The lived experiences of play and the perspectives of disabled children and their parents surrounding brain-computer interfaces.

Brain-computer interfaces (BCI) offer promise to the play of children with significant physical impairments, as BCI technology can enable disabled children to control computer devices, toys, and robots using only their brain signals. However, there is little research on the unique needs of disabled children when it comes to BCI-enabled play. Thus, this paper explored the lived experiences of play for children with significant physical impairments and examined how BCI could potentially be implemented into disabled children's play experiences by applying a social model of childhood disability. Descriptive qualitative methodology was employed by conducting four semi-structured interviews with two children with significant physical impairments and their parents. We found that disabled children's play can be interpreted as passive or active depending on one's definition and perceptions surrounding play. Moreover, disabled children continue to face physical, economic, and technological barriers in their play, as well as play restrictions from physical impairments. We urge that future research should strive to directly hear from disabled children themselves, as their perspectives may differ from their parents' views. Also, future BCI development should strive to incorporate video games, recreational and entertainment applications/platforms, toys and switch-adapted toys, and power wheelchairs to better support the play of children with significant physical impairments.Implications for RehabilitationAssistive technology research should strive to examine the social, infrastructural, and environmental barriers that continue to disable and restrict participation for disabled children and their families through applying a social model of childhood disability and other holistic frameworks that look beyond individual factorsFuture research that examines the needs and lives of disabled children should strive to directly seek the opinions and perspectives of disabled children themselvesBrain-computer interface development should strive to incorporate video games, recreational and entertainment applications/platforms, toys and switch-adapted toys, and power wheelchairs to better support the play of children with significant physical impairments.

User confidence and electrodermal activity during haptic exploration for perceptual comparisons using a robotic system.

Children with physical impairments may have trouble effectively performing the hand movements used in haptic exploration and may miss information about object properties. Assistive robotic systems with haptic feedback may enable children with physical impairments to haptically explore objects. However, it is important to understand if they might be encountering difficulty in assessing object properties with the system. As such, we examined two methods to ascertain a user's uncertainty or stress when doing the exploration, user confidence and electrodermal activity (EDA). Twenty adults and ten children without physical impairments manipulated four pairs of objects to examine size, roughness, hardness and shape. All participants performed the manipulation by controlling a robotic system and by manual exploration in a randomized crossover design. Adults' confidence was lower when using the robotic system and correlated with lower accuracy at determining object properties. Children's responses indicated that they may not have understood how to self-rate confidence. EDA, a potentially objective measure of stress during the task, was actually lower for adults when they used the robotic system, suggesting less physiological arousal than when using their hands. Children's EDA was variable.

Amplification of Heart Sounds Using Digital Stethoscope in Simulation-Based Neonatal Resuscitation.

OBJECTIVE: The accuracy, timeliness, and reliability of the current methods of heart rate (HR) determination in neonatal resuscitation are debatable, each having its own limitations. We aim to compare three methods of HR assessment: (1) traditional stethoscope, (2) electrocardiogram and traditional stethoscope, and (3) digital stethoscope with loudspeaker amplification of heart sounds. STUDY DESIGN: This was a simulated crossover experiment using a high-fidelity manikin. Each team with a physician, a nurse, and a respiratory therapist performed the resuscitations using the three methods (three different scenarios) in different order. The person controlling the HR via manikin controller was blinded, but the single recorder and the providers were not. RESULTS: Eighteen resuscitations were completed (six teams of three methods each). The time to first HR recording (p < 0.001), total number of HR recorded (p < 0.001), and time to recognize dips in HR was significantly improved in the digital stethoscope group (p = 0.009). CONCLUSION: Use of digital stethoscope with amplification improved documentation of HR and earlier recognition of HR changes. KEY POINTS: · Amplified heartbeats during neonatal resuscitation improved documentation.. · Amplified infant heartbeats resulted in earlier recognition of HR changes (increase or decrease).. · Providers using this method had greater satisfaction..

Loose Attitudes: Politics of Self-Knowledge in Our Bodies, Ourselves and The House of God.

Readers of Samuel Shem's medical satire The House of God (1978) have long worried about the bad attitude of his main characters: young male internal medicine trainees. This article examines the interns' atrocious affections, using the feminist classic Our Bodies, Ourselves (1973) as a counterweight to the masculinist perspective of House of God. These radically different critiques of United States medicine derive from a shared sociopolitical context and represent a historically specific response to the personal politics of sexual liberation and self-actualization in the 1970s. I show that Shem and the Boston Women's Health Book Collective share a rhetorical strategy of "loose expertise" grounded in embodied knowledge, which connects both texts to the radical social movements of the late 1960s. Loose expertise enables institutional critique by shifting the domain of knowledge away from traditional structures of authority, but inhibits intersectional critique by essentializing the individual subject position of the author. The article concludes by examining the relationship of both texts to the medical humanities.

Life history and bionomics of Glycobius speciosus (Coleoptera: Cerambycidae: Cerambycinae: Clytini).

Glycobius speciosus (Say) was studied in New York State to elucidate poorly known aspects of its biology. Head capsule size from excavated larvae coupled with gallery lengths measured at the time of excavation was used to characterize larval development. Partial life tables indicated nearly 20% of G. speciosus survive to adulthood. Larvae experienced 30% of their mortality during early development, 27% during mid-larval development, and 43% during late larval development. Predation by hairy woodpeckers, Dryobates villosus (Linnaeus) (Piciformes: Picidae), the only unambiguous source of mortality, accounted for 43% mortality in naturally infested trees located and followed 2004-2009, and 74% late instar mortality. One parasitoid, Dolichomitus irritator (Fabricius) (Hymenoptera: Ichneumonidae), was recovered from a single larva. Beetles emerged between 316 accumulated DD (base 10 °C) and 648 DD. Males emerged prior to, or simultaneously with, females and lived longer. Female fecundity averaged 41.3 ± 6 eggs. Larval eclosion occurred 7-10 days after oviposition. Non-functional ovipositors observed in 16% of females represented an appreciable reproductive loss. In 77% of infested trees 1 oviposition site was located and in 70% of oviposition sites examined only 1 or 2 larvae successfully eclosed, penetrated the bark to the phloem-xylem interface, and began feeding. Beetles preferred southern and eastern aspects for oviposition which occurred preferentially on the lower bole (<20 cm). Male beetles had longer and wider antennae than females, pronotal pits containing gland pores, and a straight to concave posterior margin of the terminal sternite compared to the more rounded margin of females.

EEG hybrid brain-computer interfaces: A scoping review applying an existing hybrid-BCI taxonomy and considerations for pediatric applications.

Most hybrid brain-computer interfaces (hBCI) aim at improving the performance of single-input BCI. Many combinations are possible to configure an hBCI, such as using multiple brain input signals, different stimuli or more than one input system. Multiple studies have been done since 2010 where such interfaces have been tested and analyzed. Results and conclusions are promising but little has been discussed as to what is the best approach for the pediatric population, should they use hBCI as an assistive technology. Children might face greater challenges when using BCI and might benefit from less complex interfaces. Hence, in this scoping review we included 42 papers that developed hBCI systems for the purpose of control of assistive devices or communication software, and we analyzed them through the lenses of potential use in clinical settings and for children. We extracted taxonomic categories proposed in previous studies to describe the types of interfaces that have been developed. We also proposed interface characteristics that could be observed in different hBCI, such as type of target, number of targets and number of steps before selection. Then, we discussed how each of the extracted characteristics could influence the overall complexity of the system and what might be the best options for applications for children. Effectiveness and efficiency were also collected and included in the analysis. We concluded that the least complex hBCI interfaces might involve having a brain inputs and an external input, with a sequential role of operation, and visual stimuli. Those interfaces might also use a minimal number of targets of the strobic type, with one or two steps before the final selection. We hope this review can be used as a guideline for future hBCI developments and as an incentive to the design of interfaces that can also serve children who have motor impairments.

Exploring environmental factors affecting assistive technology strategies in mathematics learning for students with physical disabilities.

PURPOSE: To explore the environmental facilitators and barriers affecting K-12 students with physical disabilities when using two assistive technology (AT) strategies, LEGO Mindstorms robots and a computer, in mathematics lessons. MATERIALS AND METHODS: A qualitative multiple case study with three students with physical disabilities was conducted. The participants did five lessons in concepts they were studying in school with each AT strategy in a controlled environment. Observations of the lessons, and parent and teacher interviews after the last session were collected. RESULTS: The AT strategies acted as facilitators because they were easy to use, participants could participate actively, and parents and school staff wanted to implement them. However, the strategies presented some barriers since the students required more time to complete the lessons with the robot, and some computer programs were not compatible with the students' skills. Also, barriers such as lack of technical knowledge on the part of parents and teachers, distractions in the environment, and funding issues were reported. CONCLUSION: This study may be useful for rehabilitation staff and teachers who are considering implementing AT to support the participation of students with disabilities. Personnel needs to be trained to use the AT strategies, and several modifications may be necessary for the satisfactory use of the devices.IMPLICATIONS FOR REHABILITATIONHands-on manipulation promotes the active learning of early mathematical concepts. Students with disabilities may have the opportunity to participate in active learning through assistive technology (AT).Knowledge about environmental factors that may facilitate or limit the use of AT in the classroom will help teaching staff make decisions when implementing these strategies with students with disabilities.The use of an AT strategy may depend on the objectives the rehabilitation staff and teachers want to achieve during a task. For instance, the robot could be used for tailoring a task according to the student's needs and abilities. On the other hand, computer programs could be considered if time and ease of use are important factors.

Preliminary testing of eye gaze interfaces for controlling a haptic system intended to support play in children with physical impairments: Attentive versus explicit interfaces.

INTRODUCTION: Children with physical impairments may face challenges to play because of their motor impairments, which could lead to negative impacts in their development. The objective of this article was to compare two eye gaze interfaces that identified the desired toy a user wanted to reach with a haptic-enabled telerobotic system in a play activity. METHODS: One of the interfaces was an attentive user interface predicted the toy that children wanted to reach by observing where they incidentally focused their gaze. The other was an explicit eye input interface determined the toy after the child dwelled for 500 ms on a selection point. Five typically developing children, an adult with cerebral palsy (CP) and a child with CP participated in this study. They controlled the robotic system to play a whack-a-mole game. RESULTS: The prediction accuracy of the attentive interface was higher than 89% in average, for all participants. All participants did the activity faster with the attentive interface than with the explicit interface. CONCLUSIONS: Overall, the attentive interface was faster and easier to use, especially for children. Children needed constant prompting and were not 100% successful at using the explicit interface.

A feasibility study of eye gaze with biofeedback in a human-robot interface.

Play is a vital activity in which children learn skills and explore the environment through object manipulation. Assistive robots have been used to provide access to play, and Forbidden Region Virtual Fixture (FRVF) guidance at the user interface could help the users make the robot traverse the play environment more efficiently because it behaves like virtual walls to follow. Eye gaze was used to indicate the user's intended target and generate the location of the virtual walls in a card sorting task. We eliminated the typical computer screen required for visual feedback to confirm gaze location, and examined the use of alternative feedback. In this feasibility study, first a group of adults without physical impairment tested the system with auditory and vibrotactile feedback modalities for the gaze fixation and with the virtual walls on and off for robot movement. Then case studies with children and individuals with physical impairments were performed. Even though gaze fixation feedback and the virtual wall did not improve the performance of adult participants without impairment, the feedback increased the speed and accuracy of the gaze fixation and the virtual walls improved the movement efficiency for the participants with impairment and a 6-year-old child without impairment.

"Now I know how to not repeat history": Teaching and Learning Through a Pandemic with the Medical Humanities.

We reflect on our experience co-teaching a medical humanities elective, "Pandemics and Plagues," which was offered to undergraduates during the Spring 2021 semester, and discuss student reactions to studying epidemic disease from multidisciplinary medical humanities perspectives while living through the world Covid-19 pandemic. The course incorporated basic microbiology and epidemiology into discussions of how epidemics from the Black Death to HIV/AIDS have been portrayed in history, literature, art, music, and journalism. Students self-assessed their learning gains and offered their insights using the SALG (Student Assessment of their Learning Gains), describing how the course enhanced their understanding of the current pandemic. In class discussions and written assignments, students paid particular attention to issues of social justice, political context, and connections between past pandemics and Covid-19. Student responses indicate enhanced understanding of the scientific and medical aspects of epidemics and also increased appreciation of the insights to be gained from the medical humanities. We discuss co-teaching the class during a real-time, twenty-four-hour-news-cycle pandemic, and the ways in which that experience underlines the value of a "critical medical humanities" approach for undergraduates.

Using a robotic teleoperation system for haptic exploration.

INTRODUCTION: When children with physical impairments cannot perform hand movements for haptic exploration, they miss opportunities to learn about object properties. Robotics systems with haptic feedback may better enable object exploration. METHODS: Twenty-four adults and ten children without physical impairments, and one adult with physical impairments, explored tools to mix substances or transport different sized objects. All participants completed the tasks with both a robotic system and manual exploration. Exploratory procedures used to determine object properties were also observed. RESULTS: Adults and children accurately identified appropriate tools for each task using manual exploration, but they were less accurate using the robotic system. The adult with physical impairment identified appropriate tools for transport in both conditions, however had difficulty identifying tools used for mixing substances. A new exploratory procedure was observed, Tapping, when using the robotic system. CONCLUSIONS: Adults and children could make judgements on tool utility for tasks using both manual exploration and the robotic system, however they experienced limitations in the robotics system that require more study. The adult with disabilities required less assistance to explore tools when using the robotic system. The robotic system may be a feasible way for individuals with physical disabilities to perform haptic exploration.

Effect of feedback and target size on eye gaze accuracy in an off-screen task.

PURPOSE: Eye gaze interfaces have been used by people with severe physical impairment to interact with various assistive technologies. If used to control robots, it would be beneficial if individuals could gaze directly at targets in the physical environment rather than have to switch their gaze between a screen with representations of robot commands and the physical environment to see the response of their selection. By using a homogeneous transformation technique, eye gaze coordinates can be mapped between the reference coordinate frame of eye tracker and the coordinate frame of objects in the physical environment. Feedback about where the eye tracker has determined the eye gaze is fixated is needed so users can select targets more accurately. Screen-based assistive technologies can use visual feedback, but in a physical environment, other forms of feedback need to be examined. MATERIALS AND METHODS: In this study, an eye gaze system with different feedback conditions (i.e., visual, auditory, vibrotactile, and no-feedback) was tested when participants received visual feedback on a display (on-screen) and when looking directly at the physical environment (off-screen). Target selection tasks in both screen conditions were performed by ten non-disabled adults, three non-disabled children, and two adults and one child with cerebral palsy. RESULTS: Tasks performed with gaze fixation feedback modalities were accomplished faster and with higher success than tasks performed without feedback, and similar results were observed in both screen conditions. No significant difference was observed in performance across the feedback modalities, but participants had personal preferences. CONCLUSION: The homogeneous transformation technique enabled the use of a stationary eye tracker to select target objects in the physical environment, and auditory and vibrotactile feedback enabled participants to be more accurate selecting targets than without it.Implications for RehabilitationBeing able to select target objects in the physical environment by eye gaze could make it easier for children with disabilities to control assistive robots, because in this way they do not have to change their focus between a computer screen with commands and the robot.Providing auditory or vibrotactile feedback when using an eye gaze system made it faster and easier to know if a target was being gazed upon.Being able to select targets in the environment using eye gaze could be beneficial for other assistive technology, too, such as destination selection for power wheelchairs.

Advancing Brain-Computer Interface Applications for Severely Disabled Children Through a Multidisciplinary National Network: Summary of the Inaugural Pediatric BCI Canada Meeting.

Thousands of youth suffering from acquired brain injury or other early-life neurological disease live, mature, and learn with only limited communication and interaction with their world. Such cognitively capable children are ideal candidates for brain-computer interfaces (BCI). While BCI systems are rapidly evolving, a fundamental gap exists between technological innovators and the patients and families who stand to benefit. Forays into translating BCI systems to children in recent years have revealed that kids can learn to operate simple BCI with proficiency akin to adults. BCI could bring significant boons to the lives of many children with severe physical impairment, supporting their complex physical and social needs. However, children have been neglected in BCI research and a collaborative BCI research community is required to unite and push pediatric BCI development forward. To this end, the pediatric BCI Canada collaborative network (BCI-CAN) was formed, under a unified goal to cooperatively drive forward pediatric BCI innovation and impact. This article reflects on the topics and discussions raised in the foundational BCI-CAN meeting held in Toronto, ON, Canada in November 2019 and suggests the next steps required to see BCI impact the lives of children with severe neurological disease and their families.

The pharmacokinetics of para-aminosalicylic acid and its relationship to efficacy and intolerance.

Following its introduction as an antituberculosis agent close to 75 years ago, the use of para-aminosalicylic acid (PAS) has been limited by gastrointestinal intolerance and multiple formulations were produced in attempts to reduce its occurrence. More recently, an enteric-coated, granular, slow-release PAS formulation (PASER) was introduced and is now in wide-spread use for the treatment of drug-resistant tuberculosis. The current PASER dosing regimen is based on recommendations derived from older studies using a variety of different PAS formulations and relegate PAS to a role as an exclusively bacteriostatic agent. However, there is ample evidence that if sufficiently high serum concentrations are reached, PAS can be bactericidal and that intolerance following once daily dosing, that aids the achievement of such concentrations, is no worse than that following intermittent daily dosing. In particular, prevention of resistance to companion drugs appears to be dependent on the size of the single dose, and hence the peak concentrations, and not on maintaining serum levels consistently above minimum inhibitory concentration. We present a narrative review of the development of PAS formulations, dosing practices, and published data regarding pharmacokinetics and pharmacodynamics and the relationship of PAS dosage to intolerance and efficacy. Our conclusions suggests that we are at present not using PAS to its maximum ability to contribute to regimen efficacy and protect companion drugs.

Testing of an assistive robot system for haptic exploration of objects.

INTRODUCTION: When children with physical impairments cannot perform hand movements for haptic exploration, they may miss opportunities to learn the properties of objects. Assistive robots may enable them to make manipulation actions. OBJECTIVE: To examine the differences between using a robotic teleoperation system with haptic feedback and manual exploration when making perceptual comparisons about object properties. Accuracy and exploratory procedures (EP) using the system were compared to those in manual exploration. METHOD: Twenty adults without physical disabilities and ten typically developing children manipulated four pairs of objects and chose one based on size, roughness, hardness and shape. All participants completed the task with the robotic system (Tech) and manual exploration (No Tech), with the order counterbalanced. RESULTS AND CONCLUSION: Participants performed a previously unidentified EP, "tapping", in the Tech condition. Enclosure was not possible with the robot end effector, but tapping afforded the required perceptual information. Adults' perceptual comparisons were always accurate and they predominantly performed the optimum EP in both conditions. Even when children performed the optimum EP with the system, their answers were less accurate than with manual exploration. Most gave the correct answer, except for hardness, which was likely due to mechanical flexibility in the robotic system.

Pharmacokinetics of Para-Aminosalicylic Acid and Its 2 Major Metabolites: A Potential Relationship to the Development of Gastrointestinal Intolerance.

Para-aminosalicylic acid (PAS), often the last drug remaining for treatment of drug-resistant tuberculosis, is notorious for causing gastrointestinal intolerance; however, the cause of PAS intolerance is uncertain. The objective of this study was to assess relationships between peak concentrations of PAS administered as a granular slow-release enteric coated formulation, and its metabolites acetyl-PAS and glycine-PAS, and intolerance. PAS and its metabolites were measured in 29 adult patients with drug-resistant tuberculosis at Brooklyn Hospital, Cape Town, randomized to receive granular slow-release enteric-coated PAS 4 g twice daily or 8 g once daily for 1 week, followed by the alternative regimen. Concentrations of PAS and its metabolites were determined by liquid chromatography and tandem mass spectrometry, and a visual analogue scale evaluated intolerance. Spearman's correlation test assessed the relationship between maximum plasma concentrations (Cmax ) and intolerance scores. A large interindividual variability was observed for the PAS Cmax (40.42-68.55 mg/L) following 4 g twice daily; (62.69-102.41 mg/L) for 8 g once daily and a similar wide Cmax range found for the metabolites acetyl-PAS and glycine-PAS. Twenty-six patients reported at least 1 intolerance episode, but most visual analogue scale scores clustered around 0. Significant inverse associations were found between acetyl-PAS Cmax and bloating (rho = -0.448; P = .025) and diarrhea (rho = -0.407; P = .044) for the twice-daily regimen and a similar inverse association found for glycine-PAS and diarrhea (rho = -0.412; P = .041). Plasma concentrations of the metabolites did not correlate with the occurrence of gastrointestinal symptoms, but higher metabolite concentrations correlated with lower intolerance scores; slow metabolism of PAS and its continued presence in the intestinal tract may be the main cause of intolerance.

Supporting Play by Applying Haptic Guidance Along a Surface Learnt from Single Motion Trajectories.

Haptic-enabled teleoperated robots can help children with physical disabilities to reach toys by applying haptic guidance towards their toys, thus compensating for their limitations in reaching and manipulating objects. In this article we preliminarily tested a learning from demonstration (LfD) approach, where a robotic system learnt the surface that best approximated to all motion trajectories demonstrated by the participants while playing a whack-a-mole game. The end-goal of the system is for therapists or parents to demonstrate to it how to play a game, and then be used by children with physical disabilities. In this study, four adults without disabilities participated, to identify aspects that will be necessary to improve before conducting trials with children. During the demonstration phase, participants played the game in normal teleoperation, assuming the role of the therapist/parent. Then, the surface was modeled using a neural network. Participants played the game without and with the haptic guidance. The movements of the robotic system were mirrored to induce errors in movements, and thus require the guidance. Participants spent more time, moved the robot longer distances, and had jerkier movements when they played the game with the guidance than without it. Possible reasons were discussed, and several solutions were proposed to improve the system. The main contribution of this paper was the learning of a surface instead of learning a single motion trajectory.

Esomeprazole to treat women with preterm preeclampsia: a randomized placebo controlled trial.

BACKGROUND: Preterm preeclampsia has a high rate of fetal death or disability. There is no treatment to slow the disease, except delivery. Preclinical studies have identified proton pump inhibitors as a possible treatment. OBJECTIVE: The purpose of this study was to examine whether esomeprazole could prolong pregnancy in women who have received a diagnosis of preterm preeclampsia. STUDY DESIGN: We performed a double-blind, randomized controlled trial at Tygerberg Hospital in South Africa. Women with preterm preeclampsia (gestational age 26 weeks+0 days to 31 weeks+6 days) were assigned randomly to 40-mg daily esomeprazole or placebo. The primary outcome was a prolongation of gestation of 5 days. Secondary outcomes were maternal and neonatal outcomes. We compared circulating markers of endothelial dysfunction that was associated with preeclampsia and performed pharmacokinetic studies. RESULTS: Between January 2016 and April 2017, we recruited 120 participants. One participant was excluded because of incorrect randomization, which left 59 participants in the esomeprazole and 60 participants in the placebo group. Median gestational age at enrolment was 29+4 weeks gestation. There were no between-group differences in median time from randomization to delivery: 11.4 days (interquartile range, 3.6-19.7 days) in the esomeprazole group and 8.3 days (interquartile range, 3.8-19.6 days) in the placebo group (3 days longer in the esomeprazole arm; 95% confidence interval, -2.9-8.8; P=.31). There were no placental abruptions in the esomeprazole group and 6 (10%) in the placebo group (P=.01, P=.14 adjusted). There were no differences in other maternal or neonatal outcomes or markers of endothelial dysfunction. Esomeprazole and its metabolites were detected in maternal blood among those treated with esomeprazole, but only trace amounts in the umbilical cord blood. CONCLUSION: Daily esomeprazole (40 mg) did not prolong gestation in pregnancies with preterm preeclampsia or decrease circulating soluble fms-like tyrosine kinase 1 concentrations. Higher levels in the maternal circulation may be needed for clinical effect.

Usability testing of a developed assistive robotic system with virtual assistance for individuals with cerebral palsy: a case study.

This paper presents a novel application of an assistive robotic system with virtual assistance to enhance manual performance of individuals with cerebral palsy. Cerebral palsy affects one's voluntary motor movements resulting in limited opportunities to actively engage in physical manipulative activities that require fine motor movements and coordination. Lack of object manipulation and environmental exploration can result in further impairments such as cognitive and social delays. The proposed assistive robotic system has been developed to enhance hand movements of people with disabilities when performing a functional task colouring. This paper presents the usability testing of the effectiveness of the developed system with an individual with cerebral palsy in a set of colouring tasks. Assisted and unassisted approaches were compared and analysed through quantitative and qualitative measures. The robotic-based approach was further compared with the participant's typical alternate access method to perform the same proposed tasks. The robotic system with virtual assistance was clinically validated to be significantly more effective, compared to both unassisted and typical approaches, by increasing the hand controllability, reducing the physical load and increasing the easiness of maintaining movements within the lines. Future studies will inform the use of the system for children with disabilities to provide them with assisted play for functional and playful activities. Implications for rehabilitation Robotic system can enhance manual performance in individuals with disabilities. Participating in a robot-mediated play activity could increase children's motivation and engagement. The developed robotic system can contribute to a basis for clinical and home-based implementation of the technology to promote manual play activities for children with disabilities.

Preliminary testing by adults of a haptics-assisted robot platform designed for children with physical impairments to access play.

Development of children's cognitive and perceptual skills depends heavily on object exploration and experience in their physical world. For children who have severe physical impairments, one of the biggest concerns is the loss of opportunities for meaningful play with objects, including physical contact and manipulation. Assistive robots can enable children to perform object manipulation through the control of simple interfaces. Touch sensations conveyed through haptic interfaces in the form of force reflection or force assistance can help a child to sense the environment and to control a robot. A robotic system with forbidden region virtual fixtures (VFs) was tested in an object sorting task. Three sorting tasks-by color, by shape, and by both color and shape-were performed by 10 adults without disability and one adult with cerebral palsy. Tasks performed with VFs were accomplished faster than tasks performed without VFs, and deviations of the motion area were smaller with VFs than without VFs. For the participant with physical impairments, two out of three tasks were slower with the VFs. This implies that forbidden region VFs are not always able to improve user task performance. Alignment with an individual's unique motion characteristics can improve VF assistance.