Background: Access to prosthetic, orthotic and related assistive services remains uneven globally; this manuscript examines the systemic causes and rehabilitation consequences within the context of India. We frame service gaps as health-systems failures with measurable workforce, supply-chain, financing and data components. Methods: A narrative policy review was undertaken using targeted searches of peer-reviewed literature, government reports, professional body publications, and NGO datasets. Key themes were synthesized across governance, workforce, supply chain, financing, and monitoring domains to derive pragmatic policy interventions. (Authors should replace or update search dates and data sources as required prior to submission.) Findings/Observations: Four structural deficits drive undercoverage: (1) insufficient trained P&O workforce and uneven geographic distribution; (2) fragmented manufacturing and procurement with limited quality control; (3) inadequate public financing and poor insurance/benefits coverage for device services; and (4) absence of routine service and outcome surveillance. These deficits produce preventable functional dependency, increased caregiver burden, and inequitable accessâmost pronounced among rural, low-income, and disabled populations. Conclusions: Closing P&O service gaps requires integrated health-systems actions: workforce scale-up and credentialing, pooled procurement and quality standards, explicit public financing pathways, and routine service/outcome monitoring. Policy recommendations (summary): Five priority actions are proposed: national workforce strategy, accreditation and CE frameworks; standardized device procurement and quality assurance; finance and benefit design for assistive services; decentralized service hubs with tele-rehabilitation links; and a national monitoring dashboard tied to performance indicators.
Open access
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Prosthetics and Rehabilitation Robotics
Assistive Technology in Communication and Mobility
Move to Earn (MtoE) initiatives emerged during the COVID-19 pandemic. STEPN, the leading MtoE walking applications (app.) using various artificial intelligence (AI) techniques, allows users to earn rewards by walking, jogging, or running with their mobile devices while wearing Non-Fungible Token (NFT) shoes. Although MtoE games have huge potentials to improve our quality of life (QOL), there is no scientific papers to point out the possibilities. This work describes present situation of MtoE and importance of AI to establish MtoE projects, and proposes several potential applications of MtoE, including as an aid to support athletes, international students, and bedridden individuals. This is the primitive survey research of MtoE projects as a trigger to start scientific discussions.
Deborah de SĂĄ Pereira Belfort, Bruno Biselli, MĂ´nica Samuel Ăvila, Renata Lopes Hames ¡ 18 authors
Background: In middle-income countries, costs limit widespred use of left ventricular assist device (LVAD) as a strategy for end-stage heart failure. We aim to describe the experience of a LVAD program in a middle-income country in a hub-and-spoke model. Methods: Patients fulfilling strict inclusion and exclusion criteria were referred from different centers in Brazil for LVAD implantation through a philanthropy program financed via a Brazilian Federal Government tax exemption structure. LVAD implantation was performed in a hub-and-spoke model with a single implanting center. Data were collected retrospectively using hospital records and telephone contact with other centers. Patients who received LVAD implants external to the philanthropic program, either at this or other Brazilian centers, were not included. Results: Between January 1, 2013 and December 31, 2020, 20 adult patients underwent long-term continuous flow LVAD implantation with decentralization of postimplant patient care in regional centers. Patients were referred from 11 centers from 7 states in Brazil and underwent LVAD implantation through a philanthropy program. The median age was 52.5 years and 85% were Interagency Registry for Mechanically Assisted Circulatory Support profile 3 patients. Two patients had Chagas cardiomyopathy. The overall survival censored for competing risks at 1 and 2 years were 90% and 84%, respectively. Three patients (15%) underwent heart transplantation in the first 2 years after LVAD implantation. Twelve patients returned to their original centers and were followed remotely. Conclusions: This study presents a successful LVAD implantation program in a hub-and-spoke model in Brazil. Centralization of LVAD implantation with decentralization of postimplant patient care in regional centers is feasible and safe, enabling optimal allocation of resources in middle-income countries.
For a lower-limb exoskeleton, accurate and timely extraction of gait features, such as the timing of important gait events and walking state transitions, is a fundamental requirement to provide appropriate assistive action, and this becomes much more challenging for stroke patients due to the existence of hemiplegic gait. In view of this, this study develops an adaptive oscillator-based gait feature extraction method only using thigh-worn inertial measurement units (IMUs) for assisting stroke patients with portable hip exoskeletons. The algorithm is capable of 1) estimating the zero position of the thigh during locomotion, 2) estimating the timing of heel strike, and 3) detecting the walking state transition timely. To validate the proposed method, an experimental study with both healthy subjects and stroke patients has been performed, suggesting accurate estimations of the zero position of the thigh and the timing of heel strike, and a lower detection delay of walking state transitions compared to state-of-the-art studies. To the best of the authorsâ knowledge, this study represents the first proof of feasibility to extract these gait features of stroke patients with hemiplegic gait only using thigh-worn IMUs, paving the way for future clinical applications of portable hip exoskeletons.
We describe the design, fabrication, and characterization of a novel pneumatic artificial muscle actuator with embedded contraction sensing. The muscle is composed of three main components: elastomer air chamber, embedded Kevlar threads, and a helical microchannel filled with a liquid conductor. When the air chamber is inflated with compressed air, the constrained length of the Kevlar threads causes the muscle to contract in the axial direction. During this contraction, the microchannel can detect the shape change of the muscle by sensing, the expansion of the air chamber. This sensing capability increases the controllability of pneumatic muscles. A novel manufacturing method is proposed to embed Kevlar threads and a helical microchannel in an elastomer tube. Then, a liquid metal is injected into the microchannel to make a soft sensor that can detect the geometrical change of the muscle. The muscle prototype was characterized to demonstrate its actuation and sensing capability.
Due to the ageing and the decreasing birth rate in Japanese society, an important problem of providing nursing care for the elderly has occurred. Therefore, it is strongly desired to develop a wearable actuator to use in nursing care or rehabilitation. The purpose of this study is to develop a high-power flexible actuator with a displacement sensor which can be used in supporting a bathing. In our previous study, we proposed and tested a rubber artificial muscle with the inner diameter sensor. The inner diameter sensor consists of two electric circuit boards with two photo reflectors. Two boards are bonded together to contract the inner diameter sensor. The sensor also has a doughnutshaped bulkhead to keep a seal. The sensor is inserted into the tube of the artificial muscle. The senor is set at the end of tube. This sensor can be expected to estimate the axial direction displacement of the rubber artificial muscle, because the relation between the inner diameter and the axial directional displacement of the muscle has a strong correlation. However, if the external bending force is applied to the end of the muscle, the inner diameter sensor cannot hold at the center position of the tube. Therefore, the sensor cannot measure the inner diameter exactly. In this study, the improvement of the inner diameter sensor was executed. The improved sensor has 4 photo reflectors on the two electric circuit boards to compensate the measuring error. The position control was also carried out by using the actuator with the built-in inner diameter sensor. As a result, the axial direction displacement of the muscle could be estimated well by the tested inner diameter sensor, and a relatively good position control performance was obtained.