Physical Therapists' Acceptance of a Wearable, Fabric-Based Sensor System (Motion Tape) for Use in Clinical Practice: Qualitative Focus Group Study.

BACKGROUND: Low back pain (LBP) is a costly global health condition that affects individuals of all ages and genders. Physical therapy (PT) is a commonly used and effective intervention for the management of LBP and incorporates movement assessment and therapeutic exercise. A newly developed wearable, fabric-based sensor system, Motion Tape, uses novel sensing and data modeling to measure lumbar spine movements unobtrusively and thus offers potential benefits when used in conjunction with PT. However, physical therapists' acceptance of Motion Tape remains unexplored. OBJECTIVE: The primary aim of this research study was to evaluate physical therapists' acceptance of Motion Tape to be used for the management of LBP. The secondary aim was to explore physical therapists' recommendations for future device development. METHODS: Licensed physical therapists from the American Physical Therapy Association Academy of Leadership Technology Special Interest Group participated in this study. Overall, 2 focus groups (FGs; N=8) were conducted, in which participants were presented with Motion Tape samples and examples of app data output on a poster. Informed by the Technology Acceptance Model, we conducted semistructured FGs and explored the wearability, usefulness, and ease of use of and suggestions for improvements in Motion Tape for PT management of LBP. FG data were transcribed and analyzed using rapid qualitative analysis. RESULTS: Regarding wearability, participants perceived that Motion Tape would be able to adhere for several days, with some variability owing to external factors. Feedback was positive for the low-profile and universal fit, but discomfort owing to wires and potential friction with clothing was of concern. Other concerns included difficulty with self-application and potential skin sensitivity. Regarding usefulness, participants expressed that Motion Tape would enhance the efficiency and specificity of assessments and treatment. Regarding ease of use, participants stated that the app would be easy, but data management and challenges with interpretation were of concern. Physical therapists provided several recommendations for future design improvements including having a wireless system or removable wires, customizable sizes for the tape, and output including range of motion data and summary graphs and adding app features that consider patient input and context. CONCLUSIONS: Several themes related to Motion Tape's wearability, usefulness, and ease of use were identified. Overall, physical therapists expressed acceptance of Motion Tape's potential for assessing and monitoring low back posture and movement, both within and outside clinical settings. Participants expressed that Motion Tape would be a valuable tool for the personalized treatment of LBP but highlighted several future improvements needed for Motion Tape to be used in practice.

Endotracheal tube forces exerted on the larynx and a novel support device to reduce it.

Objective: Endotracheal tubes (ETTs) are commonly associated with laryngeal injury that may be short lasting and temporary or more severe and life altering. Injury is believed to result from forces that these ETTs exert on the larynx. Here we quantify the forces of ETTs of various sizes on the laryngotracheal complex to gain a more quantitative understanding of these potential damaging forces. Here we also perform preclinical testing of a novel support device to offload these forces. Methods: Endotracheal intubation was performed on a fresh human cadaver using various ETT sizes. A strain-sensitive graphene nanosheet sensor and a commercially available force sensing resistor were secured behind the larynx, anterior to the prevertebral fascia. The forces exerted on the larynx were measured for each of the commonly used ETTs. A novel support device, ETT clip (Endo Clip), was attached to the ETTs and changes in these forces were observed. Results: Forces exerted on the laryngotracheal complex by various ETTs were observed to increase with increasing tube size. This pressure can be significantly reduced with a novel ETT clip. Conclusion: Here we demonstrate the first quantitative measurement of forces that ETTs exert on the larynx. We demonstrate a novel device that can easily clip onto an ETT reducing pressure on the laryngotracheal complex. This preclinical test paves the way for a human clinical trial. Level of evidence: 5.

Multi-Defect Detection in Additively Manufactured Lattice Structures Using 3D Electrical Resistance Tomography.

Cellular lattice structures possess high strength-to-weight ratios suitable for advanced lightweight engineering applications. However, their quality and mechanical performance can degrade because of defects introduced during manufacturing or in-service. Their complexity and small length scale features make defects difficult to detect using conventional nondestructive evaluation methods. Here we propose a current injection-based method, electrical resistance tomography (ERT), that can be used to detect damaged struts in conductive cellular lattice structures with their intrinsic electromechanical properties. The reconstructed conductivity distributions from ERT can reveal the severity and location of damaged struts without having to probe each strut. However, the low central sensitivity of ERT may result in image artifacts and inaccurate localization of damaged struts. To address this issue, this study introduces an absolute, high throughput, conductivity reconstruction algorithm for 3D ERT. The algorithm incorporates a strut-based normalized sensitivity map to compensate for lower interior sensitivity and suppresses reconstruction artifacts. Numerical simulations and experiments on fabricated representative cellular lattice structures were performed to verify the ability of ERT to quantitatively identify single and multiple damaged struts. The improved performance of this method compared with classical ERT was observed, based on greatly decreased imaging and reconstructed value errors.

Muscle Engagement Monitoring Using Self-Adhesive Elastic Nanocomposite Fabrics.

Insight into, and measurements of, muscle contraction during movement may help improve the assessment of muscle function, quantification of athletic performance, and understanding of muscle behavior, prior to and during rehabilitation following neuromusculoskeletal injury. A self-adhesive, elastic fabric, nanocomposite, skin-strain sensor was developed and validated for human movement monitoring. We hypothesized that skin-strain measurements from these wearables would reveal different degrees of muscle engagement during functional movements. To test this hypothesis, the strain sensing properties of the elastic fabric sensors, especially their linearity, stability, repeatability, and sensitivity, were first verified using load frame tests. Human subject tests conducted in parallel with optical motion capture confirmed that they can reliably measure tensile and compressive skin-strains across the calf and tibialis anterior. Then, a pilot study was conducted to assess the correlation of skin-strain measurements with surface electromyography (sEMG) signals. Subjects did biceps curls with different weights, and the responses of the elastic fabric sensors worn over the biceps brachii and flexor carpi radialis (i.e., forearm) were well-correlated with sEMG muscle engagement measures. These nanocomposite fabric sensors were validated for monitoring muscle engagement during functional activities and did not suffer from the motion artifacts typically observed when using sEMGs in free-living community settings.

A Feature-Encoded Physics-Informed Parameter Identification Neural Network for Musculoskeletal Systems.

Identification of muscle-tendon force generation properties and muscle activities from physiological measurements, e.g., motion data and raw surface electromyography (sEMG), offers opportunities to construct a subject-specific musculoskeletal (MSK) digital twin system for health condition assessment and motion prediction. While machine learning approaches with capabilities in extracting complex features and patterns from a large amount of data have been applied to motion prediction given sEMG signals, the learned data-driven mapping is black-box and may not satisfy the underlying physics and has reduced generality. In this work, we propose a feature-encoded physics-informed parameter identification neural network (FEPI-PINN) for simultaneous prediction of motion and parameter identification of human MSK systems. In this approach, features of high-dimensional noisy sEMG signals are projected onto a low-dimensional noise-filtered embedding space for the enhancement of forwarding dynamics prediction. This FEPI-PINN model can be trained to relate sEMG signals to joint motion and simultaneously identify key MSK parameters. The numerical examples demonstrate that the proposed framework can effectively identify subject-specific muscle parameters and the trained physics-informed forward-dynamics surrogate yields accurate motion predictions of elbow flexion-extension motion that are in good agreement with the measured joint motion data.

Topological design of strain sensing nanocomposites.

High-performance piezoresistive nanocomposites have attracted extensive attention because of their significant potential as next-generation sensing devices for a broad range of applications, such as monitoring structural integrity and human performance. While various piezoresistive nanocomposites have been successfully developed using different material compositions and manufacturing techniques, current development procedures typically involve empirical trial and error that can be laborious, inefficient, and, most importantly, unpredictable. Therefore, this paper proposed and validated a topological design-based methodology to strategically manipulate the piezoresistive effect of nanocomposites to achieve a wide range of strain sensitivities without changing the material system. In particular, patterned nanocomposite thin films with stress-concentrating and stress-releasing topologies were designed. The strain sensing properties of the different topology nanocomposites were characterized and compared via electromechanical experiments. Those results were compared to both linear and nonlinear piezoresistive material model numerical simulations. Both the experimental and simulation results indicated that the stress-concentrating topologies could enhance strain sensitivity, whereas the stress-releasing topologies could significantly suppress bulk film piezoresistivity.

Ankle sprain bracing solutions and future design consideration for civilian and military use.

INTRODUCTION: Ankle sprains are common injuries within the civilian and military populations, with lingering symptoms that include pain, swelling, giving-way, and a high likelihood for recurrence. Numerous bracing systems are available to stabilize the ankle joint following sprains, with new design iterations frequently entering the market. Currently available braces generally include sleeve, lace-up, and stirrup designs. Sleeves provide mild compression and warmth but limited stability for the ankle, while lace-ups and stirrups appear to be more effective at preventing and treating lateral ankle sprains. AREAS COVERED: This review summarizes the use of various brace options in practice. Their major clinical benefits, and limitations are highlighted, followed by an overview of emerging concepts in brace design. Current advancements in biomechanical simulation, multifunctional material fabrication, and wearable, field-deployed devices for human injury surveillance are discussed, providing possibilities for conceiving new design concepts for next-generation smart ankle braces. EXPERT OPINION: Performance of the commercially available braces are limited by their current design concepts. Suggestions on future brace design include: (1) incorporating high-performance materials suitable for extreme environments, (2) leveraging modeling and simulation techniques to predict mechanical support requirements, and (3) implementing adaptive, customizable componentry material to meet the needs of each unique patient.

Distributed Strain Monitoring Using Nanocomposite Paint Sensing Meshes.

Strain measurements are vital for monitoring the load-bearing capacity and safety of structures. A common approach is to affix strain gages onto structural surfaces. On the other hand, most aerospace, automotive, civil, and mechanical structures are painted and coated, often with many layers, prior to their deployment. There is an opportunity to design smart and multifunctional paints that can be directly pre-applied onto structural surfaces to serve as a sensing layer among their other layers of functional paints. Therefore, the objective of this study was to design a strain-sensitive paint that can be used for structural monitoring. Carbon nanotubes (CNT) were dispersed in paint by high-speed shear mixing, while paint thinner was employed for adjusting the formulation's viscosity and nanomaterial concentration. The study started with the design and fabrication of the CNT-based paint. Then, the nanocomposite paint's electromechanical properties and its sensitivity to applied strains were characterized. Third, the nanocomposite paint was spray-coated onto patterned substrates to form "Sensing Meshes" for distributed strain monitoring. An electrical resistance tomography (ERT) measurement strategy and algorithm were utilized for reconstructing the conductivity distribution of the Sensing Meshes, where the magnitude of conductivity (or resistivity) corresponded to the magnitude of strain, while strain directionality was determined based on the strut direction in the mesh.

Atomization Control to Improve Soft Actuation Through Vaporization.

Soft actuation through droplet evaporation has significantly improved the actuation speed of methods that utilize liquid vaporization. Instead of boiling bulk liquid, this method implements atomization to disperse small droplets into a heater. Due to the large surface area of the droplets, the liquid evaporates much faster even at small temperature changes. However, further analysis is required to maximize the performance of this complex multi-physics method. This study was conducted to provide further insight into the atomizer and how it affects actuation. Numerical simulations were used to inspect the vibration modes and determine how frequency and voltage affect the atomization process. These results were used to experimentally control the atomizer, and the droplet growth on the heater surface was analyzed to study the evaporation process. A cuboid structure was inflated with the actuator to demonstrate its performance. The results show that simply maximizing the atomization rate creates large droplets on the surface of the heater, which slows down the vaporization process. Thus, an optimal atomization rate should be determined for ideal performance.

Rapid Soft Material Actuation Through Droplet Evaporation.

Soft material actuation is a promising field that can potentially solve several limitations of traditional robotic systems. These systems comprise soft and flexible materials to achieve high degrees of freedom and compliance with their surroundings. One method to actuate such structures is to vaporize liquid that is embedded inside the soft material. The soft elastomers are inflated since the generated vapor occupies a much larger volume after phase transformation. The simplest and widely used design to vaporize such liquids is installing a heating element near the liquid. Heating the system beyond the boiling point rapidly boils the liquid and deforms the structure. However, this technique possesses several limitations, such as the heating element must be in the liquid's vicinity, and boiling the liquid requires high temperatures. In addition, embedding a small amount of liquid for faster boiling prevents the use of valves to exhaust the vapor. Instead, the structure is slowly cooled until it returns to its original position. In this study, these limitations are addressed by combining heating with vibrating mesh atomization. The atomizer disperses the liquid into small droplets, which vaporize much faster as compared with simply heating the bulk liquid. Actuation through vibrating mesh atomization was first characterized and compared with other techniques. Then, the introduced method was used to demonstrate cyclic actuation, and a bistable structure was designed and fabricated to demonstrate gripping motion.

Laboratory Evaluation of Railroad Crosslevel Tilt Sensing Using Electrical Time Domain Reflectometry.

Crosslevel is defined as the difference in elevation between the top surface of two railroad tracks. Severe changes in crosslevel, for example, due to earthquakes, ground settlement, or crushed ballasts, affect track geometry and can cause train derailment. Therefore, the objective of this study was to monitoring railroad crosslevel by using electrical time domain reflectometry (ETDR) to simultaneously interrogate multiple capacitive tilt sensor prototypes connected in a transmission line. ETDR works by propagating an electrical pulse signal from one end of the transmission line and then monitoring the characteristics of each reflected pulse, which is affected by the capacitance (or tilt) of the sensors. This study begins with a discussion of the capacitive tilt sensor's design. These 3D-printed sensors were tested to characterize their tilt sensing performance. Then, multiple tilt sensors were connected in a transmission line and interrogated by ETDR. The ability to use ETDR to multiplex and interrogate sensors subjected to different angles of tilt was validated.

Sensing and actuation technologies for smart socket prostheses.

The socket is the most critical part of every lower-limb prosthetic system, since it serves as the interfacial component that connects the residual limb with the artificial system. However, many amputees abandon their socket prostheses due to the high-level of discomfort caused by the poor interaction between the socket and residual limb. In general, socket prosthesis performance is determined by three main factors, namely, residual limb-socket interfacial stress, volume fluctuation of the residual limb, and temperature. This review paper summarizes the various sensing and actuation solutions that have been proposed for improving socket performance and for realizing next-generation socket prostheses. The working principles of different sensors and how they have been tested or used for monitoring the socket interface are discussed. Furthermore, various actuation methods that have been proposed for actively modifying and improving the socket interface are also reviewed. Through the continued development and integration of these sensing and actuation technologies, the long-term vision is to realize smart socket prostheses. Such smart socket systems will not only function as a socket prosthesis but will also be able to sense parameters that cause amputee discomfort and self-adjust to optimize its fit, function, and performance.

Bio-Inspired Active Skins for Surface Morphing.

Mechanical metamaterials that leverage precise geometrical designs and imperfections to induce unique material behavior have garnered significant attention. This study proposes a Bio-Inspired Active Skin (BIAS) as a new class of instability-induced morphable structures, where selective out-of-plane material deformations can be pre-programmed during design and activated by in-plane strains. The deformation mechanism of a unit cell geometrical design is analyzed to identify how the introduction of hinge-like notches or instabilities, versus their pristine counterparts, can pave way for controlling bulk BIAS behavior. Two-dimensional arrays of repeating unit cells were fabricated, with notches implemented at key locations throughout the structure, to harvest the instability-induced surface features for applications such as camouflage, surface morphing, and soft robotic grippers.

Role of indentation depth and contact area on human perception of softness for haptic interfaces.

In engineering, the "softness" of an object, as measured by an indenter, manifests as two measurable parameters: (i) indentation depth and (ii) contact area. For humans, softness is not well defined, although it is believed that perception depends on the same two parameters. Decoupling their relative contributions, however, has not been straightforward because most bulk-"off-the-shelf"-materials exhibit the same ratio between the indentation depth and contact area. Here, we decoupled indentation depth and contact area by fabricating elastomeric slabs with precise thicknesses and microstructured surfaces. Human subject experiments using two-alternative forced-choice and magnitude estimation tests showed that the indentation depth and contact area contributed independently to perceived softness. We found an explicit relationship between the perceived softness of an object and its geometric properties. Using this approach, it is possible to design objects for human interaction with a desired level of perceived softness.

Field responsive mechanical metamaterials.

Typically, mechanical metamaterial properties are programmed and set when the architecture is designed and constructed, and do not change in response to shifting environmental conditions or application requirements. We present a new class of architected materials called field responsive mechanical metamaterials (FRMMs) that exhibit dynamic control and on-the-fly tunability enabled by careful design and selection of both material composition and architecture. To demonstrate the FRMM concept, we print complex structures composed of polymeric tubes infilled with magnetorheological fluid suspensions. Modulating remotely applied magnetic fields results in rapid, reversible, and sizable changes of the effective stiffness of our metamaterial motifs.

Noncontact Strain Monitoring of Osseointegrated Prostheses.

The objective of this study was to develop a noncontact, noninvasive, imaging system for monitoring the strain and deformation states of osseointegrated prostheses. The proposed sensing methodology comprised of two parts. First, a passive thin film was designed such that its electrical permittivity increases in tandem with applied tensile loading and decreases while unloading. It was found that patterning the thin films could enhance their dielectric property's sensitivity to strain. The film can be deposited onto prosthesis surfaces as an external coating prior to implant. Second, an electrical capacitance tomography (ECT) measurement technique and reconstruction algorithm were implemented to capture strain-induced changes in the dielectric property of nanocomposite-coated prosthesis phantoms when subjected to different loading scenarios. The preliminary results showed that ECT, when coupled with strain-sensitive nanocomposites, could quantify the strain-induced changes in the dielectric property of thin film-coated prosthesis phantoms. The results suggested that ECT coupled with embedded thin films could serve as a new noncontact strain sensing method for scenarios when tethered strain sensors cannot be used or instrumented, especially in the case of osseointegrated prostheses.

Micro-patterned graphene-based sensing skins for human physiological monitoring.

Ultrathin, flexible, conformal, and skin-like electronic transducers are emerging as promising candidates for noninvasive and nonintrusive human health monitoring. In this work, a wearable sensing membrane is developed by patterning a graphene-based solution onto ultrathin medical tape, which can then be attached to the skin for monitoring human physiological parameters and physical activity. Here, the sensor is validated for monitoring finger bending/movements and for recognizing hand motion patterns, thereby demonstrating its future potential for evaluating athletic performance, physical therapy, and designing next-generation human-machine interfaces. Furthermore, this study also quantifies the sensor's ability to monitor eye blinking and radial pulse in real-time, which can find broader applications for the healthcare sector. Overall, the printed graphene-based sensing skin is highly conformable, flexible, lightweight, nonintrusive, mechanically robust, and is characterized by high strain sensitivity.

Monitoring osseointegrated prosthesis loosening and fracture using electrical capacitance tomography.

A noncontact, noninvasive, electrical permittivity imaging technique is proposed for monitoring loosening of osseointegrated prostheses and bone fracture. The proposed method utilizes electrical capacitance tomography (ECT), which employs a set of noncontact electrodes, arranged in a circular fashion around the imaging area, for electrical excitations and measurements. An inverse reconstruction algorithm was developed and implemented to reconstruct the electrical permittivity distribution of the interrogated region from boundary capacitance measurements. In this study, osseointegrated prosthesis phantoms were prepared using plastic rods and Sawbone femur specimens, which were subjected to prosthesis loosening and fracture monitoring tests. The results demonstrated that the spatial location and extent of prosthesis loosening and bone fracture could be estimated from the ECT reconstructed permittivity maps. The resolution of the reconstructed images was further enhanced by a limited region tomography algorithm, and its accuracy in terms of identifying the severity, location, and shape of bone fracture was also investigated and compared with conventional full region tomography.

Characterizing the Conductivity and Enhancing the Piezoresistivity of Carbon Nanotube-Polymeric Thin Films.

The concept of lightweight design is widely employed for designing and constructing aerospace structures that can sustain extreme loads while also being fuel-efficient. Popular lightweight materials such as aluminum alloy and fiber-reinforced polymers (FRPs) possess outstanding mechanical properties, but their structural integrity requires constant assessment to ensure structural safety. Next-generation structural health monitoring systems for aerospace structures should be lightweight and integrated with the structure itself. In this study, a multi-walled carbon nanotube (MWCNT)-based polymer paint was developed to detect distributed damage in lightweight structures. The thin film's electromechanical properties were characterized via cyclic loading tests. Moreover, the thin film's bulk conductivity was characterized by finite element modeling.