TUESDAY, JULY 26, 2022

Session 1: Blended rehabilitation: challenges in integrating eHealth in rehabilitation care / 11:45 - 13:15

Target audience

Physicians, health professionals, private partners (e.g. developers, companies), public partners (e.g. authorities), health insurance companies, patients, researchers.

Content

1. Overview by means of the CEHRES-roadmap in co-creation in iterative development, implementation and evaluation (10 minutes). Jorit Meesters
2. Challenges in development in co-creation (20 minutes). Christiane Grünloh
3. Challenges in implementation (unavailable: (20 minutes). Klaasjan van Haastrecht
4. Challenges in evaluation (20 minutes). Stephanie Kosterink
5. Panel discussion (20 minutes). Speakers and audience
   
   

Summary

Using eHealth to provide blended rehabilitation care has the potential to improve outcomes, reduce costs and enhance self-management of patients. The development, implementation and evaluation of blended rehabilitation care is however challenging. This mini-symposium introduces the CEHRES roadmap as a model to facilitate these co-creative processes and enhance the collaboration between stakeholders (e.g. developers, patients, health professionals and researchers).

After the introduction of the CEHRES roadmap several experts present the challenges in the development, implementation and evaluation from their own perspective but also in relation to the other stakeholders.

Challenges in development in co-creation: Lex van Velsen
Co-creation is a buzzword for developing eHealth. But what exactly is co-creation? And how can I use co-creation to my advantage? By presenting different examples of eHealth development processes, I will show good practices and pitfalls, so that the participant knows how to involve end-users in design.

Challenges in implementation: speaker to be announced

Challenges in evaluation: Stephanie Kosterink

There is a discrepancy between the evaluation of eHealth and tradition research methodology. These methodology, as randomized controlled trials (RCTs) are time consuming and hamper the development of technology. To support the implementation of eHealth and blended rehabilitation care it is important to go beyond these tradition research methodology and focus on more pragmatic research methodologies.

Objectives

The objectives of this mini symposium are to present and discuss:

• The importance and complexity of co-creation in developing, implementing and evaluating blended rehabilitation care
• Research methods for evaluating blended care
• Implementation strategies for blended care

Speakers:

• Jorit Meesters: Meesters@basaltrevalidatie.nl
• Lex van Velsen: vanvelsen@rrd.nl
• Stephanie Jansen – Kosterink: kosterink@rrd.nl

Session 2: From in-center to at-home rehabilitation: the wearable solution / 17:00 - 18:30

Summary

With an aging population the number of patients who need rehabilitation care is expected to increase. This increase in care demands is accompanied by a decrease in available care professionals. Besides, traditional objective assessments such as gait analysis, is time consuming and expensive. This poses a major challenge to adequate resource allocation in rehabilitation. More simple assessment and unsupervised rehabilitation treatment at home is expected to address this problem. Hence, there is an urgent need for technology-supported assessment and treatment at home, with the supervision of a therapist only if needed. In this symposium, examples of innovative developments and potential “in real-life” applications will be presented.

Speakers: 

• Johannes (Hans) Bussmann, Erasmus MC, Rotterdam, the Netherlands
  
  An interactive tool for self-directed, home-based and personalized arm rehabilitation after stroke
  
  After stroke intensive arm therapy is essential for gaining and retaining functional improvements. Because of high costs, shortage of therapists, patient burden and adherence issues, intensive arm treatment is scarcely applied, and this will become even more challenging in the future. Therefore, there is an urgent need for sustainable, technology-supported and motivating treatment in the home setting, with direct supervision of a therapist only if needed.
  
  This was the background of several research projects aiming at the development and evaluation of a new and interactive therapy aid based on movement sensors to assess, stimulate and optimize the daily use and exercise of the affected arm in the home environment by objective, personalized feedback to the patient and his/her therapist. In the presentation the tool will be described in more detail, as well as the results of the studies performed so far and the plans for the future.
  
  
• Jaap Buurke, University of Twente, The Netherlands
  
  Enabling 3D movement analysis in everyday clinical practice
  
  In current clinical practice, 3D movement analysis is an important tool to assess patients and guide clinical decision making. It provides objective data about individual balance and walking patterns. 3D movement analysis however is lab based, expensive and labour and time intensive. Wearable sensors are cheap and easy to apply within limited amount of time. As such, wearable sensors not only have the potential to replace expensive lab based 3D opto-electronic devices but also offer the possibility to assess individuals outside the lab during therapy or in their natural environment.
  
  
• Charissa Roossien, University Medical Center Groningen, the Netherlands
  
  Sensor technologies for sustainable employability
  
  Sensor technologies are of interest to monitor and improve the workload and health of workers. The main challenge is to reliable monitor the individual workload without interfering with workability. Sensor technologies for occupational rehabilitation must be developed, validated and implemented to gain sustainable employability. 
  
  
• Laura Marchal-Crespo, Technical University Delft, the Netherlands
  
  Towards minimally supervised hyper-realistic robotic rehabilitation.
  
  Sensorimotor impairments of the hand after stroke can drastically reduce the ability to perform activities of daily living. To promote recovery of the lost functions, there is an increasing interest in minimally supervised and unsupervised rehabilitation to increase therapy dosage and complement conventional therapy. Novel portable robotic devices are been developed, which together with immersive virtual reality using low-cost head mounted displays, could potentially provide a safe, intuitive, naturalistic training environment. Rehabilitation games that leverage interactive tangible game elements with diverse haptic characteristics to provide somatosensory training might further foster recovery.
  
  

WEDNESDAY, JULY 27, 2022

Session 3: Advanced prosthetics development; are we still in control? / 11:45 - 13:15

Target audience

Physicians, health professionals, researchers, engineers, private partners (e.g. developers, companies), patients.

Content

This session will cover developments in the field of lower and upper limb prosthetics with focus on motor learning and motor control of advanced prosthetics

Summary

Prostheses for lower or upper limbs support the performance of task-specific activities in people after limb amputation or limb reduction defects and are of great importance in obtaining and maintaining the user's independence. New developments in prosthetics for both the lower and upper limbs are increasingly aimed at refining the motor control of the prosthesis as well that of the user. But how does this motor learning process take place and what sensory information is indispensable? Or does the future prosthesis regulate all that itself? In the next session, these aspects of prosthetic control will be discussed.

Objectives

• To provide new developments on control mechanism in prosthetics
• Discuss new methods on learning to control lower limb prothesis
• To discuss a framework of closed-loop motor control in upper limb prosthetics.
• To provide clinical knowledge to teach functional skills in upper limb prosthesis users 

Chairs:

• Han Houdijk PhD
• Hans Rietman MD, PhD

Speakers:

• Erik Prinsen PT, Ph.D. (20 min): Intent recognition for the control of lower limb prostheses using inertial sensors and EMG
  
  The current generation of lower-limb protheses is only limitedly able to adapt to different walking environments. The introduction of power prosthetic components have paved the way to improve this adaptability to different gait tasks. To be able to achieve this, it is paramount that the user intention for different gait tasks (for instance, stair walking) can be detected. Recent research has shown that using inertial sensors and EMG can contribute to developing robust classification algorithms for motor intent. In this presentation, we will provide an overview of the work that we did in the H2020-project MyLeg in which we used inertial sensors combined with either bipolar, multi-array and fine-wire EMG to classify motor intent for a wide range of different motor tasks.
  
  
• He (Helen) Huang, Ph.D. (20 min): Personalizing Robotic Lower Limb Prostheses Using Reinforcement Learning
  
  Robotic lower limb prosthesis is the state-of-the-art technology in clinics to help amputees to restore their motor function. However, current designs cannot accommodate inter- and intra-amputee variations automatically. To cope with such variations, a subset of the parameters controlling the prosthesis is often tuned manually and heuristically, which is time and labor intensive. In this talk, I will discuss our recently effort in developing an automatic tuning method based on reinforcement learning for robotic transfemoral prostheses to achieve personalized gait assistance. Our innovation may lead to a new clinical solution that is generalizable to computerized lower limb prostheses to enable user adaptation in the future.
  
  
• Strahinja Dosen, Ph.D. (20 min): Artificial sensory feedback inspired by human motor control
  
  Closing the control loop by providing artificial sensory feedback to a user of a hand prosthesis is an important step towards achieving complete bionic replacement. Despite important recent developments, designing effective feedback that will improve prosthesis utility in realistic conditions is still a challenge. In this lecture, we will propose that effective feedback can be developed starting from the deep understanding of human motor control in the context of prosthesis use, rather than ad-hoc technical solutions. We will propose a conceptual framework of closed-loop motor control and illustrate how such a framework can be used to inspire novel approaches to sensory feedback. Finally, we will briefly touch upon our recent efforts towards clinical translation of the novel methods.
  
  
• Liselotte Hermansson, OT Ph.D. (20 min): Acquisition of functional skills in upper limb prosthesis users
  
  During the presentation I will demonstrate and talk about how we teach prosthesis use and functional skills to upper limb prosthesis users, both children and adults. The training goes from integrating the prosthesis into the body scheme to control of advanced myoelectric multi-grip hands. Establishing wearing habits, learning motor control and motor skills through activity performance support users’ benefit of the myoelectric hand. From our clinical studies we find that in most patients these skills are maintained throughout growth and ageing.
  
  

Session 4: Designing for children / 17:00 - 18:30    

Target audience

Physicians, health professionals, private partners (e.g. developers, companies), public partners (e.g. authorities), health insurance companies, patients, researchers.

Speakers:

• Mathieu Gielen, Co-design with children (25 min)

If your product or service has an impact on children’s lives, it is important to ground its design on an empathic understanding of children’s wishes, needs and perspectives. It can mean the difference between a highly appreciated and intensively used product – or a flop. Within the world of innovation, increasing attention is given to co-design with children and related participatory approaches. It allows children to form and express their opinions and inform the design team, not just on core functionalities but on a rich palette of features that determine children’s experience. Mathieu Gielen, Assistant Professor in Designing for and with Children at Delft University of Technology, will highlight the possibilities and pitfalls of involving children in your innovation processes.

• Iris van Wijk / Edwin Verbrugge, Prosthetics for children (25 min)

To achieve optimal use of prostheses in children, other considerations apply than in adults. The young child is still developing its motor abilities; it grows; it handles a prosthesis in ways that differ from adult handling; other user requirementsmight apply. Iris van Wijk, pediatric rehabilitation consultant at rehabilitation center De Hoogstraat Utrecht will introduce child-specific considerations in upper limb prosthetics; Edwin Verbrugge, CPO at Rijndam Orthopaedics will illustrate pediatric aspects of lower limb prosthetics.

• Ruud van der Wel/Karin van Dijk, Enabling gaming for children with disabilities (25 min)

Gaming is an important form of leisure and social interaction for children. Ruud van der Wel and Karin van Dijk of NMA Gaming foundation will speak about creating unique adaptations to enable disabled children to play regular games and implementing these adaptations in the target audience.

• Panel discussion: Speakers and audience (15 min)

Objectives

The objectives of this mini symposium are to present and discuss:

• Principles of co-designing with children
• Age-related considerations in designing prosthetics and adaptations
• Practical solutions and approaches for individual adaptations for children

Chair:

Robert Pangalila, MD PhD pediatric rehabilitation consultant, Rijndam rehabilitation and Erasmus University Medical Centre

Speakers:

• Mathieu Gielen, MSc Assistant Professor in Designing for and with Children at Delft University of Technology, m.a.gielen@tudelft.nl
• Iris van Wijk, MD PhD pediatric rehabilitation consultant, rehabilitation centre De Hoogstraat Utrecht, i.v.wijk@dehoogstraat.nl
• Edwin Verbrugge, CPO Rijndam Orthopaedics Rotterdam, EVerbrugge@rijndam.nl
• Ruud van der Wel, NMA gaming; respiratory therapist, Rijndam rehabilitation, rvdwel@rijndam.nl
• Karin van Dijk, NMA gaming

THURSDAY, JULY 28, 2022

Session 5: Exoskeletons for individuals with a spinal cord injury: a historic perspective, current state-of-the-art and future developments / 11:45 - 13:15

Target audience

Physicians, health professionals, researchers, engineers, private partners (e.g. developers, companies), patients.

Content

This session will cover developments in the field of exoskeletons for the lower extremity with a special emphasis on individuals with a spinal cord injury.

Summary

Exoskeletons allow individuals with a spinal cord injury to walk again, instead of being confined to a wheelchair. Besides the fact that being able to walk again is empowering for individuals with a spinal cord injury, it has additional benefits such as better endurance and improved bladder and bowel control. However, there are several challenges with the respect to the clinical application of exoskeletons of which balance control is the major one. This session will provide a historic perspective, the state-of-the-art and future developments of exoskeletons for individuals with a spinal cord injury. 

Objectives

• To provide an overview of the current state-of-the-art of exoskeletons
• Discuss ways to improve balance control of exoskeletons
• To provide an overview of future developments of exoskeletons

Chairs:

Ilse van Nes, MD, PhD

Erik Prinsen, PhD

Speakers:

• Ilse van Nes MD, PhD , The clinical use of an exoskeleton in people with complete Spinal Cord Injury (20 min)
  
  People with a complete spinal cord injury are fully dependent on the wheelchair for their mobility. Due to the current technological developments, they have the possibility to walk again. In this presentation an overview about the history of walking in paraplegic patients will be presented and I will also inform you about the latest developments in this area. Key-factors that are necessary for a successful implementation of an innovation will be mentioned. Also the results of our research on the use of the exoskeleton at home will be shown.
  
  
• Edwin van Asseldonk PhD
  Using exoskeletons to support balance control in healthy persons and persons with spinal cord injury (20 min)
  
  One of the ongoing challenges in exoskeletons and an often-heard wish of their users is to support balance control and recovery and in doing so decrease need to rely on crutches or canes. Here we will present the recent efforts to improve balance control of exoskeleton users while standing and walking.
   
• Heike Vallery, PhD (20 min)
  Reaction moments matter when designing lower-extremity robots: Joint moments versus free moments
  
  

  Wearable robotics to restore or assist locomotion are usually designed to impose joint moments. This means that for each moment exerted on one body segment, an equal and opposite reaction moment has to be exerted on another body segment. This reaction moment can aid or counteract the intended effect. In this talk, we will explore the implications of this design choice for different tasks, particularly related to balance. We will also compare it to alternative, seemingly reaction-free actuation schemes that impose free moments on only one segment, for example using gyroscopic actuators.

  
  
• Lieke Roelofs, Project MARCH (20 min)
  Project MARCH has one vision, we believe that we can use technology to improve the quality of life for people with paraplegia. We are a non-profit student team of the TU Delft, and consists of people from various backgrounds and years of studies. Each year a new team comes in to build on the knowledge of past years. With the help of our pilot, a paraplegic, we are pushing the boundaries in exoskeleton technology to build an exoskeleton ready for daily use. In this short presentation, we take you along our journey, and show you what our plans for 2022 are.
  
  

Session 6: Manual wheeled mobility / 15:40 - 17:10

Target audience

Physicians, health professionals (PT’s and OT’s), researchers, engineers, private partners (e.g. developers, companies), patients.

Content

During this session recent innovations will be presented and discussed from a multi-disciplinary perspective, including rehabilitation physicians, engineers and human movement scientists.

Summary

Manual wheelchair users depend on their upper-body for all their activities, yet overuse injuries and limited physical capacity are still very common. Support of these individuals should not only be aimed at their primary need for mobility, but also at the need of being able to exercise and enjoy sports for a healthy lifestyle, to maintain and improve participation according to the International Classification of Functioning, Disability & Health. To that end, the proper design and fitting, correct skill training and the assessment thereof are crucial.

Chairs:

• Prof dr. Hans Rietman
• Riemer Vegter
  
  

Presenters:

Riemer Vegter, Assistant Professor (NL) (15min):

• • Future perspectives on wheeled mobility technology, training and assessment
  • https://www.rug.nl/staff/r.j.k.vegter/ 
    
    

• dr. Rory Cooper (USA)(15min):
  • Transforming Wheelchair Design and Fabrication https://www.shrs.pitt.edu/people/rory-cooper
  • Manual wheelchairs and those used for most sports applications are based on structures designed and fabricated with tubes. This approach has dominated for nearly 90-years. However, new engineering approaches and machines may make it possible to transforms wheelchair design with the goal of reducing cost to the consumer and improving quality. New manual wheelchairs designs and processes will be introduced. 
    
    

• Reto Togni, PhD-student (CH)(15min)
  • Leaning for Turning: Novel Steering Technologies in Manual Wheelchairs promise more delightful, intuitive and efficient physical activity
  • https://www.linkedin.com/in/reto-togni-8a4b16121/?originalSubdomain=ch
  • Manual Wheelchairs do not steer but are turned by braking unilaterally. This has been described to be frustrating, challenging and inefficient while requiring constant use of both hands. With “Leaning for Turning”, we aim to establish a new paradigm in the design of manual wheelchairs based on the principle of using the backrest for directing kinetic energy. This enables natural and dynamic movement, facilitates easier one-handed propulsion and promotes healthier physical activity by activating core musculature while relieving the upper extremities. The iterative development process of steering technologies in manual wheelchairs was fuelled by the systematic evaluation of various movement characteristics with users to ensure save, controlled and comfortable use across different functional groups. The resulting prototype was instrumented with force sensors to compare conventional and steered wheelchair propulsion in a series of experiments where 15 able-bodied volunteers and a group of 15 wheelchair users with various physical abilities (and pathologies ranging from amputation to complete cervical spinal cord injury) completed a standardized course in both configurations. This talk draws preliminary conclusions from this juxtaposition and explores implications of key findings – chief among which is a drastic improvement of overall energy efficiency in manual wheelchair propulsion thanks to the ability to control direction without braking. 
    
    

• Sonja de Groot (NL)(15min), Associate Professor
  • Implementation of a wheelchair propulsion laboratory in clinical practice
  • https://research.vu.nl/en/persons/sonja-de-groot
  • To prevent overuse injuries and to obtain and maintain mobility and develop an active lifestyle, both wheelchair (e.g. mass, tyre pressure) and user (e.g. fitness, propulsion technique in terms of force application on the rim) must be in the best condition. Furthermore, the wheelchair-user interface (e.g. seat height, rim and wheel diameter) needs to be ergonomically tuned to the best wheeling performance in different environments for the specific individual. Despite a considerable number of studies by several research groups into wheelchair propulsion over the last 30 years, to date wheelchair fitting is a personalized professional skill that has little scientific foundation. Furthermore, monitoring the propulsion technique and physical strain of new wheelchair users in Dutch rehabilitation is not common practice. However, this approach can be useful to optimize the wheelchair, the interface, and to educate the user in establishing the best propulsion technique, to improve physical capacity and prevent upper-extremity overuse injuries. For implementing a wheelchair propulsion laboratory in clinical practice standardized testing and proper interpretation of individual outcomes is important. 
    
    

• Dr. Felix Chenier, Associate Professor (CAN)(15min)
  • Reporting and interpreting shoulder angles in wheelchair propulsion
  • https://crir.ca/en/member/felix-chenier-ph-d-ing/
  • Shoulder angles are unambiguous for movements that are confined to standard anatomic planes. However, functional movements such as propelling a wheelchair combine multiple planes, and therefore shoulder angles are more ambiguous in these conditions. Over the years, many conventions have been used to represent shoulder angles: attitude vector/quaternion, cardan angles, Euler angles, and the Globe system. However, these methods fail to represent shoulder angles in a way that is both easily and correctly interpreted by practitioners, and free of numerical instability such as gimbal lock. The recently introduced Tilt-and-Torsion (TT) method is an extension of the Euler YXY method, the latter being recommended by the International Society of Biomechanics. Like Euler YXY, TT uses the plane of elevation, elevation, and humeral rotation to express shoulder angles, but it reports the humeral rotation independently from the plane of elevation. In this presentation, we overview the impact of using different methods to express shoulder angles in wheelchair propulsion with 10 wheelchair basketball athletes who sprinted in straight line using a sports wheelchair. During these sprints, humeral rotation ranged from 14° (externally) to 13° when expressed using TT, which is consistent with typical maximal ranges of humeral rotation, compared to 65° to 50° with Euler YXY. We also present why TT is less affected by gimbal lock compared to the other methods.