A perspective on intelligent devices and environments in medical rehabilitation☆
Introduction
There is a large and growing segment of our world population—people with reduced functional capabilities due to aging or disability. The number and percentages of people in need of advanced assistive technology are increasing every year. About 60 million Americans have a disability that affects one or more of their major life activities [1]. Perceptive, cognitive, and musculoskeletal diseases that impair motor skills dramatically increase with age. A number of subpopulations are of particular interest. In 2030, over 20% of the U.S. population will be over 65 years of age, with one in two working adults serving as informal caregivers [1]. Globally, the number of people older than 65 years is anticipated to double between 1997 and 2025. There is little debate that the 76 million American children born between 1945 and 1964 represent a cohort that is significant on account of its size [1]. Boomers account for about 39% of Americans over the age of 18 and 29% of the total population [1]. Adults with disabilities comprise approximately 21,455,000 of the 169,765,000 of working-age individuals in the US. However, only 30% of adults with disabilities are employed [2]. In Japan, the percentage of people of the age of 65 is also on the rise and it is project that by 2030 that approximately 30% of the population will be over 65 [3]. In Europe it is projected that by 2060 that 30% of the population will be over 65 [4]. As individuals, families, communities, and a planet, we are facing new technical and social challenges to attain, prolong, and preserve quality of life.
Recent advancements of technologies, including computation, robotics, machine learning, communication, and miniaturization of sensors bring us closer to futuristic visions of compassionate intelligent devices and technology-embedded environments. While many intelligent systems have been developed, most of them are for manufacturing, military, space exploration, and entertainment. Their use for improving health-related quality of life has been treated as a specialized and minor area. Assistive technology, for example, has fallen in the cracks between medical and intelligent-system technologies. The missing element is a basic understanding of how to relate human functions (physiological, physical, and cognitive) to the design of intelligent devices and systems that aid and interact with people.
The purpose of this manuscript is to highlight some of the emerging research topics in medical rehabilitation that should be possible because of advances in technology. It is not intended as an exhaustive review of assistive technology, but rather to provide a perspective into some of the requirements, challenges, and possibilities of future assistive technology.
Section snippets
Translation of research into clinical practice
Rehabilitation engineering research is generally conducted within the scope of health professions, basic science, and engineering programs [5]. Rehabilitation engineers (RE) may define their occupational roles as primarily involving clinical care and service delivery, design and development, or research, or may be involved in a combination of these activities [6]. The field of rehabilitation engineering integrates clinical care and research, allowing each to influence the future direction of
Pervasive assistive technology
A dilemma faced by clinicians is reconciling the fact that observations of patients only occur during infrequent, face-to-face meetings in a clinic or laboratory, while ideal observations are assessments that reflect the patient's capabilities in the real world, where distractions are present and multi-task performance is often required. As such, there is a need for ecologically valid tests that provide information about a person's ability to function in a real-life environment [14]. One way to
Cognitive assistive technologies
More than 21 million persons living in the United States have a cognitive disability and this number is expected to increase rapidly as the nation's population ages [45]. A much greater number of people worldwide have cognitive impairment, and the numbers are growing rapidly as the percentage of the world population ages. Cognitive impairment is a substantial limitation in one's capacity for mental tasks, including conceptualizing, planning, sequencing thoughts and actions, remembering,
Rehabilitation monitoring and coaching technologies
Despite attempts at using simple reminders (e.g., timers, pressure monitors, PDA reminders/surveys), user's guides (e.g., handouts, note cards), and consumer booklets developed to promote clinical practice guidelines, users do not seem to follow clinician instructions [74]. Novel approaches are emerging that use machine learning and artificial intelligence for real-time coaching of the person with disabilities for long-term monitoring of the person's use of the equipment and to provide hard
Human device interfaces, assessment, and training
Clinical problems drive focused research studies. For example, the majority of control interfaces used for such devices as power wheelchairs, alternative and augmentative communication devices, environmental control, adaptive automobile driving, and computer access are suboptimal for those with severe upper limb impairments or movement disorders [74]. Engineers are often faced with challenging cases in which customization and fitting of a control interface may still not meet all of the users’
Robotic assisted therapy
One application of rehabilitation engineering that has recently received a lot of attention is the use of technology, specifically robotics, to augment traditional physical and occupational therapy. Two of the most well-known systems are the InMotion2 (formerly known as the MIT-MANUS) from Interactive Motion Technologies, Inc. and the Lokomat from Hocoma, but numerous other systems have been developed. As these systems have been reviewed elsewhere [80], [81], [82], [83], we will not attempt to
Personal mobility and manipulation technology
For people who require assistance with both mobility and manipulation, technology provides few practical solutions. A survey of practicing clinicians reported that between 10% and 40% of their clients who desired powered mobility (power wheelchairs or scooters) could not be fitted with them because sensory impairments, poor motor function or cognitive deficits made it impossible for the clients to safely drive using existing controls [119], [120], [121] This lack of technological solutions
Summary
As the number of people with reduced functional capabilities due to aging and disabilities increases, advances in assistive technologies are needed. Traditional robotics and intelligent systems research (e.g., factory automation and entertainment) has not fulfilled the increasing and multiple requirements of the people with disabilities’ needs. Researchers need to leverage recent advancements of technologies to bring us closer to futuristic visions of compassionate intelligent devices and
Conflicts of interest
None.
Acknowledgements
This material is based upon work supported by the National Science Foundation under Cooperative Agreement EEC-0540865. This material is also based upon work supported by the Office of Research and Development, Rehabilitation Research & Development Service, Department of Veterans Affairs, Grant# B3142C.
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