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.
In this paper, we describe our prototype of an ultrasound guidance system to address the need for an easy-touse, cost-effective, and portable technology to improve ultrasound-guided procedures. The system consists of a lockable, articulating needle guide that attaches to an ultrasound probe and a user-interface that provides real-time visualization of the predicted needle trajectory overlaid on the ultrasound image. Our needle guide ensures proper needle alignment with the ultrasound imaging plane. Moreover, the calculated needle trajectory is superimposed on the real-time ultrasound image, eliminating the need for the practitioner to estimate the target trajectory, and thereby reducing injuries from needle readjustment. Finally, the guide is lockable to prevent needle deviation from the desired trajectory during insertion. This feature will also allow the practitioner to free one hand to complete simple tasks that usually require a second practitioner to perform. Overall, our system eliminates the experience required to develop the fine hand movement and dexterity needed for traditional ultrasound-guided procedures. The system has the potential to increase efficiency, safety, quality, and reduce costs for a wide range of ultrasound-guided procedures. Furthermore, in combination with portable ultrasound machines, this system will enable these procedures to be more easily performed by unskilled practitioners in non-ideal situations such as the battlefield and other disaster relief areas.
This paper proposes an analytical approach to the robust design of mechanisms, to achieve motion and accuracy requirements given a desired transmission ratio and allowable geometrical variations. The focus is on four-bar and slider-crank mechanisms, which are common elements for the transmission of rotary motion, especially over distances, which are too big for the use of conventional elements such as gears, and motion along a predefined guide-curve, which often is a straight line. For many power transmission applications, a constant relation between the motions of an input and corresponding output element is required. For a four-bar linkage, a value of 1 is the only possible constant transmission ratio—achieved when the mechanism has a parallelogram configuration. In the case of a slider-crank linkage a constant transmission ratio can be achieved with a properly designed circular guide-curve, which makes the slider-crank essentially equivalent to a four-bar. In practice, however, as a result of variations in link lengths due to manufacturing tolerances and load-induced or thermal deformations, the transmission ratio for a parallelogram four-bar linkage will deviate substantially from its ideal theoretical value of 1. Even small changes in link lengths due to deformations or joint backlash can cause unacceptable instantaneous transmission ratio variations. The concepts presented are not limited to the design of four-bars and slider-cranks but can also be applied universally in the design of other mechanisms.
The main challenges of Computed Tomography (CT)-guided organ puncture are the mental registration of the medical imaging data with the patient anatomy, required when planning a trajectory, and the subsequent precise insertion of a needle along it. An interventional telerobotic system, such as Robopsy, enables precise needle insertion, however, in order to minimize procedure time and number of CT scans, this system should be driven by an interface that is directly integrated with the medical imaging data. In this study we have developed and evaluated such an interface that provides the user with a point-and-click functionality for specifying the desired trajectory, segmenting the needle and automatically calculating the insertion parameters (angles and depth). In order to highlight the advantages of such an interface, we compared robotic-assisted targeting using the old interface (non-image-based) where the path planning was performed on the CT console and transferred manually to the interface with the targeting procedure using the new interface (image-based). We found that the mean procedure time (n=5) was 22±5 min (non-image-based) and 19±1 min (image-based) with a mean number of CT scans of 6±1 (non-image-based) and 5±1 (image-based). Although the targeting experiments were performed in gelatin with homogenous properties our results indicate that an image-based interface can reduce procedure time as well as number of CT scans for percutaneous needle biopsies.
Computed tomography (CT) guided percutaneous punctures of the liver for cancer diagnosis and therapy (e.g. tumor biopsy, radiofrequency ablation) are well-established procedures in clinical routine. One of the main challenges related to these interventions is the accurate placement of the needle within the lesion. Several navigation concepts have been introduced to compensate for organ shift and deformation in real-time, yet, the operator error remains an important factor influencing the overall accuracy of the developed systems. The aim of this study was to investigate whether the operator error and, thus, the overall insertion error of an existing navigation system could be further reduced by replacing the user with the medical robot Robopsy. For this purpose, we performed navigated needle insertions in a static abdominal phantom as well as in a respiratory liver motion simulator and compared the human operator error with the targeting error performed by the robot. According to the results, the Robopsy driven needle insertion system is able to more accurately align the needle and insert it along its axis compared to a human operator. Integration of the robot into the current navigation system could thus improve targeting accuracy in clinical use.
A quasi-passive leg exoskeleton is presented for load-carrying augmentation during walking. The exoskeleton has no actuators, only ankle and hip springs and a knee variable damper. Without a payload, the exoskeleton weighs 11.7kg and requires only 2 Watts of electrical power during loaded walking. For a 36kg payload, we demonstrate that the quasi-passive exoskeleton transfers on average 80% of the load to the ground during the single support phase of walking. By measuring the rate of oxygen consumption on a study participant walking at a self-selected speed, we find that the exoskeleton slightly increases the walking metabolic cost of transport (COT) as compared to a standard loaded backpack (10% increase). However, a similar exoskeleton without joint springs or damping control (zero-impedance exoskeleton) is found to increase COT by 23% compared to the loaded backpack, highlighting the benefits of passive and quasi-passive joint mechanisms in the design of efficient, low-mass leg exoskeletons.