Rozprawy doktorskie na temat „Robotics in medicine”

Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
Introduction: Mankind has long been fascinated with automatons in all their many forms. Machines now have applications in virtually every aspect of life and are changing the face of modern medicine. This thesis reviews briefly reviews the long and complicated history of machines in medicine and how they have shaped and continue to mold clinical practice. Methods: Sources were gathered from multiple databases. Primarily, PubMed, Springerlink, and Science Direct. Printed texts were also consulted as well as news articles. Images compiled for this article are either the work of the author otherwise cited. Data Synthesis: This history of robots in modern medicine is perhaps best conceived as beginning with the surgical arts. The perennial problems of surgery have always been bleeding, pain, and infection. Over the years, applications of robotics have served to enhance the capabilities of modern surgeons while minimizing the amount of trauma the patient endures during the procedure. The newest frontier in robotics is set to be perhaps nominally invasive. The creation of nanorobots allows physicians to monitor and treat patients at the cellular and molecular level. Conclusion: The rise of robotics in medicine has significant and far reaching impact on the wider social world. It dramatically alters economics, education and our relationship with energy resources. Further it forces medicine and humanity in general to redefine our role on the planet and consider the very nature of what makes us human. The future of medical robotics is perhaps the world of Asimov's dreams but also his nightmares.

In this thesis the development of a remotely controlled system used for visual monitoring of surgical procedures at distant locations in described. The system has been developed for laboratory testing, where in the longer term it is to be verified under field conditions. Using existing technology in areas of serial communication and videoconferencing in a new configuration, it has been possible to achieve such a system. The system is intended to assist in performing complex surgical procedures at remote locations where specialist surgeons are normally unavailable. With the prototype system developed in this thesis, a remotely based general surgeon performing an operation can consult and interact with other specialist surgeons through visual operation and voice communications. The teleoperated system consists of two computers, a commercially available robot and a videoconferencing unit
Master of Engineering (Hons)

The objective of this research effort is to further rehabilitation techniques for children by developing and validating the core technologies needed to integrate therapy instruction with child-robot play interaction in order to improve upper-arm rehabilitation. Using computer vision techniques such as Motion History Imaging (MHI), Multimodal Mean, edge detection, and Random Sample Consensus (RANSAC), movements can be quantified through robot observation. Also incorporating three-dimensional data obtained via an infrared projector coupled with a Principle Component Analysis (PCA), depth information can be utilized to create a robust algorithm. Finally, utilizing prior knowledge regarding exercise data, physical therapeutic metrics, and novel approaches, a mapping to therapist instructions can be created allowing robotic feedback and intelligent interaction.

Nurses who provide care in robotic surgery must have sufficient special training in the operation of the da Vinci robot to perform their roles with knowledge and confidence that can yield optimal patient outcomes. The local nursing practice problem in the project facility, and the focus of this doctoral project, was the lack of an evidenced-based robotics education program for registered nurses who participate in robotic surgery. The gap in practice was nurses' lack of knowledge, which interfered with the care provided to the robotic surgical population. The purpose of this project was to develop a staff robotics education program in order to answer the question if the implementation of an evidence-based robotics education program would improve nurses' knowledge in the practice of robotic surgery. The education program was developed using Knowles adult learning theory and information obtained from a comprehensive literature search. A planning team, consisting of local clinicians with expertise in robotic surgery, provided feedback and assisted with the development of the education program and accompanying competency checklist. Ten nurses received the education, and 90-100% of the nurses reported increased knowledge and confidence regarding practice in the specialty of robotic surgery following the education. Leadership at the project site have decided to require surgical nurses receive the robotic education upon their employment and annually thereafter. The social change resulting from the use of this evidence-based robotics education program could include increased nursing performance and therefore, decreased complications for patients undergoing robotic surgery.

Whole-cell patch clamp electrophysiology of neurons in vivo enables the recording of electrical events in cells with great precision, and supports a wide diversity of morphological and molecular analysis experiments important for the understanding of single-cell and network functions in the intact brain. However, high levels of skill are required in order to perform in vivo patching, and the process is time-consuming and painstaking. Robotic systems for in vivo patching would not only empower a great number of neuroscientists to perform such experiments, but would also open up fundamentally new kinds of experiment enabled by the resultant high throughput and scalability. We discovered that in vivo blind whole cell patch clamp electrophysiology could be implemented as a straightforward algorithm and developed an automated robotic system that was capable of performing this algorithm. We validated the performance of the robot in both the cortex and hippocampus of anesthetized mice. The robot achieves yields, cell recording qualities, and operational speeds that are comparable to, or exceed, those of experienced human investigators. Building upon this framework, we developed a multichannel version of “autopatcher” robot capable establishing whole cell patch clamp recordings from pairs and triplets of neurons in the cortex simultaneously. These algorithms can be generalized to control arbitrarily large number of electrodes and the high yield, throughput and automation of complex set of tasks results in a practical solution for conducting patch clamp recordings in potentially dozens of interconnected neurons in vivo.

In this thesis the development of a remotely controlled system used for visual monitoring of surgical procedures at distant locations in described. The system has been developed for laboratory testing, where in the longer term it is to be verified under field conditions. Using existing technology in areas of serial communication and videoconferencing in a new configuration, it has been possible to achieve such a system. The system is intended to assist in performing complex surgical procedures at remote locations where specialist surgeons are normally unavailable. With the prototype system developed in this thesis, a remotely based general surgeon performing an operation can consult and interact with other specialist surgeons through visual operation and voice communications. The teleoperated system consists of two computers, a commercially available robot and a videoconferencing unit

Increasingly, diagnosis of cardiac disease, relies on computer processing of images to aid decision making. In this thesis, we use echocardiography, which is the most widely used cardiac imaging modality to study the motion of the left ventricle. Currently, clinical reporting of echocardiography examinations is operator-dependent and largely qualitative. Commercially available software does not track the left ven- tricle. Also, it does not provide quantification of regional function. This thesis establishes a framework for the quantitative regional analysis of left ven- tricular function. The endocardial and epicardial contours are automatically tracked during the cardiac cycle. A quantitative measure of regional endocardial wall excur- sion and myocardial thickening, based on a 16-segment model of the heart, is then obtained based on these boundaries. The new tracking framework is based on Kalman filtering which makes a single pre- diction as to the position of the boundary on the next frame. We develop a mea- surement model for the endocardial border, the tissue/blood interface, and the epi- cardium, the tissue/tissue interface. Having tracked the endocardial and epicardial boundaries, we introduce an interpretational space which provides clinically mean- ingful regional quantitative measures of left ventricular function. We illustrate all the concepts on one example. We apply the ideas developed to stress echocardiography, in a small retrospective clinical test.

Thesis (MScEng)--Stellenbosch University, 2009.
ENGLISH ABSTRACT: Minimal invasive surgery (MIS) enables surgeons to operate through a few small incisions made in the patient’s body. Through these incisions, long rigid instruments are inserted into the body and manipulated to perform the necessary surgical tasks. Conventional instruments, however, are constrained by having only five degrees of freedom (DOF), as well as having scaled and mirrored movements, thereby limiting the surgeon’s dexterity. Surgeons are also deprived of depth perception and hand-eye coordination due to only having two-dimensional visual feedback. Surgical robotics attempt to alleviate these drawbacks by increasing dexterity, eliminating the fulcrum effect and providing the surgeon with three-dimensional visualisation. This reduces the risks to the patient as well as to the surgeon. However, existing MIS systems are extremely expensive and bulky in operating rooms, preventing their more widespread adoption. In this thesis, a new, inexpensive seven-DOF primary slave manipulator (PSM) is presented. The four-DOF wrist is actuated through a tendon mechanism driven by five 12 VDC motors. A repeatability study on the wrist’s joint position was done and showed a standard deviation of 0.38 degrees. A strength test was also done and demonstrated that the manipulator is able to resist a 10 N opposing tip force and is capable of a theoretical gripping force of 15 N.
AFRIKAANSE OPSOMMING: Minimale indringende chirurgie (MIC) maak dit vir chirurge moontlik om operasies uit te voer deur ’n paar klein insnydings wat op die pasiënt se liggaam gemaak word. Deur hierdie insnydings word lang onbuigsame instrumente in die liggaam ingesit en gemanipuleer om die nodige chirurgiese take uit te voer. Konvensionele instrumente is egter beperk vanweë die feit dat hulle net vyf vryheidsgrade het, asook afgeskaalde bewegings en spieëlbewegings, en gevolglik die chirurg se handvaardigheid beperk. Chirurge word ook ontneem van dieptewaarneming en hand-oog-koördinasie, want hulle is beperk tot tweedimensionele visuele terugvoer. Chirurgiese robotika poog om hierdie nadele aan te spreek deur handvaardigheid te vermeerder, die hefboomeffek uit te skakel en die chirurg driedimensionele visualisering te bied. Dit verminder die risiko’s vir die pasiënt én vir die chirurg. Bestaande MIC-stelsels is egter uiters duur en neem baie plek op in teaters, wat verhoed dat hulle op ’n groter skaal gebruik word. In hierdie tesis word ’n nuwe, goedkoop sewevryheidsgrade- primêre slaafmanipuleerder (PSM) voorgelê. Die viervryheidsgrade-pols word beweeg deur ’n tendonmeganisme wat aangedryf word deur vyf 12 VDC-motors. ’n Herhaalbaarheidstudie is op die pols se gewrigsposisie gedoen, wat ’n standaardafwyking van 0.38 grade aangetoon het. ’n Sterktetoets is ook gedoen en het gewys dat die manipuleerder in staat is om ’n 10 N-teenkantelkrag te weerstaan en dat dit oor ’n teoretiese greepsterkte van 15 N beskik.

Nasopharyngeal carcinoma (NPC) is the 7th commonest cancer in Hong Kong. Improvements in radiotherapy had increased the cure. Unfortunately, up to 10% of the patient still suffered from local recurrence. Because of the deep location, nasopharyngectomy was considered a difficult operation. Developments in surgical approaches had now established nasopharyngectomy as a standard salvage for locally recurrent NPC. With improvements of endonasal endoscopic instruments and endoscopic techniques, endoscopic nasopharyngectomy as a minimally invasive surgery for salvaging small locally recurrent NPC have been reported in several cohorts with encouraging results. Robotic nasopharyngectomy remained difficult due to tight operation space and instrument considerations. The da Vinci surgical robot was marketed in 1999 as a tool to assist surgeons in performing complex surgical manipulations in tight spaces. It was later adapted to be used in the upper aerodigestive tract for endoscopic resection of small cancers transorally. As the da Vinci surgical robot was not designed for head and neck operations, adaptations are required when we tried to apply it to resect tumours in the nasopharynx. The present study aimed to develop the use of the da Vinci surgical robot to perform minimally invasive operations on the nasopharynx in a cadaveric model. Ten procedures on 3 cadavers were performed with the surgical robot. Due to instrument clutter, a transoral approach was preferred over transnasal approach. In transoral approach, the soft palate obstructs the access to the nasopharynx. We devised three approaches, namely palatal suspension approach, midline palatal split approach and lateral palatal flap approach. We also assess the advantages and limitations of the three approaches. From 2010-2014, 18 robotic nasopharyngectomies were performed. Median operation time was 232 minutes (range 125-574). Estimated median blood loss was 100ml (range 100-1800). Negative margins were achieved in 14 patients. The two-year actuarial local control was 83% and estimated mean survival was 42.7 months (95% confidence interval 35.0-50.3 months). A positive or close margin was significant associated with poor local control but not overall survival. Results were comparable to open or endoscopic nasopharyngectomy. There was no 30 days post-operative mortality but one patient suffered from hypoxic brain damage after developing angioedema in the recovery room. Two patients developed permanent palatal fistulas and one patient had severe trismus after operation. Symptomatic osteoradionecrosis occurred in three patients. When comparing the quality of life assessment with patients after open maxillary swing nasopharyngectomy operation, robotic nasopharyngectomy patients have a higher score in social functioning scale and lower symptoms scores on pain, mouth opening and social eating. The global health score and other functioning scores were statistically not different. Robotic nasopharyngectomy is a feasible minimally invasive operation for resecting selected cases of locally recurrent NPC. The operation is associated with minor long-term complications and better quality of life. Early oncological results in are also encouraging. With rapid development of medical robotic technologies, further research in the field should be continued.
published_or_final_version
Surgery
Master
Master of Surgery

Thesis (M. E.) (Honours) -- University of Western Sydney, 2002.
Thesis submitted in fulfilment of the requirements for the degree of Master of Engineering (Honours), University of Western Sydney, School of Engineering & Industrial Design, March 2002. Bibliography : p. 99-104.

This work describes a self-sensing technique for a piezoelectrically driven MRI-compatible tweezer style end effector, suitable for robot assisted, MRI guided surgery. Nested strain amplification mechanisms are used to amplify the displacement of the piezo actuators to practical levels for robotics. By using a hysteretic piezoelectric model and a two port network model for the compliant nested strain amplifiers, it is shown that force and displacement at the tweezer tip can be estimated if the input voltage and charge are measured. One piezo unit is used simultaneously as a sensor and an actuator, preserving the full actuation capability of the device. Experimental validation shows an average of 12% error between the self-sensed and true values.

Thesis (M.S.)--Electrical and Computer Engineering, Georgia Institute of Technology, 2005. Directed by Stephen DeWeerth.
Dr. Stephen DeWeerth, Committee Chair ; Dr. Robert Butera, Committee Member ; Dr. Lena Ting, Committee Member. Includes bibliographical references.

This work focuses on the use of 3D motion capture data to create and optimize a robotic human body model (RHBM) to predict the inverse kinematics of the upper body. The RHBM is a 25 degrees of freedom (DoFs) upper body model with subject specific kinematic parameters. The model was developed to predict the inverse kinematics of the upper body in the simulation of a virtual person, including persons with functional limitations such as a transradial or transhumeral amputation. Motion data were collected from 14 subjects: 10 non-amputees control subjects, 1 person with a transradial amputation, and 3 persons with a transhumeral amputation, in the University of South Florida's (USF) motion analysis laboratory. Motion capture for each subject consisted of the repetition of a series of range of motion (RoM) tasks and activities of daily living (ADLs), which were recorded using an eight camera Vicon (Oxford, UK) motion analysis system. The control subjects were also asked to repeat the motions while wearing a brace on their dominant arm. The RoM tasks consisted of elbow flexion & extension, forearm pronation & supination, shoulder flexion & extension, shoulder abduction & adduction, shoulder rotation, torso flexion & extension, torso lateral flexion, and torso rotation. The ADLs evaluated were brushing one's hair, drinking from a cup, eating with a knife and fork, lifting a laundry basket, and opening a door. The impact of bracing and prosthetic devices on the subjects' RoM, and their motion during ADLs was analyzed. The segment geometries of the subjects' upper body were extracted directly from the motion analysis data using a functional joint center method. With this method there are no conventional or segment length differences between recorded data segments and the RHBM. This ensures the accuracy of the RHBM when reconstructing a recorded task, as the model has the same geometry as the recorded data. A detailed investigation of the weighted least norm, probability density gradient projection method, artificial neural networks was performed to optimize the redundancy RHBM inverse kinematics. The selected control algorithm consisted of a combination of the weighted least norm method and the gradient projection of the null space, minimizing the inverse of the probability density function. This method increases the accuracy of the RHBM while being suitable for a wide range of tasks and observing the required subject constraint inputs.

Biological systems are able to perform complex movements with high energy-efficiency and, in general, can adapt to environmental changes more elegantly than traditionally engineered mechanical systems. The Equilibrium Point Hypothesis describes animal motor control as trajectories of equilibrium joint angle and joint stiffness. Traditional approaches to robot design are unable to implement this control scheme because they lack joint actuation methods that can control mechanical stiffness, and, in general, they are unable to take advantage of energy introduced into the system by the environment. In this paper, we describe the development and implementation of an FPGA-controlled, servo-actuated robotic joint that incorporates series-elastic actuation with specially developed nonlinear springs. We show that the joint's equilibrium angle and stiffness are independently controllable and that their independence is not lost in the presence of external joint torques. This approach to joint control emulates the behavior of antagonistic muscles, and thus produces a mechanical system that demonstrates biological similarity both in its observable output and in its method of control.

Robot is a machine with a human-like behavior which partially or completely fulfills human function when interacting with the surrounding world. Robots are divided into three types: robots with the specific program of actions, operator-controlled robots and artificial intelligence robots. No doubt, that the development of new technologies had a great impact on medicine. At present, doctors can perform operations, which seemed impossible ten years ago. Robots have become indispensable medical assistants.

Orientador: João Maurício Rosário
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecânica
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Resumo: Nesta dissertação realiza-se um estudo cinemático e dinâmico da marcha humana tendo como base a biomecânica e a antropomorfia dos membros inferiores, assim como nos paradigmas que regem a reabilitação assistida por meio da robótica. Propõe-se uma estratégia de controle de um exoesqueleto robótico para membros inferiores através do cálculo do torque computado, com a finalidade terapêutica de reabilitação da marcha. Adota-se a marcha dinâmica como inspiração para o modelo do sistema, usando uma estrutura simplificada que atuará em dois modos de funcionamento, onde a transição entre um módulo e outro será controlada por meio do formalismo de sistema de eventos. O sistema foi modelado a partir do desenvolvimento de suas equações dinâmicas e implementação em Matlab®, como também através do uso da plataforma SimMechanics® que permitiu a modelagem de componentes externas com maior grau de complexidade. Através de simulação computacional verificou-se que sistema em estudo apresentou um desempenho preciso no desenvolvimento da marcha, onde se considerou, inclusive, os efeitos do impacto que ocorrem a partir da interação do pé com solo
Abstract: In this dissertation is executed a cinematic and dynamic study of human's gait based on the field of knowledge of biomechanics and the anthropomorphic characteristics of human's leg, based as well on paradigms the rules the assisted rehabilitation with the use of robots. Here it's proposed and strategy of control of robotic exoskeletons for lower limbs through the computed torque with therapeutic goal to improve the human gait. The dynamic gait inspire the system's model, it's used a simplified structure which will function in two distinctive modes of operation, the transition between the modes is control by a system of discrete events. The modeled system is developed from its dynamic equations in Matlab® and also with the use of SimMechanics® simulation platform the allowed the inclusion of external components with greater complexity in the model. Through the computational simulation is concluded that the studied system had a precise performance in development of the gait, the control simulation included the effects of the impact that occurs when the foot interact with the solo
Mestrado
Mecanica dos Sólidos e Projeto Mecanico
Mestra em Engenharia Mecânica

In the past decade, Human Activity Recognition (HAR) has been an important part of the regular day to day life of many people. Activity recognition has wide applications in the field of health care, remote monitoring of elders, sports, biometric authentication, e-commerce and more. Each HAR application needs a unique approach to provide solutions driven by the context of the problem. In this dissertation, we are primarily discussing two application of HAR in different contexts. First, we design a novel approach for in-home, fine-grained activity recognition using multimodal wearable sensors on multiple body positions, along with very small Bluetooth beacons deployed in the environment. State-of-the-art in-home activity recognition schemes with wearable devices are mostly capable of detecting coarse-grained activities (sitting, standing, walking, or lying down), but cannot distinguish complex activities (sitting on the floor versus on the sofa or bed). Such schemes are not effective for emerging critical healthcare applications – for example, in remote monitoring of patients with Alzheimer's disease, Bulimia, or Anorexia – because they require a more comprehensive, contextual, and fine-grained recognition of complex daily user activities. Second, we introduced Watch-Dog – a self-harm activity recognition engine, which attempts to infer self-harming activities from sensing accelerometer data using wearable sensors worn on a subject's wrist. In the United States, there are more than 35,000 reported suicides with approximately 1,800 of them being psychiatric inpatients every year. Staff perform intermittent or continuous observations in order to prevent such tragedies, but a study of 98 articles over time showed that 20% to 62% of suicides happened while inpatients were on an observation schedule. Reducing the instances of suicides of inpatients is a problem of critical importance to both patients and healthcare providers. Watch-dog uses supervised learning algorithm to model the system which can discriminate the harmful activities from non-harmful activities. The system is not only very accurate but also energy efficient. Apart from these two HAR systems, we also demonstrated the difference in activity pattern between elder and younger age group. For this experiment, we used 5 activities of daily living (ADL). Based on our findings we recommend that a context aware age-specific HAR model would be a better solution than all age-mixed models. Additionally, we find that personalized models for each individual elder person perform better classification than mixed models.

Today, more and more people question the treatment without surgery. Thanks to modern research and the efforts of scientists a new possible way to use nano-robots was invented. The first thing to know about nanorobots in medicine is that they're not like the robots you're probably imagining. Scientists who build nanorobots are building tiny packages that can complete tasks in an automated way.

Teleoperation systems have been used in the operating rooms for more than a decade. However, the lack of force feedback in commercially available systems still raises safety issues and forbids surgical gestures like palpation. Although force feedback has already been implemented in experimental setups, a systematic methodology is still lacking to design the control laws.

The approach developed in this thesis is a contribution towards such a systematic

methodology: it combines the use of disturbance observers with the use of a structured fixed-order controller. This approach is validated by experiments performed on a one degree of freedom teleoperation system. A physical model of this system is proposed and validated experimentally.

Disturbance observers allow to compensate friction, which is responsible for performance degradation in teleoperation. Contrary to alternative approaches,they are based on a model of the frictionless mechanical system. This allows to compensate friction with a time varying behavior, which occurs in laparoscopy.

Parametric uncertainties in this model may lead to an unstable closed-loop. A kind of "separation principle" is provided to decouple the design of the closed-loop system from the design of the observer. It relies on a modified problem statement and on the use of available robust design and analysis tools.

A new metric is proposed to evaluate the performance of friction compensation systems experimentally. This metric evaluates the ability of a compensation system to linearize a motion system, irrespective of the task and as a function of frequency. The observer-based friction compensation is evaluated with respect to this new metric and to a task-based metric. It correctly attenuates the friction in the bandwidth of interest and significantly improves position and force tracking during a palpation task.

Structured fixed-order controllers are optimized numerically to achieve robust closed-loop performance despite modeling uncertainty. The structure is chosen among classical teleoperation structures. An efficient algorithm is selected and implemented to design such a controller, which is evaluated for a palpation task. It is compared to a full-order unstructured controller, representative of the design approach that has been used in the teleoperation literature up to now. The comparison highlights the advantages of our new approach: order-reduction steps and counter-intuitive behaviors are avoided.

A structured fixed-order controller combined with a disturbance observer is implemented during a needle insertion experiment and allowed to obtain excellent performance.
Doctorat en Sciences de l'ingénieur
info:eu-repo/semantics/nonPublished

Objective: To advance robotic surgery simulation in gynecologic oncology by: (1) conducting a randomized controlled trial of a virtual reality, proficiency-based robotic simulation curriculum to teach robotic suturing and (2) developing an inanimate model for training in the procedure of robotic pelvic lymphadenectomy. Methods: (1) Residents and attending surgeons in surgical specialties were randomized to a proficiency-based virtual reality robotic simulation curriculum or usual clinical work over 5 weeks. Ability to perform robotic suturing of an inanimate model of the vaginal cuff with the actual da Vinci® robot was assessed at baseline and after the intervention period. (2) Using anatomic texts and virtual model of the anatomy of the human pelvis, an inanimate model for training in robotic pelvic lymphadenectomy was developed using low-cost materials. The model was robotically dissected by three gynecologic oncologists and two gynecologic oncology fellows all of whom rated the model post-dissection using a structured rating scale.Results: (1) As compared to controls, the training group showed a trend to greater improvement in ability to perform robotic suturing of an inanimate model of the vaginal cuff as assessed by a global rating scale and a statistically significantly greater improvement in total knots performed. (2) The pelvic lymphadenectomy model was rated favorably for both anatomic realism and potential as a training tool. Discussion: Participation in a virtual reality robotic surgery training curriculum shows a trend to improving ability to perform inanimate tasks with the actual da Vinci® robot, suggesting a translational benefit. A high fidelity training model of robotic pelvic lymphadenectomy has been developed using low-cost materials. Both projects help to advance surgical simulation in gynecologic oncology, the first at the level of basic task training and the second in advanced techniques.
Objectifs: Améliorer la simulation chirurgicale en gynécologie oncologique par: (1) un essai randomisé contrôlé pour évaluer un curriculum de simulation en réalité virtuelle pour enseigner l'enseignement des sutures (2) développement d'un modèle anatomique pour simuler la technique de curage ganglionnaire pelvienne. Méthodes: (1) Résidents et chirurgiens étaient randomisés au curriculum d'entrainement en simulation robotique (réalité virtuelle) ou groupe témoin pendant 5 semaines. L'habileté à la suture robotique avec le da Vinci® pour faire la fermeture de la voûte vaginale était évaluée avant et après l'intervention. (2) En utilisant les livres anatomiques et un modèle virtuelle de l'anatomie du pelvis, un modèle inanimé pour l'entrainement en curage ganglionnaire par voie robotique a été créé. Le modèle était disséqué et par la suite évalué par trois gynécologues oncologues et deux fellows en gynécologie oncologie. Résultats: (1) Le groupe d'entrainement a mieux amélioré que le groupe témoin en le nombre total de noeuds fait et a montré une tendance à une plus grande amélioration en évaluation avec une échelle standardisé. (2) Le modèle de curage ganglionnaire pelvienne a eu des résultats favorables aux évaluations par les médecins qui ont fait la dissection. Discussion: L'essai randomisé démontre qu'il y a au moins une tendance pour l'entrainement en réalité virtuelle d'améliorer l'habileté de faire les exercices avec le robot da Vinci®. Un modèle de curage ganglionnaire pelvienne avec une fidélité élevée a été créé avec des bonnes évaluations. Les deux projets aident à avancer la simulation en gynécologie oncologie, le premier en technique de base et la deuxième en techniques avancées.

Machine learning is applied to a challenging and biologically significant protein classification problem: the prediction of flavonoid UGT acceptor regioselectivity from primary protein sequence. Novel indices characterizing graphical models of protein residues are introduced. The indices are compared with existing amino acid indices and found to cluster residues appropriately. A variety of models employing the indices are then investigated by examining their performance when analyzed using nearest neighbor, support vector machine, and Bayesian neural network classifiers. Improvements over nearest neighbor classifications relying on standard alignment similarity scores are reported.

The goal of this investigation was to explore the efficacy of implementing a rehabilitation robot controlled by a noninvasive brain-computer interface (BCI) to influence brain plasticity and facilitate motor learning. The motivation of this project stemmed from the need to address the population of stroke survivors who have few or no options for therapy. A stroke occurs every 40 seconds in the United States and it is the leading cause of long-term disability [1-3]. In a country where the elderly population is growing at an astounding rate, one in six persons above the age of 55 is at risk of having a stroke. Internationally, the rates of strokes and stroke-induced disabilities are comparable to those of the United States [1, 4-6]. Approximately half of all stroke survivors suffer from immediate unilateral paralysis or weakness, 30-60% of which never regain function [1, 6-9]. Many individuals who survive stroke will be forced to seek institutional care or long-term assistance. Clinicians have typically implemented stroke rehabilitative treatment using active training techniques such as constraint induced movement therapy (CIMT) and robotic therapy [10-12]. Such techniques restore motor activity by forcing the movement of weakened limbs. That active engagement of the weakened limb movement stimulates neural pathways and activates the motor cortex, thus inducing brain plasticity and motor learning. Several studies have demonstrated that active training does in fact have an effect on the way the brain restores itself and leads to faster rehabilitation [10, 13-15]. In addition, studies involving mental practice, another form of rehabilitation, have shown that mental imagery directly stimulates the brain, but is not effective unless implemented as a supplemental to active training [16, 17]. Only stroke survivors retaining residual motor ability are able to undergo active rehabilitative training; the current selection of therapies has overlooked the significant population of stroke survivors suffering from severe control loss or complete paralysis [6, 10]. A BCI is a system or device that detects minute changes in brain signals to facilitate communication or control. In this investigation, the BCI was implemented through an electroencephalograph (EEG) device. EEG devices detect electrical brain signals transmitted through the scalp that corresponded with imagined motor activity. Within the BCI, a linear transformation algorithm converted EEG spectral features into control commands for an upper-limb rehabilitative robot, thus implementing a closed-looped feedback-control training system. The concept of the BCI-robot system implemented in this investigation may provide an alternative to current therapies by demonstrating the results of bypassing motor activity using brain signals to facilitate robotic therapy. In this study, 24 able-bodied volunteers were divided into two study groups; one group trained to use sensorimotor rhythms (SMRs) (produced by imagining motor activity) to control the movement of a robot and the other group performed the 'guided-imagery' task of watching the robot move without control. This investigation looked for contrasts between the two groups that showed that the training involved with controlling the BCI-robot system had an effect on brain plasticity and motor learning. To analyze brain plasticity and motor learning, EEG data corresponding to imagined arm movement and motor learning were acquired before, during, and after training. Features extracted from the EEG data consisted of frequencies in the 5-35Hz range, which produced amplitude fluctuations that were measurably significant during reaching. Motor learning data consisted of arm displacement measures (error) produced during an motor adaptation task performed daily by all subjects. The results of the brain plasticity analysis showed persistent reductions in beta activity for subjects in the BCI group. The analysis also showed that subjects in the Non-BCI group had significant reductions in mu activity; however, these results were likely due to the fact that different EEG caps were used in each stage of the study. These results were promising but require further investigation. The motor learning data showed that the BCI group out-performed non-BCI group in all measures of motor learning. These findings were significant because this was the first time a BCI had been applied to a motor learning protocol and the findings suggested that BCI had an influence on the speed at which subjects adapted to a motor learning task. Additional findings suggested that BCI subjects who were in the 40 and over age group had greater decreases in error after the learning phase of motor assessment. These finding suggests that BCI could have positive long term effects on individuals who are more likely to suffer from a stroke and possibly could be beneficial for chronic stroke patients. In addition to exploring the effects of BCI training on brain plasticity and motor learning this investigation sought to detect whether the EEG features produced during guided-imagery could differentiate between reaching direction. While the analysis presented in this project produced classification accuracies no greater than ~77%, it formed the basis of future studies that would incorporate different pattern recognition techniques. The results of this study show the potential for developing new rehabilitation therapies and motor learning protocols that incorporate BCI.

Public perception of an emerging scientific and technological product is important for the acceptance of such a product. Ethical studies based on public surveys toward using robots in eldercare and other applications, showed a high acceptance for pet-like therapeutic robot, the human-like care robot, and a surveillance care robot. However, it also reported a rejection in the case of a bathing robot because of the judgment that the robot-based action would be inferior to the human-based action and that it would take away jobs from human workers. Taking into account this scenario, chapter IV (4.1) focus on the acceptance by practitioners that work on a daily basis with children with intellectual disabilities, and on a group of university students from two classes concerned with social professions: education and psychology. Moreover, the purpose of the other study in the chapter IV (4.2) is to examine the acceptance and willingness to use robots among psychology students with Italian (ITA) and British (UK) background cultures in order to evaluate cultural differences in the acceptance of robotics by future psychology practitioners. Both studies were conducted using a platform for Socially Assistive Robotics and a questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. In this case, the aim was to identify the capability of items in UTAUT questionnaire to reveal cultural differences, and, thus, the main factors that may influence each group in the use of robots in their future practice. This negative attitude is one of the biggest challenges that scientific research must address to be completely successful in giving actual benefits in the field of education and care. This rapid progress in technology, especially in the area of robotics, offers numerous possibilities for innovation in the education and care of individuals. Starting from these findings, in the chapter V my on-going research aims to identify effective modalities for treatment of Autism Spectrum Disorder (ASD) through interaction with a robot, and to integrate them into existing therapeutic protocols to improve their efficacy. I detail the methodology and give the results of a pilot clinical trial, focused on imitation skills, with three children affected by ASD and Intellectual Disability under treatment in a research centre specialized in the care of children with disabilities. Analysis of these initial results encourages the development of effective protocols in which the robot becomes a mediator between the child with ASD and humans and suggests some research avenues for focus in the future. However, the robotics is not only social. For this reason the aim of chapter VI, is artificial life where the models derived from the data , implement artificial organisms that replicate experimental observations. Specific skills or behaviours are not directly imitated or reproduced, as schematic photographs of a part of reality, but emerge as a result of adaptation processes put in place by the new reality built artificially. Traditionally, artificial life realizes models that simulate psychophysical activities. In fact, in the chapter VI, I will present the experimental results of a cognitive robotic approach for modelling the human cognitive deficit known as Unilateral Spatial Neglect (USN), where I replicated a previous experiment with human patients affected by the USN and iCub robotic platform. The numerical results show that the robot simulate the behaviours previously exhibited by humans and this last work of dissertation highlights some possible advantages of the use of robotic platforms to model and study cognitive dysfunctions of the human brain.

Orientador: Eleri Cardozo
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação
Made available in DSpace on 2018-08-26T06:38:13Z (GMT). No. of bitstreams: 1 Olivi_LeonardoRocha_D.pdf: 17712423 bytes, checksum: a9b0ec521405e93735844f7ce8b3b968 (MD5) Previous issue date: 2014
Resumo: A mobilidade é uma competência humana extremamente valiosa, e pode ser perdida por diversas razões, tais como traumas na coluna vertebral, acidentes vasculares cerebrais, dentre outras. Algumas tecnologias desenvolvidas para as áreas médicas, como eletroencefalografia e eletromiografia, podem ser empregadas no desenvolvimento de Interfaces Humano-Máquina (Human-Machine Interface, ou, HMI) com o objetivo de permitir que pessoas com capacidades motoras severamente comprometidas possam comunicar e operar os mais diversos equipamentos. Assim, esses usuários podem conduzir robôs móveis por meio de uma HMI adaptada para suas capacidades motoras e cognitivas. Entretanto, essas interfaces apresentam erros na identificação da ação pretendida pelo usuário, os quais comprometem sobremaneira a experiência desse usuário na interação com o mundo exterior. Para o caso dos robôs móveis assistivos, o conceito de controle compartilhado (shared control) foi concebido para compensar as taxas de erros das HMIs, e a responsabilidade pela navegação do robô é dividida entre o usuário e um sistema supervisor automático. As abordagens mais populares na literatura comutam poucos modos de comportamentos específicos para situações individualizadas, como passagens estreitas e desvio de obstáculos. Esta tese propõe uma nova técnica de controle compartilhado, denominada de navegação assistida por campos vetoriais, a qual não possui modos de operação chaveados, evitando quaisquer instabilidades e abrangendo as configurações do ambiente de maneira ilimitada, além de minimizar significativamente os erros gerados pelas HMIs e facilitar a navegação do usuário. Os campos vetoriais oferecem as navegações manual e autônoma, ampliando a interação do usuário com o ambiente. Nessa nova técnica, o sistema de controle embarcado irá executar a ação identificada pela HMI em função dos estados do robô e do ambiente, com o objetivo de maximizar a segurança e capacidade de controle do usuário. Os resultados mostrados neste trabalho evidenciam uma nova forma de tratar o problema, obtendo ganhos significativos com relação ao estado da arte, com baixa complexidade computacional, alta flexibilidade a ambientes e usuários e otimização efetiva de erros, contribuindo para a recuperação da mobilidade dos usuários
Abstract: Human mobility is an extremely valued skill that can be lost due to various reasons, such as spinal cord injuries, strokes, amputations, among others. Technologies developed for the medical areas, such as electroencephalography and electromyography, can be employed in the development of Human-Machine Interfaces (HMI) with the objective of allowing people with severe mobility impairments to communicate and to operate a wide range of equipments. Therefore, these users are allowed to conduct assistive robots allow through a HMI designed according to the user's mobility and cognitive skills. However, these interfaces still present low performance in the correct identification of the intended action by the user, which severely compromise the experience of the user when interacting with external world. In the specific case of assistive mobile robots, a shared control concept was developed in order to compensate the high error rates produced by the HMIs, where the responsibility for the navigation of the mobile robot is shared among the user and an autonomous supervisor system. The mainly approaches shown in literature switch a few modes of specific behavior for individualized situations, such as narrow corridors and obstacle avoidance. This work presents a novel shared control technique, named assistive navigation by vector fields, which does not employ switching modes, avoiding any instabilities and covering the unlimited environment configurations, significantly minimizing the HMI errors, facilitating the user's navigation. The vector fields offer both manual and autonomous navigation, increasing the user's interaction with the environment. In this novel technique, the embedded control system incorporates the HMI command with the robot and environment states, aiming the maximization of user's security and control capabilities. Results shown a novel manner for treating the problem, obtaining substantial gains over the state of art works, with low computational complexity, high flexibility concerning environments and users and effective optimization of errors, contributing for the user's mobility retrieval
Doutorado
Automação
Doutor em Engenharia Elétrica

Dans ce travail de thèse, nous examinons les principaux facteurs affectant la transparence d'un schéma de téléopération dans le contexte de la robotique médicale.Afin de déterminer ces facteurs, une analyse approfondie de l'état de l'art a été réalisée ce qui a permis de proposer une nouvelle classification de schémas de téléopération avec retour haptique.Le rôle de ces principaux facteurs a été analysé.Ces facteurs sont liés à l'architecture de commande appliquée, aux perturbations provoquées par les mouvements physiologiques des tissus manipulés ainsi qu'à la précision du modèle d'interaction robot-tissue.Les performances du schéma de téléopération à architecture 3-canaux ont été analysées en simulation pour choisir une architecture de commande dédiée aux applications médicales.Ensuite, l'influence des mouvements physiologiques de l'environnement manipulé sur la transparence du système a été analysée et un nouveau modèle d'interaction avec des tissus mous a été proposé.Un schéma de commande de téléopération basé modèle d'interaction a été proposé en se basant sur une analyse de passivité du port d'interaction robot-environnement.Enfin, l'importance de la précision du modèle d'interaction (robot-tissue) sur la transparence du schéma de téléopération avec retour d'effort basé-modèle a été analysée.Cette analyse a été validée en théorie et expérimentalement en implémentant le modèle Hunt-Crossly dans une commande utilisant un AOB pour réaliser une téléopération avec retour haptique.En conclusion de ce travail, les résultats de cette thèse ont été discutés et les perspectives futures ont également été proposées
This thesis investigates the major factors affecting teleoperation transparency in medical context.A wide state of art survey is carried out and a new point of view to classify haptic teleoperation literature is proposed in order to extract the decisive factors providing a transparent teleoperation.Furthermore, the roles of three aspects have been analysed.First, The role of the applied control architecture.To this aim, the performances of 3-channel teleoperation are analysed and guidelines to select a suitable control architecture for medical applications are proposed.The validation of these guidelines is illustrated through simulations.Second, the effects of motion disturbance in the manipulated environment on telepresence are analysed.Consequently, a new model of such moving environment is proposed and the applicability of the proposed model is shown through interaction port passivity investigation.Third analysed factor is the role of the interaction model accuracy on the transparency of interaction control based haptic teleoperation.This analysis is performed theoretically and experimentally by the design and implementation of Hunt-Crossly in AOB interaction control haptic teleoperation.The results are discussed and the future perspectives are proposed

The substantial advances of coronary CTA have resulted in a boost of use of this new technique in the last several years, which brings a big challenge to radiologists by the increasing number of exams and the large amount of data for each patient. The main goal of this study was to develop a computer tool to facilitate coronary CTA analysis by combining knowledge of medicine and image processing.Firstly, a competing fuzzy connectedness tree algorithm was developed to segment the coronary arteries and extract centerlines for each branch. The new algorithm, which is an extension of the “virtual contrast injection” method, preserves the low density soft tissue around the coronary, which reduces the possibility of introducing false positive stenoses during segmentation.Secondly, this algorithm was implemented in open source software in which multiple visualization techniques were integrated into an intuitive user interface to facilitate user interaction and provide good over¬views of the processing results. Considerable efforts were put on optimizing the computa¬tional speed of the algorithm to meet the clinical requirements.Thirdly, an automatic seeding method, that can automatically remove rib cage and recognize the aortic root, was introduced into the interactive segmentation workflow to further minimize the requirement of user interactivity during post-processing. The automatic procedure is carried out right after the images are received, which saves users time after they open the data. Vessel enhance¬ment and quantitative 2D vessel contour analysis are also included in this new version of the software. In our preliminary experience, visually accurate segmentation results of major branches have been achieved in 74 cases (42 cases reported in paper II and 32 cases in paper III) using our software with limited user interaction. On 128 branches of 32 patients, the average overlap between the centerline created in our software and the manually created reference standard was 96.0%. The average distance between them was 0.38 mm, lower than the mean voxel size. The automatic procedure ran for 3-5 min as a single-thread application in the background. Interactive processing took 3 min in average with the latest version of software. In conclusion, the presented software provides fast and automatic coron¬ary artery segmentation and visualization. The accuracy of the centerline tracking was found to be acceptable when compared to manually created centerlines.

New evidence in neuroscience has led to substantial innovations in the provision of rehabilitation therapy, which includes new therapeutic possibilities for patients suffering from central nervous system lesions. The goal of my dissertation is to understand the role of Robot- assisted Gait Training (RAGT) within a multidisciplinary rehabilitation program for patients suffering from outcomes of central nervous system lesions. In this dissertation, I studied participants with traumatic brain Injury (TBI) to determine how cognitive function at admission can interfere in functional improvement after RAGT training in a rehabilitation program and the impact of gender, age and RAGT dose (sessions) on functional improvement in subacute stroke patients. In my first experiment, I studied a cohort of patients with severe traumatic brain injury (n=80 ) to investigate the impact of the cognitive level at admission on recovery after RAGT within a multidisciplinary rehabilitation setting. I found evidence that patients with a low cognitive level at admission were mainly in the subacute phase of rehabilitation. Cognitive impairment did not preclude recovery so that irrespective of the level of cognition, patients might benefit from RAGT during a multidisciplinary program. Also, although other heterogeneous factors (age, rehabilitation phase, severity) may have influenced recovery, the cognitive level at admission influence the rehabilitation length of stay (LOS) and the time needed to receive RAGT during the multidisciplinary rehabilitation programme. In the second set of study in this dissertation, I analyzed a cohort of subacute stroke patients (n= 236) who underwent RAGT in rehabilitation programs to determine the gender-related response. This approach allowed me to highlight that both genders can be subject to the same standards of treatment beyond the differences in anatomical morphology. While I expected to have a difference in recovery, instead, I found a significant positive correlation in clinical outcome. Among subacute stroke patients, equal adherence and benefits were observed following RAGT training in both genders. A conventional rehabilitation treatment empowered by RAGT ensured good results in terms of gait recovery, without any gender differences for all parameters considered. In the third set of this thesis, I studied a subacute stroke population who were undergoing RAGT training during multidisciplinary rehabilitation (n= 236). The principal aim was to investigate the intensity of RAGT (dose) needed to reach the minimal clinical important difference (MCID), measured with the Functional Independence Measure (FIM) and the Functional Ambulatory Category (FAC). Also evaluate the clinical, demographic and functional characteristics that can predict a good functional recovery. I found, with a regression model, that a significant number of patients achieved MCID with more than 14 sessions. Also, the independence of walking on discharge was influenced by the patient's age and the severity of the damage on admission.
Nuove evidenze nel campo delle neuroscienze hanno portato innovazioni sostanziali in neuroriabilitazione che includono nuove possibilità terapeutiche per i pazienti che soffrono di esiti di lesioni del sistema nervoso centrale. L'obiettivo della mia ricerca è stato di comprendere il ruolo della rieducazione robot-assistita del cammino(RAGT) all'interno di un programma di riabilitazione multidisciplinare per pazienti affetti da esiti di lesioni del sistema nervoso centrale. In questa dissertazione, ho studiato partecipanti con lesioni cerebrali traumatiche (TBI) per determinare in che modo la funzione cognitiva al momento del ricovero può interferire nel miglioramento funzionale dopo RAGT in un programma di riabilitazione. Ho valutato inoltre l'impatto del RAGT su sesso, età e come la dose (sessioni) potrebbe contribuire nel miglioramento funzionale per i pazienti in fase subacuta dell'ictus. Nella mia prima serie di analisi, ho studiato una coorte di pazienti con grave trauma cranico (TBI) per indagare l'impatto del RAGT a secondo del livello cognitivo al momento del ricovero sul recupero, all'interno di un contesto riabilitativo multidisciplinare. Ho concluso e che i pazienti con un basso livello cognitivo al momento del ricovero erano per lo più nella fase subacuta della riabilitazione e che il deterioramento cognitivo non precludeva il recupero in modo che, indipendentemente dal livello di cognizione, i pazienti potessero beneficiare di RAGT durante un programma multidisciplinare ed ottenere risultati soddisfacenti. Inoltre, sebbene altri fattori eterogenei (età, fase di riabilitazione) possano avere influenzato il recupero; il livello cognitivo ha influenzato la durata della riabilitazione (LOS) e il tempo necessario per ricevere RAGT durante il programma di riabilitazione multidisciplinare. Nella seconda serie di analisi in questa dissertazione, ho utilizzato il set di dati di una coorte di pazienti con ictus subacuto sottoposti a RAGT nel programma di riabilitazione per determinare la risposta correlata al genere. Questo approccio mi ha permesso di evidenziare che al di là delle differenze di morfologia anatomica, entrambi i sessi possono essere soggetti agli stessi criteri di trattamento. Mentre mi aspettavo di avere differenze nel recupero, invece ho trovato una significativa correlazione positiva nel risultato clinico. Tra i pazienti con ictus subacuto sono stati osservati uguale aderenza e benefici dopo RAGT in entrambi i sessi. Un trattamento riabilitativo convenzionale potenziato da RAGT ha assicurato buoni risultati in termini di recupero dell'andatura, senza differenze di genere per tutti i parametri considerati. Nella terza serie di questo studio, ho utilizzato una popolazione di ictus subacuto che ha ricevuto RAGT durante la riabilitazione multidisciplinare. Lo scopo principale è stato quello di indagare l'intensità di RAGT (dose) necessaria per il raggiungimento della minima differenza clinica importante (MCID), misurata con la Functional Independence Measure (FIM) e la Functional Ambulatory Category (FAC). Inoltre valutare quali sono le caratteristiche cliniche, demografiche e funzionali che possono predire un buon recupero funzionale. Ho scoperto che un numero significativo di pazienti ha raggiunto la MCID con almeno 14 sessioni. Inoltre, l'indipendenza nel cammino alla dimissione è influenzata dall'età del paziente e dalla gravità del danno al momento del ricovero.

In response to the potential benefits of task specific training in rehabilitation of gait after stroke and the need for affordable, simple ways to implement it, our group designed the elliptically based robotic gait trainer (EBRGT). A design review of the EBRGT, covering the design goals, an overview of the mechanical and electrical design, and a discussion of the novelty of the device and why it may be beneficial for individuals with hemiparesis secondary to stroke is discussed (Chapter 2). To characterize the new device, a study was performed to determine if the EBRGT produced a gait pattern that mimicked level surface walking in healthy adults (chapter 3). Sagittal plane kinematic analysis suggested the EBRGT produced joint movement patterns that are similar to level surface walking at the hip and knee with less similarity between activities at the ankle. Electromyography (EMG) revealed that the EBRGT induced a cyclic muscle firing pattern that had some similarities when compared to level surface walking. We also examined the feasibility of ambulatory individuals after stroke to use the EBRGT and if their movement patterns were similar to healthy adults walking on the same device (Chapter 4). All six participants were able to walk on the device with minimal assistance. These participants had joint kinematics and EMG similar to healthy adults, suggesting that individuals with hemiparesis perform a gait like movement when using the EBRGT. Lastly, a study was performed to determine if the EBRGT could improve gait parameters and function in ambulatory individuals with hemiparesis after stroke (chapter 5). Four participants walked on the EBRGT 3x/week for 4 or 8 weeks. After the intervention, all 4 participants increased their preferred gait speed. One participant had an improvement in gait speed that indicated functional gains. The results of this research suggest that the EBRGT can produce a gait pattern that has some similarities to level surface walking and that it is feasible for ambulatory individuals with hemiparesis to use the device. The device may also improve gait parameters in ambulatory individuals after stroke, but future studies with a control group need to be performed.

För att kunna rekonstruera en tredimensionell volym av en hjärna avbildad med hjälp av magnetresonanstomografi (MRI) behöver man korrigera varje snittbild i förhållande till varandra, beroende på oundvikliga rörelser hos den röntgade patienten. Detta förfarande kallas bildregistrering och idag använder man sig primärt av en metod där en bild utses till referensbild och därefter anpassas närliggande bilder, som antas ha en minimal avvikelse, till referensen.

Syftet med detta examensarbete är att använda en annan metod vanligen utnyttjad inom datorseende för att estimera ett rörelsefält utifrån en vanlig videosekvens, genom att följa markörer som indikerar rörelse. Målet är att skapa en robust estimering av huvudets rörelse, som då kan användas för att skapa en mer noggrann korrigering och därmed också en bättre rekonstruktion.

Before reconstructing a three dimensional volume from an MR brain imaging sequence there is a need for aligning each slice, due to unavoidable movement of the patient during the scanning. This procedure is known as image registration and the method used primarily today is based on a selected slice being the reference slice and then registrating the neighbouring slices, which are assumed to be of minimal deviation.

The purpose of this thesis is to use another method commonly used in computer vision - to estimate the motion from a regular videosequence, by tracking markers indicating movement. The aim is to create a robust estimation of the movement of the head, which in turn can be used to create a more accurate alignment and volume.

Stroke is considered the most important cause of morbidity and long term disability in Europe, and is the third leading cause of death. Demographic changes will lead to an increase in both incidence and prevalence suggesting it could actually be considered as a pandemia. The incidence of stroke in Italy is about 200,000 every year, of which 80% are new episodes and 20% recidives. Following the acute phase of stroke, the patient is cured and cared by a multidisciplinary team with the aim of identifying impaired functions, reducing disability affecting activities of daily living and improving patient's participation to social life. Among the major determinants of disability after stroke there is the impairment in walking, the recovery of which can be considered as the main purpose of the neuromotor rehabilitation. To date, the conventional physiotherapy results not compleately satisfactory and is long and expensive. About half of the patients who had a first stroke has a mobility deficits that probably will lead them to be confined on wheelchair after three months of neurorehabilitation. There is therefore the need of improving the effectiveness of rehabilitation and on the other hand to reduce its costs. In the last two decades the neurorehabilitation has benefited of new principles emerging from neuroscience and through functional imaging techniques, that have allowed us to better understand the neuroplasticity of the brain. It has been stressed that intensity and task-specific exercises are essential as well as the earliness of the training. In this sense the robot for rehabilitation are born to help physiotherapists to give an early and intensive training in non-ambulatory sub-acute patients. Robotic assisted gait rehabilitation in addition to the conventional techniques has been shown to increase the chances of a return to autonomous ambulation but with wide outcomes ranging from patient to patient. Since the type of treatment is demanding and expensive it is essential to identify the type of patient who can benefit more from robotic therapy in order to optimize the economic resources available by the welfare. To date, there are no studies in the literature about the determinants recovery of ambulation with robotic therapy for ambulation. The purpose of this thesis is to identify the determinants of return to an autonomous walking in patients with stroke sequelae treated with robotic therapy. The first chapter describes the characteristics and consequences of stroke. The second chapter analyzes the gait in healthy individuals and in that suffering a stroke while in the third chapter reviews new rehabilitation methods with a particular focus on those technological and robotic. The third chapter highlights the principles of neuroscience that underlie the new technological and robot based machine for physiotherapy with indications for the future. In particular it should be noted that it is necessary the involvement of the upper brain structures, in accordance to a top-down approach, for better targeting and facilitating the recovery processes dependent on neuroplasticity. It also clarifies the concept of robotic therapy as a tool in the hands of the therapist and not as rehabilitative per se. The fourth chapter describes the research protocol for the identification of the determinants of recovery after gait robotic therapy with the discussion, contextualization of the results based on the available scientific evidence and conclusions. The study was conducted as a randomized controlled, single-blind trial evaluating 100 patients with subacute stroke and not ambulant. The study was carried out following the CONSORT guidelines on the conduct of trials of non-pharmacological effectiveness. The treatment group has carried out 20 sessions of therapies, 5 times a week for 4 weeks of therapy robotics in addition to standard therapy while the control group has carried out 20 therapy of walking training sessions with conventional techniques in addition to standard therapy. The amount of therapy was the same in the two groups. The results showed that patients undergoing therapy robotics had 6.5 times more chances to return to an unaided walking. The key factors that influenced the recovery are: Barthel Index score at admission (OR = 8,428, p = 0.001); the type of therapy as above stated (OR = 6.541, p = 0.001); the time between onset of therapy and acute event (OR = 3.768, p = 0.018), and trunk control at admission (OR = 3.018, p = 0.040). The same regression was then performed on the single group of patients who received robotic therapy. The only factor that remains predictor in this case is the control of the trunk (TCT-score at the entrance) with a probability of recovery almost 7 times higher in those who are able to control the trunk (OR = 6.9, CI 95% = 1.783 -26,706, p = 0.005). Factors not statistically significant on the entire sample remained not significant in the group of robotic therapy (age: p = 0.676, affected side: p = 0.426, type of stroke: p = 0.620, sex: p = 0.466). In conclusion, the robotic therapy is effective in patients with stroke in the subacute phase even in the most severe patients, provided a trunk control has been preserved for robotic group. The identification of the factors of effectiveness of robotic therapy is in line with personalized medicine, which from some years stands alongside the principle of evidence-based medicine.
L' ictus e' la piu' importante causa di morbilita' e disabilita' a lungo termine e la terza causa di morte in Europa. In futuro i cambiamenti demografici porteranno ad un aumento dell'incidenza e della prevalenza tanto da far pensare ad una vera e propria pandemia. I casi di ictus in Italia sono circa 200.000 ogni anno, di cui l'80% sono nuovi episodi e il 20% recidive. A seguito della fase acuta il paziente viene preso in carico da un team multidisciplinare con il fine di individuare le funzioni compromesse e le relative cure da adottare per ridurne la disabilita e migliorare la partecipazione del paziente alle attivita' di vita quotidiane. Tra i maggiori determinanti della disabilita' post ictus vi e' il recupero della deambulazione autonoma che rappresenta, infatti, lo scopo principale della riabilitazione neuromotoria. Ad oggi la fisioterapia convenzionale porta a risultati soddisfacenti ma e' lunga e costosa. Circa la meta' dei pazienti che ha avuto un primo ictus ha una mobilita' possibile con la carrozzina dopo tre mesi di neuroriabilitazione. Vi e' pertanto la necessita' da un lato di migliorare l'efficacia della riabilitazione motoria e dall'altro di ridurne i costi. Nell'ultimo ventennio la neuroriabilitazione ha beneficiato di nuovi principi emersi da studi di neuroscienze, con tecniche di imaging funzionale, che hanno permesso di comprendere meglio la neuroplasticita' dell'encefalo a seguito di una lesione cerebrale. E' stato cosi sottolineato come l'intensitaa', la precocita' e la compito-specificita' dell'esercizio siano fondamentale per incrementare ed indirizzare positivamente il recupero dipendente dalla neuroplasticita' . In questo senso i Robot per la riabilitazione nascono per aiutare i fisioterapisti a somministrare un training precoce ed intensivo in pazienti subacuti non deambulanti autonomamente. La rieducazione della deambulazione assistita da Robot in aggiunta alle tecniche convenzionali ha dimostrato di aumentare le possibilita' di un ritorno alla deambulazione autonoma ma con risultati variabili da paziente a paziente. Dal momento che la tipologia di trattamento e' impegnativa e costosa e' indispensabile identificare la tipologia di paziente che ne possa beneficiare per ottimizzare le risorse economiche messe a disposizione dal walfare. Ad oggi non vi sono in letteratura studi sui fattori determinanti il recupero della deambulazione con terapia robotica per la deambulazione. Scopo della presente tesi e' quello di identificare i fattori determinanti il ritorno ad una deambulazione autonoma in pazienti con postumi di subacuto e trattati con terapia robotica. Nel primo capitolo vengono descritte le caratteristiche dell'ictus e le conseguenze. Il secondo capitolo analizza la deambulazione nel soggetto sano ed in quello affetto da ictus mentre nel terzo capitolo vengono revisionate le nuove metodiche riabilitative con un particolare focus su quelle tecnologiche e robotiche. Vengono messi in luce i principi di neuroscienze che ne sono alla base ed analizzati criticamente con indicazioni per il futuro. In particolare si evidenzia come sia necessario un coinvolgimento delle strutture superiori encefaliche seguendo un approccio di tipo top-down per meglio indirizzare e facilitare i processi di recupero neuroplasticita' dipendenti. Si chiarisce inoltre il concetto di terapia robotica come strumento nelle mani del terapista e non come riabilitativa di per se. Nel quarto capitolo si descrive il protocollo di ricerca per l'identificazione dei fattori determinanti il recupero della deambulazione dopo terapia robotica con la discussione, la contestualizzazione dei risultati in base alle conoscenze scientifiche disponibili e le conclusioni. Nello studio di tipo randomizzato e controllato, in singolo cieco sono stati arruolati 100 pazienti con ictus subacuto non deambulanti. Lo studio e' stato condotto seguendo le linee guida CONSORT sulla conduzione dei trial di efficacia non farmacologici. Il gruppo di trattamento ha eseguito 20 sedute di terapie 5 volte a settimane per 4 settimane di terapia robotica in aggiunta alla terapia standard mentre il gruppo di controllo ha effettuato 20 sedute di terapia della deambulazione con tecniche convenzionali in aggiunta alla terapia standard. La quantita' di minuti di terapia era la stessa nei due gruppi. I risultati hanno evidenziato come i pazienti sottoposti alla terapia robotica avevano 6,5 volte in piu' la possibilita' di ritornare ad una deambulazione autonoma. I fattori che influenzavano il recupero sono: il BI in ingresso (OR=8.428, p=0.001); il tipo di terapia, con il gruppo robotico che ha mostrato una probabilita' di recupero sei volte maggiore rispetto all'altro gruppo (OR=6.541, p=0.001); il tempo intercorso tra l'evento acuto, l'inizio della riabilitazione (OR=3.768, p=0.018) e il controllo del tronco (OR=3.018, p=0.040). La stessa regressione e' stata poi effettuata sul singolo gruppo di pazienti che hanno effettuato terapia robotica. L'unico fattore che rimane predittivo in questo caso e' il controllo del tronco (TCT-score all'ingresso) con una probabilita' di recupero quasi 7 volte maggiore in chi e' in grado di controllare il tronco (OR=6.9, CI95%=1.783-26.706, p=0.005). I fattori non significativi sull'intero campione restano non significativi nel solo gruppo di terapia robotica (eta' : p=0.676, lato affetto: p=0.426, tipo di ictus: p=0.620, sesso: p=0.466). Quindi fattori di vulnerabilita' per la terapia convenzionale come eta' , sesso, lato affetto e tipo di ictus non lo sono per la terapia robotica. In conclusione la terapia robotica e' efficace nei pazienti con ictus in fase subacuta anche in pazienti piu' severi. Il controllo del tronco si e' dimostrato predittivo di recupero della deambulazione autonoma. L'identificazione dei fattori di efficacia della terapia robotica e' in linea con la medicina personalizzata, che da qualche anno affianca il principio della medicina basata sulle evidenze.

An orthopaedic saw design and commissioning to be driven by a robot was envisaged based on the requirement to develop a system that would allow a physician to automate some surgical procedures that involve limb manipulation. The project goal is to design and build a proof-of-concept prototype employing both mechatronics and Integrated Product Design techniques and tools, following the specific demands required to build a medical device such as its weight, movement's and patient's anatomic constraints. This saw have intelligent features regarding its control strategy relying on its sensing capabilities such as force feedback and blade temperature sensing. The role of temperature is particularly important because the bone overheating causes cells necrosis. The cut's force penetration sensing provides readings to estimate the saw position during surgery in course. The saw's robot handling ensures the flatness and accuracy of the cut, providing the correct requirements for the osteotomy treatment. The accomplishment of these surgical requirements would ensure a higher rate of successful procedures, besides, it would promote shorten the patients' recovery time. The designing and building of prototype themselves are the original contributions. Furthermore, the spin-offs from this work such as the system's model and the study of its control are important highlights.

Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. The aim of this doctoral research was to explore this under-researched area in three phases. Phase one: - Phase one focused on critically appraising and synthesising the available evidence on healthcare professionals’ perceptions, attitudes, and views of the facilitators and barriers to implementing electronic prescribing, electronic dispensing, and/or electronic administration of medicines in the hospital setting. The review protocol was registered with the Centre for Reviews and Dissemination and conducted according to best practice. Key facilitators included systems improved patient safety and provided better access to patients’ drug records and that team leadership and hardware/software availability and reliability were essential for successful implementation. Key barriers consisted of hardware and network problems, altered work practices, and weakened interpersonal communication between healthcare professionals and with patients. Phase two: - This phase employed a qualitative phenomenological design to gain original insight into the perceptions of local key stakeholders towards the facilitators and barriers to implementing prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospitals in Ireland using Normalization Process Theory as a theoretical framework. Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants: nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two hospital Information Technology managers. Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multidisciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. Phase three: - A similar qualitative methodology was employed in phase three of this research in order to explore the perceptions of national key stakeholders and eHealth leads towards the facilitators and barriers to system implementation. Sixteen consenting invitees participated: eight hospital leads, four government leads, two regulatory leads, and two academics. Key facilitators included enhanced patient safety, workflow efficiencies, improvements in governance, and financial gains. Perceived barriers included the introduction of new drug errors, loss of patient contact, initial time inefficiencies, and issues with the complexity of integration and standardisation of work processes. Overall, adequate technology, stakeholder involvement, and organisational leadership and support are required at a national and local level to drive the eHealth agenda forward. Testing at scale, contingency plans, and ongoing evaluations will assist in determining success or otherwise of system implementation. This research has generated novel findings with many potentially transferable themes identified which extend the evidence base. This will assist organisations to better plan for implementation of medication-related eHealth systems.

Background:la stretta relazione anatomica tra il mesoretto e le strutture nervose che attraversano la pelvi comporta un rischio elevato di lesioni accidentali del plesso ipogastrico in corso di TME, di conseguenza vi è un¿altra frequenza di disfunzioni genito urinarie dopo chirurgia rettale. La chirurgia robotica offre al chirurgo una visione tridimensionale, stabile e ad alta definizione del campo operatorio e consente un controllo molto più accurato degli strumenti che sono dotati di sette gradi di libertà, di un sistema di soppressione del tremore spontaneo e della possibilità di demoltiplicazione del movimento. La finalità del nostro studio è stata quella di valutare l¿impatto della chirurgia robotica sulla preservazione della funzionalità genito urinaria nei pazienti sottoposti a resezione anteriore del retto. Materiali e metodi: nel periodo compreso tra Gennaio 2007 e Dicembre 2010 nella Divisione di Chirurgia Addomino-Pelvica dell¿Istituto Europeo di Oncologia sono stati inseriti nello studio 74 pazienti consecutivi sottoposti a resezione completamente robotizzata per tumore del retto. Per analizzare la funzionalità sessuale maschile sono stati adottati i questionari IIEF (International Index of Erectile Function), per quella femminile i questionari dell¿ FSFI (Female Sexual Function Index) Risultati: nel nostro studio non abbiamo riscontrato alcuna differenza, per entrambi I sessi, in termini di funzionalità urinaria e di QoL a un anno dall¿intervento. Per quanto riguarda la funzionalità sessuale abbiamo registrato una riduzione di tutte le variabili analizzate dai questionari a un mese dall¿intervento. A partire da sei mesi dopo la chirurgia i punteggi calcolati per ogni item sono progressivamente aumentati fino a tornare paragonabili a quelli pre-operatori. Conclusioni: questo studio conferma che la TME nerve sparing eseguita con tecnica robotica è efficace e adeguata per il trattamento del cancro rettale e consente una migliore preservazione della funzionalità genitourinaria in comparazione con le tecniche chirurgiche classiche: open e laparoscopica.

Magíster en Ciencias de la Ingeniería, Mención Mecánica
En la actualidad la investigación de la robótica blanda ha ido en aumento en los países del primer mundo es por ello que ciencias como la biomédica, hacen necesaria esta tecnología para ocuparla en dar soluciones certeras a muchas personas con diversos problemas de salud. La línea de investigación de la robótica blanda particularmente en la medicina posee mucha trascendencia, ya que está inspirado en asemejarse a la fisionomía de los seres vivos, y realizar actividades donde la robótica rígida no puede hacerlo. El presente trabajo experimental está enmarcado dentro de esta línea de investigación, por ser concebido de un polímero para su fabricación, La creación de los sensores blandos de forma de espiral podrán medir presión en tres escalas distintas, lo cual permite detectar el rango de presión y resolución espacial donde se ejerce un estímulo de presión. La presente investigación realizada en nuestro Laboratorio de Robótica del Departamento de Ingeniería Mecánica correspondiente al diseño, fabricación y caracterización de sensores blandos multiescala con forma de espiral se ejecutó en dos fases las cuales fueron. El diseño, construcción y fabricación de un montaje experimental y el Estudio minucioso del sensor blando multiescala. El diseño, construcción y fabricación de un montaje experimental consistió en la fabricación de los sensores, creación de los diferentes dispositivos electrónicos, implementación del instrumento de medición, para que de manera sincronizada se pueda realizar los estudios al sensor. El Estudio minucioso del sensor blando multiescala consta en usar todas las herramientas computacionales, como Repetier para darle funcionamiento al instrumento de medición por medios de los comandos GCODE, el Arduino para la obtención de Datos y Matlab que se utilizó para caracterizar, analizar los datos y entrenamiento de una red neuronal. El presente experimento necesita una buena sincronización en tiempo real entre sus dos fases para la realización de la rutina para la obtención de datos, lo cual es un factor determinante para realizar un buen entrenamiento de la red neuronal que se aplica en este experimento.

Connaître la position 3D d’instruments robotisés peut être très utile dans le contexte chirurgical. Nous proposons deux méthodes automatiques pour déduire la pose 3D d’un instrument avec une unique section pliable et équipé avec des marqueurs colorés, en utilisant uniquement les images fournies par la caméra monoculaire incorporée dans l'endoscope. Une méthode basée sur les graphes permet segmenter les marqueurs et leurs coins apparents sont extraits en détectant la transition de couleur le long des courbes de Bézier qui modélisent les points du bord. Ces primitives sont utilisées pour estimer la pose 3D de l'instrument en utilisant un modèle adaptatif qui prend en compte les jeux mécaniques du système. Pour éviter les limites de cette approche dérivants des incertitudes sur le modèle géométrique, la fonction image-position-3D peut être appris selon un ensemble d’entrainement. Deux techniques ont été étudiées et améliorées : réseau des fonctions à base radiale avec noyaux gaussiens et une régression localement pondérée. Les méthodes proposées sont validées sur une cellule expérimentale robotique et sur des séquences in-vivo
Knowing the 3D position of robotized instruments can be useful in surgical context for e.g. their automatic control or gesture guidance. We propose two methods to infer the 3D pose of a single bending section instrument equipped with colored markers using only the images provided by the monocular camera embedded in the endoscope. A graph-based method is used to segment the markers. Their corners are extracted by detecting color transitions along Bézier curves fitted on edge points. These features are used to estimate the 3D pose of the instrument using an adaptive model that takes into account the mechanical plays of the system. Since this method can be affected by model uncertainties, the image-to-3d function can be learned according to a training set. We opted for two techniques that have been improved : Radial Basis Function Network with Gaussian kernel and Locally Weighted Projection. The proposed methods are validated on a robotic experimental cell and in in-vivo sequences

Termovizní zobrazování i 3D skenování jsou v současné době rychle se rozvíjející technologie. Obě technologie mají mnoho výhod, které by mohly být užitečné v medicíně. Jejich datová fúze přináší ještě více nových diagnostických informací, než kdyby byly použity samostatně. Cílem této práce je vývoj multispektrálního 3D skenovacího systému založeného na novém způsobu snímání pomocí robotického manipulátoru vybaveného laserovým snímačem, teplotní kamerou a barevnou kamerou. Navržené řešení přináší jak flexibilitu, tak přesnost. Tento systém skenování je dále využit v klinických aplikacích, aby byly ověřeny jeho schopnosti a ukázány přínosy nad rámec současného stavu techniky.

Sepsis is a life-threatening syndrome that occurs due to dysregulated body response to pathogenic infections. More than 30 million cases are recorded annually worldwide, with a high mortality rate of up to 40% of the recorded cases. Early diagnosis of sepsis will help clinicians to start proper therapy as early as possible and save lives. Circulating miRNAs in biofluids were found previously as potential biomarkers that can be used in a multi-marker panel to develop a rapid, friendly user diagnostic kit for the early sepsis diagnosis. This study assessed miRNAs from healthy donors’ human plasma by two extraction methods, manually and robotically via QIAcube. In addition to optimizing two-tailed RT-qPCR (TATAA Biocenter) technology for miRNAs detection and quantification. The extraction of miRNAs was using miRNeasy® Serum/Plasma Advanced kit (Qiagen) for the two methods. Plasma was spiked in with synthetic miRNA-210 to ensure miRNA detection and was used as a positive control for the study. The concentration and the purity of the RNA eluates were measured and statistically analyzed to identify which method could be better in conventional laboratory practice. QIAcube results showed its ability to compete with manual RNA extraction protocols. However, more studies are required for RNA extractions with different kits using QIAcube. The two-tailed RT-qPCR technology successfully detected many miRNAs, but more samples are required to be tested for accurate conclusions. The results emphasize the ability of two-tailed RT-qPCR to detect and quantify miRNAs from human plasma as potential biomarkers in a multi-marker panel for early sepsis diagnosis.

Dagens samhälle utvecklas i snabb takt och i samband med digitaliseringen uppstår nya tekniker som kan effektivisera, förbättra och förenkla arbetet inom verksamheter. En av dessa tekniker är Robotic Process Automation (RPA) som handlar om att automatisera enkla och monotona verksamhetsprocesser med tydliga regler. Implementeringen av RPA kan innebära både möjligheter och utmaningar som kan komma bli avgörande för tillvägagångssätt inom verksamheter. I nuläget existerar begränsad information kring hur RPA kan implementeras effektivt inom specifika verksamheter. Hälso- och sjukvården består i dagsläget av många processer som lämpar sig för automatisering, vilket kan frigöra tid för vårdpersonalen till mer kvalitativ vård. Samtidigt finns det utmaningar med att tillämpa ny teknik inom sjukvården, vilket inkluderar juridik, organisatoriskt motstånd och tekniska hinder. I syfte att undersöka fenomenet där RPA tillämpas inom sjukvården kommer följande studie undersöka frågeställningen: Vilka möjligheter och utmaningar förekommer vid implementering av RPA inom hälso- och sjukvården? I syfte att besvara studiens frågeställning har en kvalitativ ansats använts. Med hjälp av semistrukturerade intervjuer samlades empiriskt datamaterial in och kompletterades även med övrig dokumentation från sjukhuset. Det analyserade resultatet medförde övergripande teman som präglade diskussionens utformning. Följande studie visar möjligheter och utmaningar som förekommer före, under och efter implementeringen av RPA inom ett svenskt sjukhus. Studiens slutsats visualiserar identifierade möjligheter och utmaningar, vilket bland annat belyser användarinvolvering, ökad digital nyfikenhet och prioritering av interna resurser. I och med den begränsade forskningen som existerar inom området förvä
Today's society is developing at a rapid pace and in relation with digitalisation, new technologies are emerging that can streamline, improve and simplify the work within organizations. One of these technologies is Robotic Process Automation (RPA), which is about automating simple and monotonous business processes with clear rules. The implementation of RPA can present both opportunities and challenges that may be crucial for business operations. Currently, limited research exists on how RPA can be implemented effectively within specific organizations. The healthcare sector currently consists of many processes suitable for automation, which can free up time for healthcare professionals to provide more quality care with patients. At the same time, there are challenges in applying new technologies in healthcare, which include law, organizational resistance and technical barriers. In order to investigate the phenomenon where RPA is applied within healthcare, the following study will investigate the issue: What opportunities and challenges exist when implementing RPA in healthcare? In order to answer the research question, a qualitative approach has been used. With the help of semi-structured interviews, empirical data material was collected and also supplemented with other documentation from the hospital. The analyzed result led to overall themes that characterized the design of the discussion. The following study shows opportunities and challenges that occur before, during and after the implementation of RPA within a Swedish hospital. The study's conclusion visualizes identified opportunities and challenges, highlighting, among other things, user involvement, increased digital curiosity and prioritization of internal resources. With the limited research that exists in the field, the study is expected to contribute to new information for future implementations within the same context.

There are many clinical situations where magnetic resonance imaging (MRI) is preferable over other imaging modalities, while the major disadvantage is the relatively long scan time. Due to limited resources, this means that not all patients can be offered an MRI scan, even though it could provide crucial information. It can even be deemed unsafe for a critically ill patient to undergo the examination. In MRI, there is a trade-off between resolution, signal-to-noise ratio (SNR) and the time spent gathering data. When time is of utmost importance, we seek other methods to increase the resolution while preserving SNR and imaging time. In this work, I have studied one of the most promising methods for this task. Namely, constructing super-resolution algorithms to learn the mapping from a low resolution image to a high resolution image using convolutional neural networks. More specifically, I constructed networks capable of transferring high frequency (HF) content, responsible for details in an image, from one kind of image to another. In this context, contrast or weight is used to describe what kind of image we look at. This work only explores the possibility of transferring HF content from T1-weighted images, which can be obtained quite quickly, to T2-weighted images, which would take much longer for similar quality. By doing so, the hope is to contribute to increased efficacy of MRI, and reduce the problems associated with the long scan times. At first, a relatively simple network was implemented to show that transferring HF content between contrasts is possible, as a proof of concept. Next, a much more complex network was proposed, to successfully increase the resolution of MR images better than the commonly used bicubic interpolation method. This is a conclusion drawn from a test where 12 participants were asked to rate the two methods (p=0.0016) Both visual comparisons and quality measures, such as PSNR and SSIM, indicate that the proposed network outperforms a similar network that only utilizes images of one contrast. This suggests that HF content was successfully transferred between images of different contrasts, which improves the reconstruction process. Thus, it could be argued that the proposed multi-contrast model could decrease scan time even further than what its single-contrast counterpart would. Hence, this way of performing multi-contrast super-resolution has the potential to increase the efficacy of MRI.

In the time-lapse of hundreds of millions of years, living organisms have continuously evolved, developing a myriad of astonishing forms and abilities to be often inspirational for mankind. In 1997, Janine Benyus, paved the onset of a revolutionary discipline called biomimicry. Biomimicry can be elegantly defined as “innovation inspired by nature”. From a practical point of view, it is an approach to innovation that aims to solve human challenges by emulating nature’s time-tested strategies. A range of technological improvements have been inspired by terrestrial life and examples of biomimicry now include synthetic materials with new mechanical properties that emulate the brick-and-mortar architecture found in bone and mollusc shells; nanoparticles and cell-based therapies with strong potential for the advancement novel and more effective therapeutic and imaging systems; high-speed trains with a nose emulation the kingfisher bird’s beak, as a way of eliminating the buildup of atmospheric pressure when passing through tunnels; and renewable energy production by using bio-engineered bacteria capable of synthesising almost one thousand litres of hydrogen gas per hectare. We are at the threshold of a new era for science and engineering in which biologically inspired designs offer novel and sustainable solutions to society’s problems that may not be provided as quickly or economically by traditional paths. To address this demand, there is a continual quest to seek new materials and fabrication techniques with unprecedented integration of properties and functionalities at minimal production costs. My PhD research work focused on the development of materials, manufacturing processes and devices that aim at solving current bottlenecks in the fields of soft robotics, tissue engineering and environmental control of harmful insects.

ANTECEDENTS: Per a l’adequat diagnòstic i/o tractament dels pacients amb epilèpsia refractària o trastorns del moviment es requereix la implantació d’elèctrodes cerebrals en alguns casos seleccionats. HIPÒTESIS: El robot estereotàxic Neuromate® és una eina precisa per a la col·locació d’elèctrodes cerebrals en pacients pediàtrics. El seu ús en estereoelectroencefalografía (SEEG) i estimulació cerebral profunda (ECP) és segur i d’utilitat clínica en aquests pacients. OBJECTIUS: Verificar la precisió, seguretat i els resultats clínics obtinguts de la seva aplicació en SEEG i ECP en pacients pediàtrics. METODOLOGIA: Estudi prospectiu observacional recollint els pacients intervinguts d’aquestes dues tècniques durant els primers mesos d’ús del robot al nostre hospital. S’ha avaluat la precisió calculant les distàncies entre la trajectòria final i la trajectòria planificada a nivell del punt d’entrada i la diana per als dos grups de pacients. S’ha emprat el software Voxim® per a co-registrar el pla preoperatori amb la trajectòria final obtinguda per TC. Les distàncies s’han calculat amb les eines de mesura proporcionades per aquest mateix software. S’ha recollit també les complicacions de la cirurgia. La utilitat clínica en els pacients amb epilèpsia s’ha avaluat analitzant si la SEEG ha complementat la informació obtinguda amb els mètodes diagnòstics no invasius, permetent conjuntament delimitar l’àrea epileptògena i, secundàriament, si s’ha pogut realitzar una termocoagulació o cirurgia, i el seu pronòstic d’epilèpsia avaluat amb la classificació d’Engel i ILAE als 3 i 6 mesos de la ressecció, en cas d’ésser possible. La utilitat clínica en el grup de ECP s’ha objectivat mitjançant les escales de Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) en pacients amb signes distònics i Unified Myoclonus Rating Scale (UMRS) en pacients amb mioclònies, preopeatòriament, al mes i als 6 mesos de la cirurgia. S’ha avaluat també la qualitat de vida mitjançant la escala Neuro-QOL preoperatòriament i als 6 mesos de la intervenció. RESULTATS: 14 pacients amb edats entre 5 i 18 anys amb epilèpsia refractària al tractament mèdic han estat intervinguts dins el període d’estudi i se’ls ha implantat 164 elèctrodes de SEEG en total. L’error promig al punt d’entrada ha estat de 1.57 mm i de 1.77 mm a nivell de la diana. Un pacient va patir una meningitis i un altre un hematoma, que no han deixat seqüeles. La tècnica ha estat útil per a la presa de decisions en tots els casos. S’ha intervingut quirúrgicament 12 pacients i s’ha assolit un bon pronòstic d’epilèpsia en 9. 6 pacients d’entre 7 i 16 anys diagnosticats de distonia aïllada (DYT1 negativa) en 3 casos, coreodistonia deguda a mutació en el gen PDE2A en 1, i distonia mioclònica (SGCE positiva) en 2 han estat intervinguts d’estimulació cerebral profunda. La precisió dels elèctrodes ha estat de 1.24 mm a nivell de la diana. Aquests pacients van presentar una millora motora del 65% i funcional del 48% segons la BFMDRS. Els pacients amb mioclònies han presentat una millora del 95-100% en les mateixes i del 50-75% en la avaluació funcional de la UMRS als 6 mesos. La Neuro-QOL també ha revelat una millora en la funció motora i les relacions socials, però un empitjorament a nivell d’angoixa, funció cognitiva i dolor. La única complicació ha estat la medialització d’un elèctrode que limita la intensitat de la estimulació als contactes més inferiors. CONCLUSIONS: El robot estereotàxic Neuromate® és una eina precisa per a la implantació dels elèctrodes cerebrals en estereoelectroencefalografia (SEEG) i estimulació cerebral profunda (ECP) en pacients pediàtrics. Aquestes tècniques, tot i que invasives, són segures i de gran rendibilitat clínica en pacients seleccionats.
BACKGROUND: For the proper diagnosis and/or treatment of patients with refractory epilepsy or movement disorders, implantation of cerebral electrodes is required in some cases. HYPOTHESIS: The Neuromate® robot is an accurate tool for the placement of brain electrodes in pediatric patients. Its use in stereoelectroencephaly (SEEG) and deep brain stimulation (DBS) is safe and of clinical usefulness. OBJECTIVES: To verify the accuracy, safety and usefulness obtained from its application in SEEG and DBS in pediatric patients. METHODOLOGY: Observational prospective study collecting the patients undergoing these two techniques with the robot in our hospital. Accuracy has been evaluated at the entry and target point with the Voxim® software. Usefulness in SEEG has been evaluated and, secondly, outcome of resective surgery (if performed) with Engel and ILAE classifications at 3 and 6 months. Usefulness in DBS has been measured by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Unified Myoclonus Rating Scale (UMRS) in patients with myoclonus and Neuro-QOL preoperatively, at 1 and 6 months. RESULTS: 14 patients with ages between 5 and 18 years old with refractory epilepsy have been operated (164 SEEG electrodes). The average error at the entry point was 1.57 mm and 1.77 mm at the target point. One patient has suffered from meningitis and another a hematoma. The technique has been useful for decision-making in all cases. Resective surgery has been performed in 12 patients and a good epilepsy outcome has been achieved in 9. 6 patients between 7 and 16 years of age with dystonia have been operated on deep brain stimulation. Accuracy of the electrodes has been 1.24 mm at the target level. A motor improvement of 65% and functional of 48% according to the BFMDRS have been achieved. Patients with myoclonus have improved 95-100% in myoclonus and 50-75% in the functional evaluation of the UMRS at 6 months. Neuro-QOL has revealed an improvement in motor function and social relationships. The only complication has been the deviation of an electrode. CONCLUSIONS: The Neuromate® robot is an accurate tool for the implantation of stereoelectroencephalography (SEEG) and deep brain stimulation (DBS) electrodes in pediatric patients. These techniques are safe and of great clinical profitability in selected patients.

La telechirurgia è una tecnica operatoria che permette al medico di eseguire interventi chirurgici su pazienti fisicamente distanti. Il chirurgo esegue l’intervento mediante un sistema robotico con abilità chirurgiche eccezionali, combinato con tecnologie di comunicazione che consentono lo scambio di dati tra le postazioni e l’ausilio di un monitor per il controllo continuo del campo operatorio. In questo lavoro sono analizzati due interventi chirurgici a distanza, con particolare attenzione alle principali strumentazioni e reti telematiche utilizzate. Il primo intervento chirurgico a distanza è stato effettuato nel 2001, con paziente e chirurgo distanti 6000km. È stata utilizzata una rete ad alta velocità dedicata ATM per la trasmissione dei dati ed il sistema robotico ZEUS. L’intervento, ritenuto rischioso, non è più stato ripetuto. Nel 2019 a Milano è stato effettuato il primo intervento chirurgico a distanza tramite connessione 5G per la trasmissione dei dati, con paziente e chirurgo distanti 15km. Le principali strumentazioni utilizzate sono: sistema CALM, laser CO2 medicale, robot Panda ed esoscopio stereo 3D VITOM lato paziente; Wacom tablet, dispositivo tattile Omega.7 e display 3D HMZ-T3 lato chirurgo. Dall’analisi risulta che per il funzionamento delle tecnologie utilizzate in telechirurgia è necessaria una connettività avanzata come quella fornita dal 5G, che garantisce tempi di risposta immediati, maggiore velocità e capacità per il trasferimento dei dati ed estrema affidabilità. Tuttavia, prima che la chirurgia tele-robotica diventi comune è necessario attuare precauzioni, controlli e standard rigorosi. Per il futuro si auspica che la possibilità di eseguire manipolazioni complesse da postazioni remote consentirà al chirurgo esperto di insegnare o sorvegliare l'esecuzione di tecniche avanzate o nuove mediante intervento in tempo reale. Si elimineranno i vincoli geografici e questo permetterà di ottenere elevate competenze chirurgiche in tutto il Mondo.

Having a device with the capability of measure motions from gait produced by a human being, could be of most importance in medicine and sports. Physicians or researchers could measure and analyse key features of a person's gait for the purpose of rehabilitation or science, regarding neurological disabilities. Also in sports, professionals and hobbyists could use such a device for improving their technique or prevent injuries when performing. In this master thesis, I present the research of what technology is capable of today, regarding gait analysis devices. The research that was done has then help the development of a suggested standalone hardware sensor node for a Body Area Network, that can support research in gait analysis. Furthermore, several algorithms like for instance UWB Real-Time Location and Dead Reckoning IMU/AHRS algorithms, have been implemented and tested for the purpose of measuring motions and be able to run on the sensor node device. The work in this thesis shows that a IMU sensor have great potentials for generating high rate motion data while performing on a small mobile device. The UWB technology on the other hand, indicates a disappointment in performance regarding the intended application but can still be useful for wireless communication between sensor nodes. The report also points out the importance of using a high performance micro controller for achieving high accuracy in measurements.

Thesis (Ph.D.)--University of Nebraska-Lincoln, 2009.
Title from title screen (site viewed July 8, 2010). PDF text: xii, 156 p. : ill. (chiefly col.) ; 6 Mb. UMI publication number: AAT 3366042. Includes bibliographical references. Also available in microfilm and microfiche formats.

Physical therapy is a field with ever increasing demands as the population ages, resulting in a larger number of individuals living with impairments. Therapy is both physically intensive and time intensive for physical therapists, and can require more than one therapist per patient. The use of technology can reduce both these physical and time demands if appropriately applied, while improving repeatability and providing quantitative evaluation of performance. Through these abilities, it may also improve the quality of life for patients. The work presented here explores how the mechanical and controller design of exoskeletons can be used to improve adaptations to new gait patterns in healthy individuals. Armed with this knowledge, new treatment methods can be adapted, applied, and validated for impaired populations with the intention of recovering a more natural gait pattern. First, the ALEX II device is presented. It is a unilateral device, designed to aid in gait training for stroke survivors. The previous version, ALEX I, had several limitations in terms of pelvic freedom, leg range of motion, and the support of the gravitational load. ALEX II was designed to address these issues. Next, a study is presented, using healthy young adults (N=30), in which ALEX II was used to explore how the amount of freedom allowed at the pelvis during gait training affects the level of adaptation subjects are able to achieve. This was evaluated for five separate configurations which resemble existing exoskeletons. It was found that intermediate levels of pelvic freedom degrade the amount of adaptation and that pelvic translation contributes more to this effect than hip abduction/adduction. The next work concerns the design of ALEX III, a bilateral device with twelve active degrees-of-freedom. ALEX III was created to increase the ability to explore the functionality required for gait training, which is why it is capable of controlling 4 degrees-of-freedom at each leg, and 4 degrees-of-freedom at the pelvis. This is followed by the the design of a new type of haptic feedback which utilizes a variable, viscous damping field, which increases the damping coeffiecent as the subject moves away from a specified path. This feedback type was tested in a set of experiments in healthy young adults. The first study (N=32) compared four different settings for the new feedback, finding that while all groups demonstrated adaptations in gait, the lowest rate of change of the damping field exhibited less adaptation. The final study (N=36) compared this haptic feedback to two previously used haptic feedback types. The previously used feedback strategies used a force that pushed the leg either towards or away from the desired path. All three of these strategies were found to produce similar levels of adaptation, however the damping field used much less external force. These findings may change the way exoskeletons for gait training are designed and increase their accessibility. While all the findings need to be validated in impaired populations they can still inform the design of future exoskeletons. The first finding, that providing an intermediate amount of freedom to the pelvis can interfere with gait training, suggests that future devices should have very high amounts of freedom or very restricted pelvic motions. The final finding, that damping fields can be used to induce gait adaptations using a much lower force, can drastically change exoskeleton design and how robotic therapy is provided. Exoskeletons can be made lighter as a result of the force being highly reduced so that lighter weight components can be used, and the dissipative nature of the force reduces dependence on heavy power sources because regenerative breaking can be used to power the device. These factors also make it possible to for devices to be used overground, which may make training more transferable to the real world.