Design and evaluation of the pneumatic leg prosthesis ERiK to assist elderly amputees with sit-down and stand-up movements.

Standing up using one leg is a challenging task for those with a transfemoral amputation, particularly for elderly users with a low activity level. Active prostheses are generally not accessible to this group and available passive prostheses do not support standing up. This article presents the design and evaluation of the "Energy Restoring Intelligent Knee" (ERiK), which stores energy during sit-down in a pneumatic cylinder and returns it during stand-up. We hypothesized that the system would reduce the time needed to perform transitions and also enable higher load sharing by the prosthetic leg. However, the results of an experimental study with seven participants with transfemoral amputation contradict these hypotheses: the participants could neither move faster nor make more use of the prosthetic leg to share their body weight during transitions. We observed that a major obstacle to the useful functionality of the leg was the absence of ankle dorsiflexion - the foot tended to slip during stand-up initiation, such that only low pre-pressures and therefore support levels could be set. The rather binary action of the pneumatics also complicated movement initiation. The lessons learned from this study may be helpful to those seeking to create better designs in the future.

Prevalence of and Risk Factors for Depression Among Older Persons 6 Months After the Lushan Earthquake in China: A Cross-Sectional Survey.

BACKGROUND: Older persons are particularly vulnerable to the impact of earthquakes and are more likely to suffer from depression. OBJECTIVES: We aimed to estimate the prevalence of depression, to compare the prevalence between disaster-affected and non-disaster affected areas, and to explore additional risk factors for depression 6 months after the Lushan earthquake. DESIGN: A cross-sectional study was conducted. SETTING: A magnitude 7.0 earthquake occurred in Lushan County, Ya'an Prefecture, Sichuan Province, on April 20, 2013. In total, 196 people were killed, and 11,470 were injured over 5 days. PARTICIPANTS: A multistage cluster sampling strategy was used. A total of 1,509 older persons (aged 60 or older) participated. METHODS: The Geriatric Depression Scale-15, the University of California Los Angeles Loneliness scale, the Activities of Daily Living Scale, the Social Support Rating Scale, and the Family Apgar Index scale were used to evaluate symptoms of depression, loneliness, dependence with respect to activities of daily living, perceived social support, and family function, respectively. A generalized linear regression model and multiple logistic regression analysis were employed to identify risk factors for depression. RESULTS: Using a cutoff score of 8, the prevalence of depression was 29.16% in the hardest-hit disaster area, 29.06% in the hard-hit disaster area, 31.61% in the moderately-hit disaster area, 17.94% in the remote non-disaster area, and 12.28% in the neighboring non-disaster area. The prevalence was significantly higher in the disaster areas than in the non-disaster areas. Risk factors for depression included an educational level of elementary school or lower, a greater number of chronic illnesses, feelings of loneliness, limitations in activities of daily living, family dysfunction, and low levels of social support. CONCLUSION: Depression was highly prevalent in elderly survivors and was significantly more prevalent in disaster areas than in non-disaster areas. Psychological interventions and care should focus on older survivors.

Physical function, pain, quality of life and life satisfaction of amputees from the 2008 Sichuan earthquake: A prospective cohort study.

OBJECTIVES: To examine the development and determinants of long-term outcomes for earthquake victims with amputations, including physical function, pain, quality of life and life satisfaction. DESIGN: Prospective cohort study with 2-3 measurement points. SUBJECTS: A total of 72 people who underwent amputations following the 2008 Sichuan Earthquake and resided in Mianzhu County, Sichuan Province, China were enrolled in the study. Of these, 27 people were lost to follow-up. METHODS: Data on pain (visual analogue scale) and physical function (Barthel Index) were collected at 3 measurement points (2009, 2010 and 2012), and data on quality of life (Medical Outcomes Short-Form 36) and life satisfaction (Life Satisfaction Questionnaire-11) were collected at 2 measurement points (2010 and 2012). Data were analysed with mixed effects regression. RESULTS: Pain severity declined significantly and physical function increased by 2012. Quality of life and life satisfaction remained relatively stable between 2010 and 2012, while quality of life was significantly lower than reference values from the general population. Illiteracy and lower extremity amputations were associated with lower quality of life and life satisfaction in several domains. CONCLUSION: While amputees' functioning and pain were improved over time, quality of life and life satisfaction did not change. Illiterate earthquake survivors and those with lower extremity amputations are at particular risk of low quality of life and life satisfaction, and may require additional attention in future earthquake rehabilitation programs.

Impact of a film portrayal of a police officer with spinal cord injury on attitudes towards disability: a media effects experiment.

PURPOSE: The portrayal of disabled people in the media can influence the public's perception of disability in both positive and negative ways. In this article, an experimental before and after design is used to determine the effects of a short film on the attitudes of non-disabled and disabled persons concerning employment and productivity of persons with disabilities. METHOD: Three questions were posed to 480 study participants prior to and following a short film featuring a police officer with paraplegia. Linear mixed models were used to assess the effects of time point and disability status on the responses. RESULTS: The non-disabled participants' ratings of eligibility for employment of a paraplegic man and estimates of the employment rate of disabled people were significantly enhanced following the film. Nevertheless, the film had no significant effects on the ratings given by participants with disabilities in terms of eligibility, employment rate or productivity. CONCLUSIONS: This investigation highlights the potentially important influence of media portrayal and coverage of people with disabilities on attitudes of the public concerning disability. IMPLICATIONS FOR REHABILITATION: Restrictions in participation may result from an interaction of persons with impairments with an environment that is dominated by negative attitudes towards disability The portrayal of disabled people in the media can influence the public's attitudes towards disability in both positive and negative ways In this experimental study, attitudes of the general public were significantly improved following viewing a short film featuring a positive media portrayal of a police officer with paraplegia.

A novel body weight support system extension: initial concept and simulation study.

Body weight supported treadmill training is an approach to gait rehabilitation following a stroke or spinal cord injury. Although lateral control of balance is an important aspect of walking, many of the currently available body weight support systems have a fixed pulley configuration which can lead to lateral forces being developed in the supporting cables, interfering with the lateral balance task. In this paper, a novel extension for body weight support systems, used for treadmill walking, is presented which features a system of pulleys and trolleys. A model is developed for the device along with a basic feedback controller in order to enable simulation of the concept. The lateral forces induced by the novel system are greatly reduced in comparison to a fixed pulley system. This device has applications in balance training within gait rehabilitation programs.

A preliminary study into the effects of pelvic rotations on upper body lateral translation.

An understanding concerning the roles of the various degrees of freedom of the human body during functions such as walking is crucial to the design of robotic devices for rehabilitation. However, the function of the three rotational degrees of freedom of the pelvis during walking remains uncertain. Theories have been previously presented postulating a role of pelvic obliquity in reducing vertical movements of the body's centre of mass, and therefore in minimising energy expenditure, but these are not fully supported by empirical evidence. In this paper, an alterative role of pelvic obliquity in reducing lateral movements of the upper body is proposed. Through the application of a robotic orthosis platform, a variety of walking conditions are tested with different levels of pelvic rotation and lateral movement of the upper body. The presence of the robotic device significantly reduces the degree of pelvic obliquity. Though the data show no significant relationship between the pelvic angles and lateral movement, a trend for decreasing upper body movement with increasing pelvic obliquity is apparent.

Towards more effective robotic gait training for stroke rehabilitation: a review.

BACKGROUND: Stroke is the most common cause of disability in the developed world and can severely degrade walking function. Robot-driven gait therapy can provide assistance to patients during training and offers a number of advantages over other forms of therapy. These potential benefits do not, however, seem to have been fully realised as of yet in clinical practice. OBJECTIVES: This review determines ways in which robot-driven gait technology could be improved in order to achieve better outcomes in gait rehabilitation. METHODS: The literature on gait impairments caused by stroke is reviewed, followed by research detailing the different pathways to recovery. The outcomes of clinical trials investigating robot-driven gait therapy are then examined. Finally, an analysis of the literature focused on the technical features of the robot-based devices is presented. This review thus combines both clinical and technical aspects in order to determine the routes by which robot-driven gait therapy could be further developed. CONCLUSIONS: Active subject participation in robot-driven gait therapy is vital to many of the potential recovery pathways and is therefore an important feature of gait training. Higher levels of subject participation and challenge could be promoted through designs with a high emphasis on robotic transparency and sufficient degrees of freedom to allow other aspects of gait such as balance to be incorporated.

Effects of added inertia and body weight support on lateral balance control during walking.

A robot-driven gait orthosis which allows balance training during gait would further enhance the capabilities of robotic treadmill training in gait rehabilitation. In this paper, additional mass is attached to walking able-bodied subjects to simulate the effects of additional inertia and body weight support on the lateral balance task. The combination of additional inertia and body weight support led to reduced step widths, suggesting a stabilising effect which may reduce the challenge of the lateral balance task.