Up to eight percent of patients develop steal syndrome after prosthetic dialysis access graft placement, which is characterized by low blood flow to the hand. Steal syndrome results in a cold hand, pain, and in extreme cases, loss of function and tissue damage. A practical and easy way of adjusting the fluidic resistance in a graft to attenuate the risk of steal physiology would greatly benefit both surgeons and patients. This paper describes the design and development of a device that can be attached to a dialysis access graft at the time of surgical implantation to enable providers to externally adjust the resistance of the graft postoperatively. Bench level flow experiments and magnetic setups were used to establish design requirements and test prototypes. The Graft Resistance Adjustment Mechanism (GRAM) can be applied to a standard graft before or after it is implanted and a non-contact magnetic coupling enables actuation through the skin for graft compression. The device features a winch-driven system to provide translational movement for a graft compression unit. We expect such a device to enable noninvasive management of steal syndrome in a manner that does not change the existing graft and support technologies, thus reducing patient complications and reducing costs to hospitals.
Wearable assistive robotic devices are characterized by an interface, a meeting place of living tissue and mechanical forces, at which potential and kinetic energy are converted to one or the other form. Ecological scientists may make important contributions to the design of device interfaces because of a functional perspective on energy and information exchange. For ecological scientists, (a) behavioral forms are an assembly of whole functional systems from available parts, emerging in energy flows, and (b) nature explores for informationally based adaptive solutions to assemble behavioral forms by generating spontaneous patterns containing fluctuations. We present data from ongoing studies with infants that demonstrate how infants may explore for adaptive kicking solutions. Inspired by the ecological perspective and data from developing humans, ecological scientists may design interfaces to assist individuals with medical conditions that result in physical and/or mental impairment. We present one such device, what is called the “second skin,” to illustrate how a soft, prestressed material, worn on the skin surface, may be used synergistically with synthetic and biological muscles for assisting action. Our work on the second skin, thus far, suggests a set of ecologically inspired principles for design of wearable assistive robotic devices.