Personalised socially assistive robot for cardiac rehabilitation: Critical reflections on long-term interactions in the real world.

Lack of motivation and low adherence rates are critical concerns of long-term rehabilitation programmes, such as cardiac rehabilitation. Socially assistive robots are known to be effective in improving motivation in therapy. However, over longer durations, generic and repetitive behaviours by the robot often result in a decrease in motivation and engagement, which can be overcome by personalising the interaction, such as recognising users, addressing them with their name, and providing feedback on their progress and adherence. We carried out a real-world clinical study, lasting 2.5 years with 43 patients to evaluate the effects of using a robot and personalisation in cardiac rehabilitation. Due to dropouts and other factors, 26 patients completed the programme. The results derived from these patients suggest that robots facilitate motivation and adherence, enable prompt detection of critical conditions by clinicians, and improve the cardiovascular functioning of the patients. Personalisation is further beneficial when providing high-intensity training, eliciting and maintaining engagement (as measured through gaze and social interactions) and motivation throughout the programme. However, relying on full autonomy for personalisation in a real-world environment resulted in sensor and user recognition failures, which caused negative user perceptions and lowered the perceived utility of the robot. Nonetheless, personalisation was positively perceived, suggesting that potential drawbacks need to be weighed against various benefits of the personalised interaction.

A Data-Driven Approach to Physical Fatigue Management Using Wearable Sensors to Classify Four Diagnostic Fatigue States.

Physical exercise contributes to the success of rehabilitation programs and rehabilitation processes assisted through social robots. However, the amount and intensity of exercise needed to obtain positive results are unknown. Several considerations must be kept in mind for its implementation in rehabilitation, as monitoring of patients' intensity, which is essential to avoid extreme fatigue conditions, may cause physical and physiological complications. The use of machine learning models has been implemented in fatigue management, but is limited in practice due to the lack of understanding of how an individual's performance deteriorates with fatigue; this can vary based on physical exercise, environment, and the individual's characteristics. As a first step, this paper lays the foundation for a data analytic approach to managing fatigue in walking tasks. The proposed framework establishes the criteria for a feature and machine learning algorithm selection for fatigue management, classifying four fatigue diagnoses states. Based on the proposed framework and the classifier implemented, the random forest model presented the best performance with an average accuracy of ≥98% and F-score of ≥93%. This model was comprised of ≤16 features. In addition, the prediction performance was analyzed by limiting the sensors used from four IMUs to two or even one IMU with an overall performance of ≥88%.

Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial.

BACKGROUND: Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. METHODS: A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test). RESULTS: There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). CONCLUSION: Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. TRIAL REGISTRATION: PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.

A Socially Assistive Robot for Long-Term Cardiac Rehabilitation in the Real World.

What are the benefits of using a socially assistive robot for long-term cardiac rehabilitation? To answer this question we designed and conducted a real-world long-term study, in collaboration with medical specialists, at the Fundación Cardioinfantil-Instituto de Cardiología clinic (Bogotá, Colombia) lasting 2.5 years. The study took place within the context of the outpatient phase of patients' cardiac rehabilitation programme and aimed to compare the patients' progress and adherence in the conventional cardiac rehabilitation programme (control condition) against rehabilitation supported by a fully autonomous socially assistive robot which continuously monitored the patients during exercise to provide immediate feedback and motivation based on sensory measures (robot condition). The explicit aim of the social robot is to improve patient motivation and increase adherence to the programme to ensure a complete recovery. We recruited 15 patients per condition. The cardiac rehabilitation programme was designed to last 36 sessions (18 weeks) per patient. The findings suggest that robot increases adherence (by 13.3%) and leads to faster completion of the programme. In addition, the patients assisted by the robot had more rapid improvement in their recovery heart rate, better physical activity performance and a higher improvement in cardiovascular functioning, which indicate a successful cardiac rehabilitation programme performance. Moreover, the medical staff and the patients acknowledged that the robot improved the patient motivation and adherence to the programme, supporting its potential in addressing the major challenges in rehabilitation programmes.

Feasibility study: Towards Estimation of Fatigue Level in Robot-Assisted Exercise for Cardiac Rehabilitation.

Socially Assistive Robotics (SAR) has shown to be an important tool to assist patients in physical rehabilitation. SAR is used to provide feedback about patient's state and performance to users and health professionals, therefore, patients are monitored by means of sensor interfaces. In this context, aiming to avoid over-training conditions, one of the most important parameter to monitor is the fatigue level. However, it is usually measured by subjective scales such as Borg scale, thus, there is a need to develop systems that are able to estimate fatigue with greater accuracy. It has been demonstrated that fatigue can be associated to the decreasing performance of the exercise. Hence, this work carried out a study to determinate which temporal and kinematic features are related to the fatigue level during a sit-to-stand test. The procedure consisted of sitting down and standing up from a chair while kinematic data were measured by a Kinect sensor, in order to relate kinematic data and fatigue. Results show that temporal features (time stand-to-stand and time sit-to-stand) and 3 kinematic features (max vertical-velocity of the spin base, max knee-flexo-extension velocity, and max hip-flexo-extension velocity), have a significant correlation with the fatigue level $(p \lt 0.05)$.

Human-robot sensor interface for cardiac rehabilitation.

Cardiovascular disease is the leading cause of death in the world. A program of cardiac rehabilitation (CR) is related to physical activities or exercises to regain the optimal quality of life. CR relies on the necessity to evaluate, control and supervise a patient's status and progress. This work has two objectives: on the one hand, provide a tool for clinicians to assess the patient's status during CR. On the other hand, there is evidence that robots can motivate patients during therapeutic procedures. Our sensor interface explores the possibility to integrate a robotic agent into cardiac therapy. This work presents an exploratory experiment for on-line assessment of typical CR routines.

Problemas ético del retiro o limitación de traamiento vital en unidades de cuuidados intensivos / Ethic problems bbout retirement or limitation of life-sustainin treatment in iintensive care units / Problemas étios do retiro ou limitação de tratamento vital em unidades de terapia intensiva

La medicina crítica atraviesa sus mejores momentos. Como afirma Gracia, "los cuidados intensivos han alcanzado su mayoría de edad". Nadie cuestiona dichos adelantos para pacientes que eran considerados hace relativamente poco como desahuciados. Sin embargo, también da algo de vértigo el cambio que se ha logrado en el manejo de la muerte de dichos pacientes: el tránsito de una muerte "natural" a una muerte "gobernada por el hombre". En este contexto cobran nuevo sentido conceptos como eutanasia, distanasia, futilidad, calidad de vida, muerte digna y, de manera especial, el concepto de retiro o limitación de tratamiento vital (LET). El presente artículo de reflexión analiza los problemas éticos que se generan al implementar los protocolos de LET en las unidades de cuidados intensivos (UCI). El artículo está dividido en cuatro partes: 1. Distinciones terminológicas; 2. formas de aplicación de la LET; 3. LET en casos especiales: pediatría y personas con discapacidad, y 4. los problemas éticos específicos de la LET.

Intensive Care Medicine experiences its best time. As Gracia says, "intensive care has come of age." Nobody questions such advances for patients that were considered hopeless days ago. However, it also gives some dizzying the change that has been made in the death management of such patients: the transition from a "natural" death to death "ruled by man." In this context, concepts take on new meaning as euthanasia, dysthanasia, futility, quality of life, dying with dignity and especially, the concept of retirement or limitation of life-sustaining treatment. This article discusses the ethical problems generated by implementing the limitations of life-sustaining treatment protocols in Intensive Care Units. The article is divided into 4 parts: 1. Terminological distinctions. 2. How to apply the limitation of life-sustaining treatment. 3. Limitation of life-sustaining treatment in special cases: pediatrics and disability. 4. The specific ethical problems of limitation of life-sustaining treatment.

A medicina crítica atravessa seus melhores momentos. Como Gracia diz: "os cuidados intensivos alcançaram a maioria de idade." Ninguém questiona tais avanços para os pacientes que foram consideradas até a pouco tempo como desauciados. No entanto, da um pouco de vertigem a mudança que tem-se alcançado na gestão da morte desses pacientes: a transição de uma morte "natural" à morte «governada pelo homem". Neste contexto, cobram novo sentido conceitos como eutanásia, distanásia, futilidade, qualidade de vida, morte digna e, em particular, o conceito de retiro ou limitação de tratamento vital (LET). O presente artigo de reflexão faz a análise dos problemas éticos gerados pela implementação de protocolos de LET nas unidades de terapia intensiva (UTI). O artigo está dividido em quatro partes: 1. Distinções terminológicas; 2. Formas de aplicação do LET; 3. LET em casos especiais: pediatria e pessoas com deficiência e, 4. Os problemas éticos explícitos da LET.

Determinación de la funcionalidad de la vía auditiva en pacientes con diagnóstico de microtia y/o agenesia del conducto auditivo externo / External ear malformations and auditory function

Se analizaron los estudios de potenciales Evocados Auditivos realizados en la clínica el Bosque en 44 pacientes con diagnóstico de microtia y/o agenesia del conducto auditivo externo, entre las edades de un mes a cinco y medio años, con el fín de evaluar la funcionalidad de la vía auditiva. Encontramos que 27 pacientes lo que contribuye el 61.4 por ciento presentaron alteración de la vía auditiva. El principal compromiso fué a nivel de la onda I, es decir, la lesión fué periférica y se presentó con mayor incidencia en el sexo masculino

Clasificación de la enfermedad respiratoria aguda, en niños menores de cinco años en el Barrio Horizontes / Clasification of the acute respiratory disease, in children under five years in Barrio Horizontes

Los principales propósitos de nuestra investigación son, el conocer la incidencia de la IRA del Barrio "Horizontes", en menores de 5 años, con base en la clasificación propuesta por la OPS, según síntomas y signos predominantes, para establecer la gravedad del padecimiento y a partir de esto, tomar métodos diagnósticos, medidas terapeúticas y lo más importante, medidas preventivas dentro de la cual incluimos el educar a la familia del paciente en la detección temprana de signos y síntomas y el manejo básico que pueda ser aplicado a nivel domiciliario. Para esto, tomamos a los niños menores de 5 años que residen en el Barrio Horizontes y que hacen parte del programa de Salud Familiar, indagando en ellos signos y síntomas de Enfermedad Respiratoria Aguda por medio de visitas domiciliarias que son diligenciadas en un formulario, que muestra si se trata de IRA leve, moderada o grave. De los pacientes examinados, encontramos 219 casos de Enfermedad Respiratoria Aguda, correspondiendo el 80.36 por ciento a un grado leve, el 19.63 por ciento a un grado moderado y en ninguna visita hallamos pacientes con IRA grave. Como era de esperar, la gran mayoría de casos encontrados, corresponden a un grado leve, ya que en general los casos graves implican la estancia del niño en una institución de salud y por lo tanto es difícil encontrarlo en la visita domiciliaria. De acuerdo a los hallazgos, podemos además concluir que las variables que especificamos en los formularios son válidas para determinar el grado de enfermedad y corroborar el estudio y clasificación dado por la OPS y OMS, estableciendo con esto un diagnóstico oportuno y el tratamiento adecuado posterior. También debemos agregar que la investigación a servido para hacernos en cierto modo, peritos en cuanto a la identificación de la enfermedad respiratoria y además nos permitirá en un futuro no lejano llevar a cabo un manejo adecuado de esta patología