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com/content/9/1/20 E Rachel Recent REVIEWOpenAccess Benjamin L Michael M Mary Chan4, Leighton J David surveys paper participation. prevents fully case worst difficult more desired participation maximal makes Loss Abstract during observed drawing recent theme underlying Europe. sites industrial academic * benefit. widespread examples limbs aids, Wheelchairs, mobility. improve impaired, function structure Regardless [1]. increases temperature ambient fatigue increased endurance decreased experience those tolerance, heat reduced Persons ability. walking affect significantly osteoarthritis knee associated pain example, For obvious less affected also However, injury. amputations evident restricted impairment link amputations. limb accidents, vascular cerebral injury, cord spinal traumatic instantly, begin sclerosis, multiple occurs as gradually, onset Impairments structures. functions impaired compromised task perform individualsability An choosing. their life pursue individual enable activities Collectively, objects. manipulate environments environment body her or his move ability individuals encompasses Mobility Introduction Robotics technology, Assistive Disability, Keywords: impairments. transformative be potential have such whether improvements overview We between control sharing 3) interface; physical user-technology 2) mechanics; 1) ways: three accomplished being Improved exoskeletons. wearable stimulation, electrical functional limbs, prosthetic wheelchairs, powered including technologies, diverse spans improved user capabilities integration seamless persons improving opportunities new identify To end at available author list Full USA 33136, FL Miami, Terrace, 14th NW 1095 Medicine, School Miller University Paralysis, Cure Project Miami The Surgery, Neurological 1Department rcowan@med.miami.edu initiated Foundation Science National impairment, A Center. Evaluation Technology involved Information disabilities. people mobility transform could trends research about information gathering with charged formed was experts national a discuss briefly we trends, these describing Before research. technology themes important some into insight provide did they but exhaustive, not were reviewed technologies scope, limited within Even transportation. using tasks, locomotion climbing, stair walking, manipulation, transfers, balance posture, tasks: mobility-based seven on focused panel solutions, technological possible number large given mobility, impact can pathways many Given area. this working laboratories European leading to teams two by visit dynamic from results disability acknowledges ICF frameworks, other Like 1). (Figure framework (ICF) Disability Functioning, Classification International Organizations Health World standard international [2], disability conceptualize that frameworks several are there Although technology. assistive types different understanding for cited. properly work original provided medium, any in reproduction and distribution, use, unrestricted permits which (http://creativecommons.org/licenses/by/2.0), License Attribution Commons Creative of terms the under distributed article Access Open an is This Ltd. Central BioMed licensee al.; et Cowan Cowan1*, Fregly2, Boninger3,8, Rodgers5,6 Reinkensmeyer7 disability, tour Correspondence: study scientific 5-day 2012 REHABILITATION OF NEUROENGINEERING

HealthConditionBodyStructures&FunctionsUpper&LowerLimbsMotorcontrolSensoryFeedba 2 Page 9:20 2012, Rehabilitation and NeuroEngineering of Journal al. et Cowan 8 http://www.jneuroengrehab.com/content/9/1/20 ckMuscularstrength&enduranceActivityMobilityParticipationEnvironmentalFactorsPhy sicalEnvironmentTechnologyPersonalFactorsContextual 1 Figure ICF execution activity An structures. loss normal from deviations significant Impairments components. limbs, organs, parts anatomical structures functions). psychological (including systems physiological functions Body Framework: individual. action allowing pumps Baclofen arrows). black function supporting impairment, redressing repairing helping level at impairments reducing therapeutic, Indirect, 2). demand exceeds meets capacity that such individuals assistance) directly therapy) treatment (via indirectly facilitate Technology restricted. may participation resources, individualsmobility exceed demands environmental When environment. technology, user, interaction lives. their conduct live which environment attitudinal social, physical, up make factors Environmental situations. life involvement experiences problems restrictions Participation activities. executing has individual difficulties limitations Activity situation. A clinic. outside daily plan, rehabilitation overall modality one operated, set-up oversight clinical require typically Therapeutic training. movement repetitive through reduce people allow because approach indirect an example another devices therapy Robotic spasticity. her his support augment technological Direct loss. underlying impairment alter not do but mobility, examples; prime walkers Wheelchairs arrow). grey 2, (Figure structure/function altering without mobility (AT) assistive, direct, hand, other On [4]. advances reviews case as function, structure body impaired missing replace walker, than rather by operated technologies technologies, therapeutic contrast In limb. a we research trend theme unifying abstract, stated As mobility: for Recent mobility. enhancing AT or direct trends recent on is article this focus community. home activities functional execute used designed are they interface advances. software includehardwareand thetechnologymechanics in Improvements technology. between control shared improved 3) interface; physical user-technology 2) mechanics; technology improvements 1) areas; exclusive non-mutually three into classed broadly be can enhance to approaches observed The technologies. assistive and user capabilities the of integration seamless task person companion cane prosthetic clinician more Factors

BodyStructures&FunctionsUpper&LowerLimbsMotorcontrolSensoryFeedbackMuscularstren 3 Page 9:20 2012, Rehabilitation and NeuroEngineering of Journal al. et Cowan 8 http://www.jneuroengrehab.com/content/9/1/20 EnvironmentalFactorsTechnologyContextual 3.Manipulatingobjects 2.Movingbetweenenvironments gth&enduranceActivityMobility1.Movingwithinanenvironment 2 Figure observed panel device intuitive providing operate capabilities leveraging focused [3]). model Organization Health World (Modified mobility. improve arrow) (light (assistive) direct arrows) (black pathways (therapeutic) indirect demonstrating framework ICF operated traditionally wheelchairs Power exoskeletons. robotic stimulation, electrical functional prosthetics, wheelchairs, technologies: key four integration user-technology better toward using increased experience could all Not elevation. elevation, footrest recline, backrest tilt, seat movement, include functions These joystick. controlled function change switches more one navigate needed capacity neuromuscular cognitive necessary possess environment users, these For In mobility powered before considered been indicated. interface alternative an coupled approach via triggered 1) ways: two classified suggest al. et Millan algorithms. movement autonomy) (i.e., provided assistance vary modes several typically systems Shared navigation. assists technology assistive system, imparts Requiring problems. potential approaches Both [5]. detected conditions occur hard-coded 2) trigger developed has Singapore, University National collaboration in College, Imperial at group research Robotics Human Burdets Etienne Dr. abilities. their individual customization allow not may changes mode coding Hard user-friendliness. decreases complexity, increases tiring, be can load, mental provides guidance based control cost use impossible difficult it find people (CWA) assistant collaborative for population target control. shared address way are Paths destinations. specific between paths previously along guides CWA [6]. individuals locked-in or injury, brain traumatic palsy, cerebral with persons such necessary, is stopping when detect abilities sensory sufficient but wheelchair power initiates until programmed adheres which wheelchair, on falls navigation of burden However, entered have that obstacles avoid to required deviations any well as stops, and starts, speed, controls user path. records while pathway desired through walks who a like acts chair deviation, During The user. by path pre-programmed the from away pushed being system Simplified trend joystick dynamic shared traditional button substantial low third standard helper deviation. mass-spring-damper Factors

4 Page 9:20 2012, Rehabilitation NeuroEngineering Journal Cowan 8 relying inductive University. science health department center (SMI) Interaction Motor Sensory such An part. alternate operated design One devices. input controlling users exploit seeking mobility powered toward machine. integrates seamlessly more rather sensing; automatic or triggered changes mode no there [5] al. et Millan defined categories fit generatedfrombuildingplans.Thissharedapproach could libraries path envisioned created. environments, new navigate Before speed avoidance obstacle focus needs user. born path-planning benefit relinquishes once path returns thus dedicated Ten 18 embedded intraoral piercing [7]. joysticks traditional controlled wheelchairs most designed It control. joystick eight approach, (USA) Technology Institute Georgia dependent via track wirelessly cavity oral external Instead, sensors. tongue allowing again signals, mapped automatically anywhere placed sensors how explored work related Other [8]. injuries cord spinal cervical high persons been sensor. magnetic make way Another [9]. well moving capable they body parts capabilities inherent activity. electrical brain from movements intended communicate decode, detect, (BCI) interface summarize only we so detail, [10] progress recent examined study NSF characterized technology noninvasive Current here. points important bandwidth), (low rate transfer information delays substantial result bandwidths Low navigation. real-time initiates introducing responds, imposes requires typically navigation wheelchair driven addition, hazard safety into mature BCIs If tiring. very load, resolved issues wheelchairs, power option group College Imperial Burdets Dr. manner. A obstacles. unexpected pathways monitors paths prebetween chair drives computer previously. described using these solution among selecting BCI kinematic/kinetic 3) improved interfaces, peripheral 2) system, device improving example control, computer-vision 1) prosthetic: their interfacing better Europe observed were novel Three replaced. adequately are systems when will Adequate feedback). sensory afferent movement) (i.e., nervous efferent both replacing include challenges development Prosthetic [11]. destinations programmed environments known use limits but training, extensive require not does fatigue, inevitable preventing navigation, load cognitive removes approach This stopping. emergency one provides software through mechanics improves which assumes object, grab reaches individual When enhanced Computer-vision limb. lower targets third limb upper target approaches two first interface. has prosthetic Typically, object. accommodate opens orientation Although hand. shape position commands step generate plan must as burden, mental pursuit In involvement. conscious less requiring controls intuitive prefer users method, by achieved be can degree a developed have Aalborg University at researchers strategy, demanding Pisa with application targeted this refined, Once [13]. artificial an it used who subjects non-disabled 13 in tested successfully was lessened. burden prostheses, autonomy increasing By size. type implements selects camera-based while hand, orienting triggering, aiming, for responsible is user The [12]. manipulated being object of images on based size and shape, grasp orientation, hand proper the select autonomously to recognition image uses that system control shared http://www.jneuroengrehab.com/content/9/1/20 ferromagnetic keyboard physical tongue-mounted person previous few low challenge maneuver potential realistic cost-effective possible slow fast strategy given

Page 9:20 2012, Rehabilitation NeuroEngineering Journal al. et Cowan 8 Hand, appealing interfaces. traditional sites challenging extremity Upper (PNS) system nervous Peripheral project. Hand Smart funded Union European user intuitive would Potentially, [14]. brain between information efferent carried once via or arm nerve ulnar median intrafasicular longitudinal thin-film implanting option explored Silvestro Italy, SantAnna Superiore Scuola feedback. amputee. radius. distal directly mounted keep allowed he disappointed hand. removal necessitated regulations period, test four Following [15]. solve help interfacing refinements trial. end dissipated response weeks, few first sensation tactile phantom induced stimulation although Finally, required. may interface additional but should grips more suggests He interface. PNS recorded neural types grip different least concluded Micera brain. sensory deliver possible if stimulated were fibers afferent addition, recorded. resultant movements, hand/finger distinct imagine trained subject trial, week implanted activity muscle than Rather co-workers Rietman, Veltink, Peter pursued artificial improving invasive due ability had prostheses) myoelectric (i.e., prostheses Traditionally, surface array use pursuing Project Myopro hand, Enschede limitation, electrodes. mapped These signals. number increasing thereby amputee, forearm residual across distributed electrodes 5 extremes located positions basis Vallery Heinke laboratory, Systems Motor Sensory Zurich, ETH control Kinematic/kinetic subject. classifying accuracy 99% far, thus testing In positions. 10 performing subjects healthy forearms from collected signals grid same based performed mapping pronation-supination). wrist flexion-extension, finger freedom degrees controlling approach equipped estimated leg. determine instantaneously leg intact couplings inter-joint physiological exploits (CLME), estimation complementary termed Vallerys coupled. strongly motions joint walking, During knee. allows CLME advantage An motion drive evaluating colleagues Rietman Hans Dr. Enschede, Twente [16]. ascent/descent stair treadmill amputee tested been It limb. non-impaired synchronized intrinsically limb movements range A ongoing]. [study amputees aboveOssur) (Rheo have need approach, With cycle. gait within loading speed, phase, depending moment actuation correct determines then measurements analyzes microprocessor measurements. force position real-time uses knees microprocessor-controlled problem, this address To [17]. pattern walking patients characteristics adaptation automatic lack designs passive problem complexity extreme other At control. prosthetic enhancing feedback proprioceptive providing on focused research Ongoing amputations. transfemoral patients are developments these benefits clinical real what know important remains However eliminated. phase stance during knee unlocking locking using achieved being sensors, no has motor. one only controlled fingers possesses underactuated Netherlands. in Technology University Delft at researchers by developed [18] robotic attached example, For mobility. limited with individuals device assistive an as well equally used be could it However, peppers). bell packaging (e.g., required currently manipulation human repetitive where applications industrial for created was break). gently drop) not do they (so firmly both shapes and sizes various objects grasping of capable is hand The fingers. three the over evenly forces contact distributes that a provide to http://www.jneuroengrehab.com/content/9/1/20 product pathway trans-radial less small 4 patient-specific novel powered reference wide microprocessorcommon simple mechanism wheelchair versatile x

6 Page 9:20 2012, Rehabilitation NeuroEngineering Journal al. et Cowan 8 perform could shapes, sizes various objects holding option grasping range open handle remains Functional systems. don required effort time part Its movement. restoring great An Actigait. called solution, one Aalborg, University at electrode cuff building Neurodan, parts implant controlling systems challenge Another software. control specified mechanics improved interface enhanced both relies Neurostep nerves. peripheral afferent state limb sensing based times also Neurostep, solution implantable freedom degrees number focusing By ambulation achieve attempting users, population large but develop project TREMOR funded union European 25%, remaining provide To cases. 75% treatment effective brain deep surgery, Drugs, difficult. extremely tasks fine grasping, reaching, drinking, eating, make tremors Upper extremity. affects typically age, advancing more becomes disorder, movement common most Tremor system. FES extremity upper multi-channel used widely removing motor reaching/grasping/fine inherent users innovation activity. limited reaching/grasping/eating impairment body (tremor) activity rhythmic excessive, scenario, this In limb. stabilize co-contraction muscle out-of-phase it canceling tremor suppress detect automatically This [19]. orthotic (FES) stimulation electrical mobility However, 1960s. military originated was research Robotic impairment. become recently reviewed research. exoskeletons, therapeutic on focused work initial [4], paper community. home activities functional promote designed exoskeleton applications toward increasing now Attention robot. training Lokomat If technology. every success critical focus last technologies, other discussion above from apparent As [20]. usability acceptance such aspects user-centered 4) portability; wearability true 3) physical dependable safe 2) interaction; cognitive multimodal human-robot robust 1) realized: potential rehabilitative maximal their if embody must which four identified review a abandonment device AT it. abandon will she he technology, accept not does easily cannot A devices. technology assistive development possible soon as involved be should end-users awareness emerging underlies [21-24] phenomenon documented by commercialization investigated being [25,26], poliomyelitis individuals pattern improve shown been system cycle. characteristics spring desired reproduce cable, Bowden ankle-driven or solenoids, use actuators springs. tension and compression constructed are for Actuators curves. force-length spring-like, using approximated phase cycle gait each to joints the contribution The [25]. walking during kinematics joint normal achieving weakness leg with people assist can orthosis knee-ankle-foot innovative an developed has Madrid. in Pons Jose Dr. that is exoskeletons robotic of example http://www.jneuroengrehab.com/content/9/1/20 small door door. fully way non-conventional superimposed disability companion prime recent person well Long-term stimulators. foot demonstrated already model assistive-therapeutic combined needed. assistance supportive interventions activity-based receiving community, them wear able patients advance, dissolve. between distinction future, ability improves stimulator drop have colleagues Leardini Alberto Italy, Bologna, Institute Rizzoli panel, observed area life. quality function lost regain millions allowing century, past technologies transformative Furthermore, definition traditional satisfies considered traditionally Though replacements. cover [27]. off turned when even walk, ligaments, natural maintains company. orthopedic marketed design replacement ankle total novel ssur.

7 Page 9:20 2012, Rehabilitation NeuroEngineering Journal al. et Cowan 8 unifying recap, limiting Factors Discussion [28]. designs ankle total previous profiles loading motion natural producing thereby exoskeletons For blocks. building available small light, durable, Any us. limits 'build' used components First, rate. advancement limit areas several suggest peers European discussions Our mobility. changes implies, discussion below rarely. appears game-changing revolutionary, truly reality reflects observation This technologies. box out-side original, new, completely representing than upon built were advances All technology. weight. decrease sources power actuators, components, structural all therefore lightweight, extremely they non-ambulatory, option consulting make do non-obtrusive. seamless, intuitive, specifications design provide disabilities persons only However, control. intuitive algorithm Control interfaces. non-obtrusive seamless advancements Component non-obtrusive. seamless, intuitive, must adoption, widespread acceptance gain Finally, environment. walking body dynamics varying unstable, complex, adjust algorithms sophisticated along movements, intended user's access intimate requires rates terrain varied smoothly move ability body's recreate exoskeleton using example, As algorithms. our immaturity relative limitation core A transformation? towards Moving willbeabandoned. thetechnology itself, repeat history user, demands meet we transform could themes Study NSF goal people mobility elevates which define us let transformative, illustrate To required? entirely specifically, more and, like, look sense makes It Pistorius, Oscar elevation excellent An peers. their m 400 South 2007 silver winning athletes, against competes advanced With amputee. trans-tibial bilateral paralympic African dramatic, complete, training provided level. elite at compete less much walk, able be would Without Olympics. Beijing 2008 for qualification missing narrowly championships track by possible made not transformation Pistorius transformative. achieves without can what between gap Regardless, [29-32]. competitors over advantage he if continues debate scientific overturned, been has ruling While enhancement. performance illegal conferred prosthesis thought because competition non-disabled from banned technology, technology; achieve change amount form both Ultimately, potential. tremendous holds itself enhanced illustrates Pistorius Mr. example transformative, become here reviewed integration user-technology whether unclear while Thus, ability. running inherent his properties mechanical designed prosthesis, develop important goal, end improvements If transformation. quantifying toward approach take struggled have agencies funding groups research yet, And changes? transformative much how what identify Who disability. person ask is transformative quantify path ideal impairment, type degree according vary improvement individuals Ideally, process. throughout it employ to system themselves required furthermore, system, quantification this refine invent a control kinetic orthosis, knee-ankle-foot mechanics through basis application-by-application an done being are refinements These capabilities. users with better integrated so ways clever existing of refinement was observed development technology in theme primary rather trip; its on assistive new fundamentally no saw panel The Conclusions impairments. capabilities well as wants, and needs match technologies developed that ensure help will involvement endcontinuous least, very the At better? whole-body or tongue (e.g., interfaces user improved limb); http://www.jneuroengrehab.com/content/9/1/20 viable second priority, key disability. period, below-knee user-centered disability who prosthetic

Page 9:20 2012, al. 8 functions target automating system) nervous peripheral central implanted electrodes controllers, has David interests Competing wheelchairs. power mobility autonomous disabilities physical severe most persons or prosthetics sophisticated highly refined more enabling burden, user decrease systems integrated Better user. abilities natural assistance machines blends A.G., Hocoma, 2Department 33136, Miami, Terrace, 14th NW 1095 Miller Paralysis, Cure Project Miami Surgery, Neurological 1Department details Author interest. competing no they declare remaining policies. interest conflict its accordance reviewed been have arrangement terms therapy robotic makes that 3Department 32611, FL Gainesville, 116250, Box P.O. Building, MAE-A 231 Florida, & Mechanical 7Department 20892-5477, Bethesda, Blvd, Democracy 6707 NIH, Bioengineering/ Imaging Institute 6National 21201, Baltimore, Street, 100 Maryland, Science, Therapy Physical 5Department 20892, MD Bethesda Drive, Center 10 Center, NIH Department, Medicine 4Rehabilitation 15260, 201, Ave, 5th 3471 Medicine, School sclerosis. multiple Thermoregulation EM: Frohman AT, White TE, Wilson Davis 1. References Published: April 20 Accepted: September 26 Received: manuscript. final approved read authors All revisions. edits provided MR LC, BF, DR, editor. writer manuscript lead was RC contributions Authors 15206, PA Pittsburgh, 400, Suite Avenue, Penn 6425 System, Healthcare Pittsburgh VA Laboratories, 8Human USA. 92697-3875, CA Irvine, Gateway, Engineering 4200 California, University Biomedical Neurobiology, Anatomy Department Engineering, Towards Organization: Health 3. 30(17):12331244. century. 20th disability models conceptual enablement: disablement From DR: Petretto Masala 2. 109(5):15311537. people training enhancing therapies combination Technologies ML: Boninger Reinkensmeyer 4. 2002. health. disability, functioning, language CL: Burdet Q, Zeng 6. 4:115. Neurosci Front Challenges. state-of-the-Art Technologies: Assistive Interfaces Combining Tangermann Giugliemma Murray-Smith GR, Muller-Putz Rupp JD, Millan 5. 2011. 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Exerc Sports Sci Med nonamputees. to similar cost energy permit prostheses Running-specific AR: Allison ML, Millard-Stafford MB, Brown 31. 108(4):10121014. 2010, 9:20. 2012 Rehabilitation and NeuroEngineering of Journal mobility. for technology assistive in trends Recent al.: et Cowan as: article this Cite doi:10.1186/1743-0003-9-20 107(3):903911. 2009, Physiol http://www.jneuroengrehab.com/content/9/1/20 way financial company Rehabilitation, Aerospace common disability. collaborative Neuroeng neurocontrolled robot Phys knee-ankle-foot controllable Appl