Usability of the eNHANCE device in the adolescent DMD population: - - PowerPoint PPT Presentation

A Horizon 2020 Project

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Usability of the eNHANCE device in the adolescent DMD population: Lessons Learnt

Intention based enhancement of reaching and grasping in physically disabled people, personalized to maximize user performance Dr Jackie Pitchforth

UCL Great Ormond Street Institute of Child Health

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.

Overview

• 1. Background to the eNHANCE Project
• 2. DMD specific needs
• 3. Dry Run: Results of Pre-Clinical Trials
• 4. Problems encountered
• 5. Lessons learnt

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 1. Background to the eNHANCE Project
• Poor uptake of Upper Limb assistive devices
• Gap between End User’s needs & design
• eNHANCE project aims

– Develop an eye tracking robotic arm system – Assists with reaching & grasping tasks – Tailor device to End User’s specific needs – Integrated modular system

• Arm + wrist + glove support

– Intention based (AI) behaviour

• Employed End User centred approach
• Focus groups run to elicit End User needs

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 2. DMD specific needs
• Bilateral progressive condition affecting males
• Affects all muscles with a “near to far” gradient
• Lower limbs > upper limbs: Proximal > distal
• Target population = Electric WC users
• Focus group findings:

– 15 end-users (6 DMD + 9 carers) + 3 therapists – Switchable “subconscious” control – Bilateral – Mobile – Waterproof – Battery operated with long life

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3. Dry Run: Results of Pre-Clinical Trials
• Objectives

– To test the clinical set-up in healthy subjects prior to patient trials – To provide proof of concept for use of eye-tracking to control robotic arm – To identify potential problems prior to clinical testing

• Methods

– Tests performed in healthy subjects in an electric wheelchair – Eye-tracker calibrated – Points Apart & Maximum reach tests performed

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3a. Experimental setup: Schematic view with photo

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3b. Video of Robotic Arm Support without Eyetracker
• Eye tracker calibration video (1)

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3c. Dry Run Video
• Videos of tests (2)

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3d. Dry Run Results: Points Apart Test 1

Attempt No Distance from shoulder tip Target spot Cm Off Target Comment 1 42cm 1st N/A Out of range 2 42cm 2nd 2.5cm (At finger tips) TNR 3 42cm 3rd 9cm TNR 4 42cm 3rd 4.5cm TR 5 42cm 1st N/A Out of range 6 42cm 2nd 9cm (At red tape) TNR 7 42cm 2nd 9cm TR 8 42cm 3rd 3.5cm TNR +ML 9 42cm 3rd 3.5cm TNR +ML +Joystick hit 10 42cm 4th 3.5cm TR 11 42cm 4th 4cm TNR + Joystick hit 12 42cm 5th 2.5cm TR 13 42cm 5th 5.5cm TNR +ML 14 38cm 1st N/A Out of range 15 38cm 2nd 6.5cm (At red tape) TNR +ML 16 38cm 2nd 7cm TNR +ML 17 38cm 3rd 5cm TR 18 38cm 3rd 6.5cm TR 19 38cm 4th 4.5cm TNR +ML 20 38cm 4th 5.5cm TNR +ML 21 38cm 5th 3cm TR 22 38cm 5th 3cm TNR +ML 23 58cm 1st N/A Out of range 24 58cm 3rd N/A Out of bounds 25 58cm 5th N/A Out of range

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3d. Dry Run Results: Points Apart Test 2

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• Moves to target 7/25

attempts

• Accuracy: 4.7-5.0cm

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3e. Dry Run Results: Maximum Reach Test

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• Moved to target 3/5

attempts

• Accuracy 3.5-7cm

No Distance to shoulder tip Distance to right cm Off Target Comment A 52cm 4cm 7cm TR B1 52cm 14cm 4cm TNR +ML B2 52cm 14cm 3.5 TR C 46cm 17cm 4.5cm TR D 56cm 17cm N/A Out of range

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 3f. Dry Run Observations
• 3x unintended actions observed

– 1x “Out of range” task  upwards motion of robotic arm – 2x Unexpected robotic arm motion secondary to an unintended wink – Electric wheelchair controller clipped by robotic arm

• Subject arm and body position = comfortable

– BUT Leg position NOT ideal feet on ground (not foot-rests): table too low

• Winks not always correctly identified

– Each attempt > 2-3 winks to activate the robotic arm

• 2x mild adverse events

– Mild headache: mostly likely secondary to sustained focusing – Red nasal bridge indentation due to the eye tracker: persisted > 12 hours – Both events fully resolved spontaneously

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.

3g: Interpretation of Dry Run Results

• Demonstrated “proof of concept” in healthy subjects
• Current setup cannot comfortably accommodate an electric WC
• Technical issues to be resolved prior to clinical testing

– Robotic arm must not “clip” electric wheelchair joystick – Different sizes of subjects needs to be accommodated eg In smaller subjects (Distance from Shoulder tip to artificial >30cm) subject leans and assumes a non-physiological position – Height of table needs to be raised to accommodate foot rest

• May result in robotic arm clipping table -> potentially erroneous

results

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 4a. Problems encountered

Model

INVACARE TDX Pride Mobility Jazzy 1143 INVACARE Action 2000

Type Electric Electric Electric Manual

Length

90cm 100cm 85cm 90cm

Height to joystick

88cm N/A 79cm N/A

Height to arm rest

75cm Removed 73cm 72cm

Height to seat

62cm (59-64cm) 56cm 56cm 51cm

Width (Wheel-wheel) 62cm

62cm 61cm 53cm

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• 1. Assumptions

eg Initial testing conducted in a manual WC and assumed it would apply to electric WC

• 2. One size does not fit all

eg Smaller subjects struggled to reach arm support This will be relevant for young DMD boys

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 4b. Problems encountered
• 3. Different countries = different rules

– eg Ethics consideration

• 4. Different countries = different equipment

– eg Removable WC controllers

• 5. Different conditions = different needs

– eg Stroke patients can have difficulty grasping but still walk. – If DMD have difficulty grasping then won’t be ambulant.

• 6. Different fields = different language/jargon

– eg Technical (Software, hardware, ROS interfaces) vs – Medical (Contractures, Nonambulant, Genetic X-linked condition)

• 7. Different disciplines = different priorities

– eg Safety- not known to be harmful is not the same as safe

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.
• 5. Lessons learnt
• Proof of concept demonstrated
• Device needs to fit patient NOT patient to fit device

– Device needs to accommodate electric WCs including controllers – Patient size and condition (younger children; bilateral symmetric weakness)

• Seeing is believing

– Videos and practical demonstrations useful for communicating practical problems across different teams

• Question assumptions
• Possibilities versus practicalities: challenge is to find the

pragmatic solutions

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This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.

Many thanks to all the eNHANCE project partners:

University

• f Twente

Clinical Partners:

• University College of

London (Duchenne Dystrophy)

• Roessingh Research

and Development (Stroke) Technical Partners:

• Imperial College of

London

• Hankamp
• Focal Meditech
• Noldus
• Bioservo
• Hacker

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644000. This result reflects

• nly the author’s view and the Commission is not responsible for any use of the information in this result.

Questions?

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