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Li Y, Wang M, Wang L, Cao Y, Liu Y, Zhao Y, Yuan R, Yang M, Lu S, Sun Z, Zhou F, Qian Z, Kang H. Advances in the Application of AI Robots in Critical Care: Scoping Review. J Med Internet Res 2024; 26:e54095. [PMID: 38801765 PMCID: PMC11165292 DOI: 10.2196/54095] [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: 10/29/2023] [Revised: 03/07/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In recent epochs, the field of critical medicine has experienced significant advancements due to the integration of artificial intelligence (AI). Specifically, AI robots have evolved from theoretical concepts to being actively implemented in clinical trials and applications. The intensive care unit (ICU), known for its reliance on a vast amount of medical information, presents a promising avenue for the deployment of robotic AI, anticipated to bring substantial improvements to patient care. OBJECTIVE This review aims to comprehensively summarize the current state of AI robots in the field of critical care by searching for previous studies, developments, and applications of AI robots related to ICU wards. In addition, it seeks to address the ethical challenges arising from their use, including concerns related to safety, patient privacy, responsibility delineation, and cost-benefit analysis. METHODS Following the scoping review framework proposed by Arksey and O'Malley and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a scoping review to delineate the breadth of research in this field of AI robots in ICU and reported the findings. The literature search was carried out on May 1, 2023, across 3 databases: PubMed, Embase, and the IEEE Xplore Digital Library. Eligible publications were initially screened based on their titles and abstracts. Publications that passed the preliminary screening underwent a comprehensive review. Various research characteristics were extracted, summarized, and analyzed from the final publications. RESULTS Of the 5908 publications screened, 77 (1.3%) underwent a full review. These studies collectively spanned 21 ICU robotics projects, encompassing their system development and testing, clinical trials, and approval processes. Upon an expert-reviewed classification framework, these were categorized into 5 main types: therapeutic assistance robots, nursing assistance robots, rehabilitation assistance robots, telepresence robots, and logistics and disinfection robots. Most of these are already widely deployed and commercialized in ICUs, although a select few remain under testing. All robotic systems and tools are engineered to deliver more personalized, convenient, and intelligent medical services to patients in the ICU, concurrently aiming to reduce the substantial workload on ICU medical staff and promote therapeutic and care procedures. This review further explored the prevailing challenges, particularly focusing on ethical and safety concerns, proposing viable solutions or methodologies, and illustrating the prospective capabilities and potential of AI-driven robotic technologies in the ICU environment. Ultimately, we foresee a pivotal role for robots in a future scenario of a fully automated continuum from admission to discharge within the ICU. CONCLUSIONS This review highlights the potential of AI robots to transform ICU care by improving patient treatment, support, and rehabilitation processes. However, it also recognizes the ethical complexities and operational challenges that come with their implementation, offering possible solutions for future development and optimization.
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Affiliation(s)
- Yun Li
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Min Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuan Cao
- The Second Hospital, Hebei Medical University, Hebei, China
| | - Yuyan Liu
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhao
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Rui Yuan
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mengmeng Yang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Siqian Lu
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Zhichao Sun
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Feihu Zhou
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhirong Qian
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian, China
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hongjun Kang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Yildiz A, Ahmed I, Mustafaoglu R, Kesiktas FN. Effects of robot-assisted arm training on respiratory muscle strength, activities of daily living, and quality of life in patients with stroke: a single-blinded randomized controlled trial. Physiother Theory Pract 2024:1-9. [PMID: 38165122 DOI: 10.1080/09593985.2023.2299727] [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: 07/17/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Post-stroke clinical changes not only affect extremities and trunk muscles but also the respiratory muscles. PURPOSE To determine the effect of robot-assisted arm training with conventional rehabilitation (CombT) on respiratory muscle strength, activities of daily living (ADL), and quality of life in patients with stroke and to compare the results with conventional rehabilitation (CR). METHODS It was a two-arm, single-blinded, randomized controlled trial in which 66 patients were randomly allocated to either CombT or CR to receive 30 sessions (5/week) over 6 weeks. The respiratory muscle strength (maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)), activities of daily life (ABILHAND questionnaire), and quality of life (Stroke Impact Scale (SIS)) were measured before and 6 weeks after training. RESULTS The CombT group showed significantly better MIP, MEP, and performance in ADLs after 6 weeks of training compared to the CR group (p < .01). The effect size was large for MIP (d = 0.9) and MEP (d = 0.9), whereas medium for performance in ADLs (d = 0.62). Also, the SIS-arm strength (p < .01), hand function (p = .04), ADLs (p = .02), and recovery (p = .04) were significantly better in CombT group with a medium (d = 0.6, d = 0.5, d = 0.5, and d = 0.5, respectively) effect size compared with CR group. CONCLUSIONS Both CombT and CR groups improved respiratory muscle strength, performance in ADLs, and quality of life in patients with stroke. However, CombT appears to offer more comprehensive benefits, highlighting its valuable role in respiratory and functional recovery after stroke.
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Affiliation(s)
- Abdurrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Ishtiaq Ahmed
- Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Fatma Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
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de Crignis AC, Ruhnau ST, Hösl M, Lefint J, Amberger T, Dressnandt J, Brunner H, Müller F. Robotic arm training in neurorehabilitation enhanced by augmented reality - a usability and feasibility study. J Neuroeng Rehabil 2023; 20:105. [PMID: 37568195 PMCID: PMC10422755 DOI: 10.1186/s12984-023-01225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Robotic therapy and serious gaming support motor learning in neurorehabilitation. Traditional monitor-based gaming outputs cannot adequately represent the third dimension, whereas virtual reality headsets lack the connection to the real world. The use of Augmented Reality (AR) techniques could potentially overcome these issues. The objective of this study was thus to evaluate the usability, feasibility and functionality of a novel arm rehabilitation device for neurorehabilitation (RobExReha system) based on a robotic arm (LBR iiwa, KUKA AG) and serious gaming using the AR headset HoloLens (Microsoft Inc.). METHODS The RobExReha system was tested with eleven adult inpatients (mean age: 64.4 ± 11.2 years; diagnoses: 8 stroke, 2 spinal cord injury, 1 Guillain-Barré-Syndrome) who had paretic impairments in their upper limb. Five therapists administered and evaluated the system. Data was compared with a Reference Group (eleven inpatients; mean age: 64.3 ± 9.1 years; diagnoses: 10 stroke, 1 spinal cord injury) who trained with commercially available robotic therapy devices (ArmeoPower or ArmeoSpring, Hocoma AG). Patients used standardized questionnaires for evaluating usability and comfort (Quebec User Evaluation of Satisfaction with assistive technology [QUEST]), workload (Raw Task Load Index [RTLX]) and a questionnaire for rating visual perception of the gaming scenario. Therapists used the QUEST, the System Usability Scale and the short version of the User Experience Questionnaire. RESULTS Therapy with the RobExReha system was safe and feasible for patients and therapists, with no serious adverse events being reported. Patients and therapists were generally satisfied with usability. The patients' usability ratings were significantly higher in the Reference Group for two items of the QUEST: reliability and ease of use. Workload (RTLX) ratings did not differ significantly between the groups. Nearly all patients using the RobExReha system perceived the gaming scenario in AR as functioning adequately despite eight patients having impairments in stereoscopic vision. The therapists valued the system's approach as interesting and inventive. CONCLUSIONS We demonstrated the clinical feasibility of combining a novel robotic upper limb robot with an AR-serious game in a neurorehabilitation setting. To ensure high usability in future applications, a reliable and easy-to-use system that can be used for task-oriented training should be implemented. TRIAL REGISTRATION Ethical approval was obtained and the trial was registered at the German Clinical Trials Register (DRKS00022136).
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Affiliation(s)
| | | | - Matthias Hösl
- Schön Klinik Bad Aibling, Bad Aibling, Germany
- Schön Klinik Vogtareuth, Vogtareuth, Germany
| | - Jérémy Lefint
- Fraunhofer Institute for Manufacturing, Engineering and Automation IPA, Stuttgart, Germany
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Safety, Feasibility and Efficacy of Lokomat ® and Armeo ®Spring Training in Deconditioned Paediatric, Adolescent and Young Adult Cancer Patients. Cancers (Basel) 2023; 15:cancers15041250. [PMID: 36831593 PMCID: PMC9954270 DOI: 10.3390/cancers15041250] [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: 12/21/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. OBJECTIVE This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant satisfaction) and efficacy (Peak Oxygen uptake (VO2peak), 6-min walk test, gait speeds, Canadian Occupational Performance Measure, quality of life) of Lokomat® and Armeo®Spring training in children and adolescents and young adults (AYAs) during or soon after cancer treatment. METHOD This was a 6-week single arm pre-post study. Cancer patients with significant musculoskeletal, neurological, gait and/or upper limb deficiency aged 5 to 25 years were recruited. The rehabilitation program included access to two robotic orthoses: the Lokomat® and/or Armeo®Spring. Robotic devices utilised real-time biofeedback and computer games to engage and guide participants through a repetitive functional range of movement aimed at improving functional deficiencies. Progressive increases in exercise intensity and duration were encouraged. RESULTS Twentey-eight participants were approached for study; twenty-one consented. Seventy-six percent completed the six-week intervention with an overall adherence of 83%. The mean participant satisfaction score was 8.8/10. Forty-nine adverse events were recorded throughout the course of the study, forty-five grade 1, three grade 2 and one grade 3. No adverse events led to withdrawal from the study. Preliminary efficacy results indicate large beneficial effects on VO2peak (r = 0.63), 10 m comfortable pace walk (r = 0.51) and maximal pace walk (r = 0.60), 6-min walk test (r = 0.60), maximal back and leg strength (r = 0.71), trunk flexibility (r = 0.60), The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) (r = 0.61), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT F) r = 0.53 and the Canadian Occupational Performance Measure, satisfaction (r = 0.88) and performance scores (r = 0.83), and moderate beneficial effects on Leisure Score Index (LSI) (r = 0.30). CONCLUSION Our results suggest that Lokomat® and Armeo®Spring training is safe and feasible for use in children and AYAs who are currently undergoing or have recently completed cancer therapy. A larger controlled trial investigating the efficacy of robotics rehabilitation in this cohort is warranted.
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Shin S, Lee HJ, Chang WH, Ko SH, Shin YI, Kim YH. A Smart Glove Digital System Promotes Restoration of Upper Limb Motor Function and Enhances Cortical Hemodynamic Changes in Subacute Stroke Patients with Mild to Moderate Weakness: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11247343. [PMID: 36555960 PMCID: PMC9782087 DOI: 10.3390/jcm11247343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
This study was a randomized controlled trial to examine the effects of the RAPAEL® Smart Glove digital training system on upper extremity function and cortical hemodynamic changes in subacute stroke patients. Of 48 patients, 20 experimental and 16 controls completed the study. In addition to conventional occupational therapy (OT), the experimental group received game-based digital hand motor training with the RAPAEL® Smart Glove digital system, while the control group received extra OT for 30 min. The Fugl-Meyer assessment (UFMA) and Jebsen-Tayler hand function test (JTT) were assessed before (T0), immediately after (T1), and four weeks after intervention (T2). Cortical hemodynamics (oxyhemoglobin [OxyHb] concentration) were measured by functional near-infrared spectroscopy. The experimental group had significantly better improvements in UFMA (T1-T0 mean [SD]; Experimental 13.50 [7.49]; Control 8.00 [4.44]; p = 0.014) and JTT (Experimental 21.10 [20.84]; Control 5.63 [5.06]; p = 0.012). The OxyHb concentration change over the ipsilesional primary sensorimotor cortex during the affected wrist movement was greater in the experimental group (T1, Experimental 0.7943 × 10-4 μmol/L; Control -0.3269 × 10-4 μmol/L; p = 0.025). This study demonstrated a beneficial effect of game-based virtual reality training with the RAPAEL® Smart Glove digital system with conventional OT on upper extremity motor function in subacute stroke patients.
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Affiliation(s)
- Seyoung Shin
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hwang-Jae Lee
- Robot Business Team, Samsung Electronics, Suwon 16677, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- Correspondence: (Y.-I.S.); (Y.-H.K.); Tel.: +82-51-360-2872 (Y.-I.S.); +82-2-3410-2824 (ext. 2818) (Y.-H.K.); Fax: +82-2-3410-0388 (Y.-H.K.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Science and Technology, Department of Medical Devices Management and Research, Department of Digital Healthcare, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
- Correspondence: (Y.-I.S.); (Y.-H.K.); Tel.: +82-51-360-2872 (Y.-I.S.); +82-2-3410-2824 (ext. 2818) (Y.-H.K.); Fax: +82-2-3410-0388 (Y.-H.K.)
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Olczak A, Truszczyńska-Baszak A, Stępień A. The Use of Armeo ®Spring Device to Assess the Effect of Trunk Stabilization Exercises on the Functional Capabilities of the Upper Limb-An Observational Study of Patients after Stroke. SENSORS 2022; 22:s22124336. [PMID: 35746117 PMCID: PMC9229540 DOI: 10.3390/s22124336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
Almost half of stroke patients report impaired function of the upper limb and hand. Stability of the trunk is required for the proper movement of the body, including the legs and arms. The aim of the study was to analyze the effect of trunk stabilization exercises on coordinated movement of the affected upper limb in patients after stroke, using an Armoe®Spring device and the “wall” and “abacus” functional tests. Materials and methods: This is a randomized, double-blinded study. The research was carried out in the Rehabilitation Clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group used classic exercises. The importance of the trunk for upper limb coordination was assessed on the Armeo®Spring device using three evaluation programs, “perpendicular fishing”; “horizontal fishing”; “reaction time”, and two proprietary tests, “wall” and “abacus”. Results: The post-treatment analysis showed significantly better results in the study group for the abacus (p < 0.001), wall (p = 0.003) tests, and a significantly higher percentage of task completion in the vertical fishing (p = 0.036) and reaction time (p = 0.009) tests. Conclusions: Physiotherapy including exercises to stabilize the trunk had a significant effect on increasing the functional efficiency of the affected upper limb and on improving the handgrip strength. The Armeo®Spring device is a good device for the functional assessment of the upper limb before and after therapy.
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Affiliation(s)
- Anna Olczak
- Military Institute of Medicine, Rehabilitation Clinic, 128 Szaserów Street, 04-141 Warsaw, Poland
- Correspondence:
| | | | - Adam Stępień
- Military Institute of Medicine, Neurological Clinic, 128 Szaserów Street, 04-141 Warsaw, Poland;
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Raciti L, Pignolo L, Perini V, Pullia M, Porcari B, Latella D, Isgrò M, Naro A, Calabrò RS. Improving Upper Extremity Bradykinesia in Parkinson’s Disease: A Randomized Clinical Trial on the Use of Gravity-Supporting Exoskeletons. J Clin Med 2022; 11:jcm11092543. [PMID: 35566669 PMCID: PMC9104168 DOI: 10.3390/jcm11092543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022] Open
Abstract
Hand movements are particularly impaired in patients with Parkinson’s Disease (PD), contributing to functional disability and difficulties in activities of daily living. Growing evidence has shown that robot-assisted therapy may be considered an effective and reliable method for the delivery of the highly repetitive training that is needed to trigger neuroplasticity, as intensive, repetitive and task-oriented training could be an ideal strategy to facilitate the relearning of motor function and to minimize motor deficit. The purpose of this study is to evaluate the improvement of hand function with semi-autonomous exercises using an upper extremity exoskeleton in patients with PD. A multicenter, parallel-group, randomized clinical trial was then carried out at the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy). Thirty subjects with a diagnosis of PD and a Hoehn–Yahr score between 2 and 3 were enrolled in the study. Patients were 1:1 randomized into either the experimental group (ERT), receiving 45 min training daily, 6 days weekly, for 8 weeks with Armeo®Spring (Volketswil, Switzerland) (a gravity-supporting device), or the control group (CPT), which was subjected to the same amount of conventional physical therapy. Motor abilities were assessed before and after the end of the training. The main outcomes measures were the Nine-hole peg test and the motor section of the UPDRS. All patients belonging to ERT and 9 out of 15 patients belonging to the CPT completed the trial. ERT showed a greater improvement in the primary outcome measure (nine-hole peg test) than CPT. Moreover, a statistically significant improvement was found in ERT concerning upper limb mobility, and disease burden as compared to CPT. Using an upper extremity exoskeleton (i.e., the Armeo®Spring) for semi-autonomous training in an inpatient setting is a new perspective to train patients with PD to improve their dexterity, executive function and, potentially, quality of life.
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Affiliation(s)
- Loredana Raciti
- GCA-Centro Spoke AO Cannizzaro, Catania, IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy;
| | - Loris Pignolo
- S. Anna Institute, Research in Advanced Neurorehabilitation, 88900 Crotone, Italy;
| | - Valentina Perini
- Spoke Centre of Palermo, IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy;
| | - Massimo Pullia
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (M.P.); (B.P.); (D.L.); (M.I.)
| | - Bruno Porcari
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (M.P.); (B.P.); (D.L.); (M.I.)
| | - Desiree Latella
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (M.P.); (B.P.); (D.L.); (M.I.)
| | - Marco Isgrò
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (M.P.); (B.P.); (D.L.); (M.I.)
| | - Antonino Naro
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Rocco Salvatore Calabrò
- Behavioral and Robotic Neurorehabilitation Unit, IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy; (M.P.); (B.P.); (D.L.); (M.I.)
- Correspondence: ; Fax: +39-9060128950
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Joo MC, Jung KM, Kim JH, Jung YJ, Chang WN, Shin HJ. Robot-Assisted Therapy Combined with Trunk Restraint in Acute Stroke Patients: A Randomized Controlled Study. J Stroke Cerebrovasc Dis 2022; 31:106330. [PMID: 35219973 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Reducing the compensatory mechanism by restraining unnecessary trunk movements may help enhance the effectiveness of robot-assisted therapy. OBJECTIVE This study aimed to investigate the effects of robot-assisted therapy in combination with trunk restraint on upper extremity function and on daily activities in patients with acute stroke (≤ 30days of onset). METHODS Thirty-six acute stroke patients were randomly assigned to an experimental (n=18) or control (n=18) group. The experimental group performed robot-assisted therapy combined with trunk restraint, while the control group performed only robot-assisted therapy. Both groups were treated for 30 min, 5 days a week, for a total of 3 weeks. The outcome measures included the Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, upper extremity muscle strength, and modified Barthel index. RESULTS After the intervention, both groups showed significant improvements in Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, elbow extensor muscle strength, and modified Barthel index (p < 0.05). Post-intervention, the experimental group exhibited greater changes in the Fugl-Meyer assessment upper extremity, motor activity log, and elbow extensor muscle strength (p < 0.05). CONCLUSION Our study suggests that robot-assisted therapy in combination with trunk restraint is more effective for improving upper extremity function than only robot-assisted therapy in acute stroke patients.
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Affiliation(s)
- Min-Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine and Hospital, Iksan, South Korea
| | - Kyeoung-Man Jung
- Department of Physical Therapy, Wonkwang University Hospital, Iksan, South Korea.
| | - Ji-Hee Kim
- Department of Rehabilitation Medicine, Wonkwang University Medical School and Hospital, Iksan, South Korea
| | - Yu-Jin Jung
- Department of Occupational Therapy, Wonkwang University Hospital, Iksan, South Korea
| | - Woo-Nam Chang
- Department of Physical Therapy, College of Health & Welfare Science, Yong-In University, Gyeonggi, South Korea
| | - Hyeon-Jin Shin
- Department of Occupational Therapy, Wonkwang University Hospital, Iksan, South Korea
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Mechatronic Design of a Robot for Upper Limb Rehabilitation at Home. JOURNAL OF BIONIC ENGINEERING 2021. [DOI: 10.1007/s42235-021-0066-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThis paper addresses the design of a novel bionic robotic device for upper limb rehabilitation tasks at home. The main goal of the design process has been to obtain a rehabilitation device, which can be easily portable and can be managed remotely by a professional therapist. This allows to treat people also in regions that are not easily reachable with a significant cost reduction. Other potential benefits can be envisaged, for instance, in the possibility to keep social distancing while allowing rehabilitation treatments even during a pandemic spread. Specific attention has been devoted to design the main mechatronic components by developing specific kinematics and dynamics models. The design process includes the implementation of a specific control hardware and software. Preliminary experimental tests are reported to show the effectiveness and feasibility of the proposed design solution.
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Rozevink SG, van der Sluis CK, Garzo A, Keller T, Hijmans JM. HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke. J Neuroeng Rehabil 2021; 18:48. [PMID: 33726801 PMCID: PMC7961165 DOI: 10.1186/s12984-021-00841-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/18/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). METHODS Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation. RESULTS Twelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements. CONCLUSION Patients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535 .
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Affiliation(s)
- Samantha G Rozevink
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ainara Garzo
- Neurorehabilitation Area, Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Thierry Keller
- Neurorehabilitation Area, Health Division of TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Juha M Hijmans
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Sehle A, Stuerner J, Hassa T, Spiteri S, Schoenfeld MA, Liepert J. Behavioral and neurophysiological effects of an intensified robot-assisted therapy in subacute stroke: a case control study. J Neuroeng Rehabil 2021; 18:6. [PMID: 33430912 PMCID: PMC7798321 DOI: 10.1186/s12984-020-00792-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/25/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Physical training is able to induce changes at neurophysiological and behavioral level associated with performance changes for the trained movements. The current study explores the effects of an additional intense robot-assisted upper extremity training on functional outcome and motor excitability in subacute stroke patients. METHODS Thirty moderately to severely affected patients < 3 months after stroke received a conventional inpatient rehabilitation. Based on a case-control principle 15 patients were assigned to receive additional 45 min of robot-assisted therapy (Armeo®Spring) 5 times per week (n = 15, intervention group, IG). The Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) was chosen as primary outcome parameter. Patients were tested before and after a 3-week treatment period as well as after a follow-up period of 2 weeks. Using transcranial magnetic stimulation motor evoked potentials (MEPs) and cortical silent periods were recorded from the deltoid muscle on both sides before and after the intervention period to study effects at neurophysiological level. Statistical analysis was performed with non-parametric tests. Correlation analysis was done with Spearman´s rank correlation co-efficient. RESULTS Both groups showed a significant improvement in FMA-UE from pre to post (IG: + 10.6 points, control group (CG): + 7.3 points) and from post to follow-up (IG: + 3.9 points, CG: + 3.3 points) without a significant difference between them. However, at neurophysiological level post-intervention MEP amplitudes were significantly larger in the IG but not in the CG. The observed MEP amplitudes changes were positively correlated with FMA-UE changes and with the total amount of robot-assisted therapy. CONCLUSION The additional robot-assisted therapy induced stronger excitability increases in the intervention group. However, this effect did not transduce to motor performance improvements at behavioral level. Trial registration The trial was registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER DRKS00015083. Registration date: September 4th, 2018. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015083 . Registration was done retrospectively.
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Affiliation(s)
- Aida Sehle
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Jana Stuerner
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Thomas Hassa
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Stefan Spiteri
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Mircea A Schoenfeld
- Department of Neurological Rehabilitation, Kliniken Schmieder, Heidelberg, Germany.,Department of Neurology, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Joachim Liepert
- Lurija Institute and Department of Neurological Rehabilitation, Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany.
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Jiang S, You H, Zhao W, Zhang M. Effects of short-term upper limb robot-assisted therapy on the rehabilitation of sub-acute stroke patients. Technol Health Care 2020; 29:295-303. [PMID: 33285652 DOI: 10.3233/thc-202127] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robot-assisted therapy (RT) has become a promising stroke rehabilitation intervention. OBJECTIVE To examine the effects of short-term upper limb RT on the rehabilitation of sub-acute stroke patients. METHODS Subjects were randomly assigned to the RT group (n= 23) or conventional rehabilitation (CR) group (n= 22). All subjects received conventional rehabilitation therapy for 30 minutes twice a day, for 2 weeks. In addition, the RT group received RT for 30 minutes twice a day, for 2 weeks. The outcomes before treatment (T0) and at 2 weeks (T1) and 1 month follow-up (T2) were evaluated in the patients using the upper limb motor function test of the Fugl-Meyer assessment (FMA) the Motricity Index (MI), the Modified Ashworth Scale (MAS), the Functional Independence Measure (FIM), and the Barthel Index (BI). RESULTS There were significant improvements in motor function scales (P< 0.001 for FMA and MI) and activities of daily living (P< 0.001 for FIM and BI) but without muscle tone (MAS, P> 0.05) in the RT and CR groups. Compared to the CR group, the RT group showed improvements in motor function and activities of daily living (P< 0.05 for FMA, MI, FIM, BI) at T1 and T2. There was no significant difference between the two groups in muscle tone (MAS, P> 0.05). CONCLUSIONS RT may be a useful tool for sub-acute stroke patients' rehabilitation.
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Cheng N, Phua KS, Lai HS, Tam PK, Tang KY, Cheng KK, Yeow RCH, Ang KK, Guan C, Lim JH. Brain-Computer Interface-Based Soft Robotic Glove Rehabilitation for Stroke. IEEE Trans Biomed Eng 2020; 67:3339-3351. [DOI: 10.1109/tbme.2020.2984003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Brihmat N, Loubinoux I, Castel-Lacanal E, Marque P, Gasq D. Kinematic parameters obtained with the ArmeoSpring for upper-limb assessment after stroke: a reliability and learning effect study for guiding parameter use. J Neuroeng Rehabil 2020; 17:130. [PMID: 32993695 PMCID: PMC7523068 DOI: 10.1186/s12984-020-00759-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients. METHODS This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the 'horizontal catch' exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring' data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). RESULTS We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%. CONCLUSIONS After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.
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Affiliation(s)
- Nabila Brihmat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Isabelle Loubinoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Evelyne Castel-Lacanal
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Physical and Rehabilitation Medicine, University Hospital of Toulouse, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France. .,Department of Physiological Explorations, University Hospital of Toulouse, Toulouse, France. .,Service des Explorations Fonctionnelles Physiologiques, Hôpital Rangueil, 1 Avenue du Pr Poulhes, 31059, Toulouse, France.
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15
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Wuennemann MJ, Mackenzie SW, Lane HP, Peltz AR, Ma X, Gerber LM, Edwards DJ, Kitago T. Dose and staffing comparison study of upper limb device-assisted therapy. NeuroRehabilitation 2020; 46:287-297. [DOI: 10.3233/nre-192993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marissa J. Wuennemann
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Stuart W. Mackenzie
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Heather Pepper Lane
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Avrielle R. Peltz
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Linda M. Gerber
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cown University, Joondalup, Australia
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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16
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Design and Analysis of a Wearable Upper Limb Rehabilitation Robot with Characteristics of Tension Mechanism. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10062101] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Nowadays, patients with mild and moderate upper limb paralysis caused by cerebral apoplexy are uncomfortable with autonomous rehabilitation. In this paper, according to the “rope + toothed belt” generalized rope drive design scheme, we design a utility model for a wearable upper limb rehabilitation robot with a tension mechanism. Owing to study of the human upper extremity anatomy, movement mechanisms, and the ranges of motion, it can determine the range of motion angles of the human arm joints, and design the shoulder joint, elbow joint, and wrist joint separately under the principle of ensuring the minimum driving torque. Then, the kinematics, workspace and dynamics analysis of each structure are performed. Finally, the control system of the rehabilitation robot is designed. The experimental results show that the structure is convenient to wear on the human body, and the robot’s freedom of movement matches well with the freedom of movement of the human body. It can effectively support and traction the front and rear arms of the affected limb, and accurately transmit the applied traction force to the upper limb of the joints. The rationality of the wearable upper limb rehabilitation robot design is verified, which can help patients achieve rehabilitation training and provide an effective rehabilitation equipment for patients with hemiplegia caused by stroke.
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Abstract
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease.
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18
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Adomavičienė A, Daunoravičienė K, Kubilius R, Varžaitytė L, Raistenskis J. Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System. ACTA ACUST UNITED AC 2019; 55:medicina55040098. [PMID: 30970655 PMCID: PMC6524064 DOI: 10.3390/medicina55040098] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/21/2019] [Accepted: 04/03/2019] [Indexed: 01/07/2023]
Abstract
Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.
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Affiliation(s)
- Aušra Adomavičienė
- Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Santariskiu g.2, LT-08661 Vilnius, Lithuania.
| | - Kristina Daunoravičienė
- Department of Biomechanical Engineering, Vilnius Gediminas Technical University, J. Basanavičiaus g. 28, 03224 Vilnius, Lithuania.
| | - Raimondas Kubilius
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161 Kaunas, Lithuania.
| | - Lina Varžaitytė
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161 Kaunas, Lithuania.
| | - Juozas Raistenskis
- Department of Rehabilitation, Physical and Sports Medicine, Faculty of Medicine, Vilnius University, Santariskiu g.2, LT-08661 Vilnius, Lithuania.
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Movement Velocity and Fluidity Improve after Armeo®Spring Rehabilitation in Children Affected by Acquired and Congenital Brain Diseases: An Observational Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1537170. [PMID: 30581845 PMCID: PMC6276530 DOI: 10.1155/2018/1537170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/29/2018] [Accepted: 11/06/2018] [Indexed: 11/17/2022]
Abstract
Background Children with cerebral palsy (CP) and acquired brain injury (ABI) often exhibit upper limb impairment, with repercussions in their daily activities. Robotic rehabilitation may promote their functional recovery, but evidence of its effectiveness is often based on qualitative functional scales. The primary aim of the present work was to assess movement precision, velocity, and smoothness using numerical indices from the endpoint trajectory of Armeo®Spring. Secondly, an investigation of the effectiveness of robotic rehabilitation in CP and ABI children was performed. Methods Upper limb functional changes were evaluated in children with CP (N=21) or ABI (N=22) treated with Armeo®Spring (20 45-minute sessions over 4 weeks) using clinical scales and numerical indices computed from the exoskeleton trajectory. Results Functional scales (i.e., QUEST and Melbourne) were sensitive to changes produced by the treatment for the whole study group and for the two etiology-based subgroups (improvements above Minimal Clinically Importance Difference). Significant improvement was also observed in terms of velocity, fluidity, and precision of the movement through the numerical indices of kinematic performance. Differences in the temporal evolution of the motor outcome were highlighted between the ABI and CP subgroups, pointing toward adopting different rehabilitative protocols in these two populations. Conclusions Robot-assisted upper limb rehabilitation seems to be a promising tool to promote and assess rehabilitation in children affected by acquired and congenital brain diseases.
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Rehmat N, Zuo J, Meng W, Liu Q, Xie SQ, Liang H. Upper limb rehabilitation using robotic exoskeleton systems: a systematic review. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2018. [DOI: 10.1007/s41315-018-0064-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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21
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Lee KS, Park JH, Beom J, Park HS. Design and Evaluation of Passive Shoulder Joint Tracking Module for Upper-Limb Rehabilitation Robots. Front Neurorobot 2018; 12:38. [PMID: 30100871 PMCID: PMC6072863 DOI: 10.3389/fnbot.2018.00038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/14/2018] [Indexed: 11/16/2022] Open
Abstract
As the number of people suffering from shoulder movement disabilities increases, there is a rising demand for shoulder rehabilitation. The natural motion of the shoulder joint [glenohumeral (GH) joint] includes not only three-degrees-of-freedom (DOF) rotation but also three-DOF translation of the joint center due to simultaneous motion of the shoulder girdle. If the motion of the shoulder girdle is restricted, then the arm cannot be raised above a certain posture. This paper presents a passive shoulder joint tracking device that allows three-DOF translation of the shoulder joint while compensating for gravity. The single-DOF vertical tracker with a constant-force spring compensates for the gross weight of the user's arm, the upper limb rehabilitation device, and the tracker itself while allowing vertical tracking motion. The two-DOF horizontal tracker consists of two linear guides arranged perpendicular to each other. The tracker freely follows the shoulder joint in the horizontal plane. The effect of using the passive shoulder joint tracking device was evaluated by means of experiments by combining two popular commercial upper limb rehabilitation apparatuses with the proposed tracker. Nineteen subjects (8 healthy persons and 11 patients with shoulder impairments) participated in the evaluation study. The movement of the GH joint and the interactive force between the subject and the commercial rehabilitation device were analyzed when subjects made the following shoulder movements: flexion/extension and abduction/adduction. The improved tracker allowed a greater range of motion and reduced interaction. The tracker can be combined with existing commercial rehabilitation devices for more natural shoulder movement during rehabilitation tasks.
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Affiliation(s)
- Kyoung-Soub Lee
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jeong-Ho Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jaewon Beom
- Department of Physical Medicine & Rehabilitation, Chung-Ang University Hospital, Seoul, South Korea
| | - Hyung-Soon Park
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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22
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Büsching I, Sehle A, Stürner J, Liepert J. Using an upper extremity exoskeleton for semi-autonomous exercise during inpatient neurological rehabilitation- a pilot study. J Neuroeng Rehabil 2018; 15:72. [PMID: 30068372 PMCID: PMC6090973 DOI: 10.1186/s12984-018-0415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper extremity exoskeleton in addition to an inpatient rehabilitation program. In addition, changes of motor functions were examined. Methods Ten stroke patients with a severe upper extremity paresis were included. They were offered to perform a semi-autonomous training with a gravity-supported, computer-enhanced device (Armeo®Spring, Hocoma AG) six times per week for 4 weeks. Feasibility was evaluated by weekly structured interviews with patients and supervisors. Motor functions were assessed before and after the training period using the Wolf Motor Function Test (WMFT). The Wilcoxon Signed Rank Test was used for assessing pre-post differences. The Pearson correlation co-efficient was used for correlating the number of completed sessions with the change in motor function. Acceptance of the device and the level of satisfaction with the training were determined by a questionnaire based on visual analogue scales. Results Neither patients nor supervisors reported side effects. However, one patient had to be excluded from analysis because of transportation difficulties from the ward to the treatment facility. Therefore, analysis was based on nine patients. On average, 13.2 (55%) sessions were realized. WMFT results showed significant improvements of proximal arm functions. The number of sessions correlated with the degree of shoulder force improvement. Patients rated the exercises to be motivating, and enjoyable and would continue using the Armeo®Spring at home if they had the opportunity. Conclusion Using an upper extremity exoskeleton for semi-autonomous training in an inpatient setting is feasible without side effects and is positively rated by the patients. It might further support the recovery of upper extremity function. Trial registration The trial was retrospectively registered. Registration number ISRCTN42633681.
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Affiliation(s)
- Imke Büsching
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.,Reha-Klinik Bellikon, Mutschellenstrasse 2, 5454, Bellikon, Switzerland
| | - Aida Sehle
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Jana Stürner
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany
| | - Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, D- 78476, Allensbach, Germany.
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Rehabilitation of Upper Limb in Children with Acquired Brain Injury: A Preliminary Comparative Study. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:4208492. [PMID: 29732047 PMCID: PMC5872655 DOI: 10.1155/2018/4208492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
Acquired brain injuries (ABIs) can lead to a wide range of impairments, including weakness or paralysis on one side of the body known as hemiplegia. In hemiplegic patients, the rehabilitation of the upper limb skills is crucial, because the recovery has an immediate impact on patient quality of life. For this reason, several treatments were developed to flank physical therapy (PT) and improve functional recovery of the upper limbs. Among them, Constraint-Induced Movement Therapy (CIMT) and robot-aided therapy have shown interesting potentialities in the rehabilitation of the hemiplegic upper limb. Nevertheless, there is a lack of quantitative evaluations of effectiveness in a standard clinical setting, especially in children, as well as a lack of direct comparative studies between these therapeutic techniques. In this study, a group of 18 children and adolescents with hemiplegia was enrolled and underwent intensive rehabilitation treatment including PT and CIMT or Armeo®Spring therapy. The effects of the treatments were assessed using clinical functional scales and upper limb kinematic analysis during horizontal and vertical motor tasks. Results showed CIMT to be the most effective in terms of improved functional scales, while PT seemed to be the most significant in terms of kinematic variations. Specifically, PT resulted to have positive influence on distal movements while CIMT conveyed more changes in the proximal kinematics. Armeo treatment delivered improvements mainly in the vertical motor task, showing trends of progresses of the movement efficiency and reduction of compensatory movements of the shoulder with respect to other treatments. Therefore, every treatment gave advantages in a specific and different upper limb district. Therefore, results of this preliminary study may be of help to define the best rehabilitation treatment for each patient, depending on the goal, and may thus support clinical decision.
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Chen J, Lum PS. Pilot testing of the spring operated wearable enhancer for arm rehabilitation (SpringWear). J Neuroeng Rehabil 2018; 15:13. [PMID: 29499712 PMCID: PMC5833152 DOI: 10.1186/s12984-018-0352-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/07/2018] [Indexed: 12/15/2022] Open
Abstract
Background Robotic devices for neurorehabilitation of movement impairments in persons with stroke have been studied extensively. However, the vast majority of these devices only allow practice of stereotyped components of simulated functional tasks in the clinic. Previously we developed SpringWear, a wearable, spring operated, upper extremity exoskeleton capable of assisting movements during real-life functional activities, potentially in the home. SpringWear assists shoulder flexion, elbow extension and forearm supination/pronation. The assistance profiles were designed to approximate the torque required to move the joint passively through its range. These three assisted DOF are combined with two passive shoulder DOF, allowing complex multi-joint movement patterns. Methods We performed a cross-sectional study to assess changes in movement patterns when assisted by SpringWear. Thirteen persons with chronic stroke performed range of motion (ROM) and functional tasks, including pick and place tasks with various objects. Sensors on the device measured rotation at all 5 DOF and a kinematic model calculated position of the wrist relative to the shoulder. Within subject t-tests were used to determine changes with assistance from SpringWear. Results Maximum shoulder flexion, elbow extension and forearm pronation/supination angles increased significantly during both ROM and functional tasks (p < 0.002). Elbow flexion/extension ROM also increased significantly (p < 0.001). When the subjects volitionally held up the arm against gravity, extension at the index finger proximal interphalangeal joint increased significantly (p = 0.033) when assisted by SpringWear. The forward reach workspace increased 19% (p = 0.002). Nine subjects could not complete the functional tasks unassisted and only one showed improvement on task completion with SpringWear. Conclusions SpringWear increased the usable workspace during reaching movements, but there was no consistent improvement in the ability to complete functional tasks. Assistance levels at the shoulder were increased only until the shoulder could be voluntarily held at 90 degrees of flexion. A higher level of assistance may have yielded better results. Also combining SpringWear with HandSOME, an exoskeleton for assisting hand opening, may yield the most dramatic improvements in functional task performance. These low-cost devices can potentially reduce effort and improve performance during task practice, increasing adherence to home training programs for rehabilitation.
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Affiliation(s)
- Ji Chen
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, 20064, USA. .,Center for Applied Biomechanics and Rehabilitation Research MedStar National Rehabilitation Hospital, Washington, DC, 20010, USA. .,The Functional & Applied Biomechanics Section Rehabilitation Medicine Department Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Peter S Lum
- Department of Biomedical Engineering, Catholic University of America, Washington, DC, 20064, USA.,Center for Applied Biomechanics and Rehabilitation Research MedStar National Rehabilitation Hospital, Washington, DC, 20010, USA
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Calabrò RS, Naro A, Russo M, Milardi D, Leo A, Filoni S, Trinchera A, Bramanti P. Is two better than one? Muscle vibration plus robotic rehabilitation to improve upper limb spasticity and function: A pilot randomized controlled trial. PLoS One 2017; 12:e0185936. [PMID: 28973024 PMCID: PMC5626518 DOI: 10.1371/journal.pone.0185936] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/19/2017] [Indexed: 12/20/2022] Open
Abstract
Even though robotic rehabilitation is very useful to improve motor function, there is no conclusive evidence on its role in reducing post-stroke spasticity. Focal muscle vibration (MV) is instead very useful to reduce segmental spasticity, with a consequent positive effect on motor function. Therefore, it could be possible to strengthen the effects of robotic rehabilitation by coupling MV. To this end, we designed a pilot randomized controlled trial (Clinical Trial NCT03110718) that included twenty patients suffering from unilateral post-stroke upper limb spasticity. Patients underwent 40 daily sessions of Armeo-Power training (1 hour/session, 5 sessions/week, for 8 weeks) with or without spastic antagonist MV. They were randomized into two groups of 10 individuals, which received (group-A) or not (group-B) MV. The intensity of MV, represented by the peak acceleration (a-peak), was calculated by the formula (2πf)2A, where f is the frequency of MV and A is the amplitude. Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio (HMR) were the primary outcomes measured before and after (immediately and 4 weeks later) the end of the treatment. In all patients of group-A, we observed a greater reduction of MAS (p = 0.007, d = 0.6) and HMR (p<0.001, d = 0.7), and a more evident increase of SICI (p<0.001, d = 0.7) up to 4 weeks after the end of the treatment, as compared to group-B. Likewise, group-A showed a greater function outcome of upper limb (Functional Independence Measure p = 0.1, d = 0.7; Fugl-Meyer Assessment of the Upper Extremity p = 0.007, d = 0.4) up to 4 weeks after the end of the treatment. A significant correlation was found between the degree of MAS reduction and SICI increase in the agonist spastic muscles (p = 0.004). Our data show that this combined rehabilitative approach could be a promising option in improving upper limb spasticity and motor function. We could hypothesize that the greater rehabilitative outcome improvement may depend on a reshape of corticospinal plasticity induced by a sort of associative plasticity between Armeo-Power and MV.
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Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
| | | | - Demetrio Milardi
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
- Department of Biomedical, Dental Sciences, and Morphological and Functional Images, University of Messina; Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi “Bonino-Pulejo” Messina; Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus; San Giovanni Rotondo, Italy
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Langan J, Subryan H, Nwogu I, Cavuoto L. Reported use of technology in stroke rehabilitation by physical and occupational therapists. Disabil Rehabil Assist Technol 2017; 13:641-647. [PMID: 28812386 DOI: 10.1080/17483107.2017.1362043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE With the patient care experience being a healthcare priority, it is concerning that patients with stroke reported boredom and a desire for greater fostering of autonomy, when evaluating their rehabilitation experience. Technology has the potential to reduce these shortcomings by engaging patients through entertainment and objective feedback. Providing objective feedback has resulted in improved outcomes and may assist the patient in learning how to self-manage rehabilitation. Our goal was to examine the extent to which physical and occupational therapists use technology in clinical stroke rehabilitation home exercise programs. MATERIALS AND METHODS Surveys were sent via mail, email and online postings to over 500 therapists, 107 responded. RESULTS Conventional equipment such as stopwatches are more frequently used compared to newer technology like Wii and Kinect games. Still, less than 25% of therapists' report using a stopwatch five or more times per week. Notably, feedback to patients is based upon objective data less than 50% of the time by most therapists. At the end of clinical rehabilitation, patients typically receive a written home exercise program and non-technological equipment, like theraband and/or theraputty to continue rehabilitation efforts independently. CONCLUSIONS The use of technology is not pervasive in the continuum of stroke rehabilitation. Implications for Rehabilitation The patient care experience is a priority in healthcare, so when patients report feeling bored and desiring greater fostering of autonomy in stroke rehabilitation, it is troubling. Research examining the use of technology has shown positive results for improving motor performance and engaging patients through entertainment and use of objective feedback. Physical and occupational therapists do not widely use technology in stroke rehabilitation. Therapists should consider using technology in stroke rehabilitation to better meet the needs of the patient.
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Affiliation(s)
- Jeanne Langan
- a Department of Rehabilitation Sciences , University at Buffalo , Buffalo , NY , USA
| | - Heamchand Subryan
- b School of Architecture , University at Buffalo , Buffalo , NY , USA
| | - Ifeoma Nwogu
- c Computer Science and Engineering , University at Buffalo , Buffalo , NY , USA
| | - Lora Cavuoto
- d Department of Industrial and Systems Engineering , University at Buffalo , Buffalo , NY , USA
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Combining Dopaminergic Facilitation with Robot-Assisted Upper Limb Therapy in Stroke Survivors: A Focused Review. Am J Phys Med Rehabil 2017; 95:459-74. [PMID: 26829074 PMCID: PMC4866584 DOI: 10.1097/phm.0000000000000438] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite aggressive conventional therapy, lasting hemiplegia persists in a large percentage of stroke survivors. The aim of this article is to critically review the rationale behind targeting multiple sites along the motor learning network by combining robotic therapy with pharmacotherapy and virtual reality–based reward learning to alleviate upper extremity impairment in stroke survivors. Methods for personalizing pharmacologic facilitation to each individual’s unique biology are also reviewed. At the molecular level, treatment with levodopa was shown to induce long-term potentiation-like and practice-dependent plasticity. Clinically, trials combining conventional therapy with levodopa in stroke survivors yielded statistically significant but clinically unconvincing outcomes because of limited personalization, standardization, and reproducibility. Robotic therapy can induce neuroplasticity by delivering intensive, reproducible, and functionally meaningful interventions that are objective enough for the rigors of research. Robotic therapy also provides an apt platform for virtual reality, which boosts learning by engaging reward circuits. The future of stroke rehabilitation should target distinct molecular, synaptic, and cortical sites through personalized multimodal treatments to maximize motor recovery.
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Perry BE, Evans EK, Stokic DS. Weight compensation characteristics of Armeo®Spring exoskeleton: implications for clinical practice and research. J Neuroeng Rehabil 2017; 14:14. [PMID: 28212673 PMCID: PMC5316193 DOI: 10.1186/s12984-017-0227-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Armeo®Spring exoskeleton is widely used for upper extremity rehabilitation; however, weight compensation provided by the device appears insufficiently characterized to fully utilize it in clinical and research settings. Methods Weight compensation was quantified by measuring static force in the sagittal plane with a load cell attached to the elbow joint of Armeo®Spring. All upper spring settings were examined in 5° increments at the minimum, maximum, and two intermediate upper and lower module length settings, while keeping the lower spring at minimum. The same measurements were made for minimum upper spring setting and maximum lower spring setting at minimum and maximum module lengths. Weight compensation was plotted against upper module angles, and slope was analyzed for each condition. Results The Armeo®Spring design prompted defining the slack angle and exoskeleton balance angle, which, depending on spring and length settings, divide the operating range into different unloading and loading regions. Higher spring tensions and shorter module lengths provided greater unloading (≤6.32 kg of support). Weight compensation slope decreased faster with shorter length settings (minimum length = −0.082 ± 0.002 kg/°; maximum length = −0.046 ± 0.001 kg/°) independent of spring settings. Conclusions Understanding the impact of different settings on the Armeo®Spring weight compensation should help define best clinical practice and improve fidelity of research. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0227-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bonnie E Perry
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Emily K Evans
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, 1350 East Woodrow Wilson Drive, Jackson, MS, 39216, USA.
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Effects of Arm Weight Support Training to Promote Recovery of Upper Limb Function for Subacute Patients after Stroke with Different Levels of Arm Impairments. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9346374. [PMID: 27517053 PMCID: PMC4969527 DOI: 10.1155/2016/9346374] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/09/2016] [Accepted: 06/22/2016] [Indexed: 11/17/2022]
Abstract
Purpose. The goal of this study was to investigate the effects of arm weight support training using the ArmeoSpring for subacute patients after stroke with different levels of hemiplegic arm impairments. Methods. 48 inpatients with subacute stroke, stratified into 3 groups from mild to severe upper extremity impairment, were engaged in ArmeoSpring training for 45 minutes daily, 5 days per week for 3 weeks, in addition to conventional rehabilitation. Evaluations were conducted at three measurement occasions: immediately before training (T1); immediately after training (T2); and at a 3-week follow-up (T3) by a blind rater. Results. Shoulder flexion active range of motion, Upper Extremity Scores in the Fugl-Meyer Assessment (FMA), and Vertical Catch had the greatest differences in gain scores for patients between severe and moderate impairments, whereas FMA Hand Scores had significant differences in gain scores between moderate and mild impairments. There was no significant change in muscle tone or hand-path ratios between T1, T2, and T3 within the groups. Conclusion. Arm weight support training is beneficial for subacute stroke patients with moderate to severe arm impairments, especially to improve vertical control such as shoulder flexion, and there were no adverse effects in muscle tone.
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Calabrò RS, Russo M, Naro A, Milardi D, Balletta T, Leo A, Filoni S, Bramanti P. Who May Benefit From Armeo Power Treatment? A Neurophysiological Approach to Predict Neurorehabilitation Outcomes. PM R 2016; 8:971-978. [PMID: 26902866 DOI: 10.1016/j.pmrj.2016.02.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/08/2016] [Accepted: 02/14/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The Armeo Power, a rehabilitation exoskeleton that allows early treatment of motor disabilities, provides intelligent arm support in a large 3-dimensional work space, thus enabling patients to perform intensive, repetitive, and goal-oriented exercises. This device could efficiently induce new connections and facilitate plasticity phenomena potentiation. Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy. OBJECTIVE To identify potential neurophysiologic markers predicting the responsiveness of stroke patients to upper limb robotic treatment. DESIGN Prospective cohort study. SETTING Behavioral and Robotic Neurorehabilitation Laboratory of IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy. PATIENTS We enrolled 35 patients who had sustained a first-ever ischemic supratentorial stroke at least 2 months before enrollment and had unilateral hemiplegia. METHODS All patients underwent 40 Armeo Power training sessions that lasted 1 hour each (ie, 5 times a week for 8 weeks). MAIN OUTCOME MEASUREMENTS We assessed the spasticity and motor function of the upper limb by means of the Modified Ashworth scale and Fugl-Meyer assessment, respectively. Moreover, we evaluated the cortical excitability and plasticity potential of the bilateral primary motor areas in response to the repetitive paired associative stimulation paradigm using transcranial magnetic stimulation and Armeo Power kinematic parameters. RESULTS The patients who showed significant repetitive paired associative stimulation aftereffects at baseline exhibited an evident increase of cortical plasticity in the affected hemisphere (motor evoked potential amplitude increase, P = .03), a decrease of interhemispheric inhibition (affected hemisphere cortical silent period duration decrease, P = .01; unaffected hemisphere cortical silent period duration increase, P = .004; repetitive paired associative stimulation aftereffect increase, P = .008). Such findings were paralleled by clinical improvements (Fugl-Meyer, P = .04) and Armeo Power kinematic improvements (elbow flexion/extension, P = .02; shoulder range of movement, P = .002). CONCLUSIONS Our data suggest that use of Armeo Power may improve upper limb motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy; Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Tina Balletta
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, San Giovanni Rotondo (FG), Italy
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Schneider JC, Ozsecen MY, Muraoka NK, Mancinelli C, Della Croce U, Ryan CM, Bonato P. Feasibility of an Exoskeleton-Based Interactive Video Game System for Upper Extremity Burn Contractures. PM R 2015; 8:445-52. [PMID: 26409198 DOI: 10.1016/j.pmrj.2015.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/13/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. OBJECTIVE To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. DESIGN Feasibility study. SETTING Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. METHODS Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. MAIN OUTCOME MEASURES Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. RESULTS The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. CONCLUSIONS This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors.
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Affiliation(s)
- Jeffrey C Schneider
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Ave, Boston, MA 02129(∗).
| | - Muzaffer Y Ozsecen
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(†)
| | - Nicholas K Muraoka
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(‡)
| | - Chiara Mancinelli
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(§)
| | - Ugo Della Croce
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA; and Università degli Studi di Sassari, Dipartimento di Scienze Politiche, Scienze della Comunicazione e Ingegneria, Sassari, Italy(¶)
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School; and Shriners Hospitals for Children, Boston, MA(#)
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA(‖)
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Abstract
This review covers the rationale, mechanisms, and availability of commercially available virtual environment-based interventions for stroke rehabilitation. It describes interventions for motor, speech, cognitive, and sensory dysfunction. Also discussed are the important features and mechanisms that allow virtual environments to facilitate motor relearning. A common challenge is the inability to translate success in small trials to efficacy in larger populations. The heterogeneity of stroke pathophysiology has been blamed, and experts advocate for the study of multimodal approaches. Therefore, this article also introduces a framework to help define new therapy combinations that may be necessary to address stroke heterogeneity.
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Affiliation(s)
- Michael J Fu
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, 2123 Martin Luther King Jr. Blvd., Cleveland, OH 44106, USA; Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA.
| | - Jayme S Knutson
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA
| | - John Chae
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, 309 Wickenden Bldg, Cleveland, OH, USA
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Nielsen JB, Willerslev-Olsen M, Christiansen L, Lundbye-Jensen J, Lorentzen J. Science-Based Neurorehabilitation: Recommendations for Neurorehabilitation From Basic Science. J Mot Behav 2015; 47:7-17. [DOI: 10.1080/00222895.2014.931273] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sabari JS, Woodbury M, Velozo CA. Rasch analysis of a new hierarchical scoring system for evaluating hand function on the motor assessment scale for stroke. Stroke Res Treat 2014; 2014:730298. [PMID: 25177513 PMCID: PMC4142312 DOI: 10.1155/2014/730298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
Abstract
Objectives. (1) To develop two independent measurement scales for use as items assessing hand movements and hand activities within the Motor Assessment Scale (MAS), an existing instrument used for clinical assessment of motor performance in stroke survivors; (2) To examine the psychometric properties of these new measurement scales. Design. Scale development, followed by a multicenter observational study. Setting. Inpatient and outpatient occupational therapy programs in eight hospital and rehabilitation facilities in the United States and Canada. Participants. Patients (N = 332) receiving stroke rehabilitation following left (52%) or right (48%) cerebrovascular accident; mean age 64.2 years (sd 15); median 1 month since stroke onset. Intervention. Not applicable. Main Outcome Measures. Data were tested for unidimensionality and reliability, and behavioral criteria were ordered according to difficulty level with Rasch analysis. Results. The new scales assessing hand movements and hand activities met Rasch expectations of unidimensionality and reliability. Conclusion. Following a multistep process of test development, analysis, and refinement, we have redesigned the two scales that comprise the hand function items on the MAS. The hand movement scale contains an empirically validated 10-behavior hierarchy and the hand activities item contains an empirically validated 8-behavior hierarchy.
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Affiliation(s)
- Joyce S. Sabari
- College of Health Related Professions, Occupational Therapy Program, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, USA
| | - Michelle Woodbury
- Ralph H Johnson VA Medical Center, Charleston, SC 29425, USA
- Department of Health Sciences and Research, Medical University of SC, Charleston, SC 29425, USA
| | - Craig A. Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC 29425, USA
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Norman SL, Doxon AJ, Gleeson BT, Provancher WR. Planar hand motion guidance using fingertip skin-stretch feedback. IEEE TRANSACTIONS ON HAPTICS 2014; 7:121-130. [PMID: 24968376 DOI: 10.1109/toh.2013.2296306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In this paper, we show that a simple haptic device can accurately guide users through planar hand movements. The device guides the user through skin stretch feedback on the fingerpad of the user's index finger. In an angle matching test evaluating two types of stimuli, users are able to discriminate between eight stimulus directions and match the motion of their hand to the stimulus direction with 10 degree accuracy. In two motion guidance tests, haptic cues effectively guide users' arm motions through the full extent of their reachable workspace. Real-time corrective feedback greatly improves user performance, keeping average user hand motions within 12 mm of the prescribed path and within 4 degree of the indicated directions. Additionally, the paper shows that participants exhibit distorted haptic perceptual responses, finding that the distortion causes a response direction bias, but that appropriate haptic feedback can correct for the effect. Such motion guidance has applications in human-machine interaction, such as upper-extremity rehabilitation.
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Coscia M, Cheung VCK, Tropea P, Koenig A, Monaco V, Bennis C, Micera S, Bonato P. The effect of arm weight support on upper limb muscle synergies during reaching movements. J Neuroeng Rehabil 2014; 11:22. [PMID: 24594139 PMCID: PMC3996016 DOI: 10.1186/1743-0003-11-22] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 02/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background Compensating for the effect of gravity by providing arm-weight support (WS) is a technique often utilized in the rehabilitation of patients with neurological conditions such as stroke to facilitate the performance of arm movements during therapy. Although it has been shown that, in healthy subjects as well as in stroke survivors, the use of arm WS during the performance of reaching movements leads to a general reduction, as expected, in the level of activation of upper limb muscles, the effects of different levels of WS on the characteristics of the kinematics of motion and of the activity of upper limb muscles have not been thoroughly investigated before. Methods In this study, we systematically assessed the characteristics of the kinematics of motion and of the activity of 14 upper limb muscles in a group of 9 healthy subjects who performed 3-D arm reaching movements while provided with different levels of arm WS. We studied the hand trajectory and the trunk, shoulder, and elbow joint angular displacement trajectories for different levels of arm WS. Besides, we analyzed the amplitude of the surface electromyographic (EMG) data collected from upper limb muscles and investigated patterns of coordination via the analysis of muscle synergies. Results The characteristics of the kinematics of motion varied across WS conditions but did not show distinct trends with the level of arm WS. The level of activation of upper limb muscles generally decreased, as expected, with the increase in arm WS. The same eight muscle synergies were identified in all WS conditions. Their level of activation depended on the provided level of arm WS. Conclusions The analysis of muscle synergies allowed us to identify a modular organization underlying the generation of arm reaching movements that appears to be invariant to the level of arm WS. The results of this study provide a normative dataset for the assessment of the effects of the level of arm WS on muscle synergies in stroke survivors and other patients who could benefit from upper limb rehabilitation with arm WS.
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Affiliation(s)
- Martina Coscia
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), BM 3210 Station 17, Lausanne CH-1015, Switzerland.
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Modification of the ladder rung walking task-new options for analysis of skilled movements. Stroke Res Treat 2013; 2013:418627. [PMID: 23577278 PMCID: PMC3610362 DOI: 10.1155/2013/418627] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/28/2013] [Indexed: 11/25/2022] Open
Abstract
Method sensitivity is critical for evaluation of poststroke motor function. Skilled walking was assessed in horizontal, upward, and downward rung ladder walking to compare the demands of the tasks and test sensitivity. The complete step sequence of a walk was subjected to analysis aimed at demonstrating the walking pattern, step sequence, step cycle, limb coordination, and limb interaction to complement the foot fault scoring system. Rats (males, n = 10) underwent unilateral photothrombotic lesion of the motor cortex of the forelimb and hind limb areas. Locomotion was video recorded before the insult and at postischemic days 7 and 28. Analysis of walking was performed frame-by-frame. Walking along the rung ladder revealed different results that were dependent on ladder inclination. Horizontal walking was found to discriminate lesion-related motor deficits in forelimb, whereas downward walking demonstrates hind limb use most sensitively. A more frequent use of the impaired forelimb that possibly supported poststroke motor learning in rats was shown. The present study provides a novel system for a detailed analysis of the complete walking sequence and will help to provide a better understanding of how rats deal with motor impairments.
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