Basics of qualitative research: Grounded theory procedures and techniques

In the nearly six decades since researchers began to explore methods of creating them, exoskeletons have progressed from the stuff of science fiction to nearly commercialized products. While there are still many challenges associated with exoskeleton development that have yet to be perfected, the advances in the field have been enormous. In this paper, we review the history and discuss the state-of-the-art of lower limb exoskeletons and active orthoses. We provide a design overview of hardware, actuation, sensory, and control systems for most of the devices that have been described in the literature, and end with a discussion of the major advances that have been made and hurdles yet to be overcome.

Lower Extremity Exoskeletons and Active Orthoses: Challenges and State-of-the-Art

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

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How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX.

There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.

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Review of control strategies for robotic movement training after neurologic injury

Soft robots are primarily composed of easily deformable matter such as fluids, gels, and elastomers that match the elastic and rheological properties of biological tissue and organs. Like an octopus squeezing through a narrow opening or a caterpillar rolling through uneven terrain, a soft robot must adapt its shape and locomotion strategy for a broad range of tasks, obstacles, and environmental conditions. This emerging class of elastically soft, versatile, and biologically inspired machines represents an exciting and highly interdisciplinary paradigm in engineering that could revolutionize the role of robotics in healthcare, field exploration, and cooperative human assistance.

Soft Robotics: A Perspective—Current Trends and Prospects for the Future

An active ankle-foot orthoses (AAFO) is presented where the impedance of the orthotic joint is modulated throughout the walking cycle to treat drop-foot gait. During controlled plantar flexion, a biomimetic torsional spring control is applied where orthotic joint stiffness is actively adjusted to minimize forefoot collisions with the ground. Throughout late stance, joint impedance is minimized so as not to impede powered plantar flexion movements, and during the swing phase, a torsional spring-damper control lifts the foot to provide toe clearance. To assess the clinical effects of variable-impedance control, kinetic and kinematic gait data were collected on two drop-foot participants wearing the AAFO. For each participant, zero, constant, and variable impedance control strategies were evaluated and the results were compared to the mechanics of three age, weight, and height matched normals. We find that actively adjusting joint impedance reduces the occurrence of slap foot allows greater powered plantar flexion and provides for less kinematic difference during swing when compared to normals. These results indicate that a variable-impedance orthosis may have certain clinical benefits for the treatment of drop-foot gait compared to conventional ankle-foot orthoses having zero or constant stiffness joint behaviors.

Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait

Is there any evidence that e-health—using information technology to manage patient care—can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted.

E-Health Technologies Show Promise In Developing Countries

An Active Ankle Foot Orthosis (AAFO) is provided where the impedance of an orthotic joint is modulated throughout the walking cycle to treat ankle foot gait pathology, such as drop foot gait. During controlled plantar flexion, a biomimetic torsional spring control is applied where orthotic joint stiffness is actively adjusted to minimize forefoot collisions with the ground. Throughout late stance, joint impedance is minimized so as not to impede powered plantar flexion movements, and during the swing phase, a torsional spring-damper (PD) control lifts the foot to provide toe clearance. To assess the clinical effects of variable-impedance control, kinetic and kinematic gait data were collected on two drop foot participants wearing the AAFO. It has been found that actively adjusting joint impedance reduces the occurrence of slap foot, allows greater powered plantar flexion, and provides for less kinematic difference during swing when compared to normals.

Active ankle foot orthosis

Background: The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing countries requires a long-term relationship with the patient, accurate and accessible records of each patient’s history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV patients in Africa during treatment and many patients not being started on treatment at all. Some programs for prevention of maternal–child transmission have more than 80% loss to follow-up of babies born to HIV-positive mothers. These patients are at great risk of developing drug resistance or dying if their antiretroviral therapy is interrupted. Similar problems have been found in the scale-up of MDR-TB treatment.
Objectives: The aim of the study was to assess the role of medical information systems in tracking patients with HIV or MDR-TB, ensuring they are promptly started on high quality care, and reducing loss to follow-up.
Methods: A literature search was conducted starting from a previous review and using Medline and Google Scholar. Due to the nature of this work and the relative lack of published articles to date, the authors also relied on personal knowledge and experience of systems in use and their own assessments of systems.
Results: Functionality for tracking patients and detecting those lost to follow-up is described in six HIV and MDR-TB treatment projects in Africa and Latin America. Preliminary data show benefits in tracking patients who have not been prescribed appropriate drugs, those who fail to return for follow-up, and those who do not have medications picked up for them by health care workers. There were also benefits seen in providing access to key laboratory data and in using this data to improve the timeliness and quality of care. Follow-up was typically achieved by a combination of reports from information systems along with teams of community health care workers. New technologies such as low-cost satellite Internet access, personal digital assistants, and cell phones are helping to expand the reach of these systems.
Conclusions: Effective information systems in developing countries are a recent innovation but will need to play an increasing role in supporting and monitoring HIV and MDR-TB projects as they scale up from thousands to hundreds of thousands of patients. A particular focus should be placed on tracking patients from initial diagnosis to initiation of effective treatment and then monitoring them for treatment breaks or loss to follow-up. More quantitative evaluations need to be performed on the impact of electronic information systems on tracking patients. [J Med Internet Res 2007;9(4):e29]

Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas.

Global Health Informatics is an emerging field, as demonstrated by several substantial and widely used electronic medical record (EMR) systems along with the emergence of mobile based or“mhealth” systems. We describe here many of the practical lessons we have learned from implementing systems in a wide range of challenging environments over the last decade. Some requirements, like data backups, skilled staff and local leadership are universally important. Others, such as limited power, poor network access and distributed populations, require different designs and strategies in resource poor environments.

Joaquin A. Blaya

Papers

Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait

E-Health Technologies Show Promise In Developing Countries

Active ankle foot orthosis

Information systems for patient follow-up and chronic management of HIV and tuberculosis: a life-saving technology in resource-poor areas.

Implementing medical information systems in developing countries, what works and what doesn't