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Background: An accurate estimation of the glenohumeral joint center of rotation (CoR) is important during alignment of braces and exoskeletons, as a misalignment will introduce undesired forces on the human body. The aim of this research was to develop a new method to estimate the glenohumeral CoR and register the location to the body using a single camera and two printed markers. Methods: During shoulder anteflexion, the arm roughly describes an arc in the sagittal plane, with the glenohumeral joint in the center. Two binary square-fiducial ArUco markers were secured to the upper arm and the scapula, their position and orientation were obtained, and a sphere was fitted to the coordinates of the arm marker. The sphere center position was then registered on the skin. The accuracy was assessed with a test bench with a known rotational center. The repeatability was assessed in vivo with five healthy participants. Results: The mean absolute offset between the true CoR of the test bench and the fitted sphere centers across multiple trials was 2.7 mm at a velocity of 30 degrees/s, and 2.5 mm at 60 degrees/s. The root mean squared distance from the estimated sphere centers after each trial to the mean sphere center across all trials per participant was 5.1 mm on average for the novice examiner and 5.2 mm for the expert examiner. Conclusions: The proposed method is able to accurately and precisely estimate the glenohumeral CoR.

BACKGROUND: Lower-limb amputations are rare but debilitating events in the lives of affected persons. Treatment of persons with amputation inherently involves many different health care professions at different stages leading to and after an amputation. There are prevailing clinical questions within the work field related to different facets of care including peri/postoperative aspects, prosthetic components, rehabilitation treatment, and health care processes.OBJECTIVES: To provide an up-to-date multidisciplinary evidence-based guideline for health care professionals involved in the treatment of persons with lower-limb amputation in the Netherlands.METHODS: Identification of key questions in a focus group, systematic review of the evidence (up to March 2019, using Embase and MEDLINE databases), and weighing considerations, culminating in clinical recommendations.RESULTS: Twelve key questions were formulated. Recommendations of two key questions were upheld in line with the previous 2012 guideline. Ten systematic literature searches were performed, leading to the inclusion of 59 studies.CONCLUSION: A summary of evidence-based conclusions, considerations, and recommendations of the 2020 guideline is presented.

Stroke is one of the leading causes of disability in adults in the European Union. It often leads to motor impairments, such as a hemiparetic lower extremity. Research indicates that early task-specific and intensive training promotes neuroplasticity and leads to recovery and/or compensation. One way to provide intensive training early after a stroke is via robot-supported training. A rehabilitation robot was designed by Life Science Robotics (Aalborg, Denmark) that can provide continuous repetitive movements of the hip, knee, and/or ankle in e.g., a lying position. In order to emphasize active contribution by the patient, actively triggered electrical stimulation (via muscle activation) can be combined with robotic assistance. The current study aims to compare different threshold estimation methods for detection of movement intention from muscle activity for actively triggered electrical stimulation during robot-supported leg movement in stroke patients. Three sub-acute stroke patients were included for a single measurement session. They performed knee extension and/or ankle dorsal flexion with four different threshold estimation methods to assess the intention detection threshold to initiate electrostimulation. The thresholds were based on the resting level of muscle activity (of m. rectus femoris or m. tibialis anterior) plus two or three times the standard deviation of the average resting value, or the resting level plus 5% or 10% of the peak muscle activity during a maximal voluntary contraction. The results showed that the method based on the resting muscle activity plus two times the standard deviation was the most stable across the three included stroke patients. This method had a detection success rate of 86.7% and was experienced as moderately comfortable. In conclusion, performing knee extension and/or ankle dorsal flexion with electromyography triggered electrostimulation is feasible in sub-acute stroke patients. Muscle activity-triggered electrostimulation combined with robotic support based on a threshold of resting levels plus two times the standard deviation seems to detect movement initiation most consistently in this small sample of sub-acute stroke patients.

Background Regaining gait capacity is an important rehabilitation goal post stroke. Compared to clinically available robotic gait trainers, robots with an assist-as-needed approach and multiple degrees of freedom (AANmDOF) are expected to support motor learning, and might improve the post-stroke gait pattern. However, their benefits compared to conventional gait training have not yet been shown in a randomized controlled trial (RCT). The aim of this two-center, assessor-blinded, RCT was to compare the effect of AANmDOF robotic to conventional training on the gait pattern and functional gait tasks during post-stroke inpatient rehabilitation. Methods Thirty-four participants with unilateral, supratentorial stroke were enrolled (mDOF robotic (combination of training in LOPES-II and conventional gait training) or conventional gait training (30 min, 3–5 times a week), focused on pre-defined training goals. Randomization and allocation to training group were carried out by an independent researcher. External mechanical work (WEXT), spatiotemporal gait parameters, gait kinematics related to pre-defined training goals, and functional gait tasks were assessed before training (T0), after training (T1), and at 4-months follow-up (T2). Results Two participants, one in each group, were excluded from analysis because of discontinued participation after T0, leaving 32 participants (AANmDOF robotic n = 17; conventional n = 15) for intention-to-treat analysis. In both groups, WEXT had decreased at T1 and had become similar to baseline at T2, while gait speed had increased at both assessments. In both groups, most spatiotemporal gait parameters and functional gait tasks had improved at T1 and T2. Except for step width (T0–T1) and paretic step length (T0–T2), there were no significant group differences at T1 or T2 compared to T0. In participants with a pre-defined goal aimed at foot clearance, paretic knee flexion improved more in the AANmDOF robotic group compared to the conventional group (T0–T2). Conclusions Generally, AANmDOF robotic training was not superior to conventional training for improving gait pattern in subacute stroke survivors. Both groups improved their mechanical gait efficiency. Yet, AANmDOF robotic training might be more effective to improve specific post-stroke gait abnormalities such as reduced knee flexion during swing. Trial registration Registry number Netherlands Trial Register (www.trialregister.nl): NTR5060. Registered 13 February 2015.

Objective: To determine the diagnostic value of the Duncan-Ely test in predicting abnormal rectus femoris activity during gait in stroke survivors walking with a stiff knee gait. Design: Cross-sectional diagnostic study. Subjects: A total of 95 patients with chronic stroke. Methods: During physical examination, the Duncan-Ely test was performed and scored. Surface electromyography of the rectus femoris was then recorded during dynamic gait. To determine the diagnostic value, the results of the Duncan-Ely test and surface electromyography recordings (gold standard) were compared. Results: The Duncan-Ely test had a sensitivity of 73%, a specificity of 29%, a positive predictive value of 60%, and a negative predictive value of 42%. The area under the curve was 0.488 ([AQ1] CI 0.355–0.621, p = 0.862), showing that the Duncan-Ely test is not better than random guessing. Conclusion: The Duncan-Ely test has no predictive value for determining abnormal activity of the rectus femoris during gait. Using this test can lead to incorrect identification of abnormal rectus femoris activity, which might hamper the selection of optimal treatment options. We recommend stopping use of the Duncan-Ely test to predict rectus femoris overactivity during swing, and instead use surface electromyography.

Objective To explore the direct influence of a soft-robotic glove on movement duration and movement execution in elderly people with decreased hand function during a reach-and-grasp task. Design Cross-sectional study. Patients Eight subjects, aged 55+ years, with decreased hand function. Methods The direct effect of the glove was explored using kinematic analysis during a reach-and-grasp task with a light (100 g) and heavy (1,000/2,500 g) cylindrical object, performed with and without the soft-robotic glove. Results There was no difference in total movement time between performance with and without the glove. With the glove, the relative time needed to transport the heavy object was shorter, while the relative time needed to grasp the heavy object was longer. In addition, transporting light objects involved a lower peak velocity and larger elbow extension, and grasping the object involved a larger hand opening compared with without glove. Conclusion As expected, no positive influence of the soft-robotic glove was found on total movement duration in elderly subjects. The influence of the glove on movement execution varied with movement phase. The positive and negative effects found may be due to a perceived confidence while carrying heavy objects with the glove, or compensation for loss of sensation, respectively. This information can be used to improve the glove design.

Background Shoulder complaints from glenohumeral subluxation are a common problem and limit patients during daily activities. Objective To assess the clinical pros and cons and usability of a newly developed shoulder orthosis (Roessingh Omo Support [ROS]) in patients with chronic shoulder complaints. Study design Retrospective cross-sectional study. Methods All patients older than 18 years who received the ROS were invited. Medical information was collected from medical records. Two questionnaires were sent to the patient: The "Shoulder Rating Questionnaire" (SRQ, max 100 points) for evaluation before and during use and a custom orthosis usability questionnaire. Results In total, 28 patients (34 orthoses) participated in the study. Neuralgic amyotrophy was the most common diagnosis (64.3%). The SRQ showed a significant positive change of 8.9 points (from 35.0 [SD 12.6] to 43.9 [SD 14.3]). The most described goal was pain reduction (76.5%). 47.1% of the patients achieved their goal(s), and 71.4% were still using the orthosis. The mean satisfaction rate was 7.1 (SD 1.4). Conclusion The use of the ROS shows a significant functional improvement (SRQ), a decrease of pain, and a high degree of satisfaction, although the individual experiences of the patients are highly variable. Some modifications to the design to improve comfort may be needed.

Many wheelchair users experience disabilities in stabilising and positioning of the head. For these users, adequate head support is required. Although several types of head supports are available, further development of these systems is needed to improve functionality and quality of life, especially for the group of severely challenged users. For this group, user needs have not been clearly established. In this article, we provide an overview of the state-of-the-art in wheelchair mounted head supports and associated scientific evidence in order to identify requirements for the next generation of head support systems.A scoping review was performed including scientific literature (PubMed/Scopus), patents (Espacenet/Google Scholar) and commercial information. Types of head support and important system characteristics for future head support systems were proposed from consultations with wheelchair users (Forty scientific papers, 90 patents and 80 descriptions of commercial devices were included in the scoping review. The identified head support systems were categorised per head support type. Only limited scientific clinical evidence with respect to the effectiveness of existing head support systems was found. From the user and expert consultations, a need was identified for personalised head support systems that intuitively combine changes in sitting and head position with continuous optimal support of the head to accommodate severely challenged users.This study presents the state-of-the-art in head support systems. Additionally, several important system characteristics are introduced that provide guidance for the development and improvement of head supports.Implications for rehabilitationEspecially for the group of severely challenged wheelchair users, current head support systems require further development to improve their users' quality of life.The desired system characteristics which are discussed in this review are an important step in the definition of requirements for the next generation of head supports.

Objective: In this paper we presented a novel shoulder subluxation support that aims to reduce the stress on the passive structures around the shoulder of patients with glenohumeral subluxation and glenohumeral-related shoulder pain. The device applies a force to the upper arm without impeding the functional range of motion of the arm. Our design contains a mechanism that statically balances the arm with two elastic bands. Methods: A technical evaluation study was conducted to assess the performance of the orthosis. Additionally, two patients evaluated the orthosis. Results: The results of the technical validation confirm the working of the balancing mechanism. The pilot study demonstrated that the shoulder support increased the feeling of stability of the shoulder joint and, to a lesser extent, decreased shoulder pain. Furthermore, both patients reported that the orthosis did not impede their range of motion. Conclusion: In this research we developed a shoulder orthosis based on two statically balanced springs that support the shoulder of patients with glenohumeral subluxation that have residual shoulder muscle force. Compared to existing shoulder supports, our design does not impede the range of motion of the arm, and continues to provide a stabilizing force to the shoulder, even if the arm is moved away from the neutral position. Tests with two participants showed promising results. Significance: The device presented in this work could have a significant impact on the shoulder function which may improve rehabilitation outcome and improve the quality of life of patients suffering from glenohumeral subluxation and shoulder pain.

Visual cues can be used to train walking patterns. Here, we studied the performance and learning capacities of healthy subjects executing a high-precision visuomotor walking task, in an augmented reality training set-up. A beamer was used to project visual stepping targets on the walking surface of an instrumented treadmill. Two speeds were used to manipulate task difficulty. All participants (n = 20) had to change their step length to hit visual stepping targets with a specific part of their foot, while walking on a treadmill over seven consecutive training blocks, each block composed of 100 stepping targets. Distance between stepping targets was varied between short, medium and long steps. Training blocks could either be composed of random stepping targets (no fixed sequence was present in the distance between the stepping targets) or sequenced stepping targets (repeating fixed sequence was present). Random training blocks were used to measure non-specific learning and sequenced training blocks were used to measure sequence-specific learning. Primary outcome measures were performance (% of correct hits), and learning effects (increase in performance over the training blocks: both sequence-specific and non-specific). Secondary outcome measures were the performance and stepping-error in relation to the step length (distance between stepping target). Subjects were able to score 76% and 54% at first try for lower speed (2.3 km/h) and higher speed (3.3 km/h) trials, respectively. Performance scores did not increase over the course of the trials, nor did the subjects show the ability to learn a sequenced walking task. Subjects were better able to hit targets while increasing their step length, compared to shortening it. In conclusion, augmented reality training by use of the current set-up was intuitive for the user. Suboptimal feedback presentation might have limited the learning effects of the subjects.

Pressure ulcers are a significant problem in health care, due to high costs and large impact on patients' life. In general, pressure ulcers develop as tissue viability decreases due to prolonged mechanical loading. The relation between load and tissue viability is highly influenced by individual characteristics. It is proposed that measurements of skin blood flow regulation could provide good assessment of the risk for pressure ulcer development, as skin blood flow is essential for tissue viability. . Therefore, the aim of this systematic review is to gain insight in the relation between mechanical load and the response of the skin and underlying tissue to this loading measured in-vivo with non-invasive techniques. A systematic literature search was performed to identify articles analysing the relation between mechanical load (pressure and/or shear) and tissue viability measured in-vivo . Two independent reviewers scored the methodological quality of the 22 included studies. Methodological information as well as tissue viability parameters during load application and after load removal were extracted from the included articles and used in a meta-analysis. Pressure results in a decrease in skin blood flow parameters, compared to baseline; showing a larger decrease with higher magnitudes of load. The steepness of the decrease is mostly dependent on the anatomical location. After load removal the magnitude of the post-reactive hyperaemic peak is related to the magnitude of pressure. Lastly, shear in addition to pressure, shows an additional negative effect, but the effect is less apparent than pressure on skin viability.

Objective: To study the six-month clinical effects of providing ankle-foot orthoses at different moments (early or delayed) in (sub)acute stroke; this is a follow-up to a published trial. Design: Randomized controlled trial.Setting: Rehabilitation centre.Subjects: Unilateral hemiparetic stroke subjects maximal six weeks post-stroke with indication for ankle-foot orthosis use.Interventions: Subjects were randomly assigned to early (at inclusion; week 1) or delayed provision (eight weeks later; week 9).Outcome measures: Functional tests assessing balance and mobility were performed bi-weekly for 17 weeks and at week 26. Results: In all, 33 subjects were randomized. No differences at week 26 were found between both groups for any of the outcome measures. However, results suggest that early provision leads to better outcomes in the first 11–13 weeks. Berg Balance Scale (P= 0.006), Functional Ambulation Categories (P=0.033) and 6-minute walk test (P

Reduced grip strength, resulting in difficulties in performing daily activities, is a common problem in the population of older adults. Newly developed soft-robotic devices have the potential to support older adults with reduced grip in daily activities. The objective of this study was to evaluate the direct, assistive effect of grip support from the wearable, soft-robotic ironHand glove. In total, 65 older adults with self-reported decline of hand function resulting from various disorders participated in this cross-sectional study. They performed various hand function tests with and without the glove during a single session. At the end, usability was scored. Participants were able to produce more pinch strength with the glove compared to without glove (p ≤ 0.001) and usability was rated very positively. However, this was not reflected in improved functional performance with the glove, as measured with timed tasks (p

To support stroke survivors in activities of daily living, wearable soft-robotic gloves are being developed. An essential feature for use in daily life is detection of movement intent to trigger actuation without substantial delays. To increase efficacy, the intention to grasp should be detected as soon as possible, while other movements are not detected instead. Therefore, the possibilities to classify reach and grasp movements of stroke survivors, and to detect the intention of grasp movements, were investigated using inertial sensing. Hand and wrist movements of 10 stroke survivors were analyzed during reach and grasp movements using inertial sensing and a Support Vector Machine classifier. The highest mean accuracies of 96.8% and 83.3% were achieved for single- and multi-user classification respectively. Accuracies up to 90% were achieved when using 80% of the movement length, or even only 50% of the movement length after choosing the optimal kernel per person. This would allow for an earlier detection of 300-750ms, but at the expense of accuracy. In conclusion, inertial sensing combined with the Support Vector Machine classifier is a promising method for actuation of grasp-supporting devices to aid stroke survivors in activities of daily living. Online implementation should be investigated in future research.

Falls are commonly reported post-stroke. Ankle-foot orthoses (AFOs) are often provided to improve safety and walking, but the effect of their use in the reduction of falls after stroke is unknown. A randomized controlled trial (RCT) on the effects of AFO-provision after stroke was performed. Effects on clinical scales, 3D-gait kinematics and muscle-activity were previously reported. This paper aims to study the effects of AFO-provision on occurrence and circumstances of falls/near falls. The RCT included unilateral hemiparetic stroke patients. AFOs were provided either early (study week 1) or delayed (study week 9). Both groups were compared in the first eight weeks of the study and diaries were used to register falls/near falls and their circumstances. Follow-up measurements were performed in week 9–52, in which both groups were provided with AFOs. Functional Ambulation Categories and Berg Balance Scale were assessed to determine walking independence and balance, respectively. Last known scores were noted in case of an incident. Thirty-three subjects were included (16 early, 17 delayed). In week 1–8, the early group, who were provided with AFOs, fell significantly more frequently compared with the delayed group, 11 versus 4 times, respectively (Incidence Rate Ratio = 2.9, p = 0.039). Out of the falls recorded in the early group, 63.6% occurred without wearing AFOs. Most of these falls occurred during transfers (36.4%) and standing (27.3%), and notably it were the subjects who did not have independent walking ability. No differences were found for near falls in week 1–8, or for falls/near falls in week 9–52. Six severe consequences (including fractures) were reported from a fall. To conclude, the subjects provided with AFOs early after stroke reported a higher number of falls, compared to the subjects that had not yet been provided with AFOs. However, in the subjects provided with AFOs, 63.6% of the falls occurred whilst without wearing the AFO. Furthermore, the majority of these incidents took place whilst subjects had no independent walking ability. This raises an interesting question of the importance of careful instructions to patients and their relatives, and the influence of potential cognitive impairments on the ability of the subjects to take on these instructions.

Background: Frequent start movements occurred during the day, yielding high upper-extremity stress. The high incidence and impact of shoulder injury on daily life wheelchair use made it clinically relevant to investigate whether power-assisted propulsion is beneficial during the start.Methods: Eleven hand-rim wheelchair users performed a start-movement in an instrumented wheelchair on a flat surface. Test order was randomly assigned to propulsion with and without power-assist. For each subject, parameters were averaged over 3 repeated starts. For statistical analysis Wilcoxon Signed Rank test was used.Findings: Intensity of mechanical shoulder loading decreased during power-assisted propulsion for anterior (147.0 (44.8) versus 121.9 (27.4) N; effect size (r) = -.75), posterior (4.8 (14.1) versus 2.7 (11.6) N; r = -.64) and inferior directed forces (82.6 (27.9) versus 68.9 (22.6) N; r = -.78) and abduction (20.2 (14.6) versus 12.9 (7.8) Nm; r = -.88) and extension moments (203 (10.7) versus 13.7 (9.1 Nm; r = -.88). Peak resultant force at the rim significantly decreased from 133.5 (38.4) N to 112.2 (25.4) N (r = -.64) and was accompanied by significant decreased shoulder abduction (35.3 (6.7) versus 333 (6.8); r = -.67) and significant increased shoulder extension (13.6 (16.3) versus 20.3 (19.1); r = -.78) during power-assisted start-up.Interpretation: Power-assist hand-rim wheelchairs are effective in reducing external shoulder load and partly effective in reducing force generation in extremes of shoulder motion during start-up. The use of power-assist wheels might reduce the risk of developing shoulder overuse injuries. (C) 2016 Elsevier Ltd. All rights reserved.

BackgroundNew developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The wearable soft-robotic ironHand glove is such a system that supports grip strength during the performance of daily activities and hand training exercises at home.DesignThis pilot randomized controlled clinical study explored the effect of prolonged use of the assistive ironHand glove during daily activities at home, in comparison to its use as a trainings tool at home, on functional performance of the hand.MethodsIn total, 91 older adults with self-perceived decline of hand function participated in this study. They were randomly assigned to a 4-weeks intervention of either assistive or therapeutic ironHand use, or control group (received no additional exercise or treatment). All participants performed a maximal pinch grip test, Box and Blocks test (BBT), Jebsen-Taylor Hand Function Test (JTHFT) at baseline and after 4-weeks of intervention. Only participants of the assistive and therapeutic group completed the System Usability Scale (SUS) after the intervention period.ResultsParticipants of the assistive and therapeutic group reported high scores on the SUS (mean = 73, SEM = 2). The therapeutic group showed improvements in unsupported handgrip strength (mean Δ = 3) and pinch strength (mean Δ = 0.5) after 4 weeks of ironHand use (p≤0.039). Scores on the BBT and JTHFT improved not only after 4 weeks of ironHand use (assistive and therapeutic), but also in the control group. Only handgrip strength improved more in the therapeutic group compared to the assistive and control group. No significant correlations were found between changes in performance and assistive or therapeutic ironHand use (p≥0.062).ConclusionThis study showed that support of the wearable soft-robotic ironHand system either as assistive device or as training tool may be a promising way to counter functional hand function decline associated with ageing.

Objective To determine: (i) whether the use of ankle-foot orthoses over a period of 26 weeks affects tibialis anterior muscle activity; (ii) whether the timing of provision of ankle-foot orthoses (early or delayed) affects the results; (iii) whether the provision of ankle-foot orthoses affects tibialis anterior muscle activity within a single measurement. Design Randomized controlled trial. Subjects Unilateral hemiparetic subjects, a maximum of 6 weeks post-stroke. Methods Subjects were assigned randomly to early (at inclusion; week 1) or delayed provision of ankle-foot orthoses (8 weeks later; week 9). Tibialis anterior electromyography was measured with and without ankle-foot orthoses, in study weeks 1, 9, 17 and 26. Results A total of 26 subjects were analysed. In a single measurement, use of an ankle-foot orthosis significantly reduced the activity levels of the tibialis anterior muscle during the swing phase (p = 0.041) compared with walking without an ankle-foot or-thosis. During the 26-week follow-up, no changes were found in tibialis anterior muscle activity in the swing phase without an ankle-foot orthosis, both within-groups (p = 0.420 early; p = 0.282 delayed), and between-groups (p = 0.987). After 26 weeks, no differences were found in tibialis anterior muscle activity between both groups in the swing phase, with (p = 0.207) or without ankle-foot orthoses (p = 0.310). Conclusion Use of ankle-foot orthoses post-stroke reduced tibialis anterior muscle activity in the swing phase within 1 measurement; however, long-term use of ankle-foot orthoses for 26 weeks did not affect such activity. Early or delayed provision of ankle-foot orthoses did not affect the findings. The results indicate that there is no need to fear negative consequences on tibialis anterior-activity because of long-term AFO-use (early) after stroke.

Many stroke survivors encounter difficulties in the performance of activities of daily life due to limitations in functional use of the hand. Robotic technology has the potential to compensate for this loss by providing the support that is required to perform activities of daily living, especially when these devices are wearable comfortably for many hours at home. As a first step towards the implementation of assistive technology in the homes of stroke survivors, usability along with the potential effect of prolonged use of a wearable soft-robotic glove during activities of daily life on functional task performance was assessed in this study. Therefore, five chronic stroke survivors were asked to use a wearable soft-robotic glove for four weeks at home during preferred activities of daily life. Before and after the home use of the glove, functional task performance was assessed in a lab environment. After the use of the glove, system usability was assessed. The prolonged use of the glove resulted in an improved supported and unsupported functional performance during tasks related to activities of daily life, as measured with the Jebsen-Taylor Hand Function Test. Promising system usability results were found indicating a good probability for acceptance of the glove. The results from this study indicate the potential of the current glove to be used as assistive tool, which even showed a therapeutic effect. Yet, the glove should be tested in a larger sample for better interpretation and confirmation of these promising results.

Objective: To investigate the feasibility of a wear-able, soft-robotic glove system developed to combine assistive support in daily life with performing therapeutic exercises on a computer at home (the HandinMind system). Design: Feasibility study. Patients: Five chronic stroke patients with limitations in activities of daily living due to impaired hand function. Methods: Participants performed a usability test and several functional tasks with the HandinMind system across 2 sessions. Feasibility was measured using the System Usability Scale (SUS), Intrinsic Motivation Inventory (IMI) and performance times of the functional tasks. Results: User acceptance measured by the SUS and IMI was scored high. The median SUS scores of sessions 1 and 2 were 80.0 (interquartile range (IQR) 70.0–88.8) and 77.5 (IQR 75.0–87.5), respectively, and the median IMI score was 6.3 points out of 7 points (IQR 6.2–6.3). Functional task performance was initially slower with the HandinMind glove compared with performance without the glove, but improved up to the level of performance without the glove across no more than 3 repetitions. Conclusion: Chronic stroke patients with impaired hand function were positive about the feasibility of the first prototype of the HandinMind system. How-ever, performance and ease of use of the system should be improved further in future development phases.

Cycling supports the mobility, health and independency of the ageing population. However, older cyclists have an increased injury risk. On average, the risk of older people to sustain an injury in a cycling accident is three times higher per cycling kilometre than for middle-aged people and the injury risk increases with age. In comparison with middle-aged cyclists (65 years) filled out a questionnaire, which included questions on demographics, bicycle specifications and personal characteristics. By means of a logistic regression, the relationship between personal factors and self-reported bicycle falls were studied. The univariate models showed that age, physical and mental impairments, bicycle model, living environment, feelings of uncertainty of the cyclist and changed cycling behaviour (such as more patience, lower speed) were related to falling off a bicycle. From the multivariate model we can conclude that several factors are associated with falling off a bicycle in the older population: (1) every year the cyclists becomes one year older (from the age of 65), the chance they have fallen increases with 7.3%, (2) If cyclists have mental impairments, the chance they have fallen increases with a factor 2.5, (3) if cyclists were less than completely confident the chance they have fallen increases with factor 1.8, (4) if cyclists live in a rural environment compared to an urban environment the chance they have fallen increases with a factor 2.1. In conclusion, demographic, cycling and personal factors can be related to increased self-reported fall risk. It is advised to take these factors into account when implementing new cycling related safety measures.

BACKGROUND Technical innovations have the potential to compensate for loss of upper-limb motor functions after stroke. However, majority of the designs do not completely meet the needs and preferences of the end users. User-centered design methods have shown that the attention to user perspectives during development of assistive technology leads to devices that better suit the needs of the users. OBJECTIVE To get more insight into the factors that can bring the design of assistive technology to higher levels of satisfaction and acceptance, studies about user perspectives on assistive technology for the upper limb after stroke are systematically reviewed. METHODS A database search was conducted in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus from inception to August 2017, supplemented with a search of reference lists. Methodological quality of the included studies was appraised. User perspectives of stroke survivors, carers, and health care professionals were extracted. A total of 35 descriptive themes were identified, from which 5 overarching themes were derived. RESULTS In total, 9 studies with information gathered from focus groups, questionnaires, and interviews were included. Barriers and enablers influencing the adoption of assistive technology for the upper limb after stroke emerged within 5 overarching but highly interdependent themes: (1) promoting hand and arm performance; (2) attitude toward technology; (3) decision process; (4) usability; and (5) practical applicability. CONCLUSIONS Expected use of an assistive technology is facilitated when it has a clear therapeutic base (expected benefit in enhancing function), its users (patients and health care professionals) have a positive attitude toward technology, sufficient information about the assistive technology is available, and usability and practical applicability have been addressed successfully in its design. The interdependency of the identified themes implies that all aspects influencing user perspectives of assistive technology need to be considered when developing assistive technology to enhance its chance of acceptance. The importance of each factor may vary depending on personal factors and the use context, either at home as an assistive aid or for rehabilitation at a clinic.

Introduction Soft-robotic gloves have been developed to enhance grip to support stroke patients during daily life tasks. Studies showed that users perform tasks faster without the glove as compared to with the glove. It was investigated whether it is possible to detect grasp intention earlier than using force sensors to enhance the performance of the glove. Methods This was studied by distinguishing reach-to-grasp movements from reach movements without the intention to grasp, using minimal inertial sensing and machine learning. Both single-user and multi-user support vector machine classifiers were investigated. Data were gathered during an experiment with healthy subjects, in which they were asked to perform grasp and reach movements. Results Experimental results show a mean accuracy of 98.2% for single-user and of 91.4% for multi-user classification, both using only two sensors: one on the hand and one on the middle finger. Furthermore, it was found that using only 40% of the trial length, an accuracy of 85.3% was achieved, which would allow for an earlier prediction of grasp during the reach movement by 1200 ms. Conclusions Based on these promising results, further research will be done to investigate the possibility to use classification of the movements in stroke patients.

The older cyclist is more prone to get cycling accidents than younger cyclists. To support the older cyclist, a rear- and front-view assistant were developed that warns the cyclist of approaching traffic. User tests to evaluate system performance, user-experience and effects on behaviour were performed with 20 older cyclists (>64 years) on a predefined route outdoors with and without support from both assistants. During this route, the cyclist was confronted with two controlled scenarios with an overtaking and an oncoming cyclist. The participants’ cycling behaviour was assessed by measuring lateral distance to the other cyclist, and distance maintained to the verge. The assistants had no effect on experienced mental workload. Both assistants received positive evaluations, although the rear-view assistant was experienced as more useful. Using the front-view assistant resulted in less lateral distance to the approaching oncoming cyclist, while the use of the rear-view assistant did not have effects on lateral distance. Copyright © 2018 Inderscience Enterprises Ltd.

Rolling resistance is one of the main forces resisting wheelchair propulsion and thus affecting stress exerted on the upper limbs. The present study investigates the differences in rolling resistance, propulsion efficiency and energy expenditure required by the user during power-assisted and manual propulsion. Different tire pressures (50%, 75%, 100%) and two different levels of motor assistance were tested. Drag force, energy expenditure and propulsion efficiency were measured in 10 able-bodied individuals under different experimental settings on a treadmill. Results showed that drag force levels were significantly higher in the 50%, compared to the 75% and 100% inflation conditions. In terms of wheelchair type, the manual wheelchair displayed significantly lower drag force values than the power-assisted one. The use of extra-power-assisted wheelchair appeared to be significantly superior to conventional power-assisted and manual wheelchairs concerning both propulsion efficiency and energy expenditure required by the user. Overall, the results of the study suggest that the use of power-assisted wheelchair was more efficient and required less energy input by the user, depending on the motor assistance provided.

Recent technological developments regarding wearable soft-robotic devices extend beyond the current application of rehabilitation robotics and enable unobtrusive support of the arms and hands during daily activities. In this light, the HandinMind (HiM) system was developed, comprising a soft-robotic, grip supporting glove with an added computer gaming environment. The present study aims to gain first insight into the feasibility of clinical application of the HiM system and its potential impact. In order to do so, both the direct influence of the HiM system on hand function as assistive device and its therapeutic potential, of either assistive or therapeutic use, were explored. A pilot randomized clinical trial was combined with a cross-sectional measurement (comparing performance with and without glove) at baseline in 5 chronic stroke patients, to investigate both the direct assistive and potential therapeutic effects of the HiM system. Extended use of the soft-robotic glove as assistive device at home or with dedicated gaming exercises in a clinical setting was applicable and feasible. A positive assistive effect of the soft-robotic glove was proposed for pinch strength and functional task performance 'lifting full cans' in most of the five participants. A potential therapeutic impact was suggested with predominantly improved hand strength in both participants with assistive use, and faster functional task performance in both participants with therapeutic application.