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Arntz A, Weber F, Handgraaf M, Lällä K, Korniloff K, Murtonen KP, Chichaeva J, Kidritsch A, Heller M, Sakellari E, Athanasopoulou C, Lagiou A, Tzonichaki I, Salinas-Bueno I, Martínez-Bueso P, Velasco-Roldán O, Schulz RJ, Grüneberg C. Technologies in Home-Based Digital Rehabilitation: Scoping Review. JMIR Rehabil Assist Technol 2023; 10:e43615. [PMID: 37253381 PMCID: PMC10415951 DOI: 10.2196/43615] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/10/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. METHODS The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. RESULTS A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. CONCLUSIONS Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.
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Affiliation(s)
- Angela Arntz
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
- Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Franziska Weber
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
- Department of Rehabilitation, Physiotherapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marietta Handgraaf
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
| | - Kaisa Lällä
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Katariina Korniloff
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Kari-Pekka Murtonen
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Julija Chichaeva
- Institute of Rehabilitation, Jamk University of Applied Sciences, Jyväskylä, Finland
| | - Anita Kidritsch
- Institute of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Mario Heller
- Department of Media & Digital Technologies, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Evanthia Sakellari
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | | | - Areti Lagiou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, University of West Attica, Athens, Greece
| | - Ioanna Tzonichaki
- Department of Occupational Therapy, University of West Attica, Athens, Greece
| | - Iosune Salinas-Bueno
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pau Martínez-Bueso
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Olga Velasco-Roldán
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma de Mallorca, Spain
| | | | - Christian Grüneberg
- Division of Physiotherapy, Department of Applied Health Sciences, University of Applied Health Sciences Bochum, Bochum, Germany
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Comparison of theoretical and experimental models for knee flexion/extension using a cable-driven robot. ROBOTICA 2023. [DOI: 10.1017/s0263574723000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
To support and facilitate the rehabilitation of patients with physical limitations and aid the therapist, several robotic structures are being studied. Among the structures, the cable-driven robots stand out. The cable-driven robots are structures actuated by cables and have the advantages of being flexible and reconfigurable for each patient. The objective of this paper is to develop a theoretical model for knee flexion/extension force and moment using a cable-driven robot. The proposed model is necessary for elaborating a referential to which diagnosis can be made and the improvement of the patient evaluated. The presented theoretical model was validated through experiments with twelve sedentary and healthy volunteers. The first procedure tested ten subjects in three thigh angles for knee flexion motion; the second procedure tested two subjects in flexion and extension for the same thigh angle. The results show the validity of the model for 88.58% of the tests in an ANOVA analysis with a 99% confidence interval. The similarity of data for different gender, ages, and intrinsic factors was noted, implying that the model is representative and independent of the subject’s individuality. Differences between flexion and extension values were observed, which need to be studied in the future.
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Aria HP, Ahrabi M, Allahverdi F, Korayem MH. Kinematic analysis and development of cable-driven rehabilitation robot for cerebral palsy patients. INT J ADV ROBOT SYST 2023. [DOI: 10.1177/17298806231157342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
This study aimed to analyze the kinematic development of a rehabilitation cable robot for patients with cerebral palsy problems. For this purpose, the walking pattern of a healthy person was analyzed in the robot by extracting his kinematic model. Therefore, a seven-link model was considered, and changes in the mass center of the links and then movements during the gait cycle were obtained with the angles related to joint changes. Next, the person’s integration with the rehabilitation cable robot was investigated with the resolution of the direct kinematic problem. In addition, the change-related outputs of the cables were obtained by the person’s movement and the attached belt. The robot was further proposed because the specific change diagram of the cables facilitates understanding how much motor torque is needed to change the length of the cable. It is noteworthy that the static person balance is provided in the existing rehabilitation robots. However, in this structure, the balance is done by the six degrees of freedom robot so that the robot can return the person to the original path when he loses his balance. Cable systems for the lower limbs (thighs and shanks) are also simulated to rehabilitate the patient. The obtained results from the simulation and the obtained output from kinematic equations for lower limb movements were also compared, and the highest deference was 2.2, 1.8, 1.8, and 1.5% for shank-back, shank-front, thigh-back, and thigh-front of the leg in the corresponding points in the outputs of both software, respectively.
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Affiliation(s)
- H Partovi Aria
- Robotics Research Laboratory, Center of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - M Ahrabi
- Robotics Research Laboratory, Center of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - F Allahverdi
- Robotics Research Laboratory, Center of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - M Habibnejad Korayem
- Robotics Research Laboratory, Center of Excellence in Experimental Solid Mechanics and Dynamics, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
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Bermejo-García J, Rodríguez Jorge D, Romero-Sánchez F, Jayakumar A, Alonso-Sánchez FJ. Actuation Strategies for a Wearable Cable-Driven Exosuit Based on Synergies in Younger and Older Adults. SENSORS (BASEL, SWITZERLAND) 2022; 23:261. [PMID: 36616858 PMCID: PMC9824617 DOI: 10.3390/s23010261] [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: 11/18/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Older adults (aged 55 years and above) have greater difficulty carrying out activities of daily living than younger adults (aged 25−55 years). Although age-related changes in human gait kinetics are well documented in qualitative terms in the scientific literature, these differences may be quantified and analyzed using the analysis of motor control strategies through kinetic synergies. The gaits of two groups of people (older and younger adults), each with ten members, were analyzed on a treadmill at a constant controlled speed and their gait kinetics were recorded. The decomposition of the kinetics into synergies was applied to the joint torques at the hip, knee, and ankle joints. Principal components determined the similarity of the kinetic torques in the three joints analyzed and the effect of the walking speed on the coordination pattern. A total of three principal components were required to describe enough information with minimal loss. The results suggest that the older group showed a change in coordination strategy compared to that of the younger group. The main changes were related to the ankle and hip torques, both showing significant differences (p-value <0.05) between the two groups. The findings suggest that the differences between the gait patterns of the two groups were closely related to a reduction in ankle torque and an increase in hip torque. This change in gait pattern may affect the rehabilitation strategy used when designing general-purpose rehabilitation devices or rehabilitation/training programs for the elderly.
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Kim J, Kim Y, Kang S, Kim SJ. Biomechanical Analysis Suggests Myosuit Reduces Knee Extensor Demand during Level and Incline Gait. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22166127. [PMID: 36015888 PMCID: PMC9413953 DOI: 10.3390/s22166127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 05/31/2023]
Abstract
An FDA-approved soft wearable robot, the Myosuit, which was designed to provide hip and knee extension torque has recently been commercialized. While studies have reported reductions in metabolic costs, increased gait speeds, and improvements in clinical test scores, a comprehensive analysis of electromyography (EMG) signals and joint kinematics is warranted because the recruitment of appropriate muscle groups during physiological movement patterns facilitates effective motor learning. Here, we compared the lower limb joint kinematics and EMG patterns while wearing the Myosuit with that of unassisted conditions when performing level overground and incline treadmill gait. The level overground gait sessions (seven healthy subjects) were performed at self-selected speeds and the incline treadmill gait sessions (four healthy subjects) were performed at 2, 3, 4, and 5 km/h. In order to evaluate how the user is assisted, we conducted a biomechanical analysis according to the three major gait tasks: weight acceptance (WA), single-limb support, and limb advancement. The results from the gait sessions suggest that Myosuit not only well preserves the users' natural patterns, but more importantly reduce knee extensor demand during the WA phase for both level and incline gait.
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A hybrid cable-driven parallel robot as a solution to the limited rotational workspace issue. ROBOTICA 2022. [DOI: 10.1017/s0263574722000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Cable-driven parallel robots (CDPRs) are still gaining attention thanks to their interesting characteristics compared to serial or classic parallel manipulators. However, the limited range of rotation of their end-effectors reduces their application fields to predominantly translational movements. In this context, the issue of extending the rotational workspace of a CDPR while maintaining a compact robot structure is addressed in this paper. This work is motivated by the need to find the optimal CDPR for upper limb rehabilitation allowing to assist the patient’s hand along a set of prescribed tasks. Firstly, a reconfigurable robot, where the motors’ locations are movable, is proposed in order to help reaching all the prescribed poses. Although this solution presents promising results compared to classical CDPRs, it involves a sizable robot structure inadequate to rehabilitation application. To improve the obtained solution, another approach is proposed, based on combining the large translational workspace of CDPRs and the large rotational workspace of serial manipulators. The optimal structure of a hybrid robot will be considered for the prototype design.
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Kim Y, Park HS. The Switchable Cable-Driven Mechanism to Control Multiple Cables Individually Using a Single Motor. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3146587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zou Y, Wu X, Zhang B, Zhang Q, Zhang A, Qin T. Stiffness Analysis of Parallel Cable-Driven Upper Limb Rehabilitation Robot. MICROMACHINES 2022; 13:mi13020253. [PMID: 35208377 PMCID: PMC8874764 DOI: 10.3390/mi13020253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/22/2022] [Accepted: 01/28/2022] [Indexed: 02/05/2023]
Abstract
This paper studies the stiffness of the parallel cable-driven upper limb rehabilitation robot (PCUR). Firstly, it was derived that the static stiffness expression of the PCUR was composed of platform pose stiffness KT and cable pose stiffness KS. It indicated that the static stiffness of the PCUR was related to the cable tension, the arrangement of the cable, and the cable stiffness. Secondly, a simulation model in MATLAB/Simscape Multibody was built. Cable tension was applied to make the moving platform in a static equilibrium state. The stiffness of the PCUR and the external force on the moving platform were changed, and the motion characteristics of the moving platform were obtained. Finally, the position changes of the moving platform under different external forces were analyzed, and the motion laws of the moving platform under different stiffnesses were summarized.
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Affiliation(s)
- Yupeng Zou
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (X.W.); (B.Z.); (Q.Z.); (A.Z.)
- Xiangyang Key Laboratory of Rehabilitation Medicine and Rehabilitation Engineering Technology, Hubei University of Arts and Science, Xiangyang 441053, China
| | - Xiangshu Wu
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (X.W.); (B.Z.); (Q.Z.); (A.Z.)
| | - Baolong Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (X.W.); (B.Z.); (Q.Z.); (A.Z.)
| | - Qiang Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (X.W.); (B.Z.); (Q.Z.); (A.Z.)
| | - Andong Zhang
- College of Mechanical and Electronic Engineering, China University of Petroleum (East China), Qingdao 266580, China; (Y.Z.); (X.W.); (B.Z.); (Q.Z.); (A.Z.)
| | - Tao Qin
- Xiangyang Key Laboratory of Rehabilitation Medicine and Rehabilitation Engineering Technology, Hubei University of Arts and Science, Xiangyang 441053, China
- School of Mechanical Engineering, Hubei University of Arts and Science, Xiangyang 441053, China
- Correspondence: ; Tel.: +86-186-7107-6897
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Xie C, Yang Q, Huang Y, Su S, Xu T, Song R. A Hybrid Arm-Hand Rehabilitation Robot With EMG-Based Admittance Controller. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:1332-1342. [PMID: 34813476 DOI: 10.1109/tbcas.2021.3130090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reach-and-grasp is one of the most fundamental activities in daily life, while few rehabilitation robots provide integrated and active training of the arm and hand for patients after stroke to improve their mobility. In this study, a novel hybrid arm-hand rehabilitation robot (HAHRR) was built for the reach-and-grasp task. This hybrid structure consisted of a cable-driven module for three-dimensional arm motion and an exoskeleton for hand motion, which enabled assistance of the arm and hand simultaneously. To implement active compliance control, an EMG-based admittance controller was applied to the HAHRR. Experimental results showed that the HAHRR with the EMG-based admittance controller could not only assist the subject in fulfilling the reach-and-grasp task, but also generate smoother trajectories compared with the force-sensing-based admittance controller. These findings also suggested that the proposed approach might be applicable to post-stroke arm-hand rehabilitation training.
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Operation Safety of a 2-DoF Planar Mechanism for Arm Rehabilitation. INVENTIONS 2021. [DOI: 10.3390/inventions6040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The operation safety of rehabilitation devices must be addressed early in the development process and before being tested on people. In this paper, the operation safety of a 2-DoF (degrees of freedom) planar mechanism for arm rehabilitation is addressed. Then, the safety and efficiency of the device operation is assessed through the Transmission Index (TI) distribution in its workspace. Furthermore, the produced stresses on the human arm are assessed via the FEM (finite element method) when the rehabilitation device reaches five critical positions within its workspace. The TI distribution showed that the proposed design has a proper behaviour from a force transmission point of view, avoiding any singular configuration that might cause a control failure and subsequent risk for the user and supporting the user’s motion with a good efficiency throughout its operational workspace. The FEM analysis showed that Nurse operation is safe for the human arm since a negligible maximum stress of 6.55 × 103 N/m2 is achieved by the human arm when the device is located on the evaluated critical positions.
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Gonzalez A, Garcia L, Kilby J, McNair P. Robotic devices for paediatric rehabilitation: a review of design features. Biomed Eng Online 2021; 20:89. [PMID: 34488777 PMCID: PMC8420060 DOI: 10.1186/s12938-021-00920-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/06/2021] [Indexed: 01/11/2023] Open
Abstract
Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices' potential because the paediatric patients' needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children's needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion-exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.
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Affiliation(s)
- Alberto Gonzalez
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Lorenzo Garcia
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Jeff Kilby
- BioDesign Lab, School of Engineering, Computer and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Abstract
AbstractThe design and control of a cable-driven rehabilitation robot, which can be configured easily for exercising different articulations such as elbows, shoulders, hips, knees and ankles without requiring any orthosis, are introduced. The passive, active-assisted and active-resisted exercises were designed and implemented using impedance control. The controller could switch between exercises according to the force feedback. The effectiveness of the proposed controller was demonstrated by experimental studies. The robot was tested first with a dummy extremity and then with a healthy subject mimicking various types of patients during the tests. Experimental results showed that satisfactory closed-loop performances were achieved.
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Sensitivity Based Selection of an Optimal Cable-Driven Parallel Robot Design for Rehabilitation Purposes. ROBOTICS 2020. [DOI: 10.3390/robotics10010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper deals with the design of an optimal cable-driven parallel robot (CDPR) for upper limb rehabilitation. The robot’s prescribed workspace is identified with the help of an occupational therapist based on three selected daily life activities, which are tracked using a Qualisys motion capture system. A preliminary architecture of the robot is proposed based on the analysis of the tracked trajectories of all the activities. A multi-objective optimization process using the genetic algorithm method is then performed, where the cable tensions and the robot size are selected as the objective functions to be minimized. The cables tensions are bounded between two limits, where the lower limit ensures a positive tension in the cables at all times and the upper limit represents the maximum torque of the motor. A sensitivity analysis is then performed using the Monte Carlo method to yield the optimal design selected out of the non-dominated solutions, forming the obtained Pareto front. The robot with the highest robustness toward the disturbances is identified, and its dexterity and elastic stiffness are calculated to investigate its performance.
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