1
|
Gerez L, Micera S, Nuckols R, Proietti T. Assessment of wearable robotics performance in patients with neurological conditions. Curr Opin Neurol 2024:00019052-990000000-00200. [PMID: 39373271 DOI: 10.1097/wco.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
PURPOSE OF REVIEW While wearable robotics is expanding within clinical settings, particularly for neurological rehabilitation, there is still a lack of consensus on how to effectively assess the performance of these devices. This review focuses on the most common metrics, whose selection and design are crucial for optimizing treatment outcomes and potentially improve the standard care. RECENT FINDINGS The literature reveals that while wearable robots are equipped with various embedded sensors, most studies still rely on traditional, nontechnological methods for assessment. Recent studies have shown that, although quantitative data from embedded sensors are available (e.g., kinematics), these are underutilized in favor of qualitative assessments. A trend toward integrating automatic assessments from the devices themselves is emerging, with a few notable studies pioneering this approach. SUMMARY Our analysis suggests a critical need for developing standardized metrics that leverage the data from embedded sensors in wearable robots. This shift could enhance the accuracy of patient assessments and the effectiveness of rehabilitation strategies, ultimately leading to better patient outcomes in neurological rehabilitation.
Collapse
Affiliation(s)
- Lucas Gerez
- ARARA Lab, James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Richard Nuckols
- Department of Mechanical & Industrial Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Tommaso Proietti
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
| |
Collapse
|
2
|
Colamarino E, Morone G, Toppi J, Riccio A, Cincotti F, Mattia D, Pichiorri F. A Scoping Review of Technology-Based Approaches for Upper Limb Motor Rehabilitation after Stroke: Are We Really Targeting Severe Impairment? J Clin Med 2024; 13:5414. [PMID: 39336901 PMCID: PMC11432574 DOI: 10.3390/jcm13185414] [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: 08/12/2024] [Revised: 09/05/2024] [Accepted: 09/08/2024] [Indexed: 09/30/2024] Open
Abstract
Technology-based approaches for upper limb (UL) motor rehabilitation after stroke are mostly designed for severely affected patients to increase their recovery chances. However, the available randomized controlled trials (RCTs) focused on the efficacy of technology-based interventions often include patients with a wide range of motor impairment. This scoping review aims at overviewing the actual severity of stroke patients enrolled in RCTs that claim to specifically address UL severe motor impairment. The literature search was conducted on the Scopus and PubMed databases and included articles from 2008 to May 2024, specifically RCTs investigating the impact of technology-based interventions on UL motor functional recovery after stroke. Forty-eight studies were selected. They showed that, upon patients' enrollment, the values of the UL Fugl-Meyer Assessment and Action Research Arm Test covered the whole range of both scales, thus revealing the non-selective inclusion of severely impaired patients. Heterogeneity in terms of numerosity, characteristics of enrolled patients, trial design, implementation, and reporting was present across the studies. No clear difference in the severity of the included patients according to the intervention type was found. Patient stratification upon enrollment is crucial to best direct resources to those patients who will benefit the most from a given technology-assisted approach (personalized rehabilitation).
Collapse
Affiliation(s)
- Emma Colamarino
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Jlenia Toppi
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Angela Riccio
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Febo Cincotti
- Department of Computer, Control, and Management Engineering “Antonio Ruberti”, Sapienza University of Rome, 00185 Rome, Italy; (E.C.); (J.T.); (F.C.)
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | - Donatella Mattia
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy; (A.R.); (D.M.); (F.P.)
| | | |
Collapse
|
3
|
Mahan EE, Oh J, Chase EDZ, Dunkelberger NB, King ST, Sayenko D, O'Malley MK. Assessing the Effect of Cervical Transcutaneous Spinal Stimulation With an Upper Limb Robotic Exoskeleton and Surface Electromyography. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2883-2892. [PMID: 39088505 DOI: 10.1109/tnsre.2024.3436583] [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: 08/03/2024]
Abstract
Transcutaneous spinal stimulation (TSS) is a promising rehabilitative intervention to restore motor function and coordination for individuals with spinal cord injury (SCI). The effects of TSS are most commonly assessed by evaluating muscle response to stimulation using surface electromyography (sEMG). Given the increasing use of robotic devices to deliver therapy and the emerging potential of hybrid rehabilitation interventions that combine neuromodulation with robotic devices, there is an opportunity to leverage the on-board sensors of the robots to measure kinematic and torque changes of joints in the presence of stimulation. This paper explores the potential for robotic assessment of the effects of TSS delivered to the cervical spinal cord. We used a four degree-of-freedom exoskeleton to measure the torque response of upper limb (UL) joints during stimulation, while simultaneously recording sEMG. We analyzed joint torque and electromyography data generated during TSS delivered over individual sites of the cervical spinal cord in neurologically intact participants. We show that site-specific effects of TSS are manifested not only by modulation of the amplitude of spinally evoked motor potentials in UL muscles, but also by changes in torque generated by individual UL joints. We observed preferential resultant action of proximal muscles and joints with stimulation at the rostral site, and of proximal joints with rostral-lateral stimulation. Robotic assessment can be used to measure the effects of TSS, and could be integrated into complex control algorithms that govern the behavior of hybrid neuromodulation-robotic systems.
Collapse
|
4
|
Fan Y, Zhu L, Wang H, Song A. Synthesize Personalized Training for Robot-Assisted Upper Limb Rehabilitation With Diversity Enhancement. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:5705-5718. [PMID: 37639418 DOI: 10.1109/tvcg.2023.3308940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
For upper limb rehabilitation, the robot-assisted technique in combination with serious games requires well-specified training plans. For the best quality of the rehabilitation process, customized game levels for each user are desired, while it is labor-intensive to design and adjust game levels for different individuals. We work on generating training content for a desktop end-effector rehabilitation robot and propose a method to automatically generate individualized training plans. By modeling the search of the training motions as finding optimal hand paths and trajectories, we introduce solving the design problem with a multi-objective optimization (MO) solver. We further improve the MO solver to enhance the diversity of the solutions. With the proposed approach, our system is capable of automatically generating various training plans considering the training intensity and dexterity of each joint in the upper limb. In addition, the enhanced diversity avoids repeated training plans, which helps motivate the user in the rehabilitation. We test our method with different requirements on the training plans and validate the solutions.
Collapse
|
5
|
Alashram AR. Combined robot-assisted therapy virtual reality for upper limb rehabilitation in stroke survivors: a systematic review of randomized controlled trials. Neurol Sci 2024:10.1007/s10072-024-07628-z. [PMID: 38837113 DOI: 10.1007/s10072-024-07628-z] [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: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Upper limb impairments are among the most common consequences following a stroke. Recently, robot-assisted therapy (RT) and virtual reality (VR) have been used to improve upper limb function in stroke survivors. OBJECTIVES This review aims to investigate the effects of combined RT and VR on upper limb function in stroke survivors and to provide recommendations for researchers and clinicians in the medical field. METHODS We searched PubMed, SCOPUS, REHABDATA, PEDro, EMBASE, and Web of Science from inception to March 28, 2024. Randomized controlled trials (RCTs) involving stroke survivors that compared combined RT and VR interventions with either passive (i.e., sham, rest) or active (i.e., traditional therapy, VR, RT) interventions and assessed outcomes related to upper limb function (e.g., strength, muscle tone, or overall function) were included. The Cochrane Collaboration tool was used to evaluate the methodological quality of the included studies. RESULTS Six studies were included in this review. In total, 201 patients with stroke (mean age 57.84 years) were involved in this review. Four studies were considered 'high quality', while two were considered as 'moderate quality' on the Cochrane Collaboration tool. The findings showed inconsistent results for the effects of combined RT and VR interventions on upper limb function poststroke. CONCLUSION In conclusion, there are potential effects of combined RT and VR interventions on improving upper limb function, but further research is needed to confirm these findings, understand the underlying mechanisms, and assess the consistency and generalizability of the results.
Collapse
Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Ammam, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| |
Collapse
|
6
|
Lee SH, Song WK. Mitigating Trunk Compensatory Movements in Post-Stroke Survivors through Visual Feedback during Robotic-Assisted Arm Reaching Exercises. SENSORS (BASEL, SWITZERLAND) 2024; 24:3331. [PMID: 38894119 PMCID: PMC11174622 DOI: 10.3390/s24113331] [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: 03/31/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
Trunk compensatory movements frequently manifest during robotic-assisted arm reaching exercises for upper limb rehabilitation following a stroke, potentially impeding functional recovery. These aberrant movements are prevalent among stroke survivors and can hinder their progress in rehabilitation, making it crucial to address this issue. This study evaluated the efficacy of visual feedback, facilitated by an RGB-D camera, in reducing trunk compensation. In total, 17 able-bodied individuals and 18 stroke survivors performed reaching tasks under unrestricted trunk conditions and visual feedback conditions. In the visual feedback modalities, the target position was synchronized with trunk movement at ratios where the target moved at the same speed, double, and triple the trunk's motion speed, providing real-time feedback to the participants. Notably, trunk compensatory movements were significantly diminished when the target moved at the same speed and double the trunk's motion speed. Furthermore, these conditions exhibited an increase in the task completion time and perceived exertion among stroke survivors. This outcome suggests that visual feedback effectively heightened the task difficulty, thereby discouraging unnecessary trunk motion. The findings underscore the pivotal role of customized visual feedback in correcting aberrant upper limb movements among stroke survivors, potentially contributing to the advancement of robotic-assisted rehabilitation strategies. These insights advocate for the integration of visual feedback into rehabilitation exercises, highlighting its potential to foster more effective recovery pathways for post-stroke individuals by minimizing undesired compensatory motions.
Collapse
Affiliation(s)
| | - Won-Kyung Song
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Center, Seoul 01022, Republic of Korea;
| |
Collapse
|
7
|
Bernal-Jiménez JJ, Polonio-López B, Sanz-García A, Martín-Conty JL, Lerín-Calvo A, Segura-Fragoso A, Martín-Rodríguez F, Cantero-Garlito PA, Corregidor-Sánchez AI, Mordillo-Mateos L. Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:337. [PMID: 38338223 PMCID: PMC10855329 DOI: 10.3390/healthcare12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.
Collapse
Affiliation(s)
- Juan J. Bernal-Jiménez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Alfredo Lerín-Calvo
- Neruon Neurobotic S.L., 28015 Madrid, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University La Salle, 28023 Madrid, Spain
| | - Antonio Segura-Fragoso
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
| | - Pablo A. Cantero-Garlito
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| |
Collapse
|
8
|
Kim SH, Ji DM, Hwang IS, Ryu J, Jin S, Kim SA, Kim MS. Three-Dimensional Magnetic Rehabilitation, Robot-Enhanced Hand-Motor Recovery after Subacute Stroke: A Randomized Controlled Trial. Brain Sci 2023; 13:1685. [PMID: 38137133 PMCID: PMC10742112 DOI: 10.3390/brainsci13121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We developed an end-effector-type rehabilitation robot that can uses electro- and permanent magnets to generate a three-way magnetic field to assist hand movements and perform rehabilitation therapy. This study aimed to investigate the therapeutic effect of a rehabilitation program using a three-dimensional (3D) magnetic force-based hand rehabilitation robot on the motor function recovery of the paralyzed hands of patients with stroke. This was a double-blind randomized controlled trial in which 36 patients with subacute stroke were assigned to intervention and control groups of 18 patients each. The intervention group received 30 min of rehabilitation therapy per day for a month using a 3D magnetic force-driven hand rehabilitation robot, whereas the control group received 30 min of conventional occupational therapy to restore upper-limb function. The patients underwent three behavioral assessments at three time points: before starting treatment (T0), after 1 month of treatment (T1), and at the follow-up 1-month after treatment completion (T2). The primary outcome measure was the Wolf Motor Function Test (WMFT), and secondary outcome measures included the Fugl-Meyer Assessment of the Upper Limb (FMA_U), Modified Barthel Index (MBI), and European Quality of Life Five Dimensions (EQ-5D) questionnaire. No participant safety issues were reported during the intervention. Analysis using repeated measures analysis of variance showed significant interaction effects between time and group for both the WMFT score (p = 0.012) and time (p = 0.010). In post hoc analysis, the WMFT scores and time improved significantly more in the patients who received robotic rehabilitation at T1 than in the controls (p = 0.018 and p = 0.012). At T2, we also consistently found improvements in both the WMFT scores and times for the intervention group that were superior to those in the control group (p = 0.024 and p = 0.018, respectively). Similar results were observed for FMA_U, MBI, and EQ-5D. Rehabilitation using the 3D hand-rehabilitation robot effectively restored hand function in the patients with subacute stroke, contributing to improvement in daily independence and quality of life.
Collapse
Affiliation(s)
- Sung-Hoon Kim
- Department of Electronics & Information Engineering, Korea University, Sejong 30019, Republic of Korea;
| | - Dong-Min Ji
- Department of Electronics Convergence Engineering, Wonkwang University, Iksan 54538, Republic of Korea;
| | - In-Su Hwang
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Jinwhan Ryu
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Sol Jin
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Soo-A Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
| |
Collapse
|
9
|
Yeh TN, Chou LW. User Experience Evaluation of Upper Limb Rehabilitation Robots: Implications for Design Optimization: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:9003. [PMID: 37960702 PMCID: PMC10647564 DOI: 10.3390/s23219003] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023]
Abstract
With the development of science and technology, people are trying to use robots to assist in stroke rehabilitation training. This study aims to analyze the result of the formative test to provide the orientation of upper limb rehabilitation robot design optimization. We invited 21 physical therapists (PTs) and eight occupational therapists (OTs) who had no experience operating any upper limb rehabilitation robots before, and 4 PTs and 1 OT who had experience operating upper limb rehabilitation robots. Data statistics use the Likert scale. The general group scored 3.5 for safety-related topics, while the experience group scored 4.5. In applicability-related questions, the main function score was 2.3 in the general group and 2.4 in the experience group; and the training trajectory score was 3.5 in the general group and 5.0 in the experience group. The overall ease of use score was 3.1 in the general group and 3.6 in the experience group. There was no statistical difference between the two groups. The methods to retouch the trajectory can be designed through the feedback collected in the formative test and gathering further detail in the next test. Further details about the smooth trajectory must be confirmed in the next test. The optimization of the recording process is also important to prevent users from making additional effort to know it well.
Collapse
Affiliation(s)
- Tzu-Ning Yeh
- Department of Medical Engineering and Rehabilitation Science, China Medical University, Taichung 404332, Taiwan;
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung 406040, Taiwan
- Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung 413505, Taiwan
| |
Collapse
|
10
|
Ren H, Liu T, Wang J. Design and Analysis of an Upper Limb Rehabilitation Robot Based on Multimodal Control. SENSORS (BASEL, SWITZERLAND) 2023; 23:8801. [PMID: 37960505 PMCID: PMC10647264 DOI: 10.3390/s23218801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023]
Abstract
To address the rehabilitation needs of upper limb hemiplegic patients in various stages of recovery, streamline the workload of rehabilitation professionals, and provide data visualization, our research team designed a six-degree-of-freedom upper limb exoskeleton rehabilitation robot inspired by the human upper limb's structure. We also developed an eight-channel synchronized signal acquisition system for capturing surface electromyography (sEMG) signals and elbow joint angle data. Utilizing Solidworks, we modeled the robot with a focus on modularity, and conducted structural and kinematic analyses. To predict the elbow joint angles, we employed a back propagation neural network (BPNN). We introduced three training modes: a PID control, bilateral control, and active control, each tailored to different phases of the rehabilitation process. Our experimental results demonstrated a strong linear regression relationship between the predicted reference values and the actual elbow joint angles, with an R-squared value of 94.41% and an average error of four degrees. Furthermore, these results validated the increased stability of our model and addressed issues related to the size and single-mode limitations of upper limb rehabilitation robots. This work lays the theoretical foundation for future model enhancements and further research in the field of rehabilitation.
Collapse
Affiliation(s)
- Hang Ren
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200000, China;
| | - Tongyou Liu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 201100, China;
| | - Jinwu Wang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200000, China;
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 201100, China;
| |
Collapse
|
11
|
Lee SH, Song WK. Effectiveness of Visual Feedback in Reducing Trunk Compensation During Arm Reaching for Home-Based Stroke Rehabilitation. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941193 DOI: 10.1109/icorr58425.2023.10304739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
This study investigates the effectiveness of visual feedback in reducing trunk compensation during one-arm reaching exercises using an end-effector robot. Results suggest that visual feedback is more effective than verbal feedback in suppressing trunk compensation, as evidenced by lower trunk movements. Synchronized target position with respect to trunk motion exhibited a suppressive effect on trunk motion, as observed by a reduction in trunk standard deviation, trunk root mean square, and trunk difference between the starting and ending positions. These findings have important implications for developing feedback techniques to address unnatural upper limb reach movements in stroke survivors during rehabilitation programs. However, the study's limitations, such as small sample size, should be considered. Future research should explore feedback techniques in different patient populations and exercise types and evaluate their long-term effects.
Collapse
|
12
|
Alhamad R, Seth N, Abdullah HA. Initial Testing of Robotic Exoskeleton Hand Device for Stroke Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:6339. [PMID: 37514633 PMCID: PMC10385738 DOI: 10.3390/s23146339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
The preliminary test results of a novel robotic hand rehabilitation device aimed at treatment for the loss of motor abilities in the fingers and thumb due to stroke are presented. This device has been developed in collaboration with physiotherapists who regularly treat individuals who have suffered from a stroke. The device was tested on healthy adults to ensure comfort, user accessibility, and repeatability for various hand sizes in preparation for obtaining permission from regulatory bodies and implementing the design in a full clinical trial. Trials were conducted with 52 healthy individuals ranging in age from 19 to 93 with an average age of 58. A comfort survey and force data ANOVA were performed to measure hand motions and ensure the repeatability and accessibility of the system. Readings from the force sensor (p < 0.05) showed no significant difference between repetitions for each participant. All subjects considered the device comfortable. The device scored a mean comfort value of 8.5/10 on all comfort surveys and received the approval of all physiotherapists involved. The device has satisfied all design specifications, and the positive results of the participants suggest that it can be considered safe and reliable. It can therefore be moved forward for clinical trials with post-stroke users.
Collapse
Affiliation(s)
- Rami Alhamad
- School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Nitin Seth
- School of Engineering, University of Guelph, Guelph, ON N1G 2W1, Canada
| | | |
Collapse
|
13
|
Tarnacka B, Korczyński B, Frasuńska J. Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure. Diagnostics (Basel) 2023; 13:diagnostics13111966. [PMID: 37296818 DOI: 10.3390/diagnostics13111966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.
Collapse
Affiliation(s)
- Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury, Health Resort Kamień Pomorski, 72-400 Kamień Pomorski, Poland
| | - Justyna Frasuńska
- Department of Rehabilitation, Medical University of Warsaw, 02-637 Warsaw, Poland
| |
Collapse
|
14
|
Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
Collapse
Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
15
|
Hu Y, Meng J, Li G, Zhao D, Feng G, Zuo G, Liu Y, Zhang J, Shi C. Fuzzy Adaptive Passive Control Strategy Design for Upper-Limb End-Effector Rehabilitation Robot. SENSORS (BASEL, SWITZERLAND) 2023; 23:4042. [PMID: 37112385 PMCID: PMC10146308 DOI: 10.3390/s23084042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
Robot-assisted rehabilitation therapy has been proven to effectively improve upper-limb motor function in stroke patients. However, most current rehabilitation robotic controllers will provide too much assistance force and focus only on the patient's position tracking performance while ignoring the patient's interactive force situation, resulting in the inability to accurately assess the patient's true motor intention and difficulty stimulating the patient's initiative, thus negatively affecting the patient's rehabilitation outcome. Therefore, this paper proposes a fuzzy adaptive passive (FAP) control strategy based on subjects' task performance and impulse. To ensure the safety of subjects, a passive controller based on the potential field is designed to guide and assist patients in their movements, and the stability of the controller is demonstrated in a passive formalism. Then, using the subject's task performance and impulse as evaluation indicators, fuzzy logic rules were designed and used as an evaluation algorithm to quantitively assess the subject's motor ability and to adaptively modify the stiffness coefficient of the potential field and thus change the magnitude of the assistance force to stimulate the subject's initiative. Through experiments, this control strategy has been shown to not only improve the subject's initiative during the training process and ensure their safety during training but also enhance the subject's motor learning ability.
Collapse
Affiliation(s)
- Yang Hu
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Jingyan Meng
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guoning Li
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Dazheng Zhao
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guang Feng
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Guokun Zuo
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Yunfeng Liu
- School of Mechanical Engineering, Zhejiang University of Technology, Hangzhou 310023, China; (Y.H.); (J.M.); (D.Z.); (Y.L.)
| | - Jiaji Zhang
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| | - Changcheng Shi
- Ningbo Cixi Institute of Biomedical Engineering, Ningbo 315300, China; (G.L.); (G.F.); (G.Z.); (J.Z.)
- Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo 315201, China
| |
Collapse
|
16
|
Kim JA, Chun MH, Lee A, Ji Y, Jang H, Han C. The effect of training using an upper limb rehabilitation robot (HEXO-UR30A) in chronic stroke patients: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33246. [PMID: 36961152 PMCID: PMC10036062 DOI: 10.1097/md.0000000000033246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Upper limb robotic rehabilitation can be beneficial to the patients when applied appropriately. HEXO-UR30A is a novel exoskeletal type upper limb rehabilitation robot that provides continuous passive motion to the shoulder joint. OBJECTIVE The purpose of this study is to evaluate the effectiveness of HEXO-UR30A on the patient's functional change, spasticity, and range of motion (ROM). METHODS We included stroke patients with upper limb hemiparesis of age > 19 years with spasticity grading of modified Ashworth scale < 3 and Brunnstrom recovery stage ≥ 4. The efficacy of the robot was investigated based on a rehabilitation program for 3 weeks. Patient's functions were compared before vs after treatment and between the HEXO group vs control. We conducted the Fugl-Meyer Assessment of the Upper Extremity, modified Barthel index, modified Ashworth scale, ROM, and Motricity Index upper limb. Patients' satisfaction was evaluated using a questionnaire after every 10 sessions of training. RESULTS In the HEXO group, the Fugl-Meyer assessment for shoulder improved significantly (P value = .006*) compared with the control group (P value = .075). Both groups showed significant improvement (P value < .05) in Motricity Index upper limb after treatment. There were some improvements in the passive and active ROM. Patients in the HEXO group reported high satisfaction with upper limb rehabilitation. CONCLUSION These results show that HEXO-UR30A can improve functional ability in chronic stroke patients. Moreover, the high satisfaction in patients might promote active involvement in upper limb rehabilitation.
Collapse
Affiliation(s)
- Ji Ae Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Anna Lee
- Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | | | | | | |
Collapse
|
17
|
Cisnal A, Gordaliza P, Pérez Turiel J, Fraile JC. Interaction with a Hand Rehabilitation Exoskeleton in EMG-Driven Bilateral Therapy: Influence of Visual Biofeedback on the Users' Performance. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23042048. [PMID: 36850650 PMCID: PMC9964655 DOI: 10.3390/s23042048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
The effectiveness of EMG biofeedback with neurorehabilitation robotic platforms has not been previously addressed. The present work evaluates the influence of an EMG-based visual biofeedback on the user performance when performing EMG-driven bilateral exercises with a robotic hand exoskeleton. Eighteen healthy subjects were asked to perform 1-min randomly generated sequences of hand gestures (rest, open and close) in four different conditions resulting from the combination of using or not (1) EMG-based visual biofeedback and (2) kinesthetic feedback from the exoskeleton movement. The user performance in each test was measured by computing similarity between the target gestures and the recognized user gestures using the L2 distance. Statistically significant differences in the subject performance were found in the type of provided feedback (p-value 0.0124). Pairwise comparisons showed that the L2 distance was statistically significantly lower when only EMG-based visual feedback was present (2.89 ± 0.71) than with the presence of the kinesthetic feedback alone (3.43 ± 0.75, p-value = 0.0412) or the combination of both (3.39 ± 0.70, p-value = 0.0497). Hence, EMG-based visual feedback enables subjects to increase their control over the movement of the robotic platform by assessing their muscle activation in real time. This type of feedback could benefit patients in learning more quickly how to activate robot functions, increasing their motivation towards rehabilitation.
Collapse
Affiliation(s)
- Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
- Correspondence:
| | - Paula Gordaliza
- Basque Center for Applied Mathematics (BCAM), 48009 Bilbo, Spain
| | - Javier Pérez Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
| | - Juan Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), School of Industrial Engineering, University of Valladolid, 47011 Valladolid, Spain
| |
Collapse
|
18
|
Falkowski P, Osiak T, Wilk J, Prokopiuk N, Leczkowski B, Pilat Z, Rzymkowski C. Study on the Applicability of Digital Twins for Home Remote Motor Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:911. [PMID: 36679706 PMCID: PMC9864302 DOI: 10.3390/s23020911] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic created the need for telerehabilitation development, while Industry 4.0 brought the key technology. As motor therapy often requires the physical support of a patient's motion, combining robot-aided workouts with remote control is a promising solution. This may be realised with the use of the device's digital twin, so as to give it an immersive operation. This paper presents an extensive overview of this technology's applications within the fields of industry and health. It is followed by the in-depth analysis of needs in rehabilitation based on questionnaire research and bibliography review. As a result of these sections, the original concept of controlling a rehabilitation exoskeleton via its digital twin in the virtual reality is presented. The idea is assessed in terms of benefits and significant challenges regarding its application in real life. The presented aspects prove that it may be potentially used for manual remote kinesiotherapy, combined with the safety systems predicting potentially harmful situations. The concept is universally applicable to rehabilitation robots.
Collapse
Affiliation(s)
- Piotr Falkowski
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Tomasz Osiak
- Chair of Clinical Physiotherapy, Faculty of Rehabilitation, The Józef Piłsudski University of Physical Education in Warsaw, 00-809 Warszawa, Poland
| | - Julia Wilk
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Norbert Prokopiuk
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Bazyli Leczkowski
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Zbigniew Pilat
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
| | - Cezary Rzymkowski
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Baldassarre A, Lulli LG, Cavallo F, Fiorini L, Mariniello A, Mucci N, Arcangeli G. Industrial exoskeletons from bench to field: Human-machine interface and user experience in occupational settings and tasks. Front Public Health 2022; 10:1039680. [PMID: 36478728 PMCID: PMC9720272 DOI: 10.3389/fpubh.2022.1039680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
Abstract
Objective Work-related musculoskeletal disorders (WRMSDs) are considered nowadays the most serious issue in the Occupational Health and Safety field and industrial exoskeletons appear to be a new approach to addressing this medical burden. A systematic review has been carried out to analyze the real-life data of the application of exoskeletons in work settings considering the subjective responses of workers. Methods The review was registered on PROSPERO. The literature search and its report have been performed following the PRISMA guidelines. A comprehensive literature search was performed in PubMed, EMBASE, Web of Science, and Scopus. Results Twenty-four original studies were included in the literature review; 42% of the papers retrieved included automobilist industry workers, 17% of the studies evaluated the use of exoskeletons in logistic facilities, and 17% of articles involved healthcare. The remaining six papers recruited farmers, plasterers, wasting collectors, construction workers, and other workmen. All the papers selected tested the use of passive exoskeletons, supporting upper arms or back. Usability, perceived comfort, perceived exertion and fatigue, acceptability and intention to use, occupational safety and health, and job performance and productivity were the main topic analyzed. Conclusion Exoskeletons are not a fix-all technology, neither for workers nor for job tasks; they tend to show more of their potential in static activities, while in dynamic tasks, they can obstacle regular job performance. Comfort and easiness of use are the key factors influencing the user's experience. More research is needed to determine the most effective and safe ways to implement exoskeleton use in occupational settings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275728, identifier CRD42021275728.
Collapse
Affiliation(s)
- Antonio Baldassarre
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucrezia Ginevra Lulli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Cavallo
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Laura Fiorini
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | | | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
21
|
Dong M, Fan W, Li J, Zhang P. Patient-Specific Exercises with the Development of an End-Effector Type Upper Limb Rehabilitation Robot. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4125606. [PMID: 36337379 PMCID: PMC9633207 DOI: 10.1155/2022/4125606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/08/2024]
Abstract
End-effector type upper limb rehabilitation robots (ULRRs) are connected to patients at one distal point, making them have simple structures and less complex control algorithms, and they can avoid abnormal motion and posture of the target anatomical joints and specific muscles. Given that the end-effector type ULRR focuses more on the rehabilitation of the combined motion of upper limb chain, assisting the patient to perform collaborative tasks, and its intervention has some advantages than the exoskeleton type ULRR, we developed a novel three-degree-of-freedom (DOF) end-effector type ULRR. The advantage of the mechanical design is that the designed end-effector type ULRR can achieve three DOFs by using a four-bar mechanism and a lifting mechanism; we also developed the patient-specific exercises including patient-passive exercise and patient-cooperative exercise, and the advantage of the developed patient-cooperative exercise is that we simplified the human-robot coupling system model into a single spring system instead of the mass-spring-damp system, which efficiently improved the response speed of the control system. In terms of the organization structure of the work, we introduced the end-effector type ULRR's mechanical design, control system, inverse solution of positions, patient-passive exercise based on the inverse solution of positions and the linear position interpolation of servo drives, and patient-cooperative exercise based on the spring model, in sequence. Experiments with three healthy subjects have been conducted, with results showing good trajectory tracking performance in patient-passive exercise and showing effective, flexible, and good real-time interactive performance in patient-cooperative exercise.
Collapse
Affiliation(s)
- Mingjie Dong
- Faculty of Materials and Manufacturing, Beijing University of Technology, No. 100 Pingleiyuan Chaoyang District, Beijing 100124, China
| | - Wenpei Fan
- Faculty of Materials and Manufacturing, Beijing University of Technology, No. 100 Pingleiyuan Chaoyang District, Beijing 100124, China
| | - Jianfeng Li
- Faculty of Materials and Manufacturing, Beijing University of Technology, No. 100 Pingleiyuan Chaoyang District, Beijing 100124, China
| | - Pengfei Zhang
- Faculty of Materials and Manufacturing, Beijing University of Technology, No. 100 Pingleiyuan Chaoyang District, Beijing 100124, China
| |
Collapse
|
22
|
Yurkewich A, Ortega S, Sanchez J, Wang RH, Burdet E. Integrating hand exoskeletons into goal-oriented clinic and home stroke and spinal cord injury rehabilitation. J Rehabil Assist Technol Eng 2022; 9:20556683221130970. [PMID: 36212185 PMCID: PMC9535266 DOI: 10.1177/20556683221130970] [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: 01/12/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Robotic exoskeletons are emerging as rehabilitation and assistive
technologies that simultaneously restore function and enable independence
for people with disabilities. Aim We investigated the feasibility and orthotic and restorative effects of an
exoskeleton-supported goal-directed rehabilitation program for people with
hand impairments after stroke or Spinal Cord Injury (SCI). Method A single-arm case-series feasibility study was conducted using a wearable
untethered hand exoskeleton during goal-directed therapy programs with
in-clinic and at-home components. Therapists trained stroke and SCI patients
to use a hand exoskeleton during rehabilitation exercises, activities of
daily living and patient-selected goals. Each patient received a 1-hour
in-clinic training session on five consecutive days, then took the
exoskeleton home for two consecutive days to perform therapist-recommended
tasks. Goal Attainment Scaling (GAS) and the Box and Block Test (BBT) were
administered at baseline, after in-clinic
therapy and after home use, with and again without wearing
the exoskeleton. The System Usability Scale (SUS), Motor Activity Log, and
Fugl-Meyer Assessment were also administered to assess the intervention’s
acceptability, adherence, usability and effectiveness. Results Four stroke patients (Chedoke McMaster Stage of Hand 2–4) and one SCI patient
(ASIA C8 Motor Stage 1) 23 ± 19 months post-injury wore the hand exoskeleton
to perform 280 ± 23 exercise repetitions in the clinic and additional
goal-oriented tasks at home. The patients performed their own goals and the
dexterity task with higher performance following the 7-days therapy program
in comparison to baseline for both exoskeleton-assisted (ΔGAS: 18 ± 10,
ΔBBT: 1 ± 5) and unassisted (ΔGAS: 14 ± 14, ΔBBT: 3 ± 4) assessments.
Therapists and patients provided ‘good’ SUS ratings of 78 ± 6 and no harmful
events were reported. Conclusions The exoskeleton-supported stroke and SCI therapy program with in-clinic and
at-home training components was feasible.
Collapse
Affiliation(s)
- Aaron Yurkewich
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK,Aaron Yurkewich, MESc, Institute of
Biomaterials and Biomedical Engineering, University of Toronto, Room 407,
Rosebrugh Bldg, 164 College St, Toronto, ON M5S 3G9, Canada.
| | - Sara Ortega
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - José Sanchez
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - Rosalie H Wang
- Occupational Science and
Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Etienne Burdet
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK
| |
Collapse
|
23
|
Bigoni C, Zandvliet SB, Beanato E, Crema A, Coscia M, Espinosa A, Henneken T, Hervé J, Oflar M, Evangelista GG, Morishita T, Wessel MJ, Bonvin C, Turlan JL, Birbaumer N, Hummel FC. A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol. Front Neurol 2022; 13:919511. [PMID: 35873764 PMCID: PMC9301337 DOI: 10.3389/fneur.2022.919511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Effective, patient-tailored rehabilitation to restore upper-limb motor function in severely impaired stroke patients is still missing. If suitably combined and administered in a personalized fashion, neurotechnologies offer a large potential to assist rehabilitative therapies to enhance individual treatment effects. AVANCER (clinicaltrials.gov NCT04448483) is a two-center proof-of-concept trial with an individual based cumulative longitudinal intervention design aiming at reducing upper-limb motor impairment in severely affected stroke patients with the help of multiple neurotechnologies. AVANCER will determine feasibility, safety, and effectivity of this innovative intervention. Thirty chronic stroke patients with a Fugl-Meyer assessment of the upper limb (FM-UE) <20 will be recruited at two centers. All patients will undergo the cumulative personalized intervention within two phases: the first uses an EEG-based brain-computer interface to trigger a variety of patient-tailored movements supported by multi-channel functional electrical stimulation in combination with a hand exoskeleton. This phase will be continued until patients do not improve anymore according to a quantitative threshold based on the FM-UE. The second interventional phase will add non-invasive brain stimulation by means of anodal transcranial direct current stimulation to the motor cortex to the initial approach. Each phase will last for a minimum of 11 sessions. Clinical and multimodal assessments are longitudinally acquired, before the first interventional phase, at the switch to the second interventional phase and at the end of the second interventional phase. The primary outcome measure is the 66-point FM-UE, a significant improvement of at least four points is hypothesized and considered clinically relevant. Several clinical and system neuroscience secondary outcome measures are additionally evaluated. AVANCER aims to provide evidence for a safe, effective, personalized, adjuvant treatment for patients with severe upper-extremity impairment for whom to date there is no efficient treatment available.
Collapse
Affiliation(s)
- Claudia Bigoni
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sarah B. Zandvliet
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Elena Beanato
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Andrea Crema
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Martina Coscia
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
- confinis AG, Sursee, Switzerland
| | - Arnau Espinosa
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - Tina Henneken
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Julie Hervé
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Meltem Oflar
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Giorgia G. Evangelista
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Takuya Morishita
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Maximilian J. Wessel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Jean-Luc Turlan
- Department of Neurological Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Niels Birbaumer
- Department of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
- *Correspondence: Friedhelm C. Hummel
| |
Collapse
|
24
|
Guo N, Wang X, Duanmu D, Huang X, Li X, Fan Y, Li H, Liu Y, Yeung EHK, To MKT, Gu J, Wan F, Hu Y. SSVEP-Based Brain Computer Interface Controlled Soft Robotic Glove for Post-Stroke Hand Function Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1737-1744. [PMID: 35731756 DOI: 10.1109/tnsre.2022.3185262] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Soft robotic glove with brain computer interfaces (BCI) control has been used for post-stroke hand function rehabilitation. Motor imagery (MI) based BCI with robotic aided devices has been demonstrated as an effective neural rehabilitation tool to improve post-stroke hand function. It is necessary for a user of MI-BCI to receive a long time training, while the user usually suffers unsuccessful and unsatisfying results in the beginning. To propose another non-invasive BCI paradigm rather than MI-BCI, steady-state visually evoked potentials (SSVEP) based BCI was proposed as user intension detection to trigger the soft robotic glove for post-stroke hand function rehabilitation. Thirty post-stroke patients with impaired hand function were randomly and equally divided into three groups to receive conventional, robotic, and BCI-robotic therapy in this randomized control trial (RCT). Clinical assessment of Fugl-Meyer Motor Assessment of Upper Limb (FMA-UL), Wolf Motor Function Test (WMFT) and Modified Ashworth Scale (MAS) were performed at pre-training, post-training and three months follow-up. In comparing to other groups, The BCI-robotic group showed significant improvement after training in FMA full score (10.05±8.03, p=0.001), FMA shoulder/elbow (6.2±5.94, p=0.0004) and FMA wrist/hand (4.3±2.83, p=0.007), and WMFT (5.1±5.53, p=0.037). The improvement of FMA was significantly correlated with BCI accuracy (r=0.714, p=0.032). Recovery of hand function after rehabilitation of SSVEP-BCI controlled soft robotic glove showed better result than solely robotic glove rehabilitation, equivalent efficacy as results from previous reported MI-BCI robotic hand rehabilitation. It proved the feasibility of SSVEP-BCI controlled soft robotic glove in post-stroke hand function rehabilitation.
Collapse
|
25
|
Just IA, Fries D, Loewe S, Falk V, Cesarovic N, Edelmann F, Feuerstein A, Haufe FL, Xiloyannis M, Riener R, Schoenrath F. Movement therapy in advanced heart failure assisted by a lightweight wearable robot: a feasibility pilot study. ESC Heart Fail 2022; 9:1643-1650. [PMID: 35320878 PMCID: PMC9065814 DOI: 10.1002/ehf2.13903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/03/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
AIMS The aim of this pilot study was to investigate the safety, feasibility, tolerability, and acceptability of an assisted mobilization of advanced heart failure patients, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). METHODS AND RESULTS Twenty patients in functional NYHA class III performed activities of daily life (ADL, n = 10) or participated in a single, standardized, 60 min rehabilitation exercise unit (REU, n = 10) with and without the Myosuit. The outcome assessment included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnoea (RPE, RPD), the ability to perform ADL or REU, and the individual acceptability. The mean age of the subjects was 49.4 (±11.0) years; 80% were male. The mean left ventricular ejection fraction was 22.1% (±7.4%) and the median NT-proBNP 2054 pg/mL (IQR 677, 3270 pg/mL). In all patients, mobilization with the Myosuit was feasible independently or with minor support. The mean individual difference in the total walking distance of the patients without and with robotic assistance was -26.5 m (95% confidence interval (CI) -142 to 78 m, P = 0.241). No adverse events occurred. RPE and RPD showed no significant difference with or without the device (ADL: RPE -0.1 m, 95% CI -1.42 to 1.62, P = 0.932 and RPD -0.95 m, 95% CI -0.38 to 2.28, P = 0.141; REU: RPE 1.1 m, 95% CI -2.90 to 0.70, P = 0.201 and RPD 0.5 m, 95% CI -2.02 to 1.02, P = 0.435). All median responses in the acceptability questionnaire were positive. The patients felt safe and enjoyed the experience; 85% would be interested in participating in robot-assisted training on a regular basis. CONCLUSION This feasibility pilot trial provides first indications that a robotic exoskeleton-assisted mobilization of patients with advanced heart failure is safe, feasible, well-tolerated, and well-accepted. The results are highly encouraging to further pursue this innovative approach in rehabilitation programmes. This trial was registered at ClinicalTrials.gov: NCT04839133.
Collapse
Affiliation(s)
- Isabell Anna Just
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| | - Denis Fries
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
| | - Sina Loewe
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
- Department of Cardiothoracic SurgeryCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Translational Cardiovascular Technologies, Department of Health SciencesETH ZürichZürichSwitzerland
| | - Nikola Cesarovic
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- Translational Cardiovascular Technologies, Department of Health SciencesETH ZürichZürichSwitzerland
| | - Frank Edelmann
- Department of CardiologyCharité‐Universitätsmedizin BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site GöttingenGöttingenGermany
| | - Anna Feuerstein
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
- Department of CardiologyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Florian L. Haufe
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Michele Xiloyannis
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Robert Riener
- Sensory‐Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS)ETH ZürichZürichSwitzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Medical FacultyUniversity of ZurichZürichSwitzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular SurgeryGerman Heart Center BerlinBerlinGermany
- DZHK (German Centre for Cardiovascular Research), Partner Site BerlinBerlinGermany
| |
Collapse
|
26
|
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.
Collapse
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;
| |
Collapse
|
27
|
Shi K, Mu F, Huang R, Huang K, Peng Z, Zou C, Yang X, Cheng H. Multimodal Human-Exoskeleton Interface for Lower Limb Movement Prediction Through a Dense Co-Attention Symmetric Mechanism. Front Neurosci 2022; 16:796290. [PMID: 35546887 PMCID: PMC9082753 DOI: 10.3389/fnins.2022.796290] [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: 10/16/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
A challenging task for the biological neural signal-based human-exoskeleton interface is to achieve accurate lower limb movement prediction of patients with hemiplegia in rehabilitation training scenarios. The human-exoskeleton interface based on single-modal biological signals such as electroencephalogram (EEG) is currently not mature in predicting movements, due to its unreliability. The multimodal human-exoskeleton interface is a very novel solution to this problem. This kind of interface normally combines the EEG signal with surface electromyography (sEMG) signal. However, their use for the lower limb movement prediction is still limited—the connection between sEMG and EEG signals and the deep feature fusion between them are ignored. In this article, a Dense con-attention mechanism-based Multimodal Enhance Fusion Network (DMEFNet) is proposed for predicting lower limb movement of patients with hemiplegia. The DMEFNet introduces the con-attention structure to extract the common attention between sEMG and EEG signal features. To verify the effectiveness of DMEFNet, an sEMG and EEG data acquisition experiment and an incomplete asynchronous data collection paradigm are designed. The experimental results show that DMEFNet has a good movement prediction performance in both within-subject and cross-subject situations, reaching an accuracy of 82.96 and 88.44%, respectively.
Collapse
Affiliation(s)
- Kecheng Shi
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Fengjun Mu
- School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Rui Huang
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Ke Huang
- Glasgow College, University of Electronic Science and Technology of China, Chengdu, China
| | - Zhinan Peng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Chaobin Zou
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiao Yang
- Department of Orthopedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong Cheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
28
|
Current State of Robotics in Hand Rehabilitation after Stroke: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Among the methods of hand function rehabilitation after stroke, robot-assisted rehabilitation is widely used, and the use of hand rehabilitation robots can provide functional training of the hand or assist the paralyzed hand with activities of daily living. However, patients with hand disorders consistently report that the needs of some users are not being met. The purpose of this review is to understand the reasons why these user needs are not being adequately addressed, to explore research on hand rehabilitation robots, to review their current state of research in recent years, and to summarize future trends in the hope that it will be useful to researchers in this research area. This review summarizes the techniques in this paper in a systematic way. We first provide a comprehensive review of research institutions, commercial products, and literature. Thus, the state of the art and deficiencies of functional hand rehabilitation robots are sought and guide the development of subsequent hand rehabilitation robots. This review focuses specifically on the actuation and control of hand functional rehabilitation robots, as user needs are primarily focused on actuation and control strategies. We also review hand detection technologies and compare them with patient needs. The results show that the trends in recent years are more inclined to pursue new lightweight materials to improve hand adaptability, investigating intelligent control methods for human-robot interaction in hand functional rehabilitation robots to improve control robustness and accuracy, and VR virtual task positioning to improve the effectiveness of active rehabilitation training.
Collapse
|
29
|
Chen JC. Using Artificial Neuro-Molecular System in Robotic Arm Motion Control-Taking Simulation of Rehabilitation as an Example. SENSORS (BASEL, SWITZERLAND) 2022; 22:2584. [PMID: 35408198 PMCID: PMC9003313 DOI: 10.3390/s22072584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 01/18/2023]
Abstract
Under the delicate control of the brain, people can perform graceful movements through the coordination of muscles, bones, ligaments, and joints. If artificial intelligence can be used to establish a control system that simulates the movements of human arms, it is believed that the application scope of robotic arms in assisting people's daily life can be greatly increased. The purpose of this study is to build a general system that can use intelligent techniques to assist in the construction of a personalized rehabilitation system. More importantly, this research hopes to establish an intelligent system that can be adjusted according to the needs of the problem domain, that is, the system can move toward the direction of problem-solving through autonomous learning. The artificial neural molecular system (ANM system), developed early in our laboratory, which captured the close structure/function relationship of biological systems, was used. The system was operated on the V-REP (Virtual Robot Experimentation Platform). The results show that the ANM system can use self-learning methods to adjust the start-up time, rotation angle, and the sequence of the motor operation of different motors in order to complete the designated task assignment.
Collapse
Affiliation(s)
- Jong-Chen Chen
- Information Management, National Yunlin University of Science and Technology, Yunlin 64002, Taiwan
| |
Collapse
|
30
|
Takebayashi T, Takahashi K, Okita Y, Kubo H, Hachisuka K, Domen K. Impact of the robotic-assistance level on upper extremity function in stroke patients receiving adjunct robotic rehabilitation: sub-analysis of a randomized clinical trial. J Neuroeng Rehabil 2022; 19:25. [PMID: 35216603 PMCID: PMC8881821 DOI: 10.1186/s12984-022-00986-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Robotic therapy has been demonstrated to be effective in treating upper extremity (UE) paresis in stroke survivors. However, it remains unclear whether the level of assistance provided by robotics in UE training could affect the improvement in UE function in stroke survivors. We aimed to exploratorily investigate the impact of robotic assistance level and modes of adjustment on functional improvement in a stroke-affected UE. Methods We analyzed the data of 30 subacute stroke survivors with mild-to-severe UE hemiplegia who were randomly assigned to the robotic therapy (using ReoGo System) group in our previous randomized clinical trial. A cluster analysis based on the training results (the percentage of each stroke patient’s five assistance modes of robotics used during the training) was performed. The patients were divided into two groups: high and low robotic assistance groups. Additionally, the two groups were sub-categorized into the following classes based on the severity of UE functional impairment: moderate-to-mild [Fugl-Meyer Assessment (FMA) score ≥ 30] and severe-to-moderate class (FMA < 30). The outcomes were assessed using FMA, FMA-proximal, performance-time in the Wolf motor function test (WMFT), and functional assessment scale (FAS) in WMFT. The outcomes of each class in the two groups were analyzed. A two-way analysis of variance (ANOVA) was conducted with robot assistance level and severity of UE function as explanatory factors and the change in each outcome pre- and post-intervention as the objective factor. Results Overall, significant differences of the group × severity interaction were found in most of the outcomes, including FMA-proximal (p = 0.038, η2 = 0.13), WMFT-PT (p = 0.021, η2 = 0.17), and WMFT-FAS (p = 0.045, η2 = 0.14). However, only the FMA score appeared not to be significantly different in each group (p = 0.103, η2 = 0.09). Conclusion An optimal amount of robotic assistance is a key to maximize improvement in post-stroke UE paralysis. Furthermore, severity of UE paralysis is an important consideration when deciding the amount of assistance in robotic therapy. Trial registration Trial enrollment was done at UMIN (UMIN 000001619, registration date was January 1, 2009)
Collapse
Affiliation(s)
- Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, College of Health and Human Sciences, Osaka Prefecture University, 3-7-30, Habikino, Osaka, 583-8555, Japan.
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Yuho Okita
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Hironobu Kubo
- Department of Medical Science, Teijin Parma Limited, Tokyo, Japan
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
| |
Collapse
|
31
|
Wnuk B, Ziaja D, Banyś M. Efficacy Assessment of Upper Limb Home-Based Exercises Using a Prototype Exercise Robot for Continuous Passive Movement Among Individuals with Paresis in the Long-Term Follow-Up: Preliminary Report. REHABILITACJA MEDYCZNA 2022. [DOI: 10.5604/01.3001.0015.7145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Home exercises are a promising alternative to outpatient care or in-hospital exercise programmes. The forms of exercises with the use of robotic devices is constantly developing, and their positive effects have been well-documented.
Research objective: The aim of this study was to evaluate the effectiveness of upper limb home-based exercises with the use of the “Best Arm” robot following the onset of diseases causing spastic paresis in long-term observation.
Materials and methods: The study comprised 40 participants at an average age of 58.73 ±16.80. For a period of 8 months, training of the limb with paresis using the “Best Arm” device was carried out to test joint mobility, hand grip strength, and to measure the circumference of the forearm and upper arm.
Results: Statistical analysis shows a significant change in active and passive range of motion, as well as muscle strength after an 8-month intervention period in the group under study.
Conclusions: Home-based exercises using a prototype of the “Best Arm” device for exercising the upper limb with paresis have had a moderate effect on improving range of motion and muscle strength. However, these exercises did not significantly improve muscle tone or the functional capabilities of the upper limb.
Collapse
Affiliation(s)
- Bartosz Wnuk
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Damian Ziaja
- Department of General and Vascular Surgery, Angiology and Phlebology, Medical University of Silesia in Katowice, Poland; Department of Physiotherapy, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Marcin Banyś
- MIDMED Limited Liability Company Katowice, Poland
| |
Collapse
|
32
|
A Case Study of Upper Limb Robotic-Assisted Therapy Using the Track-Hold Device. SENSORS 2022; 22:s22031009. [PMID: 35161755 PMCID: PMC8840074 DOI: 10.3390/s22031009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/07/2022]
Abstract
The Track-Hold System (THS) project, developed in a healthcare facility and therefore in a controlled and protected healthcare environment, contributes to the more general and broad context of Robotic-Assisted Therapy (RAT). RAT represents an advanced and innovative rehabilitation method, both motor and cognitive, and uses active, passive, and facilitating robotic devices. RAT devices can be equipped with sensors to detect and track voluntary and involuntary movements. They can work in synergy with multimedia protocols developed ad hoc to achieve the highest possible level of functional re-education. The THS is based on a passive robotic arm capable of recording and facilitating the movements of the upper limbs. An operational interface completes the device for its use in the clinical setting. In the form of a case study, the researchers conducted the experimentation in the former Tabarracci hospital (Viareggio, Italy). The case study develops a motor and cognitive rehabilitation protocol. The chosen subjects suffered from post-stroke outcomes affecting the right upper limb, including strength deficits, tremors, incoordination, and motor apraxia. During the first stage of the enrolment, the researchers worked with seven patients. The researchers completed the pilot with four patients because three of them got a stroke recurrence. The collaboration with four patients permitted the generation of an enlarged case report to collect preliminary data. The preliminary clinical results of the Track-Hold System Project demonstrated good compliance by patients with robotic-assisted rehabilitation; in particular, patients underwent a gradual path of functional recovery of the upper limb using the implemented interface.
Collapse
|
33
|
HYAKUTAKE K, MORISHITA T, SAITA K, FUKUDA H, ABE H, OGATA T, KAMADA S, INOUE T. Effect of Robot-assisted Rehabilitation to Botulinum Toxin A Injection for Upper Limb Disability in Patients with Chronic Stroke: A Case Series and Systematic Review. Neurol Med Chir (Tokyo) 2022; 62:35-44. [PMID: 34732591 PMCID: PMC8754680 DOI: 10.2176/nmc.oa.2020-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/14/2021] [Indexed: 11/20/2022] Open
Abstract
Combining single-joint hybrid assistive limb (HAL-SJ) with botulinum toxin A (BTX-A) therapy is novel and has great therapeutic potential for the rehabilitation of stroke patients with upper limb paralysis. The purpose of this observational case series study was to evaluate the effect of BTX-A and HAL-SJ combination therapy on different exoskeleton robots used for treating upper limb paralysis. The HAL-SJ combination received a BTX-A injection followed by HAL-SJ-assisted rehabilitation for 60 min per session, 10 times per week, during 2 weeks of hospitalization. Clinical evaluations to assess motor function, limb functions used during daily activities, and spasticity were performed prior to injection, at 2-week post-treatment intervention, and at the 4-month follow-up visit. The total Fugl-Meyer assessment-upper limb (FMA-UE), proximal FMA-UE, action research arm test (ARAT), Motor Activity Log (MAL), and Disability Assessment Scale (DAS) showed a statistically significant difference, and a large effect size. However, the FMA distal assessment at 2-week post-treatment intervention showed no significant difference and a moderate effect size. The FMA-UE scores of the extracted systematic review articles showed that our design improved upper limb function. The change in the total FMA-UE score in this study showed that, compared to previous reports in the exoskeletal robotic therapy group, our combination therapy had a higher score than five of the seven references. Our results suggest that BTX-A therapy and HAL-SJ combination therapy may improve upper limb function, similar to other treatment methods in the literature.
Collapse
Affiliation(s)
- Koichi HYAKUTAKE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Takashi MORISHITA
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Kazuya SAITA
- Department of Psychosocial Rehabilitation Graduate School of Biomedical and Health Sciences Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Hiroyuki FUKUDA
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Hiroshi ABE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Toshiyasu OGATA
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Satoshi KAMADA
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan
| | - Tooru INOUE
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| |
Collapse
|
34
|
Lee J, Kim H, Yang W. Development of Wrist Interface Based on Fully Actuated Coaxial Spherical Parallel Mechanism for Force Interaction. SENSORS 2021; 21:s21238073. [PMID: 34884077 PMCID: PMC8659704 DOI: 10.3390/s21238073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
To develop a wrist robotic exoskeleton-type interface (REI) for force interaction, it should have a suitable range of motion similar to human wrist activities of daily living, large torque output performance, and low moving parts inertia for dynamic motion response to cover the human behavior frequency. In this paper, a wrist REI based on a fully actuated coaxial spherical parallel mechanism (CSPM) is proposed to satisfy the aforementioned features. The fully actuated CSPM-based wrist REI (FC-WREI) has the characteristics of pure rotation similar to the human wrist, high torque output by parallel torque synthesis, and low moving parts inertia due to the base arrangement of the actuators. Due to the mechanical advantages and design optimization, the FC-WREI maximally provides torque as much as 56.49–130.43% of the maximum isometric torque of the human wrist, while providing a consistent range of motion to the human wrist without interference problem. Moreover, it is confirmed that the inertia of the FC-WREI is up to 5.35 times lower than similar devices. These advantages of the FC-WREI mean that the device is applicable to various fields of REIs for force interaction.
Collapse
Affiliation(s)
- Jaeyong Lee
- School of Robotics, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
| | - Hyungjoo Kim
- Hyundai Motor Company, Crash Safety, Saimdang-ro 17-gil 116 101-1105, Seoul 01897, Korea;
| | - Woosung Yang
- School of Robotics, Kwangwoon University, 20 Kwangwoon-ro, Nowon-gu, Seoul 01897, Korea;
- Correspondence: ; Tel.: +82-940-8115
| |
Collapse
|
35
|
Li W, Xu D. Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
36
|
Hwang D, Shin JH, Kwon S. Kinematic Assessment to Measure Change in Impairment during Active and Active-Assisted Type of Robotic Rehabilitation for Patients with Stroke. SENSORS 2021; 21:s21217055. [PMID: 34770362 PMCID: PMC8587557 DOI: 10.3390/s21217055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022]
Abstract
Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.
Collapse
Affiliation(s)
- Donghwan Hwang
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
| | - Joon-Ho Shin
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Department of Neurorehabilitation, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
| | - Suncheol Kwon
- Department of Rehabilitation & Assistive Technology, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea; or
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul 01022, Korea
- Correspondence: or (J.-H.S.); or (S.K.)
| |
Collapse
|
37
|
Design and Development of an Upper Limb Rehabilitative Robot with Dual Functionality. MICROMACHINES 2021; 12:mi12080870. [PMID: 34442492 PMCID: PMC8400039 DOI: 10.3390/mi12080870] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022]
Abstract
The design of an upper limb rehabilitation robot for post-stroke patients is considered a benchmark problem regarding improving functionality and ensuring better human–robot interaction (HRI). Existing upper limb robots perform either joint-based exercises (exoskeleton-type functionality) or end-point exercises (end-effector-type functionality). Patients may need both kinds of exercises, depending on the type, level, and degree of impairments. This work focused on designing and developing a seven-degrees-of-freedom (DoFs) upper-limb rehabilitation exoskeleton called ‘u-Rob’ that functions as both exoskeleton and end-effector types device. Furthermore, HRI can be improved by monitoring the interaction forces between the robot and the wearer. Existing upper limb robots lack the ability to monitor interaction forces during passive rehabilitation exercises; measuring upper arm forces is also absent in the existing devices. This research work aimed to develop an innovative sensorized upper arm cuff to measure the wearer’s interaction forces in the upper arm. A PID control technique was implemented for both joint-based and end-point exercises. The experimental results validated both types of functionality of the developed robot.
Collapse
|
38
|
Exoskeleton-Assisted Anthropomorphic Movement Training (EAMT) for Poststroke Upper Limb Rehabilitation: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:2074-2082. [PMID: 34174225 DOI: 10.1016/j.apmr.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the feasibility of exoskeleton-assisted anthropomorphic movement training (EAMT) and its effects on upper extremity motor impairment, function, and kinematics after stroke. DESIGN A single-blind pilot randomized controlled trial. SETTING Stroke rehabilitation inpatient unit. PARTICIPANTS Participants with a hemiplegia (N=20) due to a first-ever, unilateral, subacute stroke who had a score of 8-47 on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). INTERVENTIONS The exoskeleton group received EAMT therapy that provided task-specific training under anthropomorphic trajectories and postures. The control group received conventional upper limb therapy. For both groups, therapy was delivered at the same intensity, frequency, and duration: 45 minutes daily, 5 days per week, for 4 weeks. MAIN OUTCOME MEASURES Primary outcome: feasibility analysis. SECONDARY OUTCOMES FMA-UE, Action Research Arm Test (ARAT), modified Barthel Index (MBI), and kinematic metrics during exoskeleton therapy. RESULTS Twenty participants with subacute stroke were recruited and completed all therapy sessions. EAMT therapy was feasible and acceptable for the participants. The recruitment rate, retention rate, and number of therapists required for EAMT therapy were acceptable compared with other robotic trials. EAMT was determined to be safe, as no adverse event occurred except tolerable muscle fatigue in 2 participants. There were significant between-group differences in the change scores of FMA-UE (difference, 4.30 points; P=.04) and MBI (difference, 8.70 points; P=.03) in favor of EAMT therapy. No significant between-group difference was demonstrated for the change scores of ARAT (P=.18). Participants receiving EAMT showed significant improvements in kinematic metrics after treatment (P<.01). CONCLUSIONS Our results indicate that EAMT is a feasible approach and may improve upper extremity motor impairment, activities of daily living, and kinematics after stroke. However, fully powered randomized controlled trials are warranted to confirm the results of this pilot study and explore the underlying mechanisms by which EAMT therapy might work.
Collapse
|
39
|
A System for Neuromotor Based Rehabilitation on a Passive Robotic Aid. SENSORS 2021; 21:s21093130. [PMID: 33946361 PMCID: PMC8124495 DOI: 10.3390/s21093130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022]
Abstract
In the aging world population, the occurrence of neuromotor deficits arising from stroke and other medical conditions is expected to grow, demanding the design of new and more effective approaches to rehabilitation. In this paper, we show how the combination of robotic technologies with progress in exergaming methodologies may lead to the creation of new rehabilitation protocols favoring motor re-learning. To this end, we introduce the Track-Hold system for neuromotor rehabilitation based on a passive robotic arm and integrated software. A special configuration of weights on the robotic arm fully balances the weight of the patients’ arm, allowing them to perform a purely neurological task, overcoming the muscular effort of similar free-hand exercises. A set of adaptive and configurable exercises are proposed to patients through a large display and a graphical user interface. Common everyday tasks are also proposed for patients to learn again the associated actions in a persistent way, thus improving life independence. A data analysis module was also designed to monitor progress and compute indices of post-stroke neurological damage and Parkinsonian-type disorders. The system was tested in the lab and in a pilot project involving five patients in the post-stroke chronic stage with partial paralysis of the right upper limb, showing encouraging preliminary results.
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Paolucci T, Agostini F, Mangone M, Bernetti A, Pezzi L, Liotti V, Recubini E, Cantarella C, Bellomo RG, D'Aurizio C, Saggini R. Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach. Neurol Sci 2021; 42:5219-5229. [PMID: 33826010 PMCID: PMC8642375 DOI: 10.1007/s10072-021-05185-3] [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: 09/24/2020] [Accepted: 03/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determine the effects of an integrated rehabilitation protocol, including botulinum toxin and conventional rehabilitation exercise plus end-effector (EE) robotic training for functional recovery of the upper limb (UL) compared to training with the robot alone in post-chronic stroke patients with mild to severe spasticity, compared to training with the robot alone. METHODS In this prospective, observational case-control study, stroke patients were allocated into 2 groups: robot group (RG, patients who underwent robotic treatment with EE) and robot-toxin group (RTG, patients who in addition have carried out the injection of botulinum toxin for UL recovery). All patients were assessed by Fugl-Meyer Assessment (FMA), Motricity Index (MI), modified Ashworth scale (MAS), numeric rating scale (NRS), Box and Block Test (BBT), Frenchay Arm Test (FAT), and Barthel Index (BI) at baseline (T0), T1 (end of treatment), and T2 (3 months of follow-up). RESULTS Forty-four patients were included and analyzed (21RG; 23RTG). From the analysis between groups, the results suggested how there was a statistically significant difference in favor of RTG, specifically ΔT0-T1 and ΔT0-T2 for B&B p = 0.009 and p = 0.035; ΔT0-T1 and ΔT0-T2 for FAT with p = 0.016 and p = 0.031; ΔT0-T1 for MAS shoulder p = 0.016; ΔT0-T1 and ΔT0-T2 with p = 0.010 and p = 0.005 for MAS elbow; and ΔT0-T1 and ΔT0-T2 with p = 0.001 and p = 0.013 for MAS wrist. CONCLUSION Our results suggest, in line with the literature, a good efficacy in the reduction of spasticity and in the improvement of the function of the UL, with the reduction of pain, adopting a rehabilitation protocol integrated with BoTN, robot-assisted training, and traditional physiotherapy.
Collapse
Affiliation(s)
- Teresa Paolucci
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Agostini
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Massimiliano Mangone
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Andrea Bernetti
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Letizia Pezzi
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Vitalma Liotti
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Elena Recubini
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Cristina Cantarella
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Sciences, University of Study of Urbino Carlo Bo, Urbino, Italy
| | - Carlo D'Aurizio
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Raoul Saggini
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,IRCSS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| |
Collapse
|
42
|
Wu J, Cheng H, Zhang J, Yang S, Cai S. Robot-Assisted Therapy for Upper Extremity Motor Impairment After Stroke: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6103015. [PMID: 33454787 DOI: 10.1093/ptj/pzab010] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. METHODS The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. RESULTS Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%). CONCLUSION RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
Collapse
Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shanli Yang
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| |
Collapse
|
43
|
Vélez-Guerrero MA, Callejas-Cuervo M, Mazzoleni S. Artificial Intelligence-Based Wearable Robotic Exoskeletons for Upper Limb Rehabilitation: A Review. SENSORS 2021; 21:s21062146. [PMID: 33803911 PMCID: PMC8003246 DOI: 10.3390/s21062146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 12/14/2022]
Abstract
Processing and control systems based on artificial intelligence (AI) have progressively improved mobile robotic exoskeletons used in upper-limb motor rehabilitation. This systematic review presents the advances and trends of those technologies. A literature search was performed in Scopus, IEEE Xplore, Web of Science, and PubMed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology with three main inclusion criteria: (a) motor or neuromotor rehabilitation for upper limbs, (b) mobile robotic exoskeletons, and (c) AI. The period under investigation spanned from 2016 to 2020, resulting in 30 articles that met the criteria. The literature showed the use of artificial neural networks (40%), adaptive algorithms (20%), and other mixed AI techniques (40%). Additionally, it was found that in only 16% of the articles, developments focused on neuromotor rehabilitation. The main trend in the research is the development of wearable robotic exoskeletons (53%) and the fusion of data collected from multiple sensors that enrich the training of intelligent algorithms. There is a latent need to develop more reliable systems through clinical validation and improvement of technical characteristics, such as weight/dimensions of devices, in order to have positive impacts on the rehabilitation process and improve the interactions among patients, teams of health professionals, and technology.
Collapse
Affiliation(s)
- Manuel Andrés Vélez-Guerrero
- Software Research Group, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150002, Colombia
- Correspondence: ; Tel.: +57-320-820-6832
| | - Mauro Callejas-Cuervo
- School of Computer Science, Universidad Pedagógica y Tecnológica de Colombia, Tunja 150002, Colombia;
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Polytechnic University of Bari, 70126 Bari, Italy;
| |
Collapse
|
44
|
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 .
Collapse
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
| |
Collapse
|
45
|
Abstract
In recent years, with the current advancements in Robotics and Artificial Intelligence (AI), robots have the potential to support the field of healthcare. Robotic systems are often introduced in the care of the elderly, children, and persons with disabilities, in hospitals, in rehabilitation and walking assistance, and other healthcare situations. In this survey paper, the recent advances in robotic technology applied in the healthcare domain are discussed. The paper provides detailed information about state-of-the-art research in care, hospital, assistive, rehabilitation, and walking assisting robots. The paper also discusses the open challenges healthcare robots face to be integrated into our society.
Collapse
|
46
|
An Assist-as-Needed Controller for Passive, Assistant, Active, and Resistive Robot-Aided Rehabilitation Training of the Upper Extremity. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app11010340] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical studies have demonstrated that robot-involved therapy can effectively improve the rehabilitation training effect of motor ability and daily behavior ability of subjects with an upper limb motor dysfunction. This paper presents an impedance-based assist-as-needed controller that can be used in robot-aided rehabilitation training for subjects with an upper extremity dysfunction. Then, the controller is implemented on an end-effector upper extremity rehabilitation robot which could assist subjects in performing training with a spatial trajectory. The proposed controller enables subjects’ arms to have motion freedom by building a fault-tolerant region around the rehabilitation trajectory. Subjects could move their upper limb without any assistance within the fault-tolerant region while the robot would provide assistance according to the subjects’ functional ability when deviating from the fault-tolerant region. Besides, we also put forward the stiffness field around the fault-tolerant region to increase the robot’s assistance when subjects’ hand is moving outside the fault-tolerant region. A series of columnar rigid walls would be constructed in the controller according to the subjects’ functional ability, and the stiffness of the wall increases as the motion performance deteriorates. Furthermore, the controller contains five adjustable parameters. The controller would show different performances by adjusting these parameters and satisfy the requirement of robot-aided rehabilitation training at different rehabilitation stages such as passive, assistant, active, and resistant training. Finally, the controller was tested with an elderly female participant with different controller parameters, and experimental results verified the correctness of the controller and its potential ability to satisfy the training requirements at different rehabilitation stages. In the close future, the proposed controller in this work is planned to be applied on more subjects and also patients who have upper limb motor dysfunctions to demonstrate performance of the controller with different parameters.
Collapse
|
47
|
Park JH, Park G, Kim HY, Lee JY, Ham Y, Hwang D, Kwon S, Shin JH. A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study. J Neuroeng Rehabil 2020; 17:137. [PMID: 33076952 PMCID: PMC7574181 DOI: 10.1186/s12984-020-00763-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/20/2020] [Indexed: 12/05/2022] Open
Abstract
Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).
Collapse
Affiliation(s)
- Jin Ho Park
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Gyulee Park
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ha Yeon Kim
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ji-Yeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Yeajin Ham
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Donghwan Hwang
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Suncheol Kwon
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea. .,Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea.
| |
Collapse
|
48
|
Robotic Rehabilitation in Spinal Cord Injury: A Pilot Study on End-Effectors and Neurophysiological Outcomes. Ann Biomed Eng 2020; 49:732-745. [PMID: 32918105 DOI: 10.1007/s10439-020-02611-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022]
Abstract
Robot-aided gait training (RAGT) has been implemented to provide patients with spinal cord injury (SCI) with a physiological limb activation during gait, cognitive engagement, and an appropriate stimulation of peripheral receptors, which are essential to entrain neuroplasticity mechanisms supporting functional recovery. We aimed at assessing whether RAGT by means of an end-effector device equipped with body weight support could improve functional ambulation in patients with subacute, motor incomplete SCI. In this pilot study, 15 patients were provided with six RAGT sessions per week for eight consecutive weeks. The outcome measures were muscle strength, ambulation, going upstairs, and disease burden. Furthermore, we estimated the activation patterns of lower limb muscles during RAGT by means of surface electromyography and the resting state networks' functional connectivity (RSN-FC) before and after RAGT. Patients achieved a clinically significant improvement in the clinical outcome measures substantially up to six months post-treatment. These data were paralleled by an improvement in the stair-climbing cycle and a potentiating of frequency-specific and area-specific RSN-FC patterns. Therefore, RAGT, by means of an end-effector device equipped with body weight support, is promising in improving gait in patients with subacute, motor incomplete SCI, and it could produce additive benefit for the neuromuscular reeducation to gait in SCI when combined with conventional physiotherapy.
Collapse
|
49
|
Parras-Burgos D, Gea-Martínez A, Roca-Nieto L, Fernández-Pacheco DG, Cañavate FJF. Prototype System for Measuring and Analyzing Movements of the Upper Limb for the Detection of Occupational Hazards. SENSORS 2020; 20:s20174993. [PMID: 32899214 PMCID: PMC7506865 DOI: 10.3390/s20174993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/22/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022]
Abstract
In the work environment, there are usually different pathologies that are related to Repetitive Efforts and Movements (REM) that tend to predominantly affect the upper limbs. To determine whether a worker is at risk of suffering some type of pathology, observation techniques are usually used by qualified technical personnel. In order to define from quantitative data if there is a risk of suffering a pathology due to movements and repetitive efforts in the upper limb, a prototype of a movement measurement system has been designed and manufactured. This system interferes minimally with the activity studied, maintaining a reduced cost of manufacture and use. The system allows the study of the movements made by the subject in the work environment by determining the origin of the Musculoskeletal Disorder (MSD) from the movements of the elbow and wrist, collecting data on the position and accelerations of the arm, forearm and hand, and taking into account the risk factors established for suffering from an MSD: high repetition of movements, the use of a high force in a repetitive manner, or the adoption of forced positions. The data obtained with this system can be analyzed by qualified personnel from tables, graphs, and 3D animations at the time of execution, or stored for later analysis.
Collapse
|