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Mauro MC, Fasano A, Germanotta M, Cortellini L, Insalaco S, Pavan A, Comanducci A, Guglielmelli E, Aprile IG. Restoring of Interhemispheric Symmetry in Patients With Stroke Following Bilateral or Unilateral Robot-Assisted Upper-Limb Rehabilitation: A Pilot Randomized Controlled Trial. IEEE Trans Neural Syst Rehabil Eng 2024; 32:3590-3602. [PMID: 39269794 DOI: 10.1109/tnsre.2024.3460485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Bilateral robotic rehabilitation has proven helpful in the recovery of upper limb motor function in patients with stroke, but its effects on the cortical reorganization mechanisms underlying recovery are still unclear. This pilot Randomized Controlled Trial (RCT) aimed to evaluate the effects on the interhemispheric balance of unilateral or bilateral robotic treatments in patients with subacute stroke, using Quantitative Electroencephalography (qEEG). 19 patients with ischemic stroke underwent a 30-session upper limb neurorehabilitation intervention using a bilateral upper limb exoskeleton. Each patient was randomly assigned to the bilateral (BG, n=10) or unilateral treatment group (UG, n=9). EEG evaluations were performed before (T0) and right after (T [Formula: see text] the first treatment session, after 30 treatment sessions (T1), and at 1-week follow-up (T2), in both eyes open and eyes closed conditions. From the acquired EEG data, the pairwise-derived Brain Symmetry Index (pdBSI) was computed. In addition, clinical evaluation was performed at T0 and T1 with validated clinical scales. After the treatment, a significant improvement in clinical and EEG evaluations was observed for both groups, but only the BG showed reduced pdBSI in delta and theta bands. In the cluster of sensorimotor channels, there was no significant difference between groups. The observed changes were not maintained at follow-up. No significant changes were observed in the pdBSI after a single rehabilitation session. Results suggest that balancing of interhemispheric symmetry comes along with a clinical improvement in the upper extremity and that the pdBSI can be used to investigate the mechanisms of neuronal plasticity involved in robotic rehabilitation after stroke.
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Chan HL, Meng LF, Kao YA, Chang YJ, Chang HW, Chen SW, Wu CY. Myoelectric, Myo-Oxygenation, and Myotonometry Changes during Robot-Assisted Bilateral Arm Exercises with Varying Resistances. SENSORS (BASEL, SWITZERLAND) 2024; 24:1061. [PMID: 38400219 PMCID: PMC10892273 DOI: 10.3390/s24041061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/26/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Robot-assisted bilateral arm training has demonstrated its effectiveness in improving motor function in individuals post-stroke, showing significant enhancements with increased repetitions. However, prolonged training sessions may lead to both mental and muscle fatigue. We conducted two types of robot-assisted bimanual wrist exercises on 16 healthy adults, separated by one week: long-duration, low-resistance workouts and short-duration, high-resistance exercises. Various measures, including surface electromyograms, near-infrared spectroscopy, heart rate, and the Borg Rating of Perceived Exertion scale, were employed to assess fatigue levels and the impacts of exercise intensity. High-resistance exercise resulted in a more pronounced decline in electromyogram median frequency and recruited a greater amount of hemoglobin, indicating increased muscle fatigue and a higher metabolic demand to cope with the intensified workload. Additionally, high-resistance exercise led to increased sympathetic activation and a greater sense of exertion. Conversely, engaging in low-resistance exercises proved beneficial for reducing post-exercise muscle stiffness and enhancing muscle elasticity. Choosing a low-resistance setting for robot-assisted wrist movements offers advantages by alleviating mental and physiological loads. The reduced training intensity can be further optimized by enabling extended exercise periods while maintaining an approximate dosage compared to high-resistance exercises.
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Affiliation(s)
- Hsiao-Lung Chan
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (H.-L.C.); (Y.-A.K.); (H.-W.C.)
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan;
| | - Ling-Fu Meng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan 33302, Taiwan;
- Division of Occupational Therapy, Department of Rehabilitation, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan
| | - Yung-An Kao
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (H.-L.C.); (Y.-A.K.); (H.-W.C.)
| | - Ya-Ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan;
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan 33302, Taiwan
| | - Hao-Wei Chang
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan; (H.-L.C.); (Y.-A.K.); (H.-W.C.)
| | - Szi-Wen Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan;
- Department of Electronic Engineering, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan 33305, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
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Tang C, Zhou T, Zhang Y, Yuan R, Zhao X, Yin R, Song P, Liu B, Song R, Chen W, Wang H. Bilateral upper limb robot-assisted rehabilitation improves upper limb motor function in stroke patients: a study based on quantitative EEG. Eur J Med Res 2023; 28:603. [PMID: 38115157 PMCID: PMC10729331 DOI: 10.1186/s40001-023-01565-x] [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: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Upper limb dysfunction after stroke seriously affects quality of life. Bilateral training has proven helpful in recovery of upper limb motor function in these patients. However, studies evaluating the effectiveness of bilateral upper limb robot-assisted training on improving motor function and quality of life in stroke patients are lacking. Quantitative electroencephalography (EEG) is non-invasive, simple, and monitors cerebral cortical activity, which can be used to evaluate the effectiveness of interventions. In this study, EEG was used to evaluate the effect of end-drive bilateral upper extremity robot-assisted training on upper extremity functional recovery in stroke patients. METHODS 24 stroke patients with hemiplegia were randomly divided into a conventional training (CT, n = 12) group or a bilateral upper limb robot-assisted training (BRT, n = 12) group. All patients received 60 min of routine rehabilitation treatment including rolling, transferring, sitting, standing, walking, etc., per day, 6 days a week, for three consecutive weeks. The BRT group added 30 min of bilateral upper limb robot-assisted training per day, while the CT group added 30 min of upper limb training (routine occupational therapy) per day, 6 days a week, for 3 weeks. The primary outcome index to evaluate upper limb motor function was the Fugl-Meyer functional score upper limb component (FMA-UE), with the secondary outcome of activities of daily living (ADL), assessed by the modified Barthel index (MBI) score. Quantitative EEG was used to evaluate functional brain connectivity as well as alpha and beta power current source densities of the brain. RESULTS Significant (p < 0.05) within-group differences were found in FMA-UE and MBI scores for both groups after treatment. A between-group comparison indicated the MBI score of the BRT group was significantly different from that of the CT group, whereas the FMA-UE score was not significantly different from that of the CT group after treatment. The differences of FMA-UE and MBI scores before and after treatment in the BRT group were significantly different as compared to the CT group. In addition, beta rhythm power spectrum energy was higher in the BRT group than in the CT group after treatment. Functional connectivity in the BRT group, under alpha and beta rhythms, was significantly increased in both the bilateral frontal and limbic lobes as compared to the CT group. CONCLUSIONS BRT outperformed CT in improving ADL in stroke patients within three months, and BRT facilitates the recovery of upper limb function by enhancing functional connectivity of the bilateral cerebral hemispheres.
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Affiliation(s)
- Congzhi Tang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ting Zhou
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Yun Zhang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Runping Yuan
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Xianghu Zhao
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ruian Yin
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Pengfei Song
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Bo Liu
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ruyan Song
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Wenli Chen
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China.
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China.
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Chen JC, Cheng HM. Applying an Artificial Neuromolecular System to the Application of Robotic Arm Motion Control in Assisting the Rehabilitation of Stroke Patients-An Artificial World Approach. Biomimetics (Basel) 2023; 8:385. [PMID: 37754136 PMCID: PMC10526234 DOI: 10.3390/biomimetics8050385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
Stroke patients cannot use their hands as freely as usual. However, recovery after a stroke is a long road for many patients. If artificial intelligence can assist human arm movement, it is believed that the possibility of stroke patients returning to normal hand movement can be significantly increased. In this study, the artificial neuromolecular system (ANM system) developed by our laboratory is used as the core motion control system to learn to control the mechanical arm, produce similar human rehabilitation actions, and assist patients in transiting between different activities. The strength of the ANM system lies in its ability to capture and process spatiotemporal information by exploiting the dynamic information processing inside neurons. Five experiments are conducted in this research: continuous learning, dimensionality reduction, moving problem domains, transfer learning, and fault tolerance. The results show that the ANM system can find out the arm movement trajectory when people perform different rehabilitation actions through the ability of continuous learning and reduce the activation of multiple muscle groups in stroke patients through the learning method of reducing dimensions. Finally, using the ANM system can reduce the learning time and performance required to switch between different actions through transfer learning.
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Affiliation(s)
- Jong-Chen Chen
- Information Management Department, National Yunlin University of Science and Technology, Douliu 640, Taiwan;
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Fareh R, Elsabe A, Baziyad M, Kawser T, Brahmi B, Rahman MH. Will Your Next Therapist Be a Robot?-A Review of the Advancements in Robotic Upper Extremity Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:5054. [PMID: 37299781 PMCID: PMC10255591 DOI: 10.3390/s23115054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/11/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Several recent studies have indicated that upper extremity injuries are classified as a top common workplace injury. Therefore, upper extremity rehabilitation has become a leading research area in the last few decades. However, this high number of upper extremity injuries is viewed as a challenging problem due to the insufficient number of physiotherapists. With the recent advancements in technology, robots have been widely involved in upper extremity rehabilitation exercises. Although robotic technology and its involvement in the rehabilitation field are rapidly evolving, the literature lacks a recent review that addresses the updates in the robotic upper extremity rehabilitation field. Thus, this paper presents a comprehensive review of state-of-the-art robotic upper extremity rehabilitation solutions, with a detailed classification of various rehabilitative robots. The paper also reports some experimental robotic trials and their outcomes in clinics.
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Affiliation(s)
- Raouf Fareh
- Department of Electrical Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ammar Elsabe
- Department of Computer Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Mohammed Baziyad
- Research Institute of Sciences and Engineering (RISE), University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Tunajjina Kawser
- Anatomy Department, Shaheed Tajuddin Ahmad Medical College, Gazipur 1700, Bangladesh
| | - Brahim Brahmi
- Department of Electrical Engineering, College of Ahuntsic, Montreal, QC H2M 1Y8, Canada
| | - Mohammad H. Rahman
- Mechanical Engineering, University of Wisconsin Milwaukee, Milwaukee, WI 53212, USA
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Hsu HY, Yang KC, Yeh CH, Lin YC, Lin KR, Su FC, Kuo LC. A Tenodesis-Induced-Grip exoskeleton robot (TIGER) for assisting upper extremity functions in stroke patients: a randomized control study. Disabil Rehabil 2022; 44:7078-7086. [PMID: 34586927 DOI: 10.1080/09638288.2021.1980915] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE This study was aimed toward developing a lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) and to examine the performance of the TIGER in stroke patients with hemiplegia. METHODS This was a single-blinded, randomized control trial with pre-treatment, immediate post-treatment, and 12-week follow-up assessments. Thirty-four stroke patients were recruited and randomized to either an experimental or control group, where each participant in both groups underwent 40 min of training. In addition to a 20-min bout of regular task-specific motor training, each participant in the experimental group received 20 min of TIGER training, and the controls received 20 min of traditional occupational therapy in each treatment session. Primary outcomes based on the Fugl-Meyer Motor Assessment of Upper Extremity (FMA-UE) were recorded. RESULTS Thirty-two patients (94.1%) completed the study: 17 and 15 patients in the experimental and control groups, respectively. Significant beneficial effects were found on the total score (ANCOVA, p = 0.006), the wrist score (ANCOVA, p = 0.037), and the hand score (ANCOVA, p = 0.006) for the FMA-UE in the immediate post-treatment assessment of the participants receiving the TIGER training. CONCLUSION The TIGER has beneficial effects on remediating upper limb impairments in chronic stroke patients. Clinical trial registration: ClinicalTrials.gov; identifier NCT03713476Implications for rehabilitationBased on use-dependent plasticity concepts, robot training with the more distal segments of the upper extremities has a beneficial effect in patients with chronic stroke.A novel lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) system using a mechanism involving musculotendinous coordination of the wrist and hand was proposed in this study.Between-group differences in changes in the upper limb motor performance were observed in the experimental group as compared to patients in the control group. For patients with chronic stroke, receiving 20 min of TIGER training in conjunction with 20 min of task-specific motor training led to clinically important changes in motor control and functioning of the affected upper limb.
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Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsien Yeh
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Ren Lin
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
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Durante F, Raparelli T, Beomonte Zobel P. Two-Dof Upper Limb Rehabilitation Robot Driven by Straight Fibers Pneumatic Muscles. Bioengineering (Basel) 2022; 9:377. [PMID: 36004902 PMCID: PMC9405197 DOI: 10.3390/bioengineering9080377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
In this paper, the design of a 2-dof (degrees of freedom) rehabilitation robot for upper limbs driven by pneumatic muscle actuators is presented. This paper includes the different aspects of the mechanical design and the control system and the results of the first experimental tests. The robot prototype is constructed and at this preliminary step a position and trajectory control by fuzzy logic is implemented. The pneumatic muscle actuators used in this arm are designed and constructed by the authors' research group.
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Affiliation(s)
- Francesco Durante
- Department of Industrial and Information Engineering and Economy (DIIIE), University of L’Aquila, P.le Pontieri 1, Località Monteluco, 67100 L’Aquila, Italy
| | - Terenziano Raparelli
- Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy
| | - Pierluigi Beomonte Zobel
- Department of Industrial and Information Engineering and Economy (DIIIE), University of L’Aquila, P.le Pontieri 1, Località Monteluco, 67100 L’Aquila, Italy
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Ma D, Li X, Xu Q, Yang F, Feng Y, Wang W, Huang JJ, Pei YC, Pan Y. Robot-Assisted Bimanual Training Improves Hand Function in Patients With Subacute Stroke: A Randomized Controlled Pilot Study. Front Neurol 2022; 13:884261. [PMID: 35873779 PMCID: PMC9298653 DOI: 10.3389/fneur.2022.884261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Study Design A randomized controlled pilot study. Background Bimanual therapy (BMT) is an effective neurorehabilitation therapy for the upper limb, but its application to the distal upper limb is limited due to methodological difficulties. Therefore, we applied an exoskeleton hand to perform robot-assisted task-oriented bimanual training (RBMT) in patients with stroke. Objective To characterize the effectiveness of RBMT in patients with hemiplegic stroke with upper limb motor impairment. Interventions A total of 19 patients with subacute stroke (1–6 months from onset) were randomized and allocated to RBMT and conventional therapy (CT) groups. The RBMT and CT groups received 90 min of training/day (RBMT: 60 min RBMT + 30 min CT; CT: 60 min CT for hand functional training + 30 min regular CT), 5 days/week, for 4 weeks (20 sessions during the experimental period). Assessments Clinical assessments, including the Fugl–Meyer assessment of the upper extremity (FMA-UE), action research arm test (ARAT), and wolf motor arm function test (WMFT), were conducted before and after the intervention. Results Within-group analysis showed a significant improvement in the FMA-UE and WMFT in both the CT and RBMT groups. A significant improvement in the Fugl–Meyer assessment (FMA) of the wrist and hand for the distal part in the RBMT group occurred earlier than that in the CT group. A significant improvement in WMFT time was found in both groups, but the WMFT functional ability assessment was only found in the RBMT group. No significant improvements in ARAT assessment were observed in either the CT or RBMT groups. Compared with CT, significant improvements were found in terms of the proportion of minimally clinically important differences after RBMT in FMA-UE (χ2 = 4.34, p = 0.037). No adverse events were reported by any of the participants across all sessions. Conclusions This study is the first to apply RBMT to the distal part of the upper limb. Both RBMT and CT are effective in improving the upper limb function in patients with subacute stroke. RBMT shows superior potential efficacy in facilitating recovery of the distal part of upper extremity (UE) motor function in the early stage. Future randomized control studies with a large sample size and follow-up assessments are needed to validate the present conclusions.
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Affiliation(s)
- Di Ma
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xin Li
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Quan Xu
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Yang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yutong Feng
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenxu Wang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jian-Jia Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate School of Science Design Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Coskunsu DK, Akcay S, Ogul OE, Akyol DK, Ozturk N, Zileli F, Tuzun BB, Krespi Y. Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study. Acta Neurol Scand 2022; 146:499-511. [PMID: 35855628 DOI: 10.1111/ane.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. MATERIALS & METHOD A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke (<1 month after cerebrovascular accident) and randomly allocated to experimental group (EG) and control group (CG). Neurophysiological rehabilitation program was performed to both EG and CG for 5 days a week and totally 15 sessions. The EG also received robotic rehabilitation with the EMG-driven exoskeleton hand robot (Hand of Hope®, Rehab-Robotics Company) 15 sessions over 3 weeks. Hand motor functions (Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT)), activities of daily living (Motor Activity Log (MAL)), force and EMG activities of extensor and flexor muscles for the cup test were evaluated before treatment (pretreatment) and after the 15th session (posttreatment). RESULTS Eleven patients (59.91 ± 14.20 yr) in the EG and 9 patients (70 ± 14.06 yr) in the CG completed the study. EG did not provide a significant advantage compared with the CG in FMA-UE, ARAT and MAL scores and cup-force and EMG activities (p > .05 for all). CONCLUSION In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.
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Affiliation(s)
- Dilber Karagozoglu Coskunsu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey.,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
| | - Sumeyye Akcay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey
| | - Ozden Erkan Ogul
- Faculty of Health Sciences, Department of Ergotherapy, Medipol University, Istanbul, Turkey
| | - D Kubra Akyol
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul-Cerrahpasa University, Istanbul, Turkey
| | - Necla Ozturk
- Faculty of Medicine, Department of Biophysics, Maltepe University, Istanbul, Turkey
| | - Füsun Zileli
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Birgul Baştan Tuzun
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Yakup Krespi
- Faculty of Medicine, Department of Neurology, Istinye University, Istanbul, Turkey
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Zuccon G, Lenzo B, Bottin M, Rosati G. Rehabilitation robotics after stroke: a bibliometric literature review. Expert Rev Med Devices 2022; 19:405-421. [PMID: 35786139 DOI: 10.1080/17434440.2022.2096438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is the leading cause of long-term disability in developed countries. Due to population aging, the number of people requiring rehabilitation after stroke is going to rise in the coming decades. Robot-mediated neurorehabilitation has the potential to improve clinical outcomes of rehabilitation treatments. A statistical analysis of the literature aims to focus on the main trend of this topic. AREAS COVERED A bibliometric survey on post-stroke robotic rehabilitation was performed through a database collection of scientific publications in the field of rehabilitation robotics. By covering the last 20 years, 17429 sources were collected. Relevant patterns and statistics concerning the main research areas were analyzed. Leading journals and conferences which publish and disseminate knowledge in the field were identified. A detailed nomenclature study was carried out. The time trends of the research field were captured. Opinions and predictions of future trends that are expected to shape the near future of the field were discussed. EXPERT OPINION Data analysis reveals the continuous expansion of the research field over the last two decades, which is expected to rise considerably in near future. More attention will be paid to the lower limbs rehabilitation and disease/design specific applications in early-stage patients.
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Affiliation(s)
- Giacomo Zuccon
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Basilio Lenzo
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Matteo Bottin
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Giulio Rosati
- Department of Industrial Engineering, University of Padua, Padua, Italy
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12
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Siddique T, Fareh R, Abdallah M, Ahmed Z, Rahman MH. Autonomous Exercise Generator for Upper Extremity Rehabilitation: A Fuzzy-Logic-Based Approach. MICROMACHINES 2022; 13:842. [PMID: 35744456 PMCID: PMC9229736 DOI: 10.3390/mi13060842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
In this paper, an autonomous exercise generation system based of fuzzy logic approach is presented. This work attempts to close a gap in the design of a completely autonomous robotic rehabilitation system that can recommend exercises to patients based on their data, such as shoulder range of motion (ROM) and muscle strength, from a pre-set library of exercises. The input parameters are fed into a system that uses Mamdani-style fuzzy logic rules to process them. In medical applications, the rationale behind decision making is a sophisticated process that involves a certain amount of uncertainty and ambiguity. In this instance, a fuzzy-logic-based system emerges as a viable option for dealing with the uncertainty. The system's rules have been reviewed by a therapist to ensure that it adheres to the relevant healthcare standards. Moreover, the system has been tested with a series of test data and the results obtained ensures the proposed idea's feasibility.
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Affiliation(s)
- Tanjulee Siddique
- Department of Electrical and Electronics Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Raouf Fareh
- Department of Electrical and Electronics Engineering, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Mahmoud Abdallah
- Department of Electrical Engineering, École de Technologie Supérieure, Montreal, QC H3C 1K3, Canada;
| | - Zaina Ahmed
- Department of Physiotherapy, University of Sharjah, Sharjah 27272, United Arab Emirates;
| | - Mohammad Habibur Rahman
- Biomedical/Mechanical Engineering Department, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
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13
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Ahmed T, Islam MR, Brahmi B, Rahman MH. Robustness and Tracking Performance Evaluation of PID Motion Control of 7 DoF Anthropomorphic Exoskeleton Robot Assisted Upper Limb Rehabilitation. SENSORS 2022; 22:s22103747. [PMID: 35632155 PMCID: PMC9146531 DOI: 10.3390/s22103747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023]
Abstract
Upper limb dysfunctions (ULD) are common following a stroke. Annually, more than 15 million people suffer a stroke worldwide. We have developed a 7 degrees of freedom (DoF) exoskeleton robot named the smart robotic exoskeleton (SREx) to provide upper limb rehabilitation therapy. The robot is designed for adults and has an extended range of motion compared to our previously designed ETS-MARSE robot. While providing rehabilitation therapy, the exoskeleton robot is always subject to random disturbance. Moreover, these types of robots manage various patients and different degrees of impairment, which are quite impossible to model and incorporate into the robot dynamics. We hypothesize that a model-independent controller, such as a PID controller, is most suitable for maneuvering a therapeutic exoskeleton robot to provide rehabilitation therapy. This research implemented a model-free proportional–integral–derivative (PID) controller to maneuver a complex 7 DoF anthropomorphic exoskeleton robot (i.e., SREx) to provide a wide variety of upper limb exercises to the different subjects. The robustness and trajectory tracking performance of the PID controller was evaluated with experiments. The results show that a PID controller can effectively control a highly nonlinear and complex exoskeleton-type robot.
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Affiliation(s)
- Tanvir Ahmed
- BioRobotics Laboratory, Mechanical/Biomedical Engineering Department, University of Wisconsin Milwaukee, Milwaukee, WI 53211, USA;
| | - Md Rasedul Islam
- Richard J. Resch School of Engineering, University of Wisconsin-Green Bay, Green Bay, WI 54311, USA;
| | - Brahim Brahmi
- Electrical Engineering Department, College Ahuntsic, Montreal, QC H2M 1Y8, Canada;
| | - Mohammad Habibur Rahman
- BioRobotics Laboratory, Mechanical/Biomedical Engineering Department, University of Wisconsin Milwaukee, Milwaukee, WI 53211, USA;
- Correspondence:
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14
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Robotic Systems for the Physiotherapy Treatment of Children with Cerebral Palsy: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095116. [PMID: 35564511 PMCID: PMC9100658 DOI: 10.3390/ijerph19095116] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022]
Abstract
Cerebral palsy is a neurological condition that is associated with multiple motor alterations and dysfunctions in children. Robotic systems are new devices that are becoming increasingly popular as a part of the treatment for cerebral palsy. A systematic review of the Pubmed, Web of Science, MEDLINE, Cochrane, Dialnet, CINAHL, Scopus, Lilacs and PEDro databases from November 2021 to February 2022 was conducted to prove the effectiveness of these devices for the treatment of motor dysfunctions in children who were diagnosed with cerebral palsy. Randomized clinical trials in Spanish and English were included. In total, 653 potential manuscripts were selected but only 7 of them met the inclusion criteria. Motor dysfunctions in the lower limbs and those that are specifically related to gait are the main parameters that are affected by cerebral palsy and the robotic systems Lokomat, Innowalk, Robogait and Waltbox-K are the most commonly used. There is no consensus about the effectiveness of these devices. However, it seems clear that they have presented a good complement to conventional physical therapies, although not a therapy as themselves. Unfortunately, the low quality of some of the randomized clinical trials that were reviewed made it difficult to establish conclusive results. More studies are needed to prove and test the extent to which these devices aid in the treatment of children with cerebral palsy.
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Koçak M, Gezgin E. PARS, low-cost portable rehabilitation system for upper arm. HARDWAREX 2022; 11:e00299. [PMID: 35509905 PMCID: PMC9058851 DOI: 10.1016/j.ohx.2022.e00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
This study introduces a compact low-cost single degree of freedom end-effector type upper arm rehabilitation system (PARS) along with its hardware and software elements. Proposed system is also suitable to be used in conjunction with a gaming environment. Throughout the study structural setup of the system was explained in detail along with its electronics, control system and gaming software. Introduced virtual gaming interface supports various game levels with different difficulties generated via interaction type control algorithms. Having simple structural design constructed by using basic available components, proposed system can be easily manufactured and utilized in physical rehabilitation procedures by using supplied open source codes. Introduced systems compactness and user friendly interface also allow its usage for individual home therapies for remote rehabilitation treatment procedures.
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16
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Ossmy O, Mansano L, Frenkel-Toledo S, Kagan E, Koren S, Gilron R, Reznik D, Soroker N, Mukamel R. Motor learning in hemi-Parkinson using VR-manipulated sensory feedback. Disabil Rehabil Assist Technol 2022; 17:349-361. [PMID: 32657187 DOI: 10.1080/17483107.2020.1785561] [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: 02/17/2020] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation. METHODS We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training. RESULTS Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity. DISCUSSION Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia.Implications for rehabilitationAssistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel - constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.
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Affiliation(s)
- Ori Ossmy
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Evgeny Kagan
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Koren
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Roee Gilron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Reznik
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mukamel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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17
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Xiong F, Liao X, Xiao J, Bai X, Huang J, Zhang B, Li F, Li P. Emerging Limb Rehabilitation Therapy After Post-stroke Motor Recovery. Front Aging Neurosci 2022; 14:863379. [PMID: 35401147 PMCID: PMC8984121 DOI: 10.3389/fnagi.2022.863379] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke, including hemorrhagic and ischemic stroke, refers to the blood supply disorder in the local brain tissue for various reasons (aneurysm, occlusion, etc.). It leads to regional brain circulation imbalance, neurological complications, limb motor dysfunction, aphasia, and depression. As the second-leading cause of death worldwide, stroke poses a significant threat to human life characterized by high mortality, disability, and recurrence. Therefore, the clinician has to care about the symptoms of stroke patients in the acute stage and formulate an effective postoperative rehabilitation plan to facilitate the recovery in patients. We summarize a novel application and update of the rehabilitation therapy in limb motor rehabilitation of stroke patients to provide a potential future stroke rehabilitation strategy.
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Affiliation(s)
- Fei Xiong
- Department of Operation Room, The First People’s Hospital of Jiande, Hangzhou, China
| | - Xin Liao
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Jie Xiao
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Xin Bai
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Jiaqi Huang
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Bi Zhang
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Fang Li
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
| | - Pengfei Li
- Department of Orthopedics, The First People’s Hospital of Jiande, Hangzhou, China
- *Correspondence: Pengfei Li,
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18
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Zhang M, Sun C, Liu Y, Wu X. A Robotic System to Deliver Multiple Physically Bimanual Tasks via Varying Force Fields. IEEE Trans Neural Syst Rehabil Eng 2022; 30:688-698. [PMID: 35271445 DOI: 10.1109/tnsre.2022.3158339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Individuals with physical limb disabilities are often restricted to perform activities of daily life (ADLs). While efficacy of bilateral training has been demonstrated in improving physical coordination of human limbs, few robots have been developed in simulating people's ADLs integrated with task-specific force field control. This study sought to develop a bilateral robot for better task rendering of general ADLs (gADLs), where gADL-consistent workspace is achieved by setting linear motors in series, and haptic rendering of multiple bimanual tasks (coupled, uncoupled and semi-coupled) is enabled by regulating force fields between robotic handles. Experiments were conducted with human users, and our results present a viable method of a single robotic system in simulating multiple physically bimanual tasks. In future, the proposed robotic system is expected to be serving as a coordination training device, and its clinical efficacy will be also investigated.
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19
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Robotic Device for Out-of-Clinic Post-Stroke Hand Rehabilitation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Due to the ageing population and an increasing number of stroke patients, we see the potential future of rehabilitation in telerehabilitation, which might alleviate the workload of physiotherapists and occupational therapists. In order to enable the use of telerehabilitation, devices aimed for home and independent use need to be developed. This paper describes the design of a robotic device for post-stroke wrist and finger rehabilitation and evaluates the movement it can perform. Six healthy subjects were tested in three experimental conditions: performing a coupled movement of wrist and fingers from flexion to extension without the device, with a passive device, and with an active device. The kinematics of the hand were captured using three Optotrak Certus motion capture systems and tracking 11 infrared active light-emitting diode (LED) markers. The results are presented in the form of base-line trajectories for all middle finger (MF) joints. In addition, the deviations of trajectories between conditions across all subjects were computed for the metacarpophalangeal (MCP) joint and fingertip of the MF and pinkie (PF) finger. Deviations from the base-line trajectory between measurement protocols and the root-mean-square deviation (RMSD) values indicate that the motion of the hand, imposed by the developed device, is comparable to the unconstrained motion of the healthy subjects, especially when moving into the extension, opening the hand.
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20
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Cardoso LRL, Pedro LM, Forner-Cordero A. Handlebar Robotic System for Bimanual Motor Control and Learning Research. SENSORS (BASEL, SWITZERLAND) 2021; 21:5991. [PMID: 34577199 PMCID: PMC8472032 DOI: 10.3390/s21185991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Robotic devices can be used for motor control and learning research. In this work, we present the construction, modeling and experimental validation of a bimanual robotic device. We tested some hypotheses that may help to better understand the motor learning processes involved in the interlimb coordination function. The system emulates a bicycle handlebar with rotational motion, thus requiring bilateral upper limb control and a coordinated sequence of joint sub-movements. The robotic handlebar is compact and portable and can register in a fast rate both position and forces independently from arms, including prehension forces. An impedance control system was implemented in order to promote a safer environment for human interaction and the system is able to generate force fields, suitable for implementing motor learning paradigms. The novelty of the system is the decoupling of prehension and manipulation forces of each hand, thus paving the way for the investigation of hand dominance function in a bimanual task. Experiments were conducted with ten healthy subjects, kinematic and dynamic variables were measured during a rotational set of movements. Statistical analyses showed that movement velocity decreased with practice along with an increase in reaction time. This suggests an increase of the task planning time. Prehension force decreased with practice. However, an unexpected result was that the dominant hand did not lead the bimanual task, but helped to correct the movement, suggesting different roles for each hand during a cooperative bimanual task.
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Affiliation(s)
- Lucas R. L. Cardoso
- Programa de Pós-Graduação Interunidades em Bioengenharia (EESC/FMRP/IQSC), University of São Paulo, São Carlos 13566-590, Brazil
| | - Leonardo M. Pedro
- Department of Mechanical Engineering, Federal University of São Carlos, São Carlos 13565-905, Brazil;
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory—Escola Politecnica, University of São Paulo, São Paulo 05508-010, Brazil;
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Song YH, Lee HM. Effect of Immersive Virtual Reality-Based Bilateral Arm Training in Patients with Chronic Stroke. Brain Sci 2021; 11:brainsci11081032. [PMID: 34439651 PMCID: PMC8391150 DOI: 10.3390/brainsci11081032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
Virtual reality (VR)-based therapies are widely used in stroke rehabilitation. Although various studies have used VR techniques for bilateral upper limb training, most have been only semi-immersive and have only been performed in an artificial environment. This study developed VR content and protocols based on activities of daily living to provide immersive VR-based bilateral arm training (VRBAT) for upper limb rehabilitation in stroke patients. Twelve patients with chronic stroke were randomized to a VRBAT group or a normal bilateral arm training (NBAT) group and attended 30-min training sessions five times a week for four weeks. At the end of the training, there was a significant difference in upper limb function in both groups (p < 0.05) and in the upper limb function sensory test for proprioception in the NBAT group (p < 0.05). There was no significant between-group difference in upper limb muscle activity after training. The relative alpha and beta power values for electroencephalographic measurements were significantly improved in both groups. These findings indicate that both VRBAT and NBAT are effective interventions for improving upper limb function and electroencephalographic activity in patients with chronic stroke.
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Affiliation(s)
- Yo-Han Song
- Department of Physical Therapy, Seoyeong University, Gwangju 61268, Korea;
| | - Hyun-Min Lee
- Department of Physical Therapy, Honam University, Gwangju 62399, Korea
- Correspondence:
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22
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Chan HL, Hung JW, Chang KC, Wu CY. Myoelectric analysis of upper-extremity muscles during robot-assisted bilateral wrist flexion-extension in subjects with poststroke hemiplegia. Clin Biomech (Bristol, Avon) 2021; 87:105412. [PMID: 34167043 DOI: 10.1016/j.clinbiomech.2021.105412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/06/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Muscle co-contraction during the execution of motor tasks or training is common in poststroke subjects. EMG-derived muscular activation indexes have been used to evaluate muscle co-contractions during movements. In addition, robot-assisted bilateral arm training provides a repetitive and stable training method to improve arm movements. However, quantitative measures of muscle contractions during this training in poststroke subjects have not been described. METHODS Seventeen subjects experiencing spastic hemiplegia after a stroke were recruited to perform robot-assisted bilateral wrist flexion and extension movements. The co-contraction index and two new indexes, temporal correlation and cross mutual information, which are derived from the EMGs of working muscles without the need for envelope normalization, are used to quantify intermuscular activation during wrist movements. FINDINGS Higher temporal correlation as well as higher co-contraction index was demonstrated in the affected muscles, implying the recruitment of muscle co-contractions to complete the movement task. On the other hand, a higher value of cross mutual information was exhibited in the unaffected muscles which was attributed to their distinct, rhythmic muscle contractions. The plot of temporal correlation versus cross mutual information further defined affected, unaffected synergistic, and unaffected agonist-antagonist muscular regions. Moreover, with the modified Ashworth scale, multiple regression models based on the co-contraction index and cross mutual information had the highest R-squared value of 0.733. INTERPRETATION EMG-derived intermuscular activation parameters demonstrated muscle co-contractions in the affected muscles and different types of intermuscular contractions during robot-assisted bilateral arm training. The modified Ashworth scale estimation based on multiple regression analysis of the activation indexes also demonstrated EMG-derived index a valuable method for assessing muscle spasticity in subjects with poststroke hemiplegia.
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Affiliation(s)
- Hsiao-Lung Chan
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Jen-Wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ku-Chou Chang
- Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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23
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Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Relative independence of upper limb position sense and reaching in children with hemiparetic perinatal stroke. J Neuroeng Rehabil 2021; 18:80. [PMID: 33980254 PMCID: PMC8117512 DOI: 10.1186/s12984-021-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies using clinical measures have suggested that proprioceptive dysfunction is related to motor impairment of the upper extremity following adult stroke. We used robotic technology and clinical measures to assess the relationship between position sense and reaching with the hemiparetic upper limb in children with perinatal stroke. METHODS Prospective term-born children with magnetic resonance imaging-confirmed perinatal ischemic stroke and upper extremity deficits were recruited from a population-based cohort. Neurotypical controls were recruited from the community. Participants completed two tasks in the Kinarm robot: arm position-matching (three parameters: variability [Varxy], contraction/expansion [Areaxy], systematic spatial shift [Shiftxy]) and visually guided reaching (five parameters: posture speed [PS], reaction time [RT], initial direction error [IDE], speed maxima count [SMC], movement time [MT]). Additional clinical assessments of sensory (thumb localization test) and motor impairment (Assisting Hand Assessment, Chedoke-McMaster Stroke Assessment) were completed and compared to robotic measures. RESULTS Forty-eight children with stroke (26 arterial, 22 venous, mean age: 12.0 ± 4.0 years) and 145 controls (mean age: 12.8 ± 3.9 years) completed both tasks. Position-matching performance in children with stroke did not correlate with performance on the visually guided reaching task. Robotic sensory and motor measures correlated with only some clinical tests. For example, AHA scores correlated with reaction time (R = - 0.61, p < 0.001), initial direction error (R = - 0.64, p < 0.001), and movement time (R = - 0.62, p < 0.001). CONCLUSIONS Robotic technology can quantify complex, discrete aspects of upper limb sensory and motor function in hemiparetic children. Robot-measured deficits in position sense and reaching with the contralesional limb appear to be relatively independent of each other and correlations for both with clinical measures are modest. Knowledge of the relationship between sensory and motor impairment may inform future rehabilitation strategies and improve outcomes for children with hemiparetic cerebral palsy.
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Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada. .,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
| | - Adam Kirton
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jennifer A Semrau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sean P Dukelow
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
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ZHANG LEIGANG, GUO SHUAI, SUN QING. DEVELOPMENT AND ANALYSIS OF A BILATERAL END-EFFECTER UPPER LIMB REHABILITATION ROBOT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have shown that rehabilitation training with the unaffected side guiding affected side is more consistent with the natural movement pattern of human upper limb compared with unilateral rehabilitation training, which is conducive to improve rehabilitation effect of the affected limb motor function. In this paper, a bilateral end-effector upper limb rehabilitation robot (BEULRR) based on two modern commercial manipulators is developed first, then the kinematics, reachability, and dexterity analysis of BEULRR are performed, respectively. Finally, a bilateral symmetric training protocol with the unaffected side guiding the affected side is proposed and evaluated through healthy human subject experiment testing based on BEULRR. The simulation results show that the developed BEULRR could perform spatial rehabilitation training and its rehabilitation training workspace can fully cover the physiological workspace of human upper limb. The preliminary experiment results from the healthy human subject show that the BEULRR system could provide reliable bilateral symmetric training protocol. These simulation and experiment results demonstrated that the developed BEULRR system could be used in bilateral rehabilitation training application, and also show that the BEULRR system has the potential to be applied to clinical rehabilitation training in the further step. In the close future, the proposed BEULRR and bilateral symmetric training protocol are planned to be applied in elderly volunteers and patients with upper limb motor dysfunction for further evaluating.
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Affiliation(s)
- LEIGANG ZHANG
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - SHUAI GUO
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - QING SUN
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
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25
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A Hand Motor Skills Rehabilitation for the Injured Implemented on a Social Robot. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11072943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this work, we introduce HaReS, a hand rehabilitation system. Our proposal integrates a series of exercises, jointly developed with a foundation for those with motor and cognitive injuries, that are aimed at improving the skills of patients and the adherence to the rehabilitation plan. Our system takes advantage of a low-cost hand-tracking device to provide a quantitative analysis of the performance of the patient. It also integrates a low-cost surface electromyography (sEMG) sensor in order to provide insight about which muscles are being activated while completing the exercises. It is also modular and can be deployed on a social robot. We tested our proposal in two different facilities for rehabilitation with high success. The therapists and patients felt more motivation while using HaReS, which improved the adherence to the rehabilitation plan. In addition, the therapists were able to provide services to more patients than when they used their traditional methodology.
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Baldan F, Turolla A, Rimini D, Pregnolato G, Maistrello L, Agostini M, Jakob I. Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy. J Electromyogr Kinesiol 2021; 57:102534. [PMID: 33618325 DOI: 10.1016/j.jelekin.2021.102534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recovery of hand function after stroke represents the hardest target for clinicians. Robot-assisted therapy has been proved to be effective for hand recovery. Nevertheless, studies aimed to refer patients to the best therapy are missing. METHODS With the aim to identify which clinical features are predictive for referring to robot-assisted hand therapy, 174 stroke patients were assessed with: Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Reaching Performance Scale (RPS), Box and Block Test (BBT), Modified Ashworth Scale (MAS), Nine Hole Pegboard Test (NHPT). Moreover, patients ability to control the robot with residual force and surface EMG (sEMG) independently, was checked. ROC curves were calculated to determine which of the measures were the predictors of the event. RESULTS sEMG control (AUC = 0.925) was significantly determined by FMA upper extremity (FMUE) (>24/66) and sensation (>23/24) sections, MAS at Flexor Carpi (<3/4) and total MAS (>4/20). Force control (AUC = 0.928) was correlated only with FMUE (>24/66). CONCLUSIONS FMUE and MAS were the best predictors of preserved ability to control the device by two different modalities. This finding opens the possibility to plan specific therapies aimed at maximizing the highest functional outcome achievable after stroke.
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Affiliation(s)
- Francesca Baldan
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy.
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Daniele Rimini
- Medical Physics Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Lorenza Maistrello
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Michela Agostini
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
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Astrakas LG, De Novi G, Ottensmeyer MP, Pusatere C, Li S, Moskowitz MA, Tzika AA. Improving motor function after chronic stroke by interactive gaming with a redesigned MR-compatible hand training device. Exp Ther Med 2021; 21:245. [PMID: 33603853 PMCID: PMC7851602 DOI: 10.3892/etm.2021.9676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/01/2022] Open
Abstract
New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.
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Affiliation(s)
- Loukas G Astrakas
- Medical Physics Laboratory, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Gianluca De Novi
- Medical Device and Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Mark P Ottensmeyer
- Medical Device and Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Christian Pusatere
- Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA
| | - Shasha Li
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.,Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA
| | - Michael A Moskowitz
- Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA.,Department of Neurology, Neuroscience Center, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - A Aria Tzika
- Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot enhanced stroke therapy optimizes rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil 2021; 18:10. [PMID: 33478563 PMCID: PMC7819212 DOI: 10.1186/s12984-021-00804-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
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Affiliation(s)
- Alexa B. Keeling
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Mark Piitz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Jennifer A. Semrau
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE USA
| | - Michael D. Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
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29
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Chen Y, Poole MC, Olesovsky SV, Champagne AA, Harrison KA, Nashed JY, Coverdale NS, Scott SH, Cook DJ. Robotic Assessment of Upper Limb Function in a Nonhuman Primate Model of Chronic Stroke. Transl Stroke Res 2021; 12:569-580. [PMID: 33393055 DOI: 10.1007/s12975-020-00859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/30/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
Stroke is a leading cause of death and disability worldwide and survivors are frequently left with long-term disabilities that diminish their autonomy and result in the need for chronic care. There is an urgent need for the development of therapies that improve stroke recovery, as well as accurate and quantitative tools to measure function. Nonhuman primates closely resemble humans in neuroanatomy and upper limb function and may be crucial in randomized pre-clinical trials for testing the efficacy of stroke therapies. To test the feasibility of robotic assessment of motor function in a NHP model of stroke, two cynomolgus macaques were trained to perform a visually guided reaching task and were also assessed in a passive stretch task using the Kinarm robot. Strokes were then induced in these animals by transiently occluding the middle cerebral artery, and their motor performance on the same tasks was assessed after recovery. Relative to pre-stroke performance, post-stroke hand movements of the affected limb became slower and less accurate. Regression analyses revealed both recovered and compensatory movements to complete movements in different spatial directions. Lastly, we noted decreased range of motion in the elbow joint of the affected limb post-stroke associated with spasticity during passive stretch. Taken together, these studies highlight that sensorimotor deficits in reaching movements following stroke in cynomolgus macaques resemble those in human patients and validate the use of robotic assessment tools in a nonhuman primate model of stroke for identifying and characterizing such deficits.
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Affiliation(s)
- Yining Chen
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Meredith C Poole
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Shelby V Olesovsky
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Allen A Champagne
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | | | - Joseph Y Nashed
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Nicole S Coverdale
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Douglas J Cook
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada. .,Division of Neurosurgery, Department of Surgery, Kingston General Hospital, Kingston, ON, Canada.
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Yeganeh Doost M, Herman B, Denis A, Sapin J, Galinski D, Riga A, Laloux P, Bihin B, Vandermeeren Y. Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial. Neural Regen Res 2021; 16:1566-1573. [PMID: 33433485 PMCID: PMC8323667 DOI: 10.4103/1673-5374.301030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.
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Affiliation(s)
- Maral Yeganeh Doost
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Herman
- UCLouvain, Louvain Bionics; UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Adrien Denis
- UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | | | | | - Audrey Riga
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Patrice Laloux
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur - site Mont-Godinne, Yvoir, Belgium
| | - Yves Vandermeeren
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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Panny M, Mayr A, Nagiller M, Kim Y. A domestic robotic rehabilitation device for assessment of wrist function for outpatients. J Rehabil Assist Technol Eng 2020; 7:2055668320961233. [PMID: 33329903 DOI: 10.1177/2055668320961233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/27/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Available robot-assisted stroke rehabilitation systems are often limited in their utilization in the home environment, due to several barriers such as high cost, absence of therapists, tedious training tasks, or encumbering interfaces. This paper presents a low-cost robotic rehabilitation and assessment device for restoring wrist function, offering wrist exercises incorporating pronation-supination and flexion-extension movements. Furthermore, the device is designed for the assessment of joint stiffness of the wrist, and range of motion in two degrees of freedom. Methods: Mechanical/electrical design of the device as well as the control system is described. A preliminary evaluation focused on the measurement of the torsional stiffness of the limb is presented. It is evaluated by reconstructing the known stiffness values of torsional springs by measuring the motor current required to displace them. Results The device demonstrates the ability to determine the stiffness of an object with low-cost hardware. Use case scenarios of the device for training and assessment of the wrist are presented, allowing for a range of motion of ± 75 ° and ± 65 ° , for pronation-supination and flexion-extension respectively. Conclusion The device shows potential to help objectively quantify the stiffness of the wrist movement, which consecutively could be used to represent and quantify the degree of impairment of patients after stroke in a more objective manner. Further clinical study is necessary to examine this.
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Affiliation(s)
- Matthias Panny
- Department of Mechatronics, MCI, University of Applied Sciences, Innsbruck, Austria
| | - Andreas Mayr
- Department of Neurology, Hospital Hochzirl-Natters, Zirl, Austria
| | - Marco Nagiller
- Department of Mechatronics, MCI, University of Applied Sciences, Innsbruck, Austria
| | - Yeongmi Kim
- Department of Mechatronics, MCI, University of Applied Sciences, Innsbruck, Austria
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Phan TQ, Nguyen H, Mulyk A, Vermillion BC, Lee SW. Development of Self-Adaptable Mechanism to Compensate Angle-Dependent Flexor Tone of the Elbow Joint Post-stroke: A Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4779-4782. [PMID: 33019059 DOI: 10.1109/embc44109.2020.9176501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Upper extremity impairments are common among stroke survivors. Robotic devices enable a high-dose of repetitive training for patients, but most systems are confined to the laboratory settings due to their complexity and power requirements. Previously we developed a passive elbow device that can counteract the angle-dependent tone of flexor muscles with hypertonia, but its efficacy was found limited as the increase in passive assistance during elbow extension was found not sufficient to provide assistance to those with more severe impairments. Therefore, in this study, we developed a 'self-adaptable' passive device that adjusts its assistance level based on the movements of patients. In addition to the morphological design to adjust moment arms of the elastic components, we incorporated a self-adaptation mechanism, in which the lengths of the elastic bands were adjusted by a pair of miniature linear motors based on the joint position feedback signals. The capacity of the device was then tested in a pilot testing with two healthy subjects, for whom angle-dependent flexion torque was implemented to simulate flexor hypertonia. The additional adjustment of passive component lengths was found to further increase the elbow extension assistance as the elbow joint extended. The proposed self-adapting mechanism, which does not require any complex control input from the experimenters, can be incorporated with the existing passive device to improve its functional efficacy in home-based training.
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Modular multi-motor exercise system for space exploration. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-2315-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Picelli A, Munari D, Modenese A, Filippetti M, Saggioro G, Gandolfi M, Corain M, Smania N. Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study. Eur J Phys Rehabil Med 2020; 56:444-450. [PMID: 32096616 DOI: 10.23736/s1973-9087.20.06112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. AIM To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. DESIGN Proof-of-concept, pilot, randomized controlled trial. SETTING University hospital. POPULATION Twenty adult outpatients with distal radius fracture due to wrist injury. METHODS All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. RESULTS No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. CONCLUSIONS Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. CLINICAL REHABILITATION IMPACT The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - .,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy -
| | - Daniele Munari
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Angela Modenese
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriele Saggioro
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Massimo Corain
- Unit of Hand Surgery, Department of Surgery and Odontology, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
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Evaluation of Commercial Ropes Applied as Artificial Tendons in Robotic Rehabilitation Orthoses. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to present the design, selection and testing of commercial ropes (artificial tendons) used on robotic orthosis to perform the hand movements for stroke individuals over upper limb rehabilitation. It was determined the load applied in the rope would through direct measurements performed on four individuals after stroke using a bulb dynamometer. A tensile strength test was performed using eight commercial ropes in order to evaluate the maximum breaking force and select the most suitable to be used in this application. Finally, a pilot test was performed with a user of the device to ratify the effectiveness of the rope. The load on the cable was 12.38 kgf (121.4 N) in the stroke-affected hand, which is the maximum tensile force that the rope must to supports. Paragliding rope (DuPont™ Kevlar ® ) supporting a load of 250 N at a strain of 37 mm was selected. The clinical test proved the effectiveness of the rope, supporting the requested efforts, without presenting permanent deformation, effectively performing the participant’s finger opening.
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Hung CS, Lin KC, Chang WY, Huang WC, Chang YJ, Chen CL, Grace Yao K, Lee YY. Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 100:2225-2232. [PMID: 31421096 DOI: 10.1016/j.apmr.2019.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. DESIGN A single-blind, randomized controlled trial. SETTING Four hospitals. PARTICIPANTS Outpatients with chronic stroke and mild to moderate motor impairment (N=44). INTERVENTION UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. MAIN OUTCOME MEASURES Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. RESULTS The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01). CONCLUSIONS BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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Affiliation(s)
- Chung-Shan Hung
- Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wan-Ying Chang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chih Huang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan
| | - Ya-Ju Chang
- Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kaiping Grace Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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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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Robotics in Health Care: Perspectives of Robot-Aided Interventions in Clinical Practice for Rehabilitation of Upper Limbs. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132586] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice.
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Hung CS, Hsieh YW, Wu CY, Lin KC, Lin JC, Yeh LM, Yin HP. Comparative Assessment of Two Robot-Assisted Therapies for the Upper Extremity in People With Chronic Stroke. Am J Occup Ther 2019; 73:7301205010p1-7301205010p9. [PMID: 30839256 DOI: 10.5014/ajot.2019.022368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the effects on motor and daily function of robot-assisted therapies in people with chronic stroke using the Bi-Manu-Track (BMT) and InMotion 3.0 (IMT) compared with control treatment (CT). METHOD In this comparative efficacy trial, 30 participants were randomized to receive BMT, IMT, or CT. Outcome measures included the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), and Medical Research Council (MRC) scale. RESULTS The IMT group improved more in FMA and proximal MAS scores than the BMT group (both ps < .01) and the CT group (p < .01 and p = .03, respectively). The IMT and BMT groups showed clinically relevant improvements after treatment on the MRC rather than the MAL. CONCLUSION The results indicate that the IMT might improve motor function. The IMT and BMT groups showed similar benefits for muscle power but limited improvements in self-perceived use of the affected arm.
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Affiliation(s)
- Chung-Shan Hung
- Chung-shan Hung, PhD, is Occupational Therapist, Community Health Center, Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. At the time of the study, she was Doctoral Candidate, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Wei Hsieh
- Yu-wei Hsieh, PhD, is Associate Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- Ching-yi Wu, ScD, OTR, is Professor and Chair, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- Keh-chung Lin, ScD, OTR, is Professor, School of Occupational Therapy, College of Medicine, and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan;
| | - Jui-Chi Lin
- Jui-chi Lin, MS, is Director, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Li-Min Yeh
- Li-min Yeh, BS, is Director, Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Pei Yin
- Hsin-pei Yin, MD, is Attending Physician and Chair, Department of Physical Medicine and Rehabilitation, Lo-Sheng Sanatorium and Hospital, Ministry of Health and Welfare, Taoyuan County, Taiwan
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Jo YJ, Kim YK. Consideration of Shoulder Injury Prevention and Rehabilitation Exercise for Overhead Sports Population. THE ASIAN JOURNAL OF KINESIOLOGY 2019. [DOI: 10.15758/ajk.2019.21.2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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41
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Duret C, Grosmaire AG, Krebs HI. Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Front Neurol 2019; 10:412. [PMID: 31068898 PMCID: PMC6491567 DOI: 10.3389/fneur.2019.00412] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Neurology, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan.,Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.,Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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42
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Hung CS, Hsieh YW, Wu CY, Chen YJ, Lin KC, Chen CL, Yao KG, Liu CT, Horng YS. Hybrid Rehabilitation Therapies on Upper-Limb Function and Goal Attainment in Chronic Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:116-123. [PMID: 30834812 DOI: 10.1177/1539449218825438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the treatment effects between unilateral hybrid therapy (UHT; unilateral robot-assisted therapy [RT] + modified constraint-induced movement therapy) and bilateral hybrid therapy (BHT; bilateral RT + bilateral arm training) compared with RT. Thirty patients with chronic stroke were randomized to UHT, BHT, or RT groups. Preliminary efficacy was assessed using the Fugl-Meyer Assessment (FMA), the Chedoke Arm and Hand Activity Inventory (CAHAI), and the goal attainment scaling (GAS). Possible adverse effects of abnormal muscle tone, pain, and fatigue were recorded. All groups showed large improvements in motor recovery and individual goals. Significant between-group differences were found on GAS favoring the hybrid groups but not on FMA and CAHAI. No adverse effects were reported. Hybrid therapies are safe and applicable interventions for chronic stroke and favorable for improving individual functional goals. Treatment effects on motor recovery and functional activity might be similar among the three groups.
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Affiliation(s)
| | - Yu-Wei Hsieh
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | - Ching-Yi Wu
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Keh-Chung Lin
- 5 National Taiwan University, Taipei.,6 National Taiwan University Hospital, Taipei
| | - Chia-Ling Chen
- 2 Chang Gung University, Taoyuan.,3 Chang Gung Memorial Hospital, Linkou
| | | | - Chien-Ting Liu
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
| | - Yi-Shiung Horng
- 7 Taipei Tzu Chi Hospital, Taipei.,8 Tzu Chi University, Hualien
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43
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Milia P, Peccini M, De Salvo F, Sfaldaroli A, Grelli C, Lucchesi G, Sadauskas N, Rossi C, Caserio M, Bigazzi M. Rehabilitation with robotic glove (Gloreha) in poststroke patients. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/digm.digm_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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44
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Frolov AA, Kozlovskaya IB, Biryukova EV, Bobrov PD. Use of Robotic Devices in Post-Stroke Rehabilitation. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11055-018-0668-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Abdollahi F, Corrigan M, Lazzaro EDC, Kenyon RV, Patton JL. Error-augmented bimanual therapy for stroke survivors. NeuroRehabilitation 2018; 43:51-61. [PMID: 30040762 DOI: 10.3233/nre-182413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke recovery studies have shown the efficacy of bimanual training on upper limb functional recovery and others have shown the efficacy of feedback technology that augments error. OBJECTIVE In a double-blinded randomized controlled study (N = 26), we evaluated the short-term effects of bilateral arm training to foster functional recovery of a hemiparetic arm, with half of our subjects unknowingly also receiving error augmentation (where errors were visually and haptically enhanced by a robot). METHODS Twenty-six individuals with chronic stroke were randomly assigned to practice an equivalent amount of bimanual reaching either with or without error augmentation. Participants were instructed to coordinate both arms while reaching to two targets (one for each arm) in three 45-minute treatments per week for two weeks, with a follow-up visit after one week without treatment. RESULTS Subjects' 2-week gains in Fugl-Meyer score averaged 2.92, and we also observed improvements Wolf Motor Functional Ability Scale average 0.21, and Motor Activity Log of 0.58 for quantity and 0.63 for quality of life scores. The extra benefit of error augmentation over the three weeks became apparent in Fugl-Meyer score only after removing an outlier from consideration. CONCLUSIONS This modest advantage of error augmentation was detectable over a short interval encouraging further research in interactive self-rehabilitation systems that can enhance error motor recovery.
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Affiliation(s)
- Farnaz Abdollahi
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Molly Corrigan
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Emily D C Lazzaro
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Robert V Kenyon
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - James L Patton
- University of Illinois at Chicago, Chicago, IL, USA.,Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Darbois N, Guillaud A, Pinsault N. Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review. Rehabil Res Pract 2018; 2018:6412318. [PMID: 30210873 PMCID: PMC6120256 DOI: 10.1155/2018/6412318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed. OBJECTIVES To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. METHOD Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. RESULTS In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. CONCLUSION Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.
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Affiliation(s)
- Nelly Darbois
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
| | - Albin Guillaud
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
| | - Nicolas Pinsault
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
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Mazzoleni S, Tran VD, Dario P, Posteraro F. Wrist Robot-assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: from Distal to Proximal Motor Recovery. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1889-1896. [PMID: 30106736 DOI: 10.1109/tnsre.2018.2864935] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this study, the recovery of proximal and distal segments in stroke patients who received distal training alone was investigated. Forty (20 subacute and 20 chronic) stroke patients were recruited to perform wrist robot-assisted rehabilitation training. The upper extremity, shoulder-elbow and wrist subsections of the Fugl-Meyer Assessment Scale were used to assess the motor recovery of distal and proximal segments. In addition, the Modified Ashworth Scale, the Motricity Index and the Box & Block test were used as clinical outcome measures together with kinematic parameters to evaluate the effects of the training. Significant increases in the wrist and shoulder-elbow subsections of the Fugl-Meyer Assessment Scale, Motricity Index and Box & Block test were found in both groups. Average changes in shoulder-elbow and upper extremity subsections of the Fugl-Meyer Assessment Scale in the subacute group (6.10 ± 6.60 and 15.65 ± 14.04) were significantly higher (p < 0.05) than those in the chronic group (2.30 ± 2.76 and 6.60 ± 4.64). In addition, significant increases in the movement velocity, movement smoothness and movement quality were observed in the subacute group. Our findings provide evidence that following a robot-assisted rehabilitation treatment there is a distal-to-proximal generalization in subacute stroke patients.
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48
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Liu Y, Guo S, Hirata H, Ishihara H, Tamiya T. Development of a powered variable-stiffness exoskeleton device for elbow rehabilitation. Biomed Microdevices 2018; 20:64. [PMID: 30074095 DOI: 10.1007/s10544-018-0312-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Robot-assisted movement training by means of exoskeleton devices has been proven to be an effective method for post-stroke patients to recover their motor function. However, in order to be used in home-based rehabilitation, the kinematic structure of a wearable exoskeleton device should provide portability and make allowances for the natural joint range of motion for the user. Additionally, the actuated stiffness of the target joint is desired to be adjustable in accordance with the specific impairment level of the patient's upper limb. In this paper, we present a novel portable exoskeleton device which could provide support for rehabilitation patients with variable actuated stiffness in the elbow joint. It has five passive degrees of freedom to guarantee the user's natural joint range of motion and intra-subject variability, as well as an integrated variable stiffness actuator (VSA) which can adjust the joint stiffness independently by moving the pivot position. An elbow power-assist trial with different actuated joint stiffnesses was tested on a healthy subject to evaluate the functionality of the proposed device. By regulating the joint stiffness, the proposed device could provide variable power assistance for the wearer's elbow movements.
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Affiliation(s)
- Yi Liu
- Graduate School of Engineering, Kagawa University, 2217-20 Hayashi-cho, Takamatsu, Kagawa, 761-0396, Japan.
| | - Shuxiang Guo
- Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, the Ministry of Industry and Information Technology, Beijing Institute of Technology, No. 5, Zhongguancun South Street, Haidian District, Beijing, 100081, China.
- Faculty of Engineering and Design, Kagawa University, 2217-20 Hayashi-cho, Takamatsu, Kagawa, 761-0396, Japan.
| | - Hideyuki Hirata
- Faculty of Engineering and Design, Kagawa University, 2217-20 Hayashi-cho, Takamatsu, Kagawa, 761-0396, Japan
| | - Hidenori Ishihara
- Faculty of Engineering and Design, Kagawa University, 2217-20 Hayashi-cho, Takamatsu, Kagawa, 761-0396, Japan
| | - Takashi Tamiya
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Miki-cho, Takamatsu, Kagawa, 761-0701, Japan
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49
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Lee BJB, Williams A, Ben-Tzvi P. Intelligent Object Grasping With Sensor Fusion for Rehabilitation and Assistive Applications. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1556-1565. [PMID: 29994121 DOI: 10.1109/tnsre.2018.2848549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper presents the design and control of the intelligent sensing and force-feedback exoskeleton robotic glove to create a system capable of intelligent object grasping initiated by detection of the user's intentions through motion amplification. Using a combination of sensory feedback streams from the glove, the system has the ability to identify and prevent object slippage, as well as adapting grip geometry to the object properties. The slip detection algorithm provides updated inputs to the force controller to prevent an object from being dropped, while only requiring minimal input from a user who may have varying degrees of functionality in their injured hand. This paper proposes the use of a high dynamic range, low cost conductive elastomer sensor coupled with a negative force derivative trigger that can be leveraged in order to create a controller that can intelligently respond to slip conditions through state machine architecture, and improve the grasping robustness of the exoskeleton. The improvements to the previous design are described while the details of the controller design and the proposed assistive and rehabilitative applications are explained. Experimental results confirming the validity of the proposed system are presented. Finally, this paper concludes with topics for future exploration.
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50
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Chang CK, Washabaugh EP, Gwozdziowski A, Remy CD, Krishnan C. A Semi-passive Planar Manipulandum for Upper-Extremity Rehabilitation. Ann Biomed Eng 2018; 46:1047-1065. [PMID: 29626272 DOI: 10.1007/s10439-018-2020-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
Robotic rehabilitation is a promising approach to treat individuals with neurological or orthopedic disorders. However, despite significant advancements in the field of rehabilitation robotics, this technology has found limited traction in clinical practice. A key reason for this issue is that most robots are expensive, bulky, and not scalable for in-home rehabilitation. Here, we introduce a semi-passive rehabilitation robot (SepaRRo) that uses controllable passive actuators (i.e., brakes) to provide controllable resistances at the end-effector over a large workspace in a manner that is cost-effective and safe for in-home use. We also validated the device through theoretical analyses, hardware experiments, and human subject experiments. We found that by including kinematic redundancies in the robot's linkages, the device was able to provide controllable resistances to purely resist the movement of the end-effector, or to gently steer (i.e., perturb) its motion away from the intended path. When testing these capabilities on human subjects, we found that many of the upper-extremity muscles could be selectively targeted based on the forcefield prescribed to the user. These results indicate that SepaRRo could serve as a low-cost therapeutic tool for upper-extremity rehabilitation; however, further testing is required to evaluate its therapeutic benefits in patient population.
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Affiliation(s)
- Chih-Kang Chang
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Edward P Washabaugh
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Gwozdziowski
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - C David Remy
- RAM Lab, Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA.,Michigan Robotics, College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. .,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. .,Michigan Robotics, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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