Research – Rehabilitation
Mobile Technology (M-Health) – A novel approach to facilitate and motivate self-care among the leprosy affected, 2017-2020,
Grant Amount: € 35,902, Funded by: Leprosy Research Initiative (LRI)
In Leprosy some significant factors perpetuate the onset of deformity and make disability permanent and progressive. The low socio-economic status, stigma, ignorance, lack of motivation and level of understanding of impairments and deformities are some key factors in leprosy that lead to the irregularity and discontinuation of treatment by the patient.
The non-adherence of the patient to treatment and self-care practices have led to further deterioration and worsening of the impairments. An effective way to communicate, motivate, enhance the knowledge and understanding of the disease to the patient have always been the priority for any health education program in leprosy.
This funded research project had used a 24-hour toll-free number and mobile technology a most common, cost-effective technological platform to prevent the neglect and worsening of impairments on individual diagnosed and treated for Leprosy. The research had improved the skills and knowledge of the person affected by Leprosy on impairment and disability and further helped them to prevent, even and seek appropriate management.
The Project team consisting of a Social worker, therapist used mobile phone technology and 24-hour toll free number to interact and provide feedback to the patients. The feedback given were based on the patient’s queries and were tailor made for that specific patient.
All the resources available for the leprosy affected patient through Government schemes, centers providing treatment for leprosy and its complications in the district and state were systematically collected to provide effective feedback to the patients through the toll-free number and the mobile handsets. The identified data were used to develop m-health strategies like self-care booklets and health education awareness audio modules.
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Self Care – Foot |
Self Care – Hand |
Self Care – EYE |
| Self Care – Foot | Self Care – Hand | Self Care – Eye |
Design Customized Offloading Devices to Promote Healing of Plantar Ulcers, 2017-2020, Grant Amount: € 35,497, Funded by: Leprosy Research Initiative (LRI)
Patients suffering from nerve damage caused by leprosy can have loss of sensation in the feet, which leads to wounds on the sole of the foot. Non infected simple ulcers are usually treated with total contact casts. These are heavy and prevent the wearer from doing their daily routine. In any underdeveloped country, where even a normal person may find it difficult to walk on village roads, a person with a cast will not be able to walk and is confined to the home. A lightweight alternative device, that provides the same protection of the wound, would help the patient in carrying on with the routine work while the ulcer heals inside the cast.
Through this research project the investigators pursued to develop lightweight devices that can heal the wound which would be better that the existing contact cast that is heavy. The existing treatment devices like the Total contact cast (TCC) and the Moulded double rocker shoes (MDRS) have to be worn for at least a month continuously. The devices are heavy and wearing them for such long periods of time is difficult. So, there are high levels of rejection of this excellent treatment for ulcer healing. Through this project, the developed custom design light weight devices would help to reduce pressure on the foot and help in healing of the wounds.
Initially the project focused on reviewing the existing offloading devices for the uniqueness and enabling and disabling factors in doing their ADL functions. The principles identified were then incorporated in developing designs that were able to offload plantar pressures effectively through the simulation tests that were carried out. The designs were then tested for its effectiveness in offloading the body weight. The material properties of the lightweight material were incorporated in the simulating software, and the designs were tested for its robustness. With necessary modifications done in the designs, the design prototype and working model were created. The working was tested on patients for its functionality and effectiveness.
Project – 1
Universal Cloud Based platform to monitor and prevent disability in people affected by leprosy, 2019-2025, Grant Amount: $ 20000,
Funded by: Hope Rises International
Leprosy has the potential to cause irreversible nerve damage and lifelong disabilities that result in stigma and discrimination, decreased economic productivity, and negative impact on the mental wellbeing and quality of life of affected individuals, which also impacts their families. National leprosy program prioritize the detection, treatment and cure of leprosy and the prevention and management of disability while a patient is enrolled in the program.
However, after release from treatment (RFT) which implies disease cure, most national programs do not perform well in effective surveillance and enhancing adherence to self-care and self-reporting of patients at-risk of disability and patients with already established Grade 1 and 2 disabilities. Patients live far away from leprosy referral centers and follow up and management at many instances is not uniform because of poor accessibility of the leprosy center and its staff to the patient. At Karigiri, 60% of patients live far away from the center, and visit once in 3-4 months, while consulting nearby health facilities if a problem occurs in the interim. This is where the problem of data sharing for uninterrupted and correct management occurs. A continual real time feedback and follow up mechanism is not available for patients with hands, feet and eye impairments, and many patients develop new disabilities or worsening of existing disabilities if there is interruption in their treatment or once they are RFT and lost to the system.
This innovative cloud-based platform is a first of its kind being developed to support reliable capture, storage and retrieval of leprosy disability related data. The platform will enable healthcare workers in a leprosy referral center and the national program to monitor and improve adherence of their patients to the disability management. The platform will also aid a patient’s access to uniform care, treatment and follow up from a healthcare facility anywhere within the country through shared access to their disability data with that facility when patients are unable to access their usual leprosy treatment facility, as has been the case during COVID19 lockdowns, bad climatic conditions like heavy rains, flooding, and inability to travel the long distance from their homes to their leprosy centre too frequently etc. Access to the data will also enable research institutes for deep machine learning and design thinking in the field of disability.
Interface to fabricate customized insole with dynamic peak plantar pressure data, 2023-2025, Grant Amount: $ 40000, Funded by: Hope Rises International.
A key solution developed for anaesthetic foot was a high-fidelity, customised, cost competitive footwear for people with leprosy and others using 3D scanning, designing and printing technology (customised insoles through a process of computer aided scanning, computer aided designing and computer aided fabrication). These customized insoles are fitted into prefabricated extra depth footwear which can be either purchased or manufactured. The scanning and designing can be done remotely by trained personnel at any clinic where the patient is seen, and the customised design of the insole can be sent using computer technology over the internet (email, cloud storage) to a Central Fabrication (CFAB) Unit where it will be fabricated using computer based technology.
The fabrication system uses either standard triangle language (.stl) format for additive technology like 3 dimensional printing or the standard for the exchange of the product data (.stp), which is also known as ISO 10303 is ideal for 3 dimensional milling technology and has a complete computer aided designing data. The .stp file format are in some instances converted to .stl format (which contains the model’s surface level detail) for 3 dimensional printing. The effectiveness and the strength of materials have not been compared in the orthosis, assistive devices that have fabricated either through milling or printing. There are limited technologies that transfer the peak plantar pressure data as .stp files for 3 dimensional printing or milling (voxel care technologies). However, it is at many instances become expensive to maintain. Therefore, it is very essential and key to develop an indigenous technology which would be cost effective and is easy to process the pressure data acquired. This project utilized the peak pressure data that is acquired from the various pressure areas of the foot through the sensors in fabricating orthosis apart from its use in monitoring pressure variations.
Tactile Sensory Feedback System to Predict and Prevent Peak Plantar Pressures, 2019-2020, Grant Amount: $ 21,387, Funded by: Hope Rises International.
The peripheral nerve damage causes significant impairments if not detected and treated early in Leprosy. Impairments further leads to inability in carrying out normal activities of daily living. Different reconstructive surgical procedures help in the correction of the impairments and in regaining the activities that are lost in leprosy affected patients. However, there are very few devices’ that can predict the site of impairments at an early stage.
The project through the innovative tactile sensory insoles tried to find out that if the use of a tactile sensor insole providing bio feedback on excessive plantar pressure at a particular point on the foot helps in preventing peak plantar pressure which leads to plantar ulceration.
The prototype was developed and tested through the project. An artificial biofeedback system used force sensing resistors (FSRs) embedded in manually made insoles to measure plantar pressures at critical points on the sole of the foot when walking and standing during activities of daily living. Threshold limits were identified based on repeated walking patterns of persons wearing the insoles. The FSRs transferred plantar pressure data to a transmitter via a data acquisition system. The data acquisition system used Bluetooth technology to provide biofeedback to the wearer through an audible alarm fitted on the footwear when pressures crossed set threshold limits of the calibrated insole sensors.
Patients who wore and tested the prototype received gait education on how to walk to maintain plantar pressures within threshold limits and reduce the forces exerted on their neuropathic feet. Despite this, and because of the sensory loss, there would be times when peak plantar pressures would increase. This is when the biofeedback mechanism came into play, setting off an audible signal that prompted the wearer to alter their gait and release the pressure from off the foot. This helped patients subconsciously ‘learn’ how to protect their feet while walking and standing.
Project
Design and development of exoskeleton for rehabilitation of leprosy affected individuals with motor paralysis of hand, 2025- 2027, Grant Amount ₹ 2.23 Crores, Funded by Indian Council of Medical Research (ICMR).
Collaborator: VIT University, Vellore
Impairments in leprosy are caused by neglect of the nerve damage and muscle weakness. The current management of the impairments include physiotherapy, occupational therapy, provision of prosthesis and orthosis and by tendon transfer surgeries.
This study of research aims to provide an ovel and innovative assistive device that can complement the existing rehabilitation methods available for leprosy patients.
The EMG plays a vital role in the field of rehabilitation engineering, and it has been used to train persons with muscle weakness. EMG sensors can be able to detect even a low range of signals from muscle, so this would help in developing a suitable interface for the soft exoskeleton. The outcomes of the project would provide valuable information to the leprosy clinics and the therapists in improving the rehabilitation out comes. The device that will be developed through the project would be able to use the signals of EMG to facilitate and improve the hand movements of the users, especially those having motor paralysis due to leprosy. The exoskeleton that would be developed through the project would help in assisting those with motor paralysis to carry out their exercises needed.
This device would help to improve the ability of hand function which can enhance their independence, self-esteem, and social participation. The device will also give feedback and stimulation to the user which can improve the user’s motor learning, especially for whom tendon transfer corrective surgery has been carried out. This research will contribute to the field of assistive technology and rehabilitation of leprosy which can inspire further research and innovations.
