Clinical experience in rehabilitation robotics

A robotic workstation system for the disabled, based on a commercially available arm, was tested with six patients at the Spinal Injuries Unit, Odstock Hospital, Salisbury. A questionnaire was administered to those who used the system. Users evaluated the usefulness and performance of the system and commented on their reactions to the use of robots in rehabilitation. The users were generally favourable as regards the ease of use of the system using a two-switch input, operating a scanning menu. All users wanted the robot to be able to replay previously created routines, and the majority also wanted to be able to directly control the robot as well. The users were unsure about the potential usefulness of the system. Because a robot is by definiition a flexible device, the context in which it is introduced will effect the way it is received by potential users. Tests in a hospital environment are useful because there is a high concentration of users. However the hospital environment does not fully reflect the situation in which robots are to be used. Tests with users in their own home situations will give a better idea of the usefulness of such devices. The system was not ideal from the point of visibility and layout, and was too large for use in a domestic environment. The layout was largely dictated by the geometry of the manipulator. Therefore a new workstation system has been constructed using a purpose built manipulator. This new system particularly aims to overcome the poor layout of the earlier workstation and benefits from feedback from users.     

Design, construction and application of a fully automated equimolar peptide mixture synthesizer.

A fully automated peptide synthesizer has been constructed that is capable of the synthesis of equimolar peptide mixtures and the simultaneous synthesis of 36 individual peptides. The synthesizer was constructed from a workstation of our own design utilizing a Zymark robot arm. A Macintosh II computer coordinates the movements of the robotic arm, the switching of over 40 solenoid valves and the monitoring of sensors in the workstation. The robot hands are used to deliver solvents from pressurized spigot lines and to pipet amino acid solutions from reservoirs to an array of reaction vessels. Liquid dispensing, reagent mixing and solvent removal are controlled from a multifunction I/O board in the computer. The design features of the synthesizer are presented, as well as the characterization of multiple individual peptides, a simple mixture of 19 components, and a complex mixture of 15,625 components.     

基于高性能服务器及网格技术的生物科研服务平台研究

为了解决生物科学方面的研究人员在使用生物研究软件工具中存在的“不知道、选不出、难学习和用不起”等问题,同时也为了能为生物类院校的师生提供教学辅助,利用网格技术在高性能服务器上,建立了一款服务于生物研究和教学的网上生物科研服务平台（Biological study service platform,BSP）。该平台包含“工具大全、工具论坛和web工作台”等三部分,拟分别从“找,学,用”三个方面彻底解决生物研究人员在使用生物研究软件工具中存在的问题,同时也为生物类的教师和学生提供了教与学平台。访问地址如下：http：//218．57．145．30：9999／biosp／。此外,该研究小组还将不断地更新和改进该平台,开发更多的自主应用软件,更好地服务生物科研工作。     

Cardiorespiratory fitness and muscular strength of wheelchair users.

The classification of lower-limb disabilities is commonly based on the site of the spinal cord lesion or the amount of functional muscle. Another important variable in assessing wheelchair users is their ability to carry out the activities of daily living. The cardiorespiratory fitness of those with lower-limb disabilities is usually assessed with arm-ergometry and wheelchair tests, each of which has some advantages. Muscle strength and endurance are also important aspects of the disabled person''s ability to function. Fitness is often poor in the disabled, and normal wheelchair use does not seem to prove an adequate training stimulus. Exercise with an arm ergometer and with pulleys and participation in vigorous wheelchair sports can improve physical condition. Participation in exercise programs should be based on the results of a fitness assessment and on the level of the spinal cord lesion in those with paraplegia. Progression in such programs should be gradual to ensure that the exerciser does not become discouraged and drop out of classes before fitness is increased. Data on wheelchair athletes suggest that, with persistence, many individuals in wheelchairs can adjust relatively well to their disabilities.     

Wheelchair-mounted integrated control systems for multiply handicapped people

Integrated control systems allow disabled people access to multiple functions from a single input device (for example a set of switches). Multiply handicapped users are thereby able to switch efficiently between wheelchair control, communication, computer access and control of their environment, without third-party help. Integrated systems have been developed for multiply handicapped children and adults in the Barnsley area. The design philosophy has concentrated upon utilizing, wherever possible, commercially available assistance devices and remotely controlling these via logic-based integrated control systems tailored to the needs and abilities of the individual client. This approach presents few problems as the inputs to commercially available devices are often based on simple switch control. The systems already supplied have proved, after an initial training period, to be easy to operate and have led to a considerable improvement in quality of life for the users. Computer-based, wheelchair-mounted integrated systems are now being developed. A prototype system currently emulates the logic-based controllers described above, employing the screen to display information on the current status of the system. Future development will move toward a more flexible system which will be able to read a variety of input signals and control a large number of outputs. The system will also have the facility to utilize software-based communications, keyboard emulation and environmental control packages as well as business and education software. Such a system could be easily set up, via software, for use by any disabled person.     

Influence of VDT monitor positions on discomfort and performance of users with or without bifocal lenses

The difficulty of video display terminal users with bifocal lenses through a traditional workstation increases the complaints and risks for upper extremity cumulative trauma disorders. Furthermore, the regular and no lens users also have problems with traditionally designed workstations over prolonged periods of video display terminal use. A study was conducted on 14 subjects to investigate the effect of computer monitor location for video display terminal users with or without bifocals on subjective assessment and performance. The two monitor locations were 15 degrees and 40 degrees below horizontal eye level. The experimental task consisted of reading words from computer screens and typing them from the reverse side to the next column. Each experimental session lasted one hour. Males with bifocal lenses had less discomfort in the neck, shoulders, forearms, and wrists, less tiredness and eyestrain and higher performance with a 40 degrees angle monitor than with a 15 degrees angle monitor. A similar conclusion has been reached for females. Users with bifocal lenses had significantly higher neck discomfort and lower performance than nonbifocal users. The 40 degrees angle monitor caused less neck discomfort than the 15 degrees angle monitor did. Overall, females had less physical discomfort, less tiredness, and higher performance than males.     

Optimal dispatching of multipriority jobs to two heterogeneous workstations

The general problem scenario of this paper is the following: Jobs of various priorities, stationed in a common storage area, are waiting to be dispatched to two non-identical workstations. Any of the waiting jobs can be accessed from the storage at any given time. Each job can be processed on either of the workstations, but once a job has been assigned it may not be preempted. By job priority it is meant that a higher priority job has disptach preference over a lower priority job. The processing time of a job on a given workstation is assumed to be random, the distribution being dependent on the job type and the configuration of the workstation. Specifically, the first problem studied considers only two classes of jobs: (1) “hot” jobs, whose processing is to be expedited and thus have the higher dispatch priority, and (2) “routine” jobs which may be assigned to an available workstation only if the workstation has been rejected by all “hot” jobs. The processing times are assumed to be exponentially distributed with means depending on the job class and workstation. We assume that, on the average, one workstation is faster than the other with regard to processing any job. The dispatching objective for each job class is to minimize its expected flowtime. It is shown that threshold dispatching policies are optimal for this problem. That is, the faster processor should be utilized whenever possible, and for each class there exists an explicit threshold such that when the number of jobs of that class in the buffer exceeds this threshold then a job of that class is dispatched to the slower processor, otherwise these jobs wait for the faster processor to become available. For the higher priority jobs, this threshold is shown to be a function only of the various processing rates of the two workstations. For the lower priority jobs, the threshold also depends on the number of higher priority jobs in the buffer. The results is extended to a system with n priority classes. Again, it is shown that when the processing times are exponentially distributed with different rates and the dispatching objective for each class is to minimize its expected flowtime, the optimal dispatching policies are of threshold type. Explicit thresholds are easily derived.     

Étude CESAR : justification de l’assistance respiratoire extra corporelle pour les graves syndromes de détresse respiratoire de l’adulte

BackgroundSevere acute respiratory failure in adults still has a high mortality in adults despite improvements in ventilation techniques and other treatments. The evidence about the effectiveness of extracorporeal membrane oxygenation (ECMO) was equivocal.MethodNational multi-center pragmatic randomized controlled trial. 180 adults (18-65 years) with severe (Murray score > 3.0 or pH < 7.2) but potentially reversible respiratory failure were randomized to receive either continued conventional management (CM) or to be transferred to Glenfield Hospital, Leicester, UK for consideration of ECMO. Patients were excluded if they had been on high pressure (> 30 cm H₂O of peak inspiratory pressure) and/or high FiO₂ (> 0.8) ventilation for > 7 days; had signs of intra-cranial bleeding ; had any other contra-indication to limited heparinisation ; or had any contra-indication to continuation of active treatment. The primary outcome measure was death or severe disability at six months. Analysis was by intention to treat.Results766 patients were screened. 180 were randomised; 90 to the ECMO arm of whom 68 received ECMO. No cm patients received ECMO. Fewer patients in the ECMO arm than the cm arm had died or were severely disabled 6 months after randomisation, (33/90 (36.7%) vs 46/87 (52.9%) ; RR=0.69 (95%CI 0.50 to 0.97) ; p=0.030). Only one patient (in the cm arm) was known to be severely disabled at 6 months.Randomised controlled trial and economic evaluationControlled Trial of Conventional Ventilatory Support vs Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR) [ISRCTN47279827].     

Experience in the application of Java Technologies in telemedicine

Java language has been demonstrated to be an effective tool in supporting medical image viewing in Russia. This evaluation was completed by obtaining a maximum of 20 images, depending on the client's computer workstation from one patient using a commercially available computer tomography (CT) scanner. The images were compared against standard CT images that were viewed at the site of capture. There was no appreciable difference. The client side is a lightweight component that provides an intuitive interface for end users. Each image is loaded in its own thread and the user can begin work after the first image has been loaded. This feature is especially useful on slow connection speed, 9.6 Kbps for example. The server side, which is implemented by the Java Servlet Engine works more effective than common gateway interface (CGI) programs do. Advantages of the Java Technology place this program on the next level of application development. This paper presents a unique application of Java in telemedicine.     

The effect of forearm support on children’s head, neck and upper limb posture and muscle activity during computer use

Use of computers by children has increased rapidly, however few studies have addressed factors which may reduce musculoskeletal stress during computer use by children. This study quantified the postural and muscle activity effects of providing forearm support when children used computers. Twelve male and 12 female children (10–12 years) who regularly used computers were recruited. Activities were completed using a computer with two workstation configurations, one of which provided for forearm support on the desk surface. 3D posture was analysed using an infra-red motion analysis system. Surface EMG was collected from five muscle groups in the neck/shoulder region and right upper limb. Providing a support surface resulted in more elevated and flexed upper limbs. The use of forearm or wrist support was associated with reduced muscle activity for most muscle groups. Muscle activity reductions with support were of sufficient magnitude to be clinically meaningful. The provision of a supporting surface for the arm is therefore likely to be useful for reducing musculoskeletal stresses associated with computing tasks for children.     

Upper extremity biomechanics in computer tasks differ by gender

ObjectivesThis laboratory study examined gender differences in upper extremity postures, applied forces, and muscle activity when a computer workstation was adjusted to individual anthropometry according to current guidelines.MethodsFifteen men and 15 women completed five standardized computer tasks: touch-typing, completing a form, editing text, sorting and resizing graphical objects and navigating intranet pages. Subjects worked at a height-adjustable workstation with the keyboard on top of the work surface and the mouse to the right. Subjects repeated the text editing task with the mouse in two other locations: a “high” mouse position, which simulated using a keyboard drawer with the mouse on the primary work surface, and “center” mouse position with the mouse between the keyboard and the body, centered with the body’s center line. Surface electromyography measured muscle activity; electrogoniometric and magnetic motion analysis system measured wrist, forearm and upper arm postures; load-cells measured typing forces; and a force-sensing mouse measured applied forces.ResultsRelative forces applied to the keyboard, normalized muscle activity of two forearm muscles, range of motion for the wrist and shoulder joints and external rotation of the shoulder were higher for women (p < 0.05). When subjects were dichotomized instead by anthropometry (either large/small shoulder width or arm length), the differences in forces, muscle activity of the shoulder and wrist posture and shoulder posture became more pronounced with smaller subjects having higher values. Postural differences between the genders increased in the high mouse position and decreased in the center mouse location.ConclusionsWhen a workstation is adjusted per current guidelines differences in upper extremity force, muscle activity and postural factors still exist between genders. However, these were often stronger when subjects were grouped by anthropometry suggesting that perhaps the computer input devices themselves should be scaled to be more in proportion with the anthropometry and strength of the user.     

The disabled living centre: what does it do?

Seventy five consecutive users of the Leeds disabled living foundation were surveyed. Two thirds of these users were at least moderately severely disabled. Forty eight of the 65 people (74%) who completed the questionnaire were recommended aids, and 33 had received some at the end of the survey. Only 10 of 28 people had received recommended adaptations. Few referrals were made to the centre by doctors. It is important that they tell their patients of this useful service.     

GPCALMA: Implementation in Italian hospitals of a computer aided detection system for breast lesions by mammography examination

We describe the implementation in several Italian hospitals of a computer aided detection (CAD) system, named GPCALMA (grid platform for a computer aided library in mammography), for the automatic search of lesions in X-ray mammographies. GPCALMA has been under development since 1999 by a community of physicists of the Italian National Institute for Nuclear Physics (INFN) in collaboration with radiologists. This CAD system was tested as a support to radiologists in reading mammographies. The main system components are: (i) the algorithms implemented for the analysis of digitized mammograms to recognize suspicious lesions, (ii) the database of digitized mammographic images, and (iii) the PC-based digitization and analysis workstation and its user interface. The distributed nature of data and resources and the prevalence of geographically remote users suggested the development of the system as a grid application: the design of this networked version is also reported. The paper describes the system architecture, the database of digitized mammographies, the clinical workstation and the medical applications carried out to characterize the system. A commercial CAD was evaluated in a comparison with GPCALMA by analysing the medical reports obtained with and without the two different CADs on the same dataset of images: with both CAD a statistically significant increase in sensitivity was obtained. The sensitivity in the detection of lesions obtained for microcalcification and masses was 96% and 80%, respectively. An analysis in terms of receiver operating characteristic (ROC) curve was performed for massive lesion searches, achieving an area under the ROC curve of A_z = 0.783 ± 0.008. Results show that the GPCALMA CAD is ready to be used in the radiological practice, both for screening mammography and clinical studies. GPCALMA is a starting point for the development of other medical imaging applications such as the CAD for the search of pulmonary nodules, currently under development in the framework of an INFN-funded project.     

Equipment selection and task assignment for multiproduct assembly system design

A multiproduct assembly system produces a family of similar products, where the assembly of each product entails an ordered set of tasks. An assembly system consists of a sequence of workstations. For each workstation, we assign a subset of the assembly tasks to be performed at the workstation and select the type of assembly equipment or resource to be used by the workstation. The assembly of each product requires a visit to each workstation in the fixed sequence. The problem of system design is to find the system that is capable of producing all the products in the desired volumes at minimum cost. The system cost includes the fixed capital costs for the assembly equipment and tools and the variable operating costs for the various workstations. We present and illustrate an optimization procedure that assigns tasks to workstations and selects assembly equipment for each workstation.     

A Supplementary System for a Brain-Machine Interface Based on Jaw Artifacts for the Bidimensional Control of a Robotic Arm

Non-invasive Brain-Machine Interfaces (BMIs) are being used more and more these days to design systems focused on helping people with motor disabilities. Spontaneous BMIs translate user''s brain signals into commands to control devices. On these systems, by and large, 2 different mental tasks can be detected with enough accuracy. However, a large training time is required and the system needs to be adjusted on each session. This paper presents a supplementary system that employs BMI sensors, allowing the use of 2 systems (the BMI system and the supplementary system) with the same data acquisition device. This supplementary system is designed to control a robotic arm in two dimensions using electromyographical (EMG) signals extracted from the electroencephalographical (EEG) recordings. These signals are voluntarily produced by users clenching their jaws. EEG signals (with EMG contributions) were registered and analyzed to obtain the electrodes and the range of frequencies which provide the best classification results for 5 different clenching tasks. A training stage, based on the 2-dimensional control of a cursor, was designed and used by the volunteers to get used to this control. Afterwards, the control was extrapolated to a robotic arm in a 2-dimensional workspace. Although the training performed by volunteers requires 70 minutes, the final results suggest that in a shorter period of time (45 min), users should be able to control the robotic arm in 2 dimensions with their jaws. The designed system is compared with a similar 2-dimensional system based on spontaneous BMIs, and our system shows faster and more accurate performance. This is due to the nature of the control signals. Brain potentials are much more difficult to control than the electromyographical signals produced by jaw clenches. Additionally, the presented system also shows an improvement in the results compared with an electrooculographic system in a similar environment.     

Head Pilot: A new webcam-based Head Tracking System tested in permanently disabled patients

Persons with cerebral palsy (CP) need to modify their lifestyle in order to carry out daily activities. Assistive technology facilitates communication and improves the domestic environment and mobility. The STARNAV Company has developed a Head Tracking System, Head Pilot, which uses a robust algorithm that measures, in real-time, head motion from a webcam. Head Pilot aims to control any informatic and domotic interface controlling the pointer of a PC. This work aims to create an assistive technology that is easy to use once it is set up and used. The system offers an interface control, which allows individual users to adjust the system for their comfort. The system displays a toolbar allowing the patient to choose the velocity of the pointer and to choose from several different ways to validate a task. The objective of this study was to evaluate the performance of Head Pilot by using five computerized tests of validation. Seven participants with disabilities were compared to seven participants with no relevant medical history (control group). Two versions of the software were developed and displayed on a computer screen. The time to complete the tests were measured and compared to a control group. Before testing, the disabled persons had received an orthoptic assessment, a cognitive evaluation, and a cervical motor check. Head Pilot was validated for use by the majority of users with CP who were able to control a computer except for the subject with incomplete locked-in syndrome, who required an Eye Tracker System.     

New programs: XELE—a polypeptide model-building program for a graphics workstation

A model-building program, XELE, for use in protein crystallography has been written in C under UNIX on a graphics workstation. This program makes full use of the X Window system to display the electron density distribution and to manipulate the polypeptide model, and therefore is named XELE. It utilizes a fast three-dimensional rendering package, Dorè, and is portable to other types of graphics workstations. A part of the program for the man-machine interface uses the library of X Window and X Toolkit, and therefore is highly interactive. The structure analysis program package, PROTEIN, is also implemented in an interactive mode using X Window, and has been interfaced with XELE.     

Kinematics of human arm reconstructed from spatial tracking system recordings

The kinematics of the human arm in terms of angles of rotations in the joints is reconstructed from the spatial tracking system (Fastrack() Polhemus) recordings. The human arm is modeled by three rigid bodies (the upper arm, the forearm and the hand) with seven degrees of freedom (three in the shoulder, two in the elbow and two in the wrist). Joint geometry parameters (orientations of the axes relative to the arm segments, the angles and the distances between the axes) have been calculated on the basis of passive rotations in the joints. The calculated parameters have been used to solve the direct kinematics problem for the reaching movements in different directions. The difference between calculated and recorded positions and accelerations of the hand has been used to assess the accuracy of the proposed method of kinematics reconstruction. The error analysis showed that spatial tracking system recordings and human arm kinematics reconstruction could reliably be used to accurately analyze multijoint movement in humans.     

La nouvelle Loi handicap

Although, over the centuries, disabled persons have been successively considered to be an image of evil, pity, or sin, what image and what rights are provided by the French law of 11/02/2005 on equal rights, participation and citizenship of disabled persons? Isn’t there still an enormous gap between written laws and what really happens in everyday life, as dozens of laws have been added since the first law voted in the 19th century? The vocabulary has also changed over the years from mutilated, to handicapped, to disabled. The marked differences between official figures and figures derived from the HID (Handicap Independence Incapacity) survey conducted between 1998 and 2001, clearly illustrates the difficulty of defining disability. With ageing of the French population aging and improvement of technologies, the number of disable persons will increase considerably over the years to come. Does the new law of 11/02/2005 provide a solution to this urgent situation? Has it identified all of the problems concerning accessibility, human assistance, schooling, rights of the disabled or is it just another law on disability, which is more useful to the legislator than to the people concerned? The new law focuses on four points. First of all, the right to compensation by creating a disability pension, which replaces third party benefits and professional fees benefits and adult disability pension, the right to schooling for all disabled children, the right to employment, and finally the creation of departmental disability centres, staffed by the various actors currently involved in the care of the disabled (Conseil Général, DDASS, CPAM, CAF, etc...). Creation of the disability pension is now based on five main types of assistance: human assistance, technical assistance, adaptation of the home and the vehicle as well as excess transport costs, animal assistance, and finally exceptional and specific aids. Apart from direct assistance to disabled persons, the new law is also designed to improve accessibility (law and decrees already in application since 1991 and 1994) to transport, public places, etc. However, the law also gives another definition of accessibility by extending its scope to all aspects of disability (motor, sensory, cognitive, mental, etc.). This accessibility must be implemented within defined deadlines: 3 years for transport, 5 years for universities and prefectures, and 10 years for other public buildings. Another innovation of this law is that of the initial training and continuing education of healthcare professionals of the medical and social sector (cause of disability, therapeutic innovations, educational innovations, reception and supportive care of disabled persons, announcement of disability, etc.). However, as so little progress has been made the over the centuries, many disabled people will be left by the wayside. Although politicians have now become aware of the problem, the errors, delays, and imperfections of this new law will allow tolerance rather than insertion of the disabled in the years to come. We must develop a different vision of disability, as illustrated by the creation, in 2002, of a European Commission network called “Design for All” to develop systems that can be used by healthy as well as disabled persons. Disabled persons are also trying to find solutions concerning parenthood and childbirth, as although the law has defined “all” aspects for healthy parents with a disabled child, no measures have been taken for disabled parents. The Mother-Child Department of the Institut Mutualiste Montsouris is developing a programme for these future parents with the help of ESCAVIE (Espace Conseil pour l’autonomie en milieu ordinaire de vie) in collaboration with the occupational therapist and social worker. A disabled parents association has also been formed in the Mother-Child Department. A last point does not directly concern the new law, but the bioethics law of August 2004 and preimplantation diagnosis, which was the subject of a recent debate concerning its revision. The old myth of birth control has resurfaced. Unfortunately politicians collude with the media to present this stereotyped image of the perfect, beautiful, normal baby.     

Arm crank ergometer is reliable and valid for measuring aerobic capacity during submaximal exercise

Measuring physical fitness becomes more important. Yet most instruments depend upon the function of the lower extremities. Hence, we investigated whether an adapted submaximal arm crank test on an ergometer for the upper body is reliable to use, and if the submaximal test for the arm crank ergometer is valid compared to the test on the bicycle ergometer. Different types of reliability measures of the adapted submaximal test on an arm crank ergometer were assessed in healthy volunteers, such as test-retest, interobserver, interergometer, and between arm crank and bicycle ergometer. A crossover design was used. The measurements were proportionally distributed over 30 volunteers. Based on the intraclass correlation coefficient (ICC) and the magnitude of within-person differences, we revealed a good reliability of the submaximal test. For the test-retest reliability, the ICC was 0.76, the interobserver reliability was 0.82, and the interergometer reliability 0.63. In addition, the criterion validity was also tested by comparing the calculated VO2max during the submaximal test on the arm crank ergometer and on the bicycle ergometer. Between VO2max on the arm crank and bicycle ergometer, an ICC of 0.64 was found. The results of the submaximal test on the arm crank ergometer are reliable and valid as compared with those on the bicycle crank ergometer. We showed that the submaximal test on the arm crank ergometer is suitable for measuring physical fitness in healthy people. We expect that disabled people can use this submaximal test on the arm crank ergometer for measuring their physical fitness, also.