Raya López, Rafael

The purpose of this work is to study the gap between the research evidence and the clinical practice in the physical rehabilitation of people with cerebral palsy. A review process was performed to (1) identify physical therapies to improve postural control in children with cerebral palsy and (2) determine the scientific evidence supporting the effectiveness of those therapies. A Likert-based survey addressing a total of 43 healthcare professionals involved in pediatric physical therapy departments in Spain was carried out. The discussion was mainly supported by studies of level I or II evidence (according to the Oxford scale). The search process yielded 50 studies reporting 16 therapies. A strong positive correlation between the most used treatments and elevated levels of satisfaction was found. Some well-known but not often used techniques, such as hippotherapy, were identified. The treatment with the highest degree of use and satisfaction-neurodevelopment therapy (Bobath)-and some emerging techniques, such as virtual reality, were also identified. The fact that there is a meaningful gap between clinical practice and the scientific evidence was confirmed. The identified gap brings a certain degree of controversy. While some classic and well-known therapies had poor levels of supporting evidence, other relatively new approaches showed promising results.

The craniocervical flexion test (CCFT) is recommended when examining patients with neck pain related conditions and as a deep cervical retraining exercise option. During the execution of the CCFT the examiner should visually assess that the amount of craniocervical flexion range of motion (ROM) progressively increases. However, this task is very subjective. The use of inertial wearable sensors may be a user-friendly option to measure and objectively monitor the ROM. The objectives of our study were (1) to measure craniocervical flexion range of motion (ROM) associated with each stage of the CCFT using a wearable inertial sensor and to determine the reliability of the measurements and (2) to determine craniocervical flexion ROM targets associated with each stage of the CCFT to standardize their use for assessment and training of the deep cervical flexor (DCF) muscles.

La fractura de cadera es una lesión frecuente en personas mayores de 65 años, estando asociada a una reducción en la esperanza de vida. Su rehabilitación se basa en la movilización gradual mediante terapia manual. Sin embargo, estos tratamientos no suelen ser integrales, constan de ejercicios repetitivos, resultan monótonos para el paciente y su seguimiento es principalmente cualitativo. SWalker es un andador robótico basado en un sistema de tracción y de soporte de peso, que integra sensores de marcha. Con una primera versión de este andador se llevó a cabo un estudio clínico que involucró 34 pacientes. A partir de esta experiencia se han extraído los requisitos de diseño que se consideran claves para el desarrollo de este tipo de dispositivos. Sobre la base de estos requisitosse ha construido una segunda versión del andador en la que se ha validado su usabilidad con 5 pacientes. Empleando la escala QUEST 2.0 se han comparado ambas versiones del andador, mostrando mejoras en la segunda versión en seguridad, adaptabilidad y usabilidad.

The rehabilitation of children with motor disorders is mainly focused on physical interventions. Numerous studies have demonstrated the benefits of upper function using robotic exoskeletons. However, there is still a gap between research and clinical practice, owing to the cost and complexity of these devices. This study presents a proof of concept of a 3D-printed exoskeleton for the upper limb, following a design that replicates the main characteristics of other effective exoskeletons described in the literature. 3D printing enables rapid prototyping, low cost, and easy adjustment to the patient anthropometry. The 3D-printed exoskeleton, called POWERUP, assists the user's movement by reducing the effect of gravity, thereby allowing them to perform upper limb exercises. To validate the design, this study performed an electromyographybased assessment of the assistive performance of POWERUP, focusing on the muscular response of both the biceps and triceps during elbow flexion extension movements in 11 healthy children. The Muscle Activity Distribution (MAD) is the proposed metric for the assessment. The results show that (1) the exoskeleton correctly assists elbow flexion, and (2) the proposed metric easily identifies the exoskeleton configuration: statistically significant differences (p-value D 2.26 10􀀀7 < 0.001) and a large effect size (Cohen's d D 3.78 > 0.8) in the mean MAD value were identified for both the biceps and triceps when comparing the transparent mode (no assistance provided) with the assistive mode (anti-gravity effect). Therefore, this metric was proposed as a method for assessing the assistive performance of exoskeletons. Further research is required to determine its usefulness for both the evaluation of selective motor control (SMC) and the impact of robot-assisted therapies.

The aim of the study was to develop a novel real-time, computer-based synchronization system to continuously record pressure and craniocervical flexion ROM (range of motion) during the CCFT (craniocervical flexion test) in order to assess its feasibility for measuring and discriminating the values of ROM between different pressure levels. This was a descriptive, observational, crosssectional, feasibility study. Participants performed a full-range craniocervical flexion and the CCFT. During the CCFT, a pressure sensor and a wireless inertial sensor simultaneously registered data of pressure and ROM. A web application was developed using HTML and NodeJS technologies. Forty-five participants successfully finished the study protocol (20 males, 25 females; 32 (11.48) years). ANOVAs showed large effect significant interactions between pressure levels and the percentage of full craniocervical flexion ROM when considering the 6 pressure reference levels of the CCFT (p < 0.001; 2 = 0.697), 11 pressure levels separated by 1 mmHg (p < 0.001; 2 = 0.683), and 21 pressure levels separated by 0.5 mmHg (p < 0.001; 2 = 0.671). The novel time synchronizing system seems a feasible option to provide real-time monitoring of both pressure and ROM, which could serve as reference targets to further investigate the potential use of inertial sensor technology to assess or train deep cervical flexors.

Analysis of sensorimotor control in people with and without neck pain using inertial sensor technology: study protocol for a 1-year longitudinal prospective observational study

Virtual reality (VR) has emerged as a valid addition to conventional therapy in rehabilitation and sports medicine. This has enabled the development of novel and affordable rehabilitation strategies. However, before VR devices can be used in these situations, they must accurately capture the range of motion of the body-segment where they are mounted. This study aims to state the accuracy of the Oculus Touch v2 controller when used to measure the elbow’s motion in the sagittal plane. The controller is benchmarked against an inertial sensor (ENLAZA), which has already been validated as a reliable measurement device. We have developed a virtual environment that matches both the Oculus Touch v2 and the inertial sensor orientations using a digital goniometer. We have also collected the orientation measurements given by each system for a set of 17 static angles that cover the full range of normal elbow flexion and hyperextension motion, in 10° intervals from − 10° (hyperextension) to 150° (flexion). We have applied the intra-rater reliability test to assess the level of agreement between the measurements of these devices, obtaining a value of 0.999, with a 95% confidence interval ranged from 0.996 to 1.000. By analyzing the angle measurement outcomes, we have found that the accuracy degrades at flexion values between 70° and 110°, peaking at 90°. The accuracy of Oculus Touch v2 when used to capture the elbow’s flexion motion is good enough for the development of VR rehabilitation applications based on it. However, the flaws in the accuracy that have been revealed in this experimental study must be considered when designing such applications.

This study evaluates and compares the suitability for child–computer interaction (CCI, the branch within human–computer interaction focused on interactive computer systems for children) of two devices: a standard computer mouse and the ENLAZA interface, a head mouse that measures the user’s head posture using an inertial sensor. A multidirectional pointing task was used to assess the motor performance and the users’ ability to learn such a task. The evaluation was based on the interpretation of the metrics derived from Fitts’ law. Ten children aged between 6 and 8 participated in this study. Participants performed a series of pre- and post-training tests for both input devices. After the experiments, data were analyzed and statistically compared. The results show that Fitts’ law can be used to detect changes in the learning process and assess the level of psychomotor development (by comparing the performance of adults and children). In addition, meaningful differences between the fine motor control (hand) and the gross motor control (head) were found by comparing the results of the interaction using the two devices. These findings suggest that Fitts’ law metrics offer a reliable and objective way of measuring the progress of physical training or therapy.

Neck injuries and the related pain have a high prevalence and represent an important health problem. To properly diagnose and treat them, practitioners need an accurate system for measuring Cervical Range Of Motion (CROM). This article describes the development and validation of an inexpensive, small (4 cm 4 cm 8 cm), light (< 200 g) and easy to use solution for measuring CROM using wearable inertial sensors. The proposed solution has been designed with the clinical practice in mind, after consulting with practitioners. It is composed of: (a) two wearable wireless MEMS-based inertial devices, (b) a recording and report generation software application and (c) a measurement protocol for assessing CROM. The solution provides accurate (none of our results is outside the ROM ranges when compared with previously published results based on an optical tracking device) and reliable measurements (ICC = 0.93 for interrater reliability when compared with an optical tracking device and ICC > 0.90 for test-retest reliability), surpassing the popular CROM instrument’s capabilities and precision. It also fulfills the needs for clinical practice attending to effectiveness, efficiency (4 min from setup to final report) and user’s satisfaction (as reported by practitioners). The solution has been certified for mass-production and use in medical environments.

La concepción de un nuevo prototipo o producto de apoyo es tarea de investigadores y desarrolladores, los cuales deberán conocer las necesidades reales de los usuarios a través de una interacción continua con la persona con discapacidad y los expertos, y atendiendo a los aspectos mencionados en relación con el contexto social y al mercado, con el fin de garantizar la viabilidad del producto creado.