Paolo Bonato - US grants

DESCRIPTION (provided by applicant): A unique challenge inherent in the study of multi-component mind-body interventions is objectively quantifying measures of adherence, proficiency, and functional dosage. Because variability in proficiency of practice can significantly alter physiological responses to a period of training, simple measures of class attendance or logged practice time are unlikely to capture components of dosage needed to objectively evaluate efficacy, safety, and underlying mechanisms of mind-body interventions. This Phase I SBIR application submitted by HRO Enterprises Inc, in collaboration with biomotion and mind- body researchers from Harvard Medical School, will leverage advances in wearable technology to develop a system that allows mind-body researchers to gather objective measures of adherence, proficiency and dosage. Our approach will build upon the already successful SHIMMER (Sensing Health with Intelligence, Modularity, Mobility, and Experimental Reusability) system, a commercially available platform designed explicitly for wearable non-invasive health sensing applications. Initially focusing on biomotion related aspects of adherence, proficiency and dosage, we will use wireless kinematic sensors (i.e. accelerometers and gyroscopes and force sensors) to capture distinct patterns of movement that are associated with the performance of Tai Chi and that would provide a means to assess adherence to, and proficiency of practice. Our application includes three Specific Aims: (1) To integrate the SHIMMER platform into the design of a wearable, wireless system suitable to monitor practice/training sessions; (2) To demonstrate that inertial sensors (i.e. accelerometers and gyroscopes) can capture aspects of movement biomechanics associated with the performance of Tai Chi exercise; and (3) To show that features derived from wearable sensor data can capture adherence and proficiency in the performance of Tai Chi exercise, and correlate with quantitative assessments of proficiency provided by a panel of Tai Chi experts. These initiatives will lay the groundwork for Phase II of this project in which we plan to 1) fully develop a wearable wireless system ready to be commercialized for the assessment of adherence and proficiency of performance of Tai Chi and related mind-body exercises, 2) develop and assess feedback modalities to guide mind-body practitioners and instructors in optimal training strategies, and 3) prospectively evaluate the system in clinical trials to assess changes in proficiency and dose and how they correlate with clinical outcome.

? DESCRIPTION (provided by applicant): This Small Business Innovation Research (SBIR) Phase-II project proposes a robotic system for rehabilitation of the arm and hand of stroke survivors. The system builds on hardware developed under a DARPA program and software being developed under the NIH Phase-I project. The existing hardware, called Proficio(tm), is presently being used in Phase I to develop and test BiArm(tm), a system consisting of two Proficio robot arms that enable bimanual rehabilitation. Phase II will focus on the design and development of Teneo(tm), a user- attachment for Proficio that will enable users to train hand-closing and hand-opening motions while simultaneously moving their arm to reach and grasp real objects. This novel system will be supported by a software architecture enabling development of rich visual, haptic, and physics-based environments for meaningful and engaging therapeutic games that can be tailored to patients' abilities and needs. The proposed SBIR Phase-II activities are divided into 3 aims. The first aim is to design and integrate an affordable robot end-effector (Teneo) for hand-rehabilitation. The new module will attach to the Proficio robot and will assist patients in performing hand-opening/closing motions to support activities of daily living (reaching for and grasping an object, for example). The second aim is to develop software interfaces and robot-control strategies that facilitate development of new rehabilitation strategies and empower therapists to employ activities tailored to each patient. This work will include development of powerful software modules including engaging rehabilitation activities that work in concert with the Proficio/Teneo control system. The third ai is to perform dual-site usability studies at two of the leading rehabilitation research facilities n the country. There are two long-term commercial goals: 1) develop a robotic system that researchers can use to rapidly innovate and develop new data-driven arm-and-hand rehabilitation strategies, and 2) empower therapists to tailor rehabilitation activities to individal patients while tracking progress and keeping patients engaged.

Project Summary/Abstract This Small Business Innovation Research (SBIR) Phase I project proposes a unique robotic system for upper- extremity rehabilitation for stroke survivors that combines dynamic arm-support with manipulation of physical objects. The system will be developed by integrating a component called AirCradle?, to be designed and implemented during the proposed project, with Barrett Technology's existing Burt® medical device robot. Burt® is an FDA-listed upper-extremity rehabilitation robot that supports (as needed) the weight of a patient's arm and hand while the patient moves his/her arm to interact with on-screen games. Burt® offers guided assistance, visual and haptic feedback, and activities and assessments to both help train the patient and measure progress. Clinical studies have shown that Burt® can be used to improve patients' performance of gross arm-reaching movements. However, the system lacks a component suitable to train distal functions (i.e., the manipulation of objects). To expand the capabilities of Burt®, we propose to develop the AirCradle? system. The AirCradle? is a hardware and software ?add-on? to the base Burt® system that enables the patient to manipulate real objects during goal-driven gameplay while physically assisted by the Burt® robotic arm. An integrated camera system ?reflects? the image of the patient in a mirror-like fashion while also tracking the state of physical objects. The software blends physical and virtual goals and gameplay with robot-assisted unweighing and target-guidance. The proposed Phase I activities are grouped into three aims. In the first aim, the team will develop the hardware at the end of the robot arm that physically connects to and guides the patient's arm while streaming rotary joint-angle positions to the base Burt robot. In the second aim, the team will develop a camera-based system to track the physical objects and present a mirror-like view of the patient and objects within the context of a goal-based virtual game. In the third aim, stakeholders consisting of rehabilitation specialists and stroke survivors will provide usability feedback via a focus group and a pilot study. This data along with the engineering testing and verification activities will be used to assure that ?go?/?no-go? criteria are met before moving to Phase II. The long-term commercial and societal goal is to provide a flexible robotic therapy system that assists stroke survivors in interacting with and manipulating objects to provide sustainable and affordable therapy to increase their ability to perform activities of daily living.

Project Summary/Abstract This Small Business Innovation Research (SBIR) Phase-II project proposes the deployment of an AI-powered image-processing tool, named PostureCheck?, to automatically detect when patients perform undesirable compensatory movements during robot-assisted upper-extremity (UE) rehabilitation exercises. The system is based on a standard video camera and the artificial intelligence (AI) software developed under the NIH Phase-I project. PostureCheck? will be fully integrated with Barrett Technology's existing Burt® UE rehabilitation robot, ensuring that patients are provided appropriate and timely feedback to encourage the correct performance of therapeutic exercises without requiring constant therapist supervision. Burt® is an FDA-listed UE rehabilitation robot that supports the weight of a patient's arm and hand while the patient moves his/her arm to interact with on-screen games. Burt® offers guided assistance, visual and haptic feedback, and activities and assessments to both help train the patient and measure progress. Clinical studies have shown that Burt® can be used to improve patients' performance in one-on-one sessions with a therapist. However, the system lacks the capability for a single therapist to monitor and work with several patients and Burt® systems at one time. The proposed SBIR Phase-II activities are organized in three aims. In Aim 1, the annotated dataset generated in Phase-I will be used to develop three separate AI modules. These modules will be integrated into a framework that allows therapists to monitor the outcome of the modules, and, through feedback, enable the system to auto- adapt to improve performance continuously. In Aim 2, stakeholder feedback will be gathered and integrated to design multiple user interfaces for the PostureCheck? tool. Specific interfaces will be created for use by therapists during and after RT sessions. PostureCheck? will be integrated with the Burt® device to empower therapists to provide effective feedback to patients and deter the use of compensatory movements. Finally, in Aim 3, forty-two stroke survivors will be recruited in an interventional study deploying the PostureCheck? and Burt® systems. Subjects will undergo eighteen RT sessions in either an individual or group therapy format. Motor performance between groups will be compared to gather information about the suitability of the combined systems for multi-patient RT therapy in future rehabilitation centers. The long-term commercial goal of the project is to provide a practical Burt®-plus-PostureCheck? system to empower therapists to supervise multiple patients simultaneously through a gamut of useful functionalities. The system will be suitable for deployment in clinics as well as rehabilitation centers such as wellness gyms.