificial finger equipped with a piezoelectric sensor, mounted on a fingertip, has been designed to detect surface textures of different dimensions. Signal frequencies generated during the exploratory movement of the artificial finger reliably correlate to all the widths of grooves and ridges of the surface textures under investigation. This capability provides a positive outlook in recreating a touch sensation that has been previously lost from natural fingers and palms.

Recognizing upper limb movements with wrist worn inertial sensors using k-means clustering classification.

In this paper we present a methodology for recognizing three fundamental movements of the human forearm (extension, flexion and rotation) using pattern recognition applied to the data from a single wrist-worn, inertial sensor. We propose that this technique could be used as a clinical tool to assess rehabilitation progress in neurodegenerative pathologies such as stroke or cerebral palsy by tracking the number of times a patient performs specific arm movements (e.g. prescribed exercises) with their paretic arm throughout the day. We demonstrate this with healthy subjects and stroke patients in a simple proof of concept study in which these arm movements are detected during an archetypal activity of daily-living (ADL) - 'making-a-cup-of-tea'. Data is collected from a tri-axial accelerometer and a tri-axial gyroscope located proximal to the wrist. In a training phase, movements are initially performed in a controlled environment which are represented by a ranked set of 30 time-domain features. Using a sequential forward selection technique, for each set of feature combinations three clusters are formed using k-means clustering followed by 10 runs of 10-fold cross validation on the training data to determine the best feature combinations. For the testing phase, movements performed during the ADL are associated with each cluster label using a minimum distance classifier in a multi-dimensional feature space, comprised of the best ranked features, using Euclidean or Mahalanobis distance as the metric. Experiments were performed with four healthy subjects and four stroke survivors and our results show that the proposed methodology can detect the three movements performed during the ADL with an overall average accuracy of 88% using the accelerometer data and 83% using the gyroscope data across all healthy subjects and arm movement types. The average accuracy across all stroke survivors was 70% using accelerometer data and 66% using gyroscope data. We also use a Linear Discriminant Analysis (LDA) classifier and a Support Vector Machine (SVM) classifier in association with the same set of features to detect the three arm movements and compare the results to demonstrate the effectiveness of our proposed methodology.

Recognition of elementary arm movements using orientation of a tri-axial accelerometer located near the wrist.

In this paper we present a method for recognising three fundamental movements of the human arm (reach and retrieve, lift cup to mouth, rotation of the arm) by determining the orientation of a tri-axial accelerometer located near the wrist. Our objective is to detect the occurrence of such movements performed with the impaired arm of a stroke patient during normal daily activities as a means to assess their rehabilitation. The method relies on accurately mapping transitions of predefined, standard orientations of the accelerometer to corresponding elementary arm movements. To evaluate the technique, kinematic data was collected from four healthy subjects and four stroke patients as they performed a number of activities involved in a representative activity of daily living, 'making-a-cup-of-tea'. Our experimental results show that the proposed method can independently recognise all three of the elementary upper limb movements investigated with accuracies in the range 91-99% for healthy subjects and 70-85% for stroke patients.

Characterisation of Crevice and Pit Solution Chemistries Using Capillary Electrophoresis with Contactless Conductivity Detector.

The ability to predict structural degradation in-service is often limited by a lack of understanding of the evolving chemical species occurring within a range of different microenvironments associated with corrosion sites. Capillary electrophoresis (CE) is capable of analysing nanolitre solution volumes with widely disparate concentrations of ionic species, thereby producing accurate and reliable results for the analysis of the chemical compositions found within microenvironment corrosion solutions, such as those found at crevice and pit corrosion sites. In this study, CE with contactless conductivity detection (CCD) has been used to characterize pitting and crevice corrosion solution chemistries for the first time. By using the capillary electrophoresis with contactless conductivity detection (CE-CCD) system, direct and simultaneous detection of seven metal cations (Cu2+, Ni2+, Fe3+, Fe2+, Cr3+, Mn2+, and Al3+) and chloride anions was achieved with a buffer solution of 10 mM 2,6-pyridinedicarboxylic acid and 0.5 mM cetyltrimethylammonium hydroxide at pH 4 using a pre-column complexation method. The detection limits obtained for the metal cations and chloride anions were 100 and 10 ppb, respectively. The CE-CCD methodology has been demonstrated to be a versatile technique capable of speciation and quantifying the ionic species generated within artificial pit (a pencil electrode) and crevice corrosion geometries for carbon steels and nickel-aluminium bronze, thus allowing the evolution of the solution chemistry to be assessed with time and the identification of the key corrosion analyte targets for structural health monitoring.

Mode-switching: a new technique for electronically varying the agglomeration position in an acoustic particle manipulator.

Acoustic radiation forces offer a means of manipulating particles within a fluid. Much interest in recent years has focussed on the use of radiation forces in microfluidic (or "lab on a chip") devices. Such devices are well matched to the use of ultrasonic standing waves in which the resonant dimensions of the chamber are smaller than the ultrasonic wavelength in use. However, such devices have typically been limited to moving particles to one or two predetermined planes, whose positions are determined by acoustic pressure nodes/anti-nodes set up in the ultrasonic standing wave. In most cases devices have been designed to move particles to either the centre or (more recently) the side of a flow channel using ultrasonic frequencies that produce a half or quarter wavelength over the channel, respectively. It is demonstrated here that by rapidly switching back and forth between half and quarter wavelength frequencies - mode-switching - a new agglomeration position is established that permits beads to be brought to any arbitrary point between the half and quarter-wave nodes. This new agglomeration position is effectively a position of stable equilibrium. This has many potential applications, particularly in cell sorting and manipulation. It should also enable precise control of agglomeration position to be maintained regardless of manufacturing tolerances, temperature variations, fluid medium characteristics and particle concentration.

Sensory motor systems of artificial and natural hands.

The surgeon Ambroise Paré designed an anthropomorphic hand for wounded soldiers in the 16th century. Since that time, there have been advances in technology through the use of computer-aided design, modern materials, electronic controllers and sensors to realise artificial hands which have good functionality and reliability. Data from touch, object slip, finger position and temperature sensors, mounted in the fingers and on the palm, can be used in feedback loops to automatically hold objects. A study of the natural neuromuscular systems reveals a complexity which can only in part be realised today with technology. Highlights of the parallels and differences between natural and artificial hands are discussed with reference to the Southampton Hand. The anatomical structure of parts of the natural systems can be made artificially such as the antagonist muscles using tendons. Theses solutions look promising as they are based on the natural form but in practice lack the desired physical specification. However, concepts of the lower spinal loops can be mimicked in principle. Some future devices will require greater skills from the surgeon to create the interface between the natural system and an artificial device. Such developments may offer a more natural control with ease of use for the limb deficient person.