1
|
Tornero-Aguilera JF, Stergiou M, Rubio-Zarapuz A, Martín-Rodríguez A, Massuça LM, Clemente-Suárez VJ. Optimising Combat Readiness: Practical Strategies for Integrating Physiological and Psychological Resilience in Soldier Training. Healthcare (Basel) 2024; 12:1160. [PMID: 38921275 PMCID: PMC11202720 DOI: 10.3390/healthcare12121160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
This narrative review examines the intricate psychophysiological interplay between cognitive functions and physical responses within military personnel engaged in combat. It elucidates the spectrum of responses elicited by symmetric and asymmetric warfare alongside specialised combat scenarios, including close-quarters and subterranean warfare. Central to this discourse is the emphasis on integrating training programs beyond physical conditioning to encompass psychological resilience and decision-making efficacy under duress. The exploration further ventures into applying advanced technologies such as virtual reality and wearable devices, highlighting their pivotal role in augmenting training outcomes and supporting soldier health. Through a detailed analysis of psychophysiological variations across different military branches of service, the narrative review advocates for bespoke training regimens and support frameworks tailored to address the unique exigencies of each service branch. Concluding observations stress the importance of evolving military training paradigms, advocating for adopting realistic, immersive training simulations that mirror the complexities of the contemporary battlefield. This synthesis aims to contribute to the ongoing discourse on optimising military training protocols and enhancing the operational readiness and well-being of armed forces personnel. This narrative review is essential for military psychologists, trainers, and policymakers, aiming to bridge the gap between theoretical knowledge and practical implementation in military training programs.
Collapse
Affiliation(s)
- José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.F.T.-A.); (M.S.); (A.R.-Z.); (A.M.-R.); (V.J.C.-S.)
| | - Maria Stergiou
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.F.T.-A.); (M.S.); (A.R.-Z.); (A.M.-R.); (V.J.C.-S.)
| | - Alejandro Rubio-Zarapuz
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.F.T.-A.); (M.S.); (A.R.-Z.); (A.M.-R.); (V.J.C.-S.)
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.F.T.-A.); (M.S.); (A.R.-Z.); (A.M.-R.); (V.J.C.-S.)
| | - Luís Miguel Massuça
- ICPOL—Police Research Center, Higher Institute of Police Sciences and Internal Security, 1300-663 Lisbon, Portugal
- Centro de Investigação em Desporto, Educação Física, Exercício e Saúde (CIDEFES), Lusófona University, 1749-024 Lisbon, Portugal
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200-450 Oporto, Portugal
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.F.T.-A.); (M.S.); (A.R.-Z.); (A.M.-R.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
| |
Collapse
|
2
|
Chand G, Singh S, Dhiraaj S, Kumar B, Shetty A, Halemani K, Ghatak T. Perception of robotic-assisted surgery (RAS) among medical students: a systematic review and meta-analysis. J Robot Surg 2024; 18:95. [PMID: 38413513 DOI: 10.1007/s11701-024-01847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/24/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Robotic surgery, also known as robotic-assisted surgery (RAS), involves a camera and a small surgical instrument attached to a robotic arm. A trained surgeon operates the robot from a viewing screen while being in the same room. METHODOLOGY This review was prepared following Cochrane collaboration guidelines and reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Two authors independently searched and appraised the studies published in PubMed, cumulative index to nursing and allied health literature (CINAHL), Embase, Clinical Key, and Google Scholar. Pooled data analyzed and reported in RevMan software version-5.4. RESULTS This systematic review and meta-analysis comprised 1400 medical students, from 8 studies. The participants' age ranged from 23 to 49 years. Similarly, the sample size ranged from 25 and 300. The pooled prevalence of the existing studies revealed that 29.8% of medical students, were favorable towards RAS. Effect size (ES), 95% confidence intervals (CI) and heterogeneity (I2) [ES = 29.8, 95% CI 16.4-43.2, I2 = 95.1%, P < 0.00]. About 40% of Australian medical students' positive opinion on RAS [ES = 40.4, 95% CI 25.7-55.2]. Similarly, 34.2% of students from Saudi Arabia [ES = 29.8, 95% CI 22.4-90.8, I2 = 99.3%, P < 0.00], 27.8% students from Canada [ES = 27.8, 95% CI 15.9-39.6], 24.8% from USA [ES = 24.8, 95% CI 6.9-42.7, I2 = 77.3%, P < 0.00] and 24% [ES = 24, 95% CI 18-30] from India favorable towards RAS. DISCUSSION Medical students from developed nations display favorable attitudes towards RAS. However, implementing of revised curriculum at the beginning of the graduation level sparks medical students' attitude towards robotic surgery.
Collapse
Affiliation(s)
- Gyan Chand
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Suyash Singh
- All India Institute of Medical Sciences, Raebareli, India
| | - Sanjay Dhiraaj
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Basant Kumar
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Asha Shetty
- All India Institute of Medical Scieces, Bhubaneswar, India
| | | | - Tanmoy Ghatak
- All India Institute of Medical Sciences, Raebareli, India
| |
Collapse
|
3
|
Albanese GA, Bucchieri A, Podda J, Tacchino A, Buccelli S, De Momi E, Laffranchi M, Mannella K, Holmes MWR, Zenzeri J, De Michieli L, Brichetto G, Barresi G. Robotic systems for upper-limb rehabilitation in multiple sclerosis: a SWOT analysis and the synergies with virtual and augmented environments. Front Robot AI 2024; 11:1335147. [PMID: 38638271 PMCID: PMC11025362 DOI: 10.3389/frobt.2024.1335147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/30/2024] [Indexed: 04/20/2024] Open
Abstract
The robotics discipline is exploring precise and versatile solutions for upper-limb rehabilitation in Multiple Sclerosis (MS). People with MS can greatly benefit from robotic systems to help combat the complexities of this disease, which can impair the ability to perform activities of daily living (ADLs). In order to present the potential and the limitations of smart mechatronic devices in the mentioned clinical domain, this review is structured to propose a concise SWOT (Strengths, Weaknesses, Opportunities, and Threats) Analysis of robotic rehabilitation in MS. Through the SWOT Analysis, a method mostly adopted in business management, this paper addresses both internal and external factors that can promote or hinder the adoption of upper-limb rehabilitation robots in MS. Subsequently, it discusses how the synergy with another category of interaction technologies - the systems underlying virtual and augmented environments - may empower Strengths, overcome Weaknesses, expand Opportunities, and handle Threats in rehabilitation robotics for MS. The impactful adaptability of these digital settings (extensively used in rehabilitation for MS, even to approach ADL-like tasks in safe simulated contexts) is the main reason for presenting this approach to face the critical issues of the aforementioned SWOT Analysis. This methodological proposal aims at paving the way for devising further synergistic strategies based on the integration of medical robotic devices with other promising technologies to help upper-limb functional recovery in MS.
Collapse
Affiliation(s)
| | - Anna Bucchieri
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Stefano Buccelli
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Matteo Laffranchi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kailynn Mannella
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | | | | | | | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
- AISM Rehabilitation Center Liguria, Italian Multiple Sclerosis Society (AISM), Genoa, Italy
| | - Giacinto Barresi
- Rehab Technologies Lab, Istituto Italiano di Tecnologia, Genoa, Italy
| |
Collapse
|
4
|
Carrillo C, Tilley D, Horn K, Gonzalez M, Coffman C, Hilton C, Mani K. Effectiveness of Robotics in Stroke Rehabilitation to Accelerate Upper Extremity Function: Systematic Review. Occup Ther Int 2023; 2023:7991765. [PMID: 37927581 PMCID: PMC10624545 DOI: 10.1155/2023/7991765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/24/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023] Open
Abstract
Objective To examine the effectiveness of robot-assisted therapy (RAT) combined with conventional therapy (CT) compared to CT alone in accelerating upper extremity (UE) recovery poststroke. Data Sources. We searched five databases: Ovid, MEDLINE, CINAHL, PubMed, and Scopus Study Selection. Studies were selected for this review using the following inclusion criteria: randomized controlled trials of adults, RAT combined with CT compared to CT, and Fugl-Meyer Assessment (FMA) as an outcome measure. Studies focused on children with neurological impairments, and studies that used RAT to facilitate lower extremity recovery and/or improve gait were excluded. Data Extraction. The initial search yielded 3,019 citations of articles published between January 2011 and May 2021. Fourteen articles met the inclusion criteria. Randomization, allocation sequence concealment, blinding, and other biases were assessed. Data Synthesis. Current evidence suggests that the use of RAT along with CT may accelerate upper extremity recovery, measured by FMA, in the beginning of rehabilitation. However, the progress fades over time. More empirical research is needed to validate this observation. Also, the findings related to cost-benefit analyses of RAT are inconclusive. Conclusions It is unclear whether RAT accelerates UE recovery poststroke when used in conjunction with conventional therapy. Given the capital and maintenance costs involved in developing and delivering RAT, more controlled studies examining the effectiveness and cost-benefit analysis of RAT are needed before it can be used widely. This trial is registered with CRD42021270824.
Collapse
Affiliation(s)
- Cora Carrillo
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Devyn Tilley
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Kaitlyn Horn
- University of Texas Medical Branch, Galveston, Texas, USA
| | | | | | - Claudia Hilton
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Karthik Mani
- University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
5
|
Jensen ER, Peper KK, Egger M, Muller F, Shahriari E, Haddadin S. Monitoring Active Patient Participation During Robotic Rehabilitation: Comparison Between a Robot-Based Metric and an EMG-Based Metric. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4156-4166. [PMID: 37844007 DOI: 10.1109/tnsre.2023.3323390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
While rehabilitation robots present a much-needed solution to improving early mobilization therapy in demanding clinical settings, they also present new challenges and opportunities in patient monitoring. Aside from the fundamental challenge of quantifying a patient's voluntary contribution during robot-led therapy motion, many sensors cannot be used in clinical settings due to time and space limitations. In this paper, we present and compare two metrics for monitoring a patient's active participation in the motion. The two metrics, each derived from first principles, have the same biomechanical interpretability, i.e., active work by the patient during the robotic mobilization therapy, but are calculated in two different spaces (Cartesian vs. muscle space). Furthermore, the sensors used to quantify these two metrics are fully independent from each other and the associated measurements are unrelated. Specifically, the robot-based work metric utilizes robot-integrated force sensors, while the EMG-based work metric requires electrophysiological sensors. We then apply the two metrics to therapy performed using a clinically certified, commercially available robotic system and compare them against the specific instructions given to the healthy subjects as well as against each other. Both metric outputs qualitatively match the expected behavior of the healthy subjects. Additionally, strong correlations (median [Formula: see text]) are shown between the two metrics, not only for healthy subjects (n = 12) but also for patients (n = 2), providing solid evidence for their validity and translatability. Importantly, the robot-based work metric does not rely on any sensors outside of those integrated into the robot, thus making it ideal for application in clinical settings.
Collapse
|
6
|
Swarnakar R, Yadav SL. Artificial intelligence and machine learning in motor recovery: A rehabilitation medicine perspective. World J Clin Cases 2023; 11:7258-7260. [PMID: 37946764 PMCID: PMC10631394 DOI: 10.12998/wjcc.v11.i29.7258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) are powerful technologies with the potential to revolutionize motor recovery in rehabilitation medicine. This perspective explores how AI and ML are harnessed to assess, diagnose, and design personalized treatment plans for patients with motor impairments. The integration of wearable sensors, virtual reality, augmented reality, and robotic devices allows for precise movement analysis and adaptive neurorehabilitation approaches. Moreover, AI-driven telerehabilitation enables remote monitoring and consultation. Although these applications show promise, healthcare professionals must interpret AI-generated insights and ensure patient safety. While AI and ML are in their early stages, ongoing research will determine their effectiveness in rehabilitation medicine.
Collapse
Affiliation(s)
- Raktim Swarnakar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Shiv Lal Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| |
Collapse
|
7
|
Widanage KND, Sheng Z, Chen HL, Li Y. Multi-Objective Optimization-Based Assist-as-Needed Controller for Improved Quality of Assistance in Rehabilitation Robotics. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941209 DOI: 10.1109/icorr58425.2023.10304734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Assist-as-needed (AAN) is a paradigm in rehabilitation robotics based on the fact that more active participation from human users promotes faster recovery of motor functions. Moreover, the patients and public engaged and involved in our research design stressed that in order to provide safe and patient-friendly assistance, rehabilitation robotics should be equipped with different constraints while giving minimal assistance where required. Most of the current constraint-based AAN methods are only capable of providing position or velocity constraints which limit the quality of assistance that the robotic systems could provide. In this paper, we propose a multi-objective optimization (MOO) based controller which can implement both linear and non-linear constraints to improve the quality of assistance. This MOO-based proposed controller includes not only position and velocity constraints but also a vibration constraint to subside the tremors common in rehabilitation patients. The performance of this controller is compared with a Barrier Lyapunov Function (BLF) based controller with task-space constraints in a simulation. The results indicate that the MOO-based controller behaves similarly to the BLF-based controller in terms of position constraints. It also shows that the MOO-based controller can improve the quality of assistance by constraining the velocity and subsiding the simulated tremors.
Collapse
|
8
|
Tesfazgi S, Sangouard R, Endo S, Hirche S. Uncertainty-aware automated assessment of the arm impedance with upper-limb exoskeletons. Front Neurorobot 2023; 17:1167604. [PMID: 37692885 PMCID: PMC10490610 DOI: 10.3389/fnbot.2023.1167604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Providing high degree of personalization to a specific need of each patient is invaluable to improve the utility of robot-driven neurorehabilitation. For the desired customization of treatment strategies, precise and reliable estimation of the patient's state becomes important, as it can be used to continuously monitor the patient during training and to document the rehabilitation progress. Wearable robotics have emerged as a valuable tool for this quantitative assessment as the actuation and sensing are performed on the joint level. However, upper-limb exoskeletons introduce various sources of uncertainty, which primarily result from the complex interaction dynamics at the physical interface between the patient and the robotic device. These sources of uncertainty must be considered to ensure the correctness of estimation results when performing the clinical assessment of the patient state. In this work, we analyze these sources of uncertainty and quantify their influence on the estimation of the human arm impedance. We argue that this mitigates the risk of relying on overconfident estimates and promotes more precise computational approaches in robot-based neurorehabilitation.
Collapse
Affiliation(s)
- Samuel Tesfazgi
- Chair of Information-oriented Control (ITR), TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | | | | | | |
Collapse
|
9
|
Mitchell J, Shirota C, Clanchy K. Factors that influence the adoption of rehabilitation technologies: a multi-disciplinary qualitative exploration. J Neuroeng Rehabil 2023; 20:80. [PMID: 37340496 DOI: 10.1186/s12984-023-01194-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 05/23/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Technological innovation is recognised as having the potential to enhance rehabilitation for people with disability. Yet, resistance to, and abandonment of, rehabilitation technology is prevalent and the successful translation of technology into rehabilitation settings remains limited. Therefore, the aim of this work was to develop an in-depth, multi-stakeholder perspective on what influences the adoption of rehabilitation technologies. METHODS Semi-structured focus groups were conducted as part of a larger research project aiming to facilitate the co-design of a novel neurorestorative technology. Focus group data were analysed using a five-phase hybrid deductive-inductive approach to qualitative data analysis. RESULTS Focus groups were attended by 43 stakeholders with expertise in one or more of the following fields: people with disability, allied health, human movement science, computer science, design, engineering, ethics, funding, marketing, business, product development, and research development. Six main themes influencing the adoption of technology in rehabilitation were identified: cost beyond the purchase price, benefits to all stakeholders, trust to be earned in technology, ease of technology operation, ability to access technology, and the 'co' in co-design. All six themes were found to be interrelated; in particular, the importance of direct stakeholder engagement in the development of rehabilitation technologies (the 'co' in co-design) was prevalent in all themes. CONCLUSIONS A range of complex and interrelated factors influence the adoption of rehabilitation technologies. Importantly, many of the issues that have the potential to negatively impact rehabilitation technology adoption may be addressed during development by utilising the experience and expertise of stakeholders who influence its supply and demand. Our findings state that a wider cohort of stakeholders needs to be actively engaged in the development of rehabilitation technologies to better address the factors that contribute to technology underutilisation and abandonment and facilitate better outcomes for people with disability.
Collapse
Affiliation(s)
- Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Camila Shirota
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kelly Clanchy
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
- School of Health Sciences and Social Work, Griffith University, Southport, Australia.
| |
Collapse
|
10
|
Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
Collapse
Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
11
|
Fundarò C, Casale R, Maestri R, Traversoni S, Colombo R, Salvini S, Ferretti C, Bartolo M, Buonocore M, Giardini A. Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q): development and implementation of an instrument to evaluate patients' perception during training. J Neuroeng Rehabil 2023; 20:35. [PMID: 36964543 PMCID: PMC10037786 DOI: 10.1186/s12984-023-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The introduction of technology-assisted rehabilitation (TAR) uncovers promising challenges for the treatment of motor disorders, particularly if combined with exergaming. Patients with neurological diseases have proved to benefit from TAR, improving their performance in several activities. However, the subjective perception of the device has never been fully addressed, being a conditioning factor for its use. The aims of the study were: (a) to develop a questionnaire on patients' personal experience with TAR and exergames in a real-world clinical setting; (b) to administer the questionnaire to a pilot group of neurologic patients to assess its feasibility and statistical properties. METHODS A self-administrable and close-ended questionnaire, Technology Assisted Rehabilitation Patient Perception Questionnaire (TARPP-Q), designed by a multidisciplinary team, was developed in Italian through a Delphi procedure. An English translation has been developed with consensus, for understandability purposes. The ultimate version of the questionnaire was constituted of 10 questions (5 with multiple answers), totalling 29 items, exploring the patient's performance and personal experience with TAR with Augmented Performance Feedback. TARPP-Q was then administered pre-post training in an observational, feasible, multi-centric study. The study involved in-patients aged between 18 and 85 with neurological diseases, admitted for rehabilitation with TAR (upper limb or gait). FIM scale was run to control functional performance. RESULTS Forty-four patients were included in the study. All patients answered the TARPP-Q autonomously. There were no unaccounted answers. Exploratory factor analyses identified 4 factors: Positive attitude, Usability, Hindrance perception, and Distress. Internal consistency was measured at T0. The values of Cronbach's alpha ranged from 0.72 (Distress) to 0.92 (Positive attitude). Functional Independence Measure (FIM®) scores and all TARPP-Q factors (Positive attitude, Usability, Hindrance perception, except for Distress (p = 0.11), significantly improved at the end of the treatment. A significant positive correlation between Positive attitude and Usability was also recorded. CONCLUSIONS The TARPP-Q highlights the importance of patients' personal experience with TAR and exergaming. Large-scale applications of this questionnaire may clarify the role of patients' perception of training effectiveness, helping to customize devices and interventions.
Collapse
Affiliation(s)
- Cira Fundarò
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy.
| | - Roberto Casale
- OPUSMedica PC&R, Persons, Care & Research, Piacenza, Italy
| | - Roberto Maestri
- Istituti Clinici Scientifici Maugeri, IRCCS Department of Biomedical Engineering of Montescano Institute, Pavia, PV, Italy
| | - Silvia Traversoni
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
| | - Roberto Colombo
- Istituti Clinici Scientifici Maugeri IRCCS Veruno, Veruno, NO, Italy
| | - Silvana Salvini
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Chiara Ferretti
- Istituti Clinici Scientifici Maugeri IRCSS Neuromotor Rehabilitation Unit of Montescano Institute, Pavia, PV, Italy
| | - Michelangelo Bartolo
- Habilita Department of Rehabilitation, Neurorehabilitation Unit, HABILITA Zingonia, Ciserano, Bergamo, Italy
| | - Michelangelo Buonocore
- Istituti Clinici Scientifici Maugeri Spa SB IRCCS Neurophysiopathology Unit of Montescano Institute, Pavia, PV, Italy
| | - Anna Giardini
- Istituti Clinici Scientifici Maugeri IT Department, IRCCS Pavia, Pavia, PV, Italy
| |
Collapse
|
12
|
A Novel Way to Objectively Review Emerging Rehabilitation Technologies. Am J Phys Med Rehabil 2023; 102:S75-S78. [PMID: 36634335 DOI: 10.1097/phm.0000000000002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Technology-enhanced rehabilitation can improve access to training activities in multiple care delivery settings and may improve patient outcomes. However, the rate at which rehabilitation technology is being developed makes it difficult for healthcare systems to keep pace with the volume of products emerging in this space. Formal processes are needed to help healthcare systems review products as they emerge and to determine whether they should be incorporated into clinical practice. Here, we describe an approach to reviewing emerging rehabilitation technologies as performed by the Center for Emerging Rehabilitation Technology at our institution. Developed using an iterative approach, the rehabilitation technology review process used by the Center for Emerging Rehabilitation Technology team classifies technologies into the following three categories: (1) for clinical deployment, (2) for innovation in product development/product-market fit testing, and (3) for research, for example, a sponsored clinical trial. We describe the processes used to evaluate, categorize, investigate, and integrate rehabilitation technology, share our experience with the review process, and make recommendations for other institutions who may wish to implement rehabilitation technology into clinical practice.
Collapse
|
13
|
Borzelli D, Pastorelli S, d’Avella A, Gastaldi L. Virtual Stiffness: A Novel Biomechanical Approach to Estimate Limb Stiffness of a Multi-Muscle and Multi-Joint System. SENSORS (BASEL, SWITZERLAND) 2023; 23:673. [PMID: 36679467 PMCID: PMC9861781 DOI: 10.3390/s23020673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
In recent years, different groups have developed algorithms to control the stiffness of a robotic device through the electromyographic activity collected from a human operator. However, the approaches proposed so far require an initial calibration, have a complex subject-specific muscle model, or consider the activity of only a few pairs of antagonist muscles. This study described and tested an approach based on a biomechanical model to estimate the limb stiffness of a multi-joint, multi-muscle system from muscle activations. The "virtual stiffness" method approximates the generated stiffness as the stiffness due to the component of the muscle-activation vector that does not generate any endpoint force. Such a component is calculated by projecting the vector of muscle activations, estimated from the electromyographic signals, onto the null space of the linear mapping of muscle activations onto the endpoint force. The proposed method was tested by using an upper-limb model made of two joints and six Hill-type muscles and data collected during an isometric force-generation task performed with the upper limb. The null-space projection of the muscle-activation vector approximated the major axis of the stiffness ellipse or ellipsoid. The model provides a good approximation of the voluntary stiffening performed by participants that could be directly implemented in wearable myoelectric controlled devices that estimate, in real-time, the endpoint forces, or endpoint movement, from the mapping between muscle activation and force, without any additional calibrations.
Collapse
Affiliation(s)
- Daniele Borzelli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - Stefano Pastorelli
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy
| | - Andrea d’Avella
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98122 Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - Laura Gastaldi
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129 Turin, Italy
| |
Collapse
|
14
|
Zhou L, Huo T, Zhang W, Han N, Wen Y, Zhang P. New techniques and methods for prevention and treatment of symptomatic traumatic neuroma: A systematic review. Front Neurol 2023; 14:1086806. [PMID: 36873443 PMCID: PMC9978738 DOI: 10.3389/fneur.2023.1086806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/02/2023] [Indexed: 02/18/2023] Open
Abstract
Generally, axons located at the central end of the nerve system will sprout after injury. Once these sprouts cannot reach the distal end of the severed nerve, they will form a traumatic neuroma. Traumatic neuromas bring a series of complex symptoms to patients, such as neuropathic pain, skin abnormalities, skeletal abnormalities, hearing loss, and visceral damage. To date, the most promising and practical clinical treatments are drug induction and surgery, but both have their limitations. Therefore, it will be the mainstream trend to explore new methods to prevent and treat traumatic neuroma by regulating and remodeling the microenvironment of nerve injury. This work first summarized the pathogenesis of traumatic neuroma. Additionally, the standard methods of prevention and treatment on traumatic neuroma were analyzed. We focused on three essential parts of advanced functional biomaterial therapy, stem cell therapy, and human-computer interface therapy to provide the availability and value of preventing and treating a traumatic neuroma. Finally, the revolutionary development of the prevention and treatment on traumatic neuroma has been prospected. How to transform the existing advanced functional materials, stem cells, and artificial intelligence robots into clinical practical technical means as soon as possible for high-quality nerve repair and prevention of neuroma was further discussed.
Collapse
Affiliation(s)
- Liping Zhou
- Key Laboratory of Trauma and Neural Regeneration, Department of Orthopaedics and Trauma, Peking University People's Hospital, Peking University, Beijing, China.,Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Tong Huo
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Wenmin Zhang
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Na Han
- Key Laboratory of Trauma and Neural Regeneration, Department of Orthopaedics and Trauma, Peking University People's Hospital, Peking University, Beijing, China
| | - Yongqiang Wen
- Beijing Key Laboratory for Bioengineering and Sensing Technology, Daxing Research Institute, School of Chemistry and Biological Engineering, University of Science and Technology Beijing, Beijing, China
| | - Peixun Zhang
- Key Laboratory of Trauma and Neural Regeneration, Department of Orthopaedics and Trauma, Peking University People's Hospital, Peking University, Beijing, China
| |
Collapse
|
15
|
Chellal AA, Lima J, Gonçalves J, Fernandes FP, Pacheco F, Monteiro F, Brito T, Soares S. Robot-Assisted Rehabilitation Architecture Supported by a Distributed Data Acquisition System. SENSORS (BASEL, SWITZERLAND) 2022; 22:9532. [PMID: 36502234 PMCID: PMC9740827 DOI: 10.3390/s22239532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 06/12/2023]
Abstract
Rehabilitation robotics aims to facilitate the rehabilitation procedure for patients and physical therapists. This field has a relatively long history dating back to the 1990s; however, their implementation and the standardisation of their application in the medical field does not follow the same pace, mainly due to their complexity of reproduction and the need for their approval by the authorities. This paper aims to describe architecture that can be applied to industrial robots and promote their application in healthcare ecosystems. The control of the robotic arm is performed using the software called SmartHealth, offering a 2 Degree of Autonomy (DOA). Data are gathered through electromyography (EMG) and force sensors at a frequency of 45 Hz. It also proves the capabilities of such small robots in performing such medical procedures. Four exercises focused on shoulder rehabilitation (passive, restricted active-assisted, free active-assisted and Activities of Daily Living (ADL)) were carried out and confirmed the viability of the proposed architecture and the potential of small robots (i.e., the UR3) in rehabilitation procedure accomplishment. This robot can perform the majority of the default exercises in addition to ADLs but, nevertheless, their limits were also uncovered, mainly due to their limited Range of Motion (ROM) and cost.
Collapse
Affiliation(s)
- Arezki Abderrahim Chellal
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Engineering Department, School of Sciences and Technology, UTAD, 5000-801 Vila Real, Portugal
| | - José Lima
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- INESC TEC—INESC Technology and Science, 4200-465 Porto, Portugal
| | - José Gonçalves
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- INESC TEC—INESC Technology and Science, 4200-465 Porto, Portugal
| | - Florbela P. Fernandes
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
| | - Fátima Pacheco
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
| | - Fernando Monteiro
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
| | - Thadeu Brito
- Research Centre in Digitalization and Intelligent Robotics CeDRI, Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- Laboratório para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, 5300-252 Bragança, Portugal
- INESC TEC—INESC Technology and Science, 4200-465 Porto, Portugal
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal
| | - Salviano Soares
- Engineering Department, School of Sciences and Technology, UTAD, 5000-801 Vila Real, Portugal
- IEETA—Institute of Electronics and Informatics Engineering of Aveiro, 3810-193 Aveiro, Portugal
| |
Collapse
|
16
|
Dostalova K, Tomasek R, Kalova M, Janura M, Rosicky J, Schnitzer M, Demel J. Review of ankle rehabilitation devices for treatment of equinus contracture. Expert Rev Med Devices 2022; 19:721-731. [PMID: 36225151 DOI: 10.1080/17434440.2022.2136029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Equinus contracture is a serious disability and attention should be paid to proper and effective treatment. Most attention is given to neurologically impaired patients, but the incidence of equinus contracture is much higher, for example, in post-traumatic patients. In addition to conventional physical therapy, robotic rehabilitation treatment is one of the promising procedures to precede severe contraction cases and the need for surgery. AREAS COVERED This study aims to cover the description of different types of stationary and wearable ankle rehabilitation devices suitable for the treatment of equinus contracture and point to deficiency in research, clinical trials, and launch of the market. EXPERT OPINION This review provides insight into ankle rehabilitation devices with a focus on equinus contracture. Due to the fact that robotic devices successfully restore the condition of patients, attention should not be paid only to those with neurological impairments. This paper points that future research should be effectively linked to clinical practice with the aim of covering a wider range of disabilities and make an effort to successfully introduce devices from development into the practice.
Collapse
Affiliation(s)
- Kamila Dostalova
- Center of Advanced Innovation Technologies, VSB-Technical University of Ostrava, CZ
| | - Radek Tomasek
- Center of Advanced Innovation Technologies, VSB-Technical University of Ostrava, CZ
| | - Martina Kalova
- Center of Advanced Innovation Technologies, VSB-Technical University of Ostrava, CZ
| | | | | | - Marek Schnitzer
- Department of Biomedical Engineering and Measurement, Technical University of Kosice, SK
| | - Jiri Demel
- Institute of Emergency Medicine, University of Ostrava, CZ.,Trauma Center, Faculty Hospital of Ostrava, CZ
| |
Collapse
|
17
|
Anusitviwat C, Vanitcharoenkul E, Chotiyarnwong P, Unnanuntana A. Surgical treatment for fragility hip fractures during the COVID-19 pandemic resulted in lower short-term postoperative functional outcome and a higher complication rate compared to the pre-pandemic period. Osteoporos Int 2022; 33:2217-2226. [PMID: 35809122 PMCID: PMC9540207 DOI: 10.1007/s00198-022-06485-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
UNLABELLED The COVID-19 pandemic adversely affected the functional outcomes of fragility hip fracture patients. This study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among patients treated during the pandemic. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods. INTRODUCTION This study aims to investigate the in-hospital complication rate and short-term postoperative functional outcomes of fragility hip fracture (FHF) patients compared between during the COVID-19 pandemic and the same 14-month time period 1 year prior to the pandemic. METHODS Using data from the Siriraj Fracture Liaison Service registry, FHF patients treated during the COVID-19 pandemic (1 March 2020 to 30 April 2021) were time-matched with FHF patients treated during the pre-pandemic period (1 March 2018 to 30 April 2019). We collected the rate of in-hospital postoperative complications and the postoperative functional outcomes at discharge and 3 months as measured by the Barthel Index (BI) and EuroQol visual analog scale (EQ-VAS). Functional outcome measures were compared between the pre-pandemic and pandemic periods. RESULTS There were 197 and 287 patients in the pre-pandemic and pandemic groups, respectively. At the 3-month postoperative follow-up, the mean postoperative BI score and change in BI score were both significantly lower in the pandemic group indicating poorer postoperative function. Moreover, FHF patients treated during the pandemic had significantly more in-hospital complications (36.6% vs. 22.8%, p = 0.002). There was no significant difference in the 3-month EQ-VAS or change in the EQ-VAS between groups. CONCLUSION The results of this study revealed a higher in-hospital complication rate and lower postoperative function at 3 months among FHF patients treated during the COVID-19 pandemic compared to the pre-pandemic period. Therefore, modified in-hospital and post-discharge protocols should be developed for implementation during pandemic crisis periods.
Collapse
Affiliation(s)
- Chirathit Anusitviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Ekasame Vanitcharoenkul
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pojchong Chotiyarnwong
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
18
|
Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091248. [PMID: 36143925 PMCID: PMC9505091 DOI: 10.3390/medicina58091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.
Collapse
|
19
|
Realmuto J, Sanger TD. Assisting Forearm Function in Children With Movement Disorders via A Soft Wearable Robot With Equilibrium-Point Control. Front Robot AI 2022; 9:877041. [PMID: 35783026 PMCID: PMC9240630 DOI: 10.3389/frobt.2022.877041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
Wearable robots are envisioned to amplify the independence of people with movement impairments by providing daily physical assistance. For portable, comfortable, and safe devices, soft pneumatic-based robots are emerging as a potential solution. However, due to the inherent complexities, including compliance and nonlinear mechanical behavior, feedback control for facilitating human–robot interaction remains a challenge. Herein, we present the design, fabrication, and control architecture of a soft wearable robot that assists in supination and pronation of the forearm. The soft wearable robot integrates an antagonistic pair of pneumatic-based helical actuators to provide active pronation and supination torques. Our main contribution is a bio-inspired equilibrium-point control scheme for integrating proprioceptive feedback and exteroceptive input (e.g., the user’s muscle activation signals) directly with the on/off valve behavior of the soft pneumatic actuators. The proposed human–robot controller is directly inspired by the equilibrium-point hypothesis of motor control, which suggests that voluntary movements arise through shifts in the equilibrium state of the antagonistic muscle pair spanning a joint. We hypothesized that the proposed method would reduce the required effort during dynamic manipulation without affecting the error. In order to evaluate our proposed method, we recruited seven pediatric participants with movement disorders to perform two dynamic interaction tasks with a haptic manipulandum. Each task required the participant to track a sinusoidal trajectory while the haptic manipulandum behaved as a Spring-Dominate system or Inertia-Dominate system. Our results reveal that the soft wearable robot, when active, reduced user effort on average by 14%. This work demonstrates the practical implementation of an equilibrium-point volitional controller for wearable robots and provides a foundational path toward versatile, low-cost, and soft wearable robots.
Collapse
Affiliation(s)
- Jonathan Realmuto
- Department of Mechanical Engineering, University of California, Riverside, Riverside, CA, United States
- *Correspondence: Jonathan Realmuto,
| | - Terence D. Sanger
- Department of Electrical Engineering and Computer Science, University of California, Irvine, Irvine, CA, United States
- Children’s Hospital of Orange County, Orange, CA, United States
| |
Collapse
|
20
|
Roboethics in Remote Human Interactions and Rehabilitative Therapeutics. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Global aging, the need for continuous high-quality services, and the recent COVID-19 pandemic have caused many sectors to reduce in-person contact between individuals where possible, and to instead use remote communication technology. With increased robot use replacing in-person interventions, ethical considerations arise. The benefits of robotic technology must be weighed against the possibility of harm to humans. The first rules of roboethics were written by Isaac Asimov in 1942, but these pre-date the range of robotic applications used today. There is no central agency for oversight in Canada, although universities and funding organizations have developed guidelines. Roboethical considerations include data use and privacy, the common good, and safety. Humans may potentially form emotional bonds with robots. Loss of jobs to automation is also a concern, particularly when many workers have suffered job losses due to the pandemic. Some health care services have switched to a remote care model, to reduce the spread of COVID-19. Remote hand rehabilitation of patients with brain injury is possible with iManus. Using a portable smart-glove technology, patients practice rehabilitative hand movements that are analyzed remotely through a sensor that offers instantaneous feedback. A therapist monitors their patient’s progress remotely and designs individualized programs. This technology benefits humanity by improving access to care for patients globally. The importance of data security and privacy is emphasized. As patient progress will be monitored by a human (a therapist), the safety of iManus is not a concern. The principles discussed in this paper can help researchers and engineers design ethical robotics in remote health care settings.
Collapse
|
21
|
3D Localization of Hand Acupoints Using Hand Geometry and Landmark Points Based on RGB-D CNN Fusion. Ann Biomed Eng 2022; 50:1103-1115. [PMID: 35660982 DOI: 10.1007/s10439-022-02986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/21/2022] [Indexed: 11/01/2022]
Abstract
Acupoint stimulation has proven to be of significant importance for rehabilitation and preventive therapy. Moxibustion, a kind of acupoint therapy, has mainly been performed by practitioners relying on manual localization and positioning of acupoints, leading to variance in the accuracy owing to human error. Developments in the automatic detection of acupoints using deep learning techniques have proven to somewhat tackle the problem. But the current methods lack depth-based localization and are thus confined to two-dimensional (2D) localization. In this research, a new approach towards 3D acupoint localization is introduced, based on a fusion of RGB and depth convolutional neural networks (CNN) to guide the manipulator. This research aims to tackle the challenge of real-time 3D acupoint localization in order to provide guidance for robot-controlled moxibustion. In the first step, the 3D sensor (Kinect v1) is calibrated and transformation matrix is computed to project the depth data into the RGB domain. Secondly, a fusion of RGB-CNN and depth-CNN is employed, in order to obtain 3D localization. Lastly, 3D coordinates are fed to the manipulator to perform artificially controlled moxibustion therapy. Furthermore, a 3D acupoint dataset consisting of RGB and depth images of hands, is constructed to train, validate and test the network. The network was able to localize 5 sets of acupoints with an average localization error of less than 0.09. Further experiments prove the efficacy of the approach and lay grounds for development of automatic moxibustion robots.
Collapse
|
22
|
Heng W, Solomon S, Gao W. Flexible Electronics and Devices as Human-Machine Interfaces for Medical Robotics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2107902. [PMID: 34897836 PMCID: PMC9035141 DOI: 10.1002/adma.202107902] [Citation(s) in RCA: 107] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/08/2021] [Indexed: 05/02/2023]
Abstract
Medical robots are invaluable players in non-pharmaceutical treatment of disabilities. Particularly, using prosthetic and rehabilitation devices with human-machine interfaces can greatly improve the quality of life for impaired patients. In recent years, flexible electronic interfaces and soft robotics have attracted tremendous attention in this field due to their high biocompatibility, functionality, conformability, and low-cost. Flexible human-machine interfaces on soft robotics will make a promising alternative to conventional rigid devices, which can potentially revolutionize the paradigm and future direction of medical robotics in terms of rehabilitation feedback and user experience. In this review, the fundamental components of the materials, structures, and mechanisms in flexible human-machine interfaces are summarized by recent and renowned applications in five primary areas: physical and chemical sensing, physiological recording, information processing and communication, soft robotic actuation, and feedback stimulation. This review further concludes by discussing the outlook and current challenges of these technologies as a human-machine interface in medical robotics.
Collapse
Affiliation(s)
- Wenzheng Heng
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Samuel Solomon
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Wei Gao
- Andrew and Peggy Cherng Department of Medical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| |
Collapse
|
23
|
Barak Ventura R, Stewart Hughes K, Nov O, Raghavan P, Ruiz Marín M, Porfiri M. Data-Driven Classification of Human Movements in Virtual Reality-Based Serious Games: Preclinical Rehabilitation Study in Citizen Science. JMIR Serious Games 2022; 10:e27597. [PMID: 35142629 PMCID: PMC8874800 DOI: 10.2196/27597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Sustained engagement is essential for the success of telerehabilitation programs. However, patients’ lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science–based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). Objective This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. Methods In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users’ range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software’s response to their movements. During calibration, the time series of the users’ movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. Results The classification achieved high performance, reaching 99.9% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8%). Conclusions Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation.
Collapse
Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Kora Stewart Hughes
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Manuel Ruiz Marín
- Department of Quantitative Methods, Law and Modern Languages, Technical University of Cartagena, Cartagena, Spain.,Murcia Bio-Health Institute (IMIB-Arrixaca), Health Science Campus, Cartagena, Spain
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Center for Urban Science and Progress, New York University, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| |
Collapse
|
24
|
Li L, Tyson S, Weightman A. Professionals' Views and Experiences of Using Rehabilitation Robotics With Stroke Survivors: A Mixed Methods Survey. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:780090. [PMID: 35047969 PMCID: PMC8757825 DOI: 10.3389/fmedt.2021.780090] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/22/2021] [Indexed: 01/01/2023] Open
Abstract
Objective: To understand the reason for low implementation of clinical and home-based rehabilitation robots and their potential. Design: Online questionnaire (November 2020 and February 2021). Subjects: A total of 100 professionals in stroke rehabilitation area were involved (Physiotherapists n = 62, Occupation therapists n = 35). Interventions: Not applicable. Main Measures: Descriptive statistics and thematic content analysis were used to analyze the responses: 1. Participants' details, 2. Professionals' views and experience of using clinical rehabilitation robots, 3. Professionals' expectation and concerns of using home-based rehabilitation robots. Results: Of 100 responses, 37 had experience of rehabilitation robots. Professionals reported that patients enjoyed using them and they increased accessibility, autonomy, and convenience especially when used at home. The main emergent themes were: "aims and objectives for rehabilitation robotics," "requirements" (functional, software, and safety), "cost," "patient factors" (contraindications, cautions, and concerns), and "staff issues" (concerns and benefits). The main benefits of rehabilitation robots were that they provided greater choice for therapy, increased the amount/intensity of treatment, and greater motivation to practice. Professionals perceived logistical issues (ease of use, transport, and storage), cost and limited adaptability to patients' needs to be significant barriers to tier use, whilst acknowledging they can reduce staff workload to a certain extent. Conclusion: The main reported benefit of rehabilitation robots were they increased the amount of therapy and practice after stroke. Ease of use and adaptability are the key requirements. High cost and staffing resources were the main barriers.
Collapse
Affiliation(s)
- Lutong Li
- Department of Mechanical, Aerospace and Civil Engineering, School of Engineering, University of Manchester, Manchester, United Kingdom
| | - Sarah Tyson
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Andrew Weightman
- Department of Mechanical, Aerospace and Civil Engineering, School of Engineering, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
25
|
A compact, compliant, and biomimetic robotic assistive glove driven by twisted string actuators. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2021. [DOI: 10.1007/s41315-021-00198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
26
|
Jayasree-Krishnan V, Ghosh S, Palumbo A, Kapila V, Raghavan P. Developing a Framework for Designing and Deploying Technology-Assisted Rehabilitation After Stroke: A Qualitative Study. Am J Phys Med Rehabil 2021; 100:774-779. [PMID: 33141773 DOI: 10.1097/phm.0000000000001634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Many unmet rehabilitation needs of patients with stroke can be addressed effectively using technology. However, technological solutions have not yet been seamlessly incorporated into clinical care. The purpose of this pilot study was to examine how to bridge the gaps between the recovery process, technology, and clinical practice to impact stroke rehabilitation meaningfully. DESIGN Semistructured interviews were performed using a grounded theory approach with purposive sampling of 17 diverse expert providers in acute care, inpatient, and outpatient stroke rehabilitation settings. Common themes were identified from qualitative analyses of the transcribed conversations to develop a guiding framework from the emerging concepts. RESULTS Four core themes emerged that addressed major barriers in stroke rehabilitation and technology-assisted solutions to overcome these barriers: (1) accessibility to quality rehabilitation, (2) adaptability to patient differences, (3) accountability or compliance with rehabilitation, and (4) engagement with rehabilitation. CONCLUSIONS The results suggest a four-pronged framework, the A3E framework that stands for Accessibility, Adaptability, Accountability, and Engagement, to comprehensively address existing barriers in providing rehabilitation services. This framework can guide technology developers and clinicians in designing and deploying technology-assisted rehabilitation solutions for poststroke rehabilitation, particularly using telerehabilitation.
Collapse
Affiliation(s)
- Veena Jayasree-Krishnan
- From the Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, Brooklyn, New York (VJ-K, SG, VK); Department of Rehabilitation Science, NYU Steinhardt School of Culture, Education, and Human Development, New York, New York (AP); and Rusk Rehabilitation, New York University School of Medicine, New York, New York (PR)
| | | | | | | | | |
Collapse
|
27
|
Sung-U S, Nisa BU, Yotsumoto K, Tanemura R. Effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy: a systematic review protocol. BMJ Open 2021; 11:e045051. [PMID: 33980527 PMCID: PMC8118031 DOI: 10.1136/bmjopen-2020-045051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The application of advanced technologies in paediatric rehabilitation to improve performance and enhance everyday functioning shows considerable promise. The aims of this systematic review are to investigate the effectiveness of robotic-assisted therapy for upper extremity function in children and adolescents with cerebral palsy and to extend the scope of intervention from empirical evidence. METHODS AND ANALYSIS Multiple databases, including MEDLINE (Ovid), PubMed, CINAHL, Scopus, Web of Science, Cochrane Library and IEEE Xplore, will be comprehensively searched for relevant randomised controlled trials and non-randomised studies. The grey literature will be accessed on the ProQuest Dissertations & Theses Global database, and a hand search from reference lists of previous articles will be performed. The papers written in English language will be considered, with no limitation on publication date. Two independent reviewers will identify eligible studies, evaluate the level of evidence (the Oxford Centre for Evidence-Based Medicine) and appraise methodological quality and risk of bias (the Standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst tool); the Grading of Recommendations Assessment, Development and Evaluation). Data will be appropriately extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. A narrative synthesis will be provided to summarise the results, and a meta-analysis will be conducted if there is sufficient homogeneity across outcomes. PROSPERO REGISTRATION NUMBER CRD42020205818. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The findings will be disseminated via a peer-reviewed journal and international conferences.
Collapse
Affiliation(s)
- Sasithorn Sung-U
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
- Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Mueang Chiang Mai, Chiang Mai, Thailand
| | - Badur Un Nisa
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Kayano Yotsumoto
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| | - Rumi Tanemura
- Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, Kobe, Hyogo, Japan
| |
Collapse
|
28
|
Lewandowski B, Wudarczyk S, Sperzyński P, Bałchanowski J. Prediction of Motion Intentions as a Novel Method of Upper Limb Rehabilitation Support. SENSORS (BASEL, SWITZERLAND) 2021; 21:E410. [PMID: 33430138 PMCID: PMC7827685 DOI: 10.3390/s21020410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/02/2021] [Accepted: 01/03/2021] [Indexed: 11/16/2022]
Abstract
This article is devoted to the novel method of upper limb rehabilitation support using a dedicated mechatronic system. The mechatronic rehabilitation system's main advantages are the repeatability of the process and the ability to measure key features and the progress of the therapy. In addition, the assisted therapy standard is the same for each patient. The new method proposed in this article is based on the prediction of the patient's intentions, understood as the intentions to perform a movement that would be not normally possible due to the patient's limited motor functions. Determining those intentions is realized based on a comparative analysis of measured kinematic (range of motion, angular velocities, and accelerations) and dynamic parameter values, as well as external loads resulting from the interaction of patients. Appropriate procedures were implemented in the control system, for which verification was conducted via experiments. The aim of the research in the article was to examine whether it is possible to sense the movement intentions of a patient during exercises, using only measured load parameters and kinematic parameters of the movement. In this study, the construction of a mechatronic system prototype equipped with sensory grip to measure the external loads, control algorithms, and the description of experimental studies were presented. The experimental studies of the mechanism were aimed at the verification of the proper operation of the system and were not a clinical trial.
Collapse
Affiliation(s)
- Bogusz Lewandowski
- Department of Mechanical Engineering, Wroclaw University of Science and Technology, 30-370 Wroclaw, Poland; (S.W.); (P.S.); (J.B.)
| | | | | | | |
Collapse
|
29
|
ÇEKMECE Ç, SADE I. İnmeli Hastalarda Robotik Rehabilitasyonun El Fonksiyonları ve Günlük Yaşam Aktiviteleri Üzerine Etkisi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.756705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Burdea G, Kim N, Polistico K, Kadaru A, Roll D, Grampurohit N. Novel integrative rehabilitation system for the upper extremity: Design and usability evaluation. J Rehabil Assist Technol Eng 2021; 8:20556683211012885. [PMID: 34422282 PMCID: PMC8373277 DOI: 10.1177/20556683211012885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/08/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Design and test the usability of a novel virtual rehabilitation system for bimanual training of gravity supported arms, pronation/supination, grasp strengthening, and finger extension. METHODS A robotic rehabilitation table, therapeutic game controllers, and adaptive rehabilitation games were developed. The rehabilitation table lifted/lowered and tilted up/down to modulate gravity loading. Arms movement was measured simultaneously, allowing bilateral training. Therapeutic games adapted through a baseline process. Four healthy adults performed four usability evaluation sessions each, and provided feedback using the USE questionnaire and custom questions. Participant's game play performance was sampled and analyzed, and system modifications made between sessions. RESULTS Participants played four sessions of about 50 minutes each, with training difficulty gradually increasing. Participants averaged a total of 6,300 arm repetitions, 2,200 grasp counts, and 2,100 finger extensions when adding counts for each upper extremity. USE questionnaire data averaged 5.1/7 rating, indicative of usefulness, ease of use, ease of learning, and satisfaction with the system. Subjective feedback on the custom evaluation form was 84% favorable. CONCLUSIONS The novel system was well-accepted, induced high repetition counts, and the usability study helped optimize it and achieve satisfaction. Future studies include examining effectiveness of the novel system when training patients acute post-stroke.
Collapse
Affiliation(s)
- Grigore Burdea
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Electrical and Computer Engineering, Rutgers – The
State University of New Jersey, Piscataway, NJ, USA
| | - Nam Kim
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Kevin Polistico
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Ashwin Kadaru
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Doru Roll
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
| | - Namrata Grampurohit
- Bright Cloud International Corp, Corporate Laboratories, North
Brunswick, NJ, USA
- Department of Occupational Therapy, Jefferson University,
Philadelphia, PA, USA
| |
Collapse
|
31
|
Thacham Poyil A, Steuber V, Amirabdollahian F. Adaptive robot mediated upper limb training using electromyogram-based muscle fatigue indicators. PLoS One 2020; 15:e0233545. [PMID: 32469912 PMCID: PMC7259541 DOI: 10.1371/journal.pone.0233545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/07/2020] [Indexed: 11/18/2022] Open
Abstract
Studies on improving the adaptability of upper limb rehabilitation training do not often consider the implications of muscle fatigue sufficiently. In this study, electromyogram features were used as fatigue indicators in the context of human-robot interaction. They were utilised for auto-adaptation of the task difficulty, which resulted in a prolonged training interaction. The electromyogram data was collected from three gross-muscles of the upper limb in 30 healthy participants. The experiment followed a protocol for increasing the muscle strength by progressive strength training, that was an implementation of a known method in sports science for muscle training, in a new domain of robotic adaptation in muscle training. The study also compared how the participants in three experimental conditions perceived the change in task difficulty levels. One task benefitted from robotic adaptation (Intervention group) where the robot adjusted the task difficulty. The other two tasks were control groups 1 and 2. There was no difficulty adjustment at all in Control 1 group and the difficulty was adjusted manually in Control 2 group. The results indicated that the participants could perform a prolonged progressive strength training exercise with more repetitions with the help of a fatigue-based robotic adaptation, compared to the training interactions, which were based on manual/no adaptation. This study showed that it is possible to alter the level of the challenge using fatigue indicators, and thus, increase the interaction time. The results of the study are expected to be extended to stroke patients in the future by utilising the potential for adapting the training difficulty according to the patient's muscular state, and also to have a large number repetitions in a robot-assisted training environment.
Collapse
Affiliation(s)
| | - Volker Steuber
- School of Computer Science, University of Hertfordshire, Hatfield, United Kingdom
| | | |
Collapse
|
32
|
Barak Ventura R, Rizzo A, Nov O, Porfiri M. A 3D printing approach toward targeted intervention in telerehabilitation. Sci Rep 2020; 10:3694. [PMID: 32111880 PMCID: PMC7048757 DOI: 10.1038/s41598-020-59927-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/05/2020] [Indexed: 01/11/2023] Open
Abstract
Neuromuscular impairment requires adherence to a rehabilitation regimen for maximum recovery of motor function. Consumer-grade game controllers have emerged as a viable means to relay supervised physical therapy to patients' homes, thereby increasing their accessibility to healthcare. These controllers allow patients to perform exercise frequently and improve their rehabilitation outcomes. However, the non-universal design of game controllers targets healthy people and does not always accommodate people with disability. Consequently, many patients experience considerable difficulty assuming certain hand postures and performing the prescribed exercise correctly. Here, we explore the feasibility of improving rehabilitation outcomes through a 3D printing approach that enhances off-the-shelf game controllers in home therapy. Specifically, a custom attachment was 3D printed for a commercial haptic device that mediates fine motor rehabilitation. In an experimental study, 25 healthy subjects performed a navigation task, with the retrofit attachment and without it, while simulating disability of the upper limb. When using the attachment, subjects extended their wrist range of motion, yet maintained their level of compensation. The subjects also showed higher motivation to repeat the exercise with the enhanced device. The results bring forward evidence for the potential of this approach in transforming game controllers toward targeted interventions in home therapy.
Collapse
Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA
| | - Alessandro Rizzo
- Dipartimento di Elettronica e Telecomunicazioni, Politecnico di Torino, Corso Duca degli Abruzzi 24, Torino, 10129, Italy.,Office of Innovation, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, 5 MetroTech Center, Brooklyn, New York, 11201, USA
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA. .,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York, 11201, USA.
| |
Collapse
|
33
|
Factors Influencing Usability of Rehabilitation Robotic Devices for Lower Limbs. SUSTAINABILITY 2020. [DOI: 10.3390/su12020598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In recent years, there has been a sharp increase in the number of elderly people in South Korea; this has led to rising costs and concerns on the quality of physical therapy treatment involving rehabilitation robotic devices. Therefore, the government has asked academia to expand its research scope to evaluate the usability of these devices. Hence, this study aimed to identify the major factors influencing the usability of a rehabilitation robotic device for lower limbs and the reasons for involving several diverse user groups for a more comprehensive evaluation. To measure usability as perceived by three primary user groups of user experience (UX) professionals, rehab professionals, and lay people, this study collected 196 survey. The results of an EFA showed that among three general quality factors and five device specific factors, visual pertinence, use confidence, and safety were the critical factors influencing usability, and the results of ANOVA offered that there was discrepancy in the influential factors, namely visual pertinence, transferring, and holding the body. These findings indicate that the necessity of employing a posture-centered approach and multiple user groups in assessing the usability of rehabilitation devices. Given these findings, it is suggested that the industry and design community should move toward implementing a more explorative perspective to enable a more human-centered and posture-concerned approach to provide better usability to the diverse users of medical devices.
Collapse
|
34
|
Improving the Efficiency of Robot-Mediated Rehabilitation by Using a New Organizational Model: An Observational Feasibility Study in an Italian Rehabilitation Center. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9245357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Robotic rehabilitation is a promising way to restore upper limb function, but new organizational models are crucial in order to improve its sustainability. We aimed to analyze the feasibility of a robot-Assisted REhabilitation Area (robotAREA) equipped with four devices, using a new organizational model in which one physiotherapist supervises up to four patients. In 33 days, 60 patients were treated in the robotAREA. Two hundred fifty-five rehabilitation sessions were analyzed, each including two, three, or four patients supervised by one physiotherapist (the R2, R3, and R4 group, respectively). For each session, the duration of (a) setup, (b) training, (c) supervision, (d) session closure, and participant satisfaction were measured. For each patient, upper limb impairment, disability, mobility, and comorbidity were recorded. The time of training in the R4 group was lower by only 2 and 3 min compared to the R2 and R3 groups, respectively, while the supervision significantly changed between the R2, R3, and R4 groups. No differences were observed in satisfaction. Moreover, according to the logistic regression analysis, when the mean disability of the group is moderate, four patients can be supervised by one physiotherapist. These results suggest that the proposed model is feasible, and the mean disability of the group could influence the proper physiotherapist/patient ratio.
Collapse
|
35
|
Fu MJ, Harley MY, Hisel T, Busch R, Wilson R, Chae J, Knutson JS. Ability of people with post-stroke hemiplegia to self-administer FES-assisted hand therapy video games at home: An exploratory case series. J Rehabil Assist Technol Eng 2019; 6:2055668319854000. [PMID: 31360537 PMCID: PMC6636424 DOI: 10.1177/2055668319854000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/03/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction This article describes the development and initial clinical testing of an innovative home-based treatment for upper extremity hemiplegia that integrates contralaterally controlled functional electrical stimulation with hand therapy video games. Methods We explored the ability of seven participants with moderate-to-severe hand impairment to self-administer 12 weeks of contralaterally controlled functional electrical stimulation video game therapy at home for 10 h/week and in-lab with a therapist for four h/week. Clinical suitability was assessed by device usage logs, qualitative surveys, and clinical motor and cognitive outcomes. Results Three participants completed the study with > 95% compliance and four did not. Factors linked to incompletion included development of trigger finger in the non-paretic hand, acceptance of a new full-time job, residence relocation, and persistence of drowsiness from anti-spasticity medication. Those who completed the treatment perceived qualitative benefits and experienced gains in motor and cognitive outcomes. Conclusion Individuals with moderate-to-severe chronic post-stroke upper extremity hemiplegia can self-administer contralaterally controlled functional electrical stimulation video game therapy for up to 90 min/day at home. We also identified social and physiological factors that may preclude its use for daily home treatment. Further studies are warranted and are in progress to estimate treatment effect and optimal dose of this intervention.
Collapse
Affiliation(s)
- Michael J Fu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA.,MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA.,Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Y Harley
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA
| | - Terri Hisel
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA
| | - Robyn Busch
- Epilepsy Center and Department of Psychiatry and Psychology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard Wilson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA.,Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - John Chae
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA.,Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Jayme S Knutson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, OH, USA.,Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
36
|
Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132689] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuromotor disorders negatively affect the sensorimotor system, limiting the ability to perform daily activities autonomously. Rehabilitation of upper limb impairments is therefore essential to improve independence and quality of life. In the last two decades, there has been a growing interest in robot-assisted rehabilitation as a beneficial way to promote children recovery process. However, a common understanding of the best drivers of an effective intervention has not been reached yet. With this aim, the current study reviewed the existing literature on robot-assisted rehabilitation protocols for upper extremities in children, with the goal of examining the effects of robotic therapy on their sensorimotor recovery process. A literature search was conducted in several electronic database to identify the studies related to the application of robotic therapy on upper limbs in the pediatric population. We analyzed three reviews and 35 studies that used 14 different robotic devices, and an overview of their characteristics, applications in the clinical setting and results is provided. Besides, the potential benefits of robot-assisted assessment and therapy are discussed to identify the key factors yielding positive outcomes in children. Finally, this review aim to lay the foundations for more effective neuroplasticity-enhancement protocols and elicit insights into robot-based approaches.
Collapse
|
37
|
Barak Ventura R, Nakayama S, Raghavan P, Nov O, Porfiri M. The Role of Social Interactions in Motor Performance: Feasibility Study Toward Enhanced Motivation in Telerehabilitation. J Med Internet Res 2019; 21:e12708. [PMID: 31094338 PMCID: PMC6540723 DOI: 10.2196/12708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Robot-mediated telerehabilitation has the potential to provide patient-tailored cost-effective rehabilitation. However, compliance with therapy can be a problem that undermines the prospective advantages of telerehabilitation technologies. Lack of motivation has been identified as a major factor that hampers compliance. Exploring various motivational interventions, the integration of citizen science activities in robotics-based rehabilitation has been shown to increase patients' motivation to engage in otherwise tedious exercises by tapping into a vast array of intrinsic motivational drivers. Patient engagement can be further enhanced by the incorporation of social interactions. OBJECTIVE Herein, we explored the possibility of bolstering engagement in physical therapy by leveraging cooperation among users in an environmental citizen science project. Specifically, we studied how the integration of cooperation into citizen science influences user engagement, enjoyment, and motor performance. Furthermore, we investigated how the degree of interdependence among users, such that is imposed through independent or joint termination (JT), affects participation in citizen science-based telerehabilitation. METHODS We developed a Web-based citizen science platform in which users work in pairs to classify images collected by an aquatic robot in a polluted water canal. The classification was carried out by labeling objects that appear in the images and trashing irrelevant labels. The system was interfaced by a haptic device for fine motor rehabilitation. We recruited 120 healthy volunteers to operate the platform. Of these volunteers, 98 were cooperating in pairs, with 1 user tagging images and the other trashing labels. The other 22 volunteers performed both tasks alone. To vary the degree of interdependence within cooperation, we implemented independent and JTs. RESULTS We found that users' engagement and motor performance are modulated by their assigned task and the degree of interdependence. Motor performance increased when users were subjected to independent termination (P=.02), yet enjoyment decreased when users were subjected to JT (P=.005). A significant interaction between the type of termination and the task was found to influence productivity (P<.001) as well as mean speed, peak speed, and path length of the controller (P=.01, P=.006, and P<.001, respectively). CONCLUSIONS Depending on the type of termination, cooperation was not always positively associated with engagement, enjoyment, and motor performance. Therefore, enhancing user engagement, satisfaction, and motor performance through cooperative citizen science tasks relies on both the degree of interdependence among users and the perceived nature of the task. Cooperative citizen science may enhance motivation in robotics-based telerehabilitation, if designed attentively.
Collapse
Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| |
Collapse
|
38
|
Nizamis K, Stienen AHA, Kamper DG, Keller T, Plettenburg DH, Rouse EJ, Farina D, Koopman BFJM, Sartori M. Transferrable Expertise From Bionic Arms to Robotic Exoskeletons: Perspectives for Stroke and Duchenne Muscular Dystrophy. ACTA ACUST UNITED AC 2019. [DOI: 10.1109/tmrb.2019.2912453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
39
|
Almekkawy M, Chen J, Ellis MD, Haemmerich D, Holmes DR, Linte CA, Panescu D, Pearce J, Prakash P, Zderic V. Therapeutic Systems and Technologies: State-of-the-Art Applications, Opportunities, and Challenges. IEEE Rev Biomed Eng 2019; 13:325-339. [PMID: 30951478 PMCID: PMC7341980 DOI: 10.1109/rbme.2019.2908940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this review, we present current state-of-the-art developments and challenges in the areas of thermal therapy, ultrasound tomography, image-guided therapies, ocular drug delivery, and robotic devices in neurorehabilitation. Additionally, intellectual property and regulatory aspects pertaining to therapeutic systems and technologies are addressed.
Collapse
|
40
|
Bodenhagen L, Suvei SD, Juel WK, Brander E, Krüger N. Robot technology for future welfare: meeting upcoming societal challenges – an outlook with offset in the development in Scandinavia. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00302-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
41
|
Nakayama S, Tolbert TJ, Nov O, Porfiri M. Social Information as a Means to Enhance Engagement in Citizen Science‐Based Telerehabilitation. J Assoc Inf Sci Technol 2018. [DOI: 10.1002/asi.24147] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Shinnosuke Nakayama
- Department of Mechanical and Aerospace Engineering New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
| | - Tyrone J. Tolbert
- Department of Mechanical and Aerospace Engineering New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
| | - Oded Nov
- Department of Technology Management and Innovation New York University Tandon School of Engineering 5 MetroTech Center, Brooklyn NY 11201
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, New York University Tandon School of Engineering 6 MetroTech Center, Brooklyn NY 11201
| |
Collapse
|
42
|
Cao W, Zhang F, Yu H, Hu B, Meng Q. Preliminary research of a novel center-driven robot for upper extremity rehabilitation. Technol Health Care 2018; 26:409-420. [PMID: 29400683 DOI: 10.3233/thc-171060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Loss of upper limb function often appears after stroke. Robot-assisted systems are becoming increasingly common in upper extremity rehabilitation. Rehabilitation robot provides intensive motor therapy, which can be performed in a repetitive, accurate and controllable manner. OBJECTIVE This study aims to propose a novel center-driven robot for upper extremity rehabilitation. METHODS A new power transmission mechanism is designed to transfer the power to elbow and shoulder joints from three motors located on the base. The forward and inverse kinematics equations of the center-driven robot (CENTROBOT) are deduced separately. The theoretical values of the scope of joint movements are obtained with the Denavit-Hartenberg parameters method. A prototype of the CENTROBOT is developed and tested. RESULTS The elbow flexion/extension, shoulder flexion/extension and shoulder adduction/abduction can be realized of the center-driven robot. The angles value of joints are in conformity with the theoretical value. CONCLUSIONS The CENTROBOT reduces the overall size of the robot arm, the influence of motor noise, radiation and other adverse factors by setting all motors on the base. It can satisfy the requirements of power and movement transmission of the robot arm.
Collapse
Affiliation(s)
- Wujing Cao
- Rehabilitation Engineering and Technology Institute, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China.,Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Fei Zhang
- Rehabilitation Engineering and Technology Institute, University of Shanghai for Science and Technology, Shanghai, China
| | - Hongliu Yu
- Rehabilitation Engineering and Technology Institute, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China.,Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Bingshan Hu
- Rehabilitation Engineering and Technology Institute, University of Shanghai for Science and Technology, Shanghai, China
| | - Qiaoling Meng
- Rehabilitation Engineering and Technology Institute, University of Shanghai for Science and Technology, Shanghai, China.,Shanghai Engineering Research Center of Assistive Devices, Shanghai, China.,Key Laboratory of Neural-functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| |
Collapse
|