People in developed countries are living longer with the help of medical advances. Literature has shown that older people prefer to stay independent and live at home for as long as possible. Therefore, it is important to find out how to best accommodate and assist them in maintaining quality of life and independence as well as easing human resources. Researchers have claimed that assistive devices assist in older people’s independence, however, only a small number of studies regarding the efficiency of assistive devices have been undertaken of which several have stated that devices are not being used. The overall aim of this research was to identify whether the disuse and ineffectiveness of assistive devices are related to change in abilities or related to the design of the devices. The objective was to gather information from the elderly; to identify what assistive devices are being used or not used and to gain an understanding on their attitudes towards assistive devices. Research was conducted in two phases. The initial phase of the research was conducted with the distribution of questionnaires to people over the age of fifty that asked general questions and specific questions on type of devices being used. Phase One was followed on by Phase Two, where participants from Phase One who had come in contact with assistive devices were invited to participate in a semi-structured interview. Questions were put forth to the interviewee on their use of and attitudes towards assistive devices. Findings indicated that the reasons for the disuse in assistive devices were mostly design related; bulkiness, reliability, performance of the device, difficulty of use. The other main reason for disuse was socially related; elderly people preferred to undertake activities on their own and only use a device as a precaution or when absolutely necessary. They would prefer not having to rely on the devices. Living situation and difference in gender did not affect the preference for the use of assistive devices over personal assistance. The majority strongly supported the idea of remaining independent for as long as possible. In conclusion, this study proposes that through these findings, product designers will have a better understanding of the requirements of an elderly user. This will enable the designers to produce assistive devices that are more practical, personalised, reliable, easy to use and tie in with the older people’s environments. Additional research with different variables is recommended to further justify these findings.

O uso de dispositivos assistivos tem sido um importante tema de interesse para pesquisas, em especial por se relacionar com a prevalência de limitações na capacidade funcional, bem como com a fragilidade em idosos. Esses dispositivos podem melhorar a autonomia, reduzir limitações funcionais, melhorar a qualidade de vida, promover melhor adaptação ao meio onde o idoso está inserido e prevenir ou reduzir níveis de fragilidade. Idosos mais velhos (80 anos e mais), residentes no domicílio, podem se beneficiar com o uso de dispositivos assistivos para se manter independentes pelo maior tempo possível. Assim, o objetivo geral deste estudo foi identificar o uso de dispositivos assistivos e sua relação com a capacidade funcional e com a fragilidade em idosos mais velhos residentes no domicílio. Trata-se de um estudo quantitativo do tipo observacional e transversal, realizado com 114 idosos com 80 anos e mais, residentes no município de Ribeirão Preto-SP. O processo de amostragem foi probabilístico, por conglomerados e de duplo estágio. Na coleta de dados, foram feitas entrevistas no domicílio, utilizando um roteiro estruturado de caracterização, Miniexame do Estado Mental, Índice de Katz, Escala de Lawton e Brody, roteiro de problemas de saúde autorreferidos, Escala de Fragilidade de Edmonton e um instrumento elaborado e validado para investigar o uso de dispositivos assistivos. Os dados foram analisados por meio do programa estatístico SAS®9.0, no qual foram gerados análises descritivas e os testes de associação entre as variáveis do estudo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto-USP. Quanto aos resultados, a maioria dos idosos era mulher (69.30%), viúva (57.89%), aposentada (63.16%) e fazia atividade doméstica (61.40%). A idade média foi 85.49 anos e 22.81% dos idosos viviam sozinhos. Os principais problemas de saúde que interferiam no cotidiano foram os problemas de coluna (24.56%) e artrite (18.42%). Ainda da análise descritiva, 79.82% não apresentaram déficit cognitivo, 50% eram independentes nas seis funções das atividades básicas da vida diária (ABVDs), 71.93% tinham dependência parcial nas atividades instrumentais da vida diária (AIVDs), 29.82% não apresentavam fragilidade, 25.44% eram aparentemente vulneráveis e 75.44% faziam uso de, pelo menos, um dispositivo assistivo. Os dispositivos mais usados foram: óculos (45.61%), barras (21.93%) e bengalas (15.79%), sendo que os idosos que mais usavam eram as mulheres (53.51%), na faixa etária de 80 a 89 anos (61.4%), que não tinham companheiro (55.26%) e que residiam com familiares (30.70%). No entanto, nos testes de associação, foram encontradas significâncias estatísticas entre o uso de dispositivos (cadeira de rodas, bengala, andador e óculos) e as ABVDs; uso de dispositivos (cadeira de rodas, bengala e óculos) e as AIVDs; uso de dispositivos (cadeira de rodas, bengala, andador, barras de apoio) e a fragilidade. Concluindo, os dispositivos que se relacionaram com as AVDs e fragilidade foram, predominantemente, aqueles que promovem e/ou auxiliam a mobilidade. Isto sugere que idosos mais velhos domiciliados, em vários níveis funcionais e de fragilidade, utilizam e se beneficiam com os dispositivos assistivos para minimizar a dependência na locomoção e na realização das AVDs / The use of assistive devices has been a major topic of interest for research, especially because it relates with the prevalence of limitations in functional capacity, as well as frailty in the elderly. These devices can improve the autonomy, reduce functional limitations, improve quality of life, better adaptation to the elderly environment and prevent or reduce frailty levels. Resident plder elderly (80 years and over) can benefit from the use of assistive devices to stay independent as long as possible. Thus, the general aim of this study was to identify the use of assistive devices and its relation with functional capacity and frailty in resident older elderly. This is a quantitative observational cross-sectional study performed with 114 elderly aged 80 and over, living in Ribeirão Preto-SP. The sampling was probabilistic, dual- stage clustering. For data collection, interviews were made at home, using a structured script for characterization, the Mini Mental State Examination, the Katz Index, the Lawton and Brody Scale, a script for self-reported health issues, the Edmonton Fragility Scale and an instrument developed and validated to investigate the use of assistive devices. Data were analyzed using the statistical software SAS®9.0 in which the descriptive analyzes and tests of association between the study variables were generated. The project was approved by the Research Ethics Committee of Ribeirão Preto College of Nursing-USP. As for the results, the majority were women (69.30%), widow(ed) (57.89%), retired (63.16%) and performed domestic activities (61.40%). The mean age was 85.49 years, and 22.81% of the elderly lived alone. The main health issues that interfered with daily living were back issues (24.56%) and arthritis (18.42%). Also in the descriptive analysis of the elderly, 79.82% had no cognitive impairment, 50% were independent in the six functions of the basic activities of daily living (BADL), 71.93% had a partial dependence in instrumental activities of daily living (IADL), 29.82% had no frailty, 25.44% were apparently vulnerable and 75.44% used at least one assistive device. The most commonly used devices were: glasses (45.61%), bars (21.93%) and canes (15.79%), and the subjects who most frequently used these devices were women (53.51%), aged 80-89 years (61.4%) who had no partner (55.26%) and lived with family members (30.70%). However, in the tests of association, statistical significance was found between the use of devices (wheelchair, cane, walker and glasses) and BADL; the use of devices (wheelchair, cane and glasses) and IADL; use of devices (wheelchair, cane, walker, grab bars) and frailty. In conclusion, the devices that were related to the ADL and frailty were predominantly those that promote and/or assisted mobility. This suggests that resident older elderly, in various functional and frailty levels, used and benefited from the assistive devices to minimize dependence on locomotion and in the performance of ADLs

Individuals who suffer from severe motor disabilities face the possibility of the loss of speech. A Brain-Computer Interface (BCI) can provide a means for communication through non-muscular control. Current BCI systems use characters that flash from gray to white (GW), making adjacent character difficult to distinguish from the target. The current study implements two types of color stimulus (grey to color [GC] and color intensification [CI]) and I hypotheses that color stimuli will; (1) reduce distraction of nontargets (2) enhance target response (3) reduce eye strain. Online results (n=21) show that GC has increased information transfer rate over CI. Mean amplitude revealed that GC had earlier positive latency than GW and greater negative amplitude than CI, suggesting a faster perceptual process for GC. Offline performance of individual optimal channels revealed significant improvement over online standardized channels. Results suggest the importance of a color stimulus for enhanced response and ease of use.

This work deals with a new approach of designing ortho-prosthetic devices in terms of mechanical solution and innovative design. The work was addressed to a specific patient with congenital malformation of upper limbs called phocomelia. A custom-made compensatory aid was made on basis of personal consultations and meetings on specialized workplace; however the aid was built in a way and from parts for other kind of disability. As it turned out, the use of this equipment is associated with many complications, and therefore as a result, this solution proved as unsatisfactory. Nevertheless, thanks to this compensation aid it was possible to specify the problems, to reveal important patterns and highlight the needs for development of entirely new and unique aid designed for patients with phocomelia disability. The work is based on these findings and knowledge acquired from bibliographic search in the field of orthotics, prosthetics, assistive devices and prosthetic equipment. A complete redesign was done with the aim to eliminate all detected problems. The presented result is a unique tool for people with specific congenital disability of upper limbs, with working label 4TE.

Made available in DSpace on 2016-04-27T18:47:20Z (GMT). No. of bitstreams: 1 Claudia Cristina Mussolini.pdf: 5103559 bytes, checksum: 952d3dbe93a9759e8c64b64fc8538643 (MD5) Previous issue date: 2007-02-16 / Assistive devices are used by elderly people to help them in their daily tasks, at work and in their integration with the community. Such devices contribute to the improvement of the elderly s functional capacity. During our field research, our attention was drawn to the fact that some of the elderly people devised and made their own assistive devices. In order to understand such behavior, our study employed a quantitative approach through semi-structured interviews with five elderly people, residents of the city of São Paulo, Brazil. Results showed that through a facilitating physical and social environment, defined types of self-efficacy expression were enabled (BANDURA, 1977;1991;1993), thus allowing those elderly people to efficiently devise, make and use albeit with some functional limitations the device that they needed. Furthermore, the assistive device built by the elderly serves as a continuous feedback for their self-esteem, since it bears the marks of their identity and life history traits. The presence of self-efficacy in the elderly s personality is an inner resource capable of minimizing the effects of functional incapacities, which may, in turn, affect their well-being and quality of life during their ageing process. Therefore, geriatric assistance programs should support and encourage the creative and productive potential of older individuals as a means to ensure their social integration and participation / Dispositivos assistivos são utilizados por idosos para auxiliá-los nas atividades de vida diária, no trabalho e na integração com a comunidade, tendo como objetivo principal a melhora da capacidade funcional. Em nossa experiência de campo, chamou a nossa atenção, o fato de alguns idosos utilizarem dispositivos assistivos idealizados e construídos por eles mesmos. Para entender este comportamento, nosso estudo utilizou-se da abordagem qualitativa, através de entrevistas semi-estruturadas com cinco idosos moradores da Cidade de São Paulo. Como resultado, percebemos que através de um ambiente físico e social facilitador houve a possibilidade da expressão da auto-eficácia (BANDURA, 1977;1991;1993) contribuindo para que estes idosos mesmo com algumas limitações funcionais - fossem capazes de pensar, construir e usar com eficiência o dispositivo que lhe faltava. Além disso, o dispositivo assistivo construído serve de constante feedback para a auto-estima dos idosos, pois traz em si marcas da sua identidade e da sua história de vida. A presença da auto-eficácia na personalidade dos idosos serve como um recurso interno para minimizar os efeitos das incapacidades funcionais que podem afetar o bem-estar e a qualidade de vida no envelhecimento. Cabe, portanto, aos programas com caráter gerontológico estimular o potencial vivencial e criativo deste segmento garantindo a sua integração e atuação social

<div>There are millions of individuals in the world who currently experience limited mobility as a result of aging, stroke, injuries to the brain or spinal cord, and certain neurological diseases. Robotic Assistive Devices (RADs) have shown superiority in helping people with limited mobility by providing physical movement assistance. However, RADs currently existing on the market for people with limited mobility are still far from intelligent.</div><div><br></div><div>Learning control strategies are developed in this study to make a Cable-Driven Assistive Device (CDAD) intelligent in assisting a human joint (e.g., a knee joint, an ankle joint, or a wrist joint). CDADs are a type of RADs designed based on Cable-Driven Parallel Robots (CDPRs). A PID–FNN control strategy and DDPG-based strategies are proposed to allow a CDAD to learn physical human-robot interactions when controlling the pose of the human joint. Both pose-tracking and trajectory-tracking tasks are designed to evaluate the PID–FNN control strategy and the DDPG-based strategies through simulations. Simulations are conducted in the Gazebo simulator using an example CDAD with three degrees of freedom and four cables. Simulation results show that the proposed PID–FNN control strategy and DDPG-based strategies work in controlling a CDAD with proper learning.</div>

Aim: The aim of this thesis was to map specific musculoskeletal impairments experienced by adults with physical disabilities at the Piña Palmera rehabilitation center in Mexico and to categorize them according to the ICF. Method: This cross-sectional study was conducted through observations and a survey based on predefined questions. The questions covered the individuals’ level of independence, pain, earlier treatment and biggest obstacle in daily life. The participants were observed when they received physical therapy or in their daily work at the center. The results from the survey and observations were later coded according to ICF. The participants were categorized and divided into groups depending on severity of their impairment: mild, moderate and severe. Results: This study includes 17 participants, nine women and eight men. The age of the participants ranged from 22 to 87 years (median: 44). The result shows an overview of the most common impairments that individuals’ who are visiting the center are affected by. The result also shows all the codes for each individual on the ICF-components. Conclusion: The group with severe loss of function had higher level of problem on the investigated components of ICF. Assistive device that should be prioritized is AFO. / Syfte: Syftet med denna studie är att kartlägga de specifika muskuloskelettära funktionsnedsättningarna hos vuxna människor med fysiska funktionshinder på Piña Palmera rehabiliteringscenter i Mexico samt att kategorisera dessa enligt International Classification of Functioning, Disability and Health. Metod: Denna tvärsnittsstudie genomfördes genom observationer och ett förberett frågeformulär. Frågeformuläret innehöll frågor som rörde individens självständighetsförmåga, smärta, tidigare behandlingar samt deltagarens självupplevda största hinder i vardagen. Deltagarna observerades under besök hos fysioterapeuten eller i deras vardagliga arbete på centret. Resultatet från intervjun och undersökningarna kodades enligt ICF och deltagarna delades in i grupper beroende på grad av funktionsnedsättning, mild, medel eller svår. Resultat: Denna studie inkluderar 17 deltagare, nio kvinnor och åtta män. Deltagarnas ålder är mellan 22 och 87 år (median: 44 år). Resultatet ger en överblick på de vanligaste funktionshindren hos individer som besöker centret. Resultatet visar också kodningen för varje individ för fyra olika komponenter inom ICF. Slutsats: Gruppen med svår funktionsnedsättning hade högre problemgrad på alla ICF-komponenter, vilket var väntat. De assisterande hjälpmedlen som bör prioriteras för centret är AFO.

This work deals with a new approach of designing ortho-prosthetic devices in terms of mechanical solution and innovative design. The work was addressed to a specific patient with congenital malformation of upper limbs called phocomelia. A custom-made compensatory aid was made on basis of personal consultations and meetings on specialized workplace; however the aid was built in a way and from parts for other kind of disability. As it turned out, the use of this equipment is associated with many complications, and therefore as a result, this solution proved as unsatisfactory. Nevertheless, thanks to this compensation aid it was possible to specify the problems, to reveal important patterns and highlight the needs for development of entirely new and unique aid designed for patients with phocomelia disability. The work is based on these findings and knowledge acquired from bibliographic search in the field of orthotics, prosthetics, assistive devices and prosthetic equipment. A complete redesign was done with the aim to eliminate all detected problems. The presented result is a unique tool for people with specific congenital disability of upper limbs, with working label 4TE.

Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide and is directly associated with "physical" risk factors prevalent in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a promising ergonomic intervention to mitigate LBP risk, by reducing muscular exertion and spine loading. The purpose of this work was to help better understand both the "intended" and "unintended" consequences of BSE use on physical risk factors for LBP, as an essential prerequisite for the safe and effective implementation of this technology in actual workplaces. The first study assessed the effects of using two BSEs on objective and subjective responses during repetitive lifting involving symmetric and asymmetric postures. Wearing both BSEs significantly reduced peak levels of trunk extensor muscle activity and reduced energy expenditure. Such reductions, though, were more pronounced in the symmetric conditions and differed between the two BSEs tested. The second study quantified the assistive torque profiles of two passive BSEs using a computerized dynamometer, with both human subjects and a mannequin. Clear differences in torque magnitudes were evident between the BSEs, though both generated more assistive torques during flexion than extension. The third study estimated the effects of BSE use on lumbosacral compressive and shear forces during repetitive lifting using an optimization-based model. Using both BSEs reduced peak compression and anteroposterior shear forces, but these effects differed between tasks and BSE designs. Reductions in composite measures of trunk muscle activity did not correspond consistently with changes in spine forces when using a BSE. The fourth study quantified the effects of two passive BSEs on trunk stability and movement coordination during repetitive lifting. Some adverse effects on stability were evident for pelvis and thorax movements and coupling of these body segments, suggesting that caution is needed in selecting a BSE for a given MMH task. Overall, we found that the efficacy of BSEs is design- and task-specific. Important safety features of the exoskeletons were also identified, providing insights on their performance boundaries. Overall, the BSEs tested were more effective and safer in tasks closer to the mid-sagittal plane and with moderate degrees of trunk flexion. / Doctor of Philosophy / Low back pain (LBP) remains the most prevalent and costly work-related disability worldwide, and the risk of LBP is related to "physical" risk factors common in manual material handling (MMH) tasks. Back-support exoskeletons (BSEs) are a new ergonomic intervention that may reduce the risk of occupational LBP, by reducing muscular efforts and loads on the spine. For the safe use of BSEs, though, it is critical to better understand both the "intended" and "unintended" consequences of this emerging technology. In this dissertation, such consequences of BSE use were evaluated in the context of repetitive lifting tasks. The first study assessed the efficacy of two BSEs in terms of physical demands during repetitive lifting tasks involving a range of torso bending and twisting. Wearing both BSEs reduced the physical demands on back muscles and decreased energy consumption. Larger reductions, though, were observed in forward bending and such reductions differed between the two BSEs tested. The second study measured the amount of support provided by two BSEs using a new measurement method, which was examined for both human subjects and a mannequin. Clear differences in the BSE support were evident between the BSEs, and both devices generated more support during torso forward bending than returning upright. The third study estimated the effects of BSE use on low back loadings during repetitive lifting using a computational model. Using both BSEs reduced loads on the low back region, though such reductions were task-specific and depended on the BSE design. The fourth study quantified the effects of the BSE use on torso stability and movement patterns during repetitive lifting. Some adverse effects on stability were evident for lower and upper torso, suggesting that caution is needed in selecting a BSE for a given MMH task. Findings from this work show the potential benefits of BSEs for use in MMH tasks, yet such benefits can depend on the BSE design and the MMH task they are used for. Further, BSE use can lead to adverse effects, especially with tasks involving extreme working postures.

L'évolution des soins médicaux auprès de la population ayant une lésion médullaire (LM) s'est traduite par une amélioration du profil fonctionnel des personnes atteintes. Ainsi une proportion importante retrouve une capacité à se tenir debout et à marcher qu'il convient d'évaluer adéquatement. Si quelques outils spécifiques à la population lésée médullaire existent pour évaluer leur ambulation, aucune évaluation de l'équilibre debout n'a été validée auprès de cette clientèle. L'échelle de Berg est un outil recommandé auprès de diverses populations, entre autres celles possédant des pathologies d'origine neurologique; et le score obtenu semble lié au niveau d'autonomie à la marche ainsi qu'aux aides techniques utilisées. L'objectif de ce projet de recherche était donc d'établir la validité concomitante de l'échelle de Berg auprès de la population LM et d'explorer les liens entre le score Berg et l'aide technique utilisée. Pour ce faire, trente-deux sujets BM ASIA D ont été recrutés parmi la clientèle hospitalisée de l'Institut de réadaptation Gingras-Lindsay de Montréal. L'évaluation de l'équilibre debout a été réalisée à l'aide de l'échelle de Berg ainsi que des tests statiques, dynamiques et des limites de stabilité du Balance Master. Le Walking Index for Spinal Cord Injury (WISCI), le Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), la vitesse de marche sur 10m et le Timed up and go ont été utilisés pour évaluer l'ambulation. Des analyses descriptives et corrélatives ont été effectuées sur les données obtenues. Une corrélation forte (0.714<Rs<0.816; p<0.01) a été observée entre l'échelle de Berg et les diverses évaluations de la marche. Des associations adéquates ont également été obtenues entre l'échelle de Berg et le test des limites de stabilité du Balance Master (-0.752<Rs<-0.463; p<0.01). Les épreuves statiques du Balance Master ont révélé de plus faibles corrélations avec les diverses mesures cliniques (-0.444<Rs<-0.414; p<0.01). Finalement, les épreuves dynamiques antéropostérieures et médiolatérales du Balance Master ont indiqué une relation équivoque avec l'échelle de Berg, n'étant reliées significativement qu'avec certaines épreuves en antéropostérieur (3 et 1s; -0.590<Rs<-0.524; p<0.01). Un effet plafond significatif est visible sur l'échelle de Berg, le WISCI et le SCI-FAI limitant leur utilité pour les personnes ayant une récupération supérieure. Les résultats ont aussi montré un profil différent des personnes tétraplégiques quant à la réussite des différentes épreuves du Berg par comparaison aux sujets paraplégiques. Pour les résultats reliés aux aides techniques, l’analyse des données descriptives révèlent que le score Berg permet généralement de faire la distinction entre les personnes indépendantes d'aides techniques, les utilisateurs de marchettes de béquilles ou de cannes, et ce, particulièrement pour les personnes paraplégiques. Cette étude a permis de documenter la validité concomitante de l'échelle de Berg auprès des personnes LM ayant une lésion incomplète (ASIA D) étant donné les relations élevées démontrées entre les paramètres de la marche et les résultats à certains tests du Balance Master. En somme, la présente étude permet de recommander l'utilisation de l'échelle de Berg pour évaluer l'équilibre debout des personnes LM. / The evolution of medical practices for people with spinal cord injury (SCI) has changed their functional profile with the result that a significant proportion recovers their ability to stand and walk. Implementing a validated scale to evaluate these aspects is therefore crucial during rehabilitation. Various walking scales have been developed specific to the SCI population, such as the Walking Index for Spinal Cord Injury (WISCI) and the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI). However, no known balance evaluation has been recommended for this population. The Berg Balance Scale has been developed and validated for various populations presenting neurological disorders. An association has been shown between the Berg score and the level of independence as well as the walking assistive devices used. The purpose of this project was therefore to validate the Berg Balance Scale for the SCI population and to explore the relationship between the Berg score and the walking assistive devices used. Thirty-two subjects were recruited from the SCI population of the Institut de réadaptation Gingras-Lindsay de Montréal. Walking evaluation was performed using the WISCI, the SCI-FAI, the walking speed on 10m and the Timed Up and Go. The balance evaluation was carried out using the Berg Balance Scale (BBS) as well as the static, dynamic and limits-of-stability tests of the Balance Master. Descriptive and correlational analyses were performed on the sample. The results showed a strong correlation between the BBS and all walking evaluations (0.714<Rs<0.816; p<0.01). The BBS was also strongly related to the limits-of-stability test (-0.752<Rs<-0.463; p<0.01). The static tests of the Balance Master were weakly correlated with the various clinical evaluations (-0.444<Rs<-0.414; p<0.01) while the dynamic tests resulted in equivocal associations with BBS, being better for the anteroposterior test (3 and 1s conditions; -0.590<Rs<-0.524; p<0.01). A significant ceiling effect was present ion the BBS, the WISCI and the SCI-FAI scales. The results also showed that paraplegic and tetraplegic subjects differ in their performance in the various items of the BBS. Descriptive analysis reveals that the BBS score can help to discriminate between walker, crutches and cane users and individuals walking independently, especially in the case of people with paraplegia. This study revealed that the BBS is a valid balance evaluation for people with incomplete (ASIA D) spinal cord injury. Its use for evaluating standing balance in the clinical and laboratory setting is therefore recommended.