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BIOENGINEERING

Enhancing autonomy

Electronic canes, exoskeletons and Braille typewriters aim to improve the lives of people with disabilities

Testing the exoskeleton developed at USP: the goal is to allow patients who have suffered spinal cord injuries or a stroke to walk again with more steadiness and stability during rehabilitation

Léo RamosTesting the exoskeleton developed at USP: the goal is to allow patients who have suffered spinal cord injuries or a stroke to walk again with more steadiness and stability during rehabilitationLéo Ramos

After a traffic accident in 2014 that resulted in a partial loss of movement in his legs, motorcycle courier Reginaldo Santos Ferreira, 33, has taken his first steps with the help of a robotic exoskeleton developed by researchers at the School of Medicine (FM) and the Polytechnic School (Poli) of the University of São Paulo (USP). Since May 2015, he has participated in testing for a prototype of the device at the Rehabilitation and Physical Medicine Institute (IMREA) of the Lucy Montoro Rehabilitation Network, in the Vila Mariana neighborhood of the city of São Paulo. “The exoskeleton makes me feel steadier when I walk. It aligns and stabilizes my hips,” says Ferreira. The patient’s feedback has been essential for the physicians, physical therapists and engineers involved in the project to make the necessary adjustments to the equipment. They want to make it more functional than the models currently available on the market. “Users of conventional exoskeletons have to support their own weight with both arms, using a walker or crutches. This means that they need to exert great physical effort to maintain their balance,” explains Linamara Rizzo Battistella, a professor at FM-USP.

The exoskeleton is one of 75 projects approved under a funding opportunity announced by the Brazilian Ministry of Science, Technology and Innovation (MCTI) in 2013, which offered R$13 million in support of assistive technology initiatives. “Assistive technology” is the term for the arsenal of resources and services designed for people with physical, visual, hearing, mental or intellectual disabilities in order to help them gain or enhance certain abilities. Partial results of some MCTI-funded projects were presented at an event held in the city of Brasília in November 2015.

Before it can go to market, the exoskeleton still needs further testing. To ensure stability for users, the researchers are working on a new system that can control the gait of patients who have suffered a spinal cord injury or cerebrovascular accident (stroke). Based on laboratory analysis of knee and ankle function when walking, they designed an exoskeleton that allows users to adjust the height of an electric motor that is attached to the device and controlled by software, through which movement intensity can be configured. The motor – the costliest part of the equipment – costs around $2,500. For now, the exoskeleton is being tested with the motor turned off. Even so, the structure gives patients stability. This stage of the process is meant to accurately assess whether the weight of the motor will hinder movement in any way, or if there is any risk of joint dislocation. “We expect to start testing the fully-functional equipment by late 2016, after analysis by the FM-USP Ethics Committee,” says Arturo Forner-Cordero, coordinator of the Biomechatronics Laboratory at Poli-USP.

Other initiatives that also received funding from the MCTI are almost ready to hit the market. The electronic cane developed at Itajaí Valley University (UNIVALI) in the state of Santa Catarina is one of them. It is equipped with sonar-like sensors that warn the user about obstacles ahead by means of sound alerts and vibrations transmitted through the grip. “A common complaint from visually impaired patients is that conventional canes do not help them identify objects above waist level, like payphones, mailboxes and suspended flowerpots,” says Alejandro Rafael Garcia Ramirez, coordinator of the project and computer engineering professor at UNIVALI.

With MCTI support, 30 canes were produced and will be tested by the end of 2016. The project is being developed in partnership with Produza, a Santa Catarina-based assembler of electronic circuit boards and components, and with Fastparts, a plastic components manufacturer. “Innovation in assistive technologies depends on dialog among universities, companies and people with disabilities. Knowing how to identify users’ demands is a must,” says Ramirez, recalling that there are 6.5 million visually-impaired Brazilians, including over 500,000 who are blind and six million with low vision, according to data from the 2010 Demographic Census prepared by the Brazilian Institute of Geography and Statistics (IBGE).

Braille typewriter by Tece, a company in Rio Claro, São Paulo State: lighter and cheaper than conventional models

TeceBraille typewriter by Tece, a company in Rio Claro, São Paulo State: lighter and cheaper than conventional modelsTece

Made in Brazil
Data from the IBGE reveal approximately 45 million people with a physical, mental or intellectual disability in Brazil, making up 24% of the total population. In the United States, for example, 54 million are disabled, or 17% of the population. But in Brazil, existing demand for assistive devices like wheelchairs and prosthetics, to name the most common, is met via imported products. “There is some domestic production, but it is very small and little known,” says Linamara Battistella. “Many projects never leave the academic environment. The more home-grown technology we make available, the lower will be the long-term cost for Brazil,” adds Battistella, emphasizing that the biggest purchasers of assistive products in Brazil are the Ministry of Education and the National Healthcare System (SUS).

In the state of São Paulo, some projects that strive to meet these challenges are funded by FAPESP’s Innovative Research in Small Businesses Program (PIPE). One of these initiatives has researchers from the University of Campinas (Unicamp) and e-Sense Biomedical Engineering Innovation working together to develop a portable monitoring device for people with total or partial mobility impairments. The equipment uses sensors to monitor vital signs like blood sugar and blood pressure, posting the data to health professionals in real time over the Internet.

“This makes it easier to monitor elderly, morbidly obese or physically disabled patients, permitting an early diagnosis,” explains André Luiz Jardini Munhoz, researcher at the Unicamp School of Chemical Engineering and project lead. Health professionals can also use the device to locate their patients with GPS and call for an ambulance in an emergency. “We have a prototype ready to be tested on patients at Unicamp’s Hospital das Clínicas. We are waiting for permission from the university’s ethics committee,” says Alexandre Chiachiri Rodrigues Silva, engineer and partner at e-Sense.

In the city of Rio Claro in the interior of São Paulo State, a company called Tece, founded by biologist Aline Piccoli Otalara, has developed a new version of a manual slate used for writing in Braille – which is still the only form of reading available to the visually disabled. Using the new model, the Braille system can be learned in 60% less time. Tece already sells the product in Brazil and some countries in Europe. Conventional Braille slates have been around since 1837. To use one, the dots that make up the characters in Braille are punched into paper (concave dots), and then read in high relief (convex dots). This forces the slate’s user to write in a “mirrored” fashion, from right to left, making the learning process harder for beginners – people with disabilities, teachers and family members alike.

“We developed a slate that is very similar to the conventional model, but permits writing the dots directly in high relief, without need for mirrored writing or turning the paper over before reading. This also facilitates writing mathematical equations,” explains Otalara, who founded Tece with former classmates from the São Paulo State University (Unesp).

In another, more recent project, also with PIPE funding, Tece started developing a Braille typewriter. The models currently available on the market are used in some classrooms and offices. “Although they are widely used, people usually do not have one at home, mainly because of the high cost,” says Otalara. She reveals that the Braille typewriter most commonly used in Brazil is imported and costs R$6,500. “The machine we are developing will be lighter, quieter and should cost no more than R$800.” To reduce costs, Tece is investing in design and new materials research. The six keys that correspond to the Braille dots, as well as the finished printed material, are in the same format used by the positive writing slate developed by the company.

Electronic cane developed by researchers at UNIVALI, being tested on the streets of Florianópolis

Daniel QueirozElectronic cane developed by researchers at UNIVALI, being tested on the streets of FlorianópolisDaniel Queiroz

Braille printer
Another example of a technology developed to meet the demands of the visually impaired is a Braille printer that can be installed on bank ATMs. The system was created by Tecassistiva, based in the city of São Paulo. “We noticed that when a visually impaired person goes to the bank to print out a statement, he needs someone else to help him access his account information. A Braille printer will give him more autonomy and security,” says Guilherme Lira, director of the company, which started testing a prototype in October 2015 in partnership with the Amazon division of the Reference Center Foundation for Innovative Technologies (CERTI), in the city of Manaus. Tecassistiva accepted the challenge of developing a Braille printer small enough to be installed in an ATM. Conventional Braille printers are much larger. In addition, it was necessary for the information to be printed out horizontally, not vertically. The company had to create its own software and conduct research to develop new electronic components. “We established partnerships with companies in Sweden and the United States, which provided us with part of the hardware system to be assessed,” says Lira, who obtained financial support from the Brazilian Innovation Agency (FINEP).

Since 2005, FINEP has issued public calls offering to support assistive technology projects that involve research institutes and companies. “We recognize that companies have to be encouraged to occupy a market that is still incipient in Brazil,” says Maurício França, superintendent of the Technology for Sustainable Development division at FINEP. França says that companies in this segment face an obstacle in that assistive products must usually meet the particular needs of each user. Some products, like prosthetics, orthopedic backrests and some wheelchairs, are built specifically for each user, demanding a higher degree of customization and requiring companies to offer a wide portfolio of products, not to mention a network of professionals to prescribe and assist with them. “Only a few companies have the structure to meet this requirement,” he explains.

Another peculiarity of the industry is that the market still depends heavily on government purchases. “One way of improving this situation would be to promote greater job inclusion for people with disabilities. This would compel many companies to buy assistive technology products in order to adapt,” França suggests.

Projects
1. Development of a portable multiparametric monitor (nº 2012/50124-5); Grant Mechanism Innovative Research in Small Businesses Program (PIPE); Principal Investigator André Luiz Jardini Munhoz (Unicamp/e-Sense); Investment R$75,847.50 and $2,500.00.
2. Development of assistive technologies aimed at people who are blind or low vision (PROVIDE) (nº 2009/52626-5); Grant Mechanism Innovative Research in Small Businesses Program (PIPE); Principal Investigator Aline Piccoli Otalara (Tece); Investment R$163,524.00.
3. Dati Braille: research, development and innovation of a Braille typewriter (nº 2012/50389-9); Grant Mechanism Innovative Research in Small Businesses Program (PIPE); Principal Investigator Aline Piccoli Otalara (Tece); Investment R$117,725.00.

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