An emerging and innovative way of organizing projects in health technology and innovation is the so-called "living lab". Because of their characteristics, living labs may provide a solution to a very old problem: How to facilitate the meaningful participation of stakeholders in science and technology? In this article, I (we use a first-person perspective in the paper) aim to contribute to the literature by providing an account of my experiences as a participation researcher with stakeholder participation in a living lab in the Netherlands. I participated in a yearlong project on ensuring freedom for residents in a closed psychogeriatric ward. Using three key moments from that experience, I illustrate why participation was the intention, but was harder to achieve in practice. Participation processes and living labs are situated in specific social and physical contexts. I discuss the "situatedness" of living labs and propose to reconceptualize them as "situated practices": The value of a living lab lies in the processes of work it conducts on specific innovations situated in its local context. A key conclusion is that providing narrative descriptions of living lab projects, with attention to situatedness and stakeholder participation, can provide invaluable examples, insights, and inspirations for other researchers in the field.

Background. The mechanism and time course of increased wrist joint stiffness poststroke and clinically observed wrist flexion deformity is still not well understood. The components contributing to increased joint stiffness are of neural reflexive and peripheral tissue origin and quantified by reflexive torque and muscle slack length and stiffness coefficient parameters. Objective. To investigate the time course of the components contributing to wrist joint stiffness during the first 26 weeks poststroke in a group of patients, stratified by prognosis and functional recovery of the upper extremity. Methods. A total of 36 stroke patients were measured on 8 occasions within the first 26 weeks poststroke using ramp-and-hold rotations applied to the wrist joint by a robot manipulator. Neural reflexive and peripheral tissue components were estimated using an electromyography-driven antagonistic wrist model. Outcome was compared between groups cross-sectionally at 26 weeks poststroke and development over time was analyzed longitudinally. Results. At 26 weeks poststroke, patients with poor recovery (Action Research Arm Test [ARAT] ≤9 points) showed a higher predicted reflexive torque of the flexors (P <.001) and reduced predicted slack length (P <.001) indicating shortened muscles contributing to higher peripheral tissue stiffness (P <.001), compared with patients with good recovery (ARAT ≥10 points). Significant differences in peripheral tissue stiffness between groups could be identified around weeks 4 and 5; for neural reflexive stiffness, this was the case around week 12. Conclusions. We found onset of peripheral tissue stiffness to precede neural reflexive stiffness. Temporal identification of components contributing to joint stiffness after stroke may prompt longitudinal interventional studies to further evaluate and eventually prevent these phenomena.

The dynamic behavior of the wrist joint is governed by nonlinear properties, yet applied mathematical models, used to describe the measured input-output (perturbation-response) relationship, are commonly linear. Consequently, the linearly estimated model parameters will depend on properties of the applied perturbation properties (such perturbation amplitude and velocity). We aimed to systematically address the effects of perturbation velocity on linearly estimated neuromechanical parameters. Using a single axis manipulator ramp and hold perturbations were applied to the wrist joint. Effects of perturbation velocity (0.5, 1 and 3 rad/s) were investigated at multiple background torque levels (0, 0.5 and 1 N·m). With increasing perturbation velocity, estimated joint stiffness remained constant, while damping and reflex gain decreased. This variation in model parameters is dependent on background torque levels, i.e. muscle contraction. These observations support the future development of nonlinear models that are capable of describing wrist joint behavior over a larger range of loading conditions, exceeding the restricted range of operation that is required for linearization.

We suggest short range stiffness (SRS) at the elbow joint as an alternative diagnostic for EMG to assess cocontraction.Elbow SRS is compared between obstetric brachial plexus lesion (OBPL) patients and healthy subjects (cross-sectional study design). Seven controls (median 28. years) and five patients (median 31. years) isometrically flexed and extended the elbow at rest and three additional torques [2.1,. 4.3,. 6.4. N. m] while a fast stretch stimulus was applied. SRS was estimated in silico using a neuromechanical elbow model simulating the torque response from the imposed elbow angle.SRS was higher in patients (250. ±. 36. N. m/rad) than in controls (150. ±. 21. N. m/rad, p = 0.014), except for the rest condition. Higher elbow SRS suggested greater cocontraction in patients compared to controls. SRS is a promising mechanical alternative to assess cocontraction, which is a frequently encountered clinical problem in OBPL due to axonal misrouting.

Background and Objective. Favorable prognosis of the upper limb depends on preservation or return of voluntary finger extension (FE) early after stroke. The present study aimed to determine the effects of modified constraint-induced movement therapy (mCIMT) and electromyography-triggered neuromuscular stimulation (EMG-NMS) on upper limb capacity early poststroke. Methods. A total of 159 ischemic stroke patients were included: 58 patients with a favorable prognosis (>10° of FE) were randomly allocated to 3 weeks of mCIMT or usual care only; 101 patients with an unfavorable prognosis were allocated to 3-week EMG-NMS or usual care only. Both interventions started within 14 days poststroke, lasted up until 5 weeks, focused at preservation or return of FE. Results. Upper limb capacity was measured with the Action Research Arm Test (ARAT), assessed weekly within the first 5 weeks poststroke and at postassessments at 8, 12, and 26 weeks. Clinically relevant differences in ARAT in favor of mCIMT were found after 5, 8, and 12 weeks poststroke (respectively, 6, 7, and 7 points; P