Arm stiffness during assisted movement after stroke: the influence of visual feedback and training

Discernment on assistive technology for the care and support requirements of older adults and differently-abled individuals

Assistive technology for the differently abled and older adults has made remarkable achievements in providing rehabilitative, adaptive, and assistive devices. It provides huge assistance for people with physical impairments to lead a better self-reliant daily life, in terms of mobility, education, rehabilitation, etc. This technology ranges from simple hand-held devices to complex robotic accessories which promote the individual's independence. This study aimed at identifying the assistance required by differently-abled individuals, and the solutions proposed by different researchers, and reviewed their merits and demerits. It provides a detailed discussion on the state of art assistive technologies, their applications, challenges, types, and their usage for rehabilitation. The study also identifies different unexplored research areas related to assistive technology that can improve the daily life of individuals and advance the field. Despite their high usage, assistive technologies have some limitations which have been briefly described in the study. This review, therefore, can help understand the utilization, and pros and cons of assistive devices in rehabilitation engineering and assistive technologies.

Self-Tuning Extended Kalman Filter Parameters to Identify Ankle's Third-Order Mechanics

The estimation of human ankle's mechanical impedance is an important tool for modeling human balance. This work presents the implementation of a parameter-estimation approach based on a state-augmented extended Kalman filter (AEKF) to infer the ankle's mechanical impedance during quiet standing. However, the AEKF filter is sensitive to the initialization of the noise covariance matrices. In order to avoid a time-consuming trial-and-error method and to obtain a better estimation performance, a genetic algorithm (GA) is proposed to best tune the measurement noise (Rk) and process noise covariances (Q) of the extended Kalman filter (EKF). Results using simulated data show the efficacy of the proposed algorithm for parameter-estimation of a third-order biomechanical model. Experimental validation of these results is also presented. They suggest that age is an influencing factor in the human balance.

Estimating Human Wrist Stiffness during a Tooling Task

In this work, we propose a practical approach to estimate human joint stiffness during tooling tasks for the purpose of programming a robot by demonstration. More specifically, we estimate the stiffness along the wrist radial-ulnar deviation while a human operator performs flexion-extension movements during a polishing task. The joint stiffness information allows to transfer skills from expert human operators to industrial robots. A typical hand-held, abrasive tool used by humans during finishing tasks was instrumented at the handle (through which both robots and humans are attached to the tool) to assess the 3D force/torque interactions between operator and tool during finishing task, as well as the 3D kinematics of the tool itself. Building upon stochastic methods for human arm impedance estimation, the novelty of our approach is that we rely on the natural variability taking place during the multi-passes task itself to estimate (neuro-)mechanical impedance during motion. Our apparatus (hand-held, finishing tool instrumented with motion capture and multi-axis force/torque sensors) and algorithms (for filtering and impedance estimation) were first tested on an impedance-controlled industrial robot carrying out the finishing task of interest, where the impedance could be pre-programmed. We were able to accurately estimate impedance in this case. The same apparatus and algorithms were then applied to the same task performed by a human operators. The stiffness values of the human operator, at different force level, correlated positively with the muscular activity, measured during the same task.

Quantitative Analysis of EEG Power Spectrum and EMG Median Power Frequency Changes after Continuous Passive Motion Mirror Therapy System

Robotic mirror therapy (MT), which allows movement of the affected limb, is proposed as a more effective method than conventional MT (CMT). To improve the rehabilitation effectiveness of post-stroke patients, we developed a sensory stimulation-based continuous passive motion (CPM)-MT system with two different operating protocols, that is, asynchronous and synchronous modes. To evaluate their effectiveness, we measured brain activation through relative and absolute power spectral density (PSD) changes of electroencephalogram (EEG) mu rhythm in three cases with CMT and CPM-MT with asynchronous and synchronous modes. We also monitored changes in muscle fatigue, which is one of the negative effects of the CPM device, based on median power frequency (MPF) and root mean square (RMS). Relative PSD was most suppressed when subjects used the CPM-MT system under synchronous control: 22.11%, 15.31%, and 16.48% on Cz, C3, and C4, respectively. The absolute average changes in MPF and RMS were 1.59% and 9.78%, respectively, with CPM-MT. Synchronous mode CPM-MT is the most effective method for brain activation, and muscle fatigue caused by the CPM-MT system was negligible. This study suggests the more effective combination rehabilitation system for MT by utilizing CPM and magnetic-based MT task to add action execution and sensory stimulation compared with CMT.

Improving Healthcare Access: A Preliminary Design of a Low-Cost Arm Rehabilitation Device

A low-cost continuous passive motion (CPM) machine, the Gannon Exoskeleton for Arm Rehabilitation (GEAR), was designed. The focus of the machine is on the rehabilitation of primary functional movements of the arm. The device developed integrates two mechanisms consisting of a four-bar linkage and a sliding rod prismatic joint mechanism that can be mounted to a normal chair. When seated, the patient is connected to the device via a padded cuff strapped on the elbow. A set of springs have been used to maintain the system stability and help the lifting of the arm. A preliminary analysis via analytical methods is used to determine the initial value of the springs to be used in the mechanism given the desired gravity compensatory force. Subsequently, a multibody simulation was performed with the software simwise 4D by Design Simulation Technologies (DST). The simulation was used to optimize the stiffness of the springs in the mechanism to provide assistance to raising of the patient's arm. Furthermore, the software can provide a finite element analysis of the stress induced by the springs on the mechanism and the external load of the arm. Finally, a physical prototype of the mechanism was fabricated using polyvinyl chloride (PVC) pipes and commercial metal springs, and the reaching space was measured using motion capture. We believed that the GEAR has the potential to provide effective passive movement to individuals with no access to postoperative or poststroke rehabilitation therapy.

The Concurrent Control of Motion and Contact Force in the Presence of Predictable Disturbances

The simultaneous control of force and motion is important in everyday activities when humans interact with objects. While many studies have analyzed the control of movement within a perturbing force field, few have investigated its dual aspects of controlling a contact force in nonisometric conditions. The mechanism by which the central nervous system controls forces during movements is still unclear, and it can be elucidated by estimating the mechanical properties of the arm during tasks with concurrent motion and contact force goals. We investigate how arm mechanics change when a force control task is accomplished during low-frequency positional perturbations of the arm. Contrary to many force regulation algorithms implemented in robotics, where contact impedance is decreased to reduce force fluctuations in response to position disturbances, we observed a steady increase of arm endpoint stiffness as the task progressed. Based on this evidence, we propose a theoretical framework suggesting that an internal model of the perturbing trajectory is formed. We observed that force regulation in the presence of predictable positional disturbances is implemented using a position control strategy together with the modulation of the endpoint stiffness magnitude, where the direction of the endpoint stiffness ellipse's major axis is oriented toward the desired force.

Time-Series Data Analysis Using Sliding Window Based SVD for Motion Evaluation

A method based on singular value decomposition (SVD) is proposed for extracting features from motion time-series data observed with various sensing systems. Matrices consisting of the sliding window (SW) subsets of time-series data are decomposed, yielding singular vectors as the patterns of the motion, and the singular values as a scalar, by which the corresponding singular vectors describe the matrices.

The sliding window based singular value decomposition was applied to analyze acceleration during walking. Three levels of walking difficulty were simulated by restricting the right knee joint in the measurement. The accelerations of the middles of the shanks and the back of the waist were measured and normalized before the SW-SVD was performed.The results showed that the first singular values inferred from the acceleration data of the restricted side (the right shank) significantly related to the increase of the restriction among all the subjects while there were no common trends in the singular values of the left shank and the waist. The SW-SVD was suggested to be a reliable method to evaluate walking disability. Furthermore, a 2D visualization tool is proposed to provide intuitive information about walking difficulty which can be used in walking rehabilitation to monitor recovery.

Changes of Shoulder, Elbow, and Wrist Stiffness Matrix Post Stroke

Stroke affects multiple joints in the arm with stereotypical patterns of arm deformity involving the shoulder, elbow, wrist, and hand and with disrupted coordination of multiple joints in active movements. However, there is a lack of systematic methods to evaluate multi-joints and multi-degree of freedoms (DOF) neuro-mechanical changes, especially for complex systems with three or more joints/DOFs involved. This paper used a novel systematic method to characterize dynamics and control of the shoulder, elbow, and wrist of the human arm individually and simultaneously, including the couplings across the multiple joints during controlled movements. A novel method was developed to decompose the complex system into manageable single-joint level for more reliable characterizations. The method was used in clinical studies to characterize the multi-joint changes associated with spastic impaired arm of 11 patients post stroke and 12 healthy controls. It was found that stroke survivors showed not only increased stiffness at the individual joints locally but also significantly higher couplings across the joints. The relative increases in couplings are often higher than that of the local joint stiffness. The multi-joint characterization provided a tool to characterize impairment of individual patients, which would allow more focused impairment-specific treatment. In general, the decomposition method can be used for even more complex systems, making characterization of intractable system dynamics of three or more joints/DOFs manageable.

Vibrations of Fractal Structures: On the Nonlinearities of Damping by Branching

To study the effect of damping due to branching in trees and fractal structures, a harmonic analysis was performed on a finite element model using commercially available software. The model represented a three-dimensional (3D) fractal treelike structure, with properties based on oak wood and with several branch configurations. As branches were added to the model using a recursive algorithm, the effects of damping due to branching became apparent: the first natural frequency amplitude decreased, the first peak widened, and the natural frequency decreased, whereas higher frequency oscillations remained mostly unaltered. To explain this nonlinear effect observable in the spectra of branched structures, an analytical interpretation of the damping was proposed. The analytical model pointed out the dependency of Cartesian damping from the Coriolis forces and their derivative with respect to the angular velocity of each branch. The results provide some insight on the control of chaotic systems. Adding branches can be an effective way to dampen slender structures but is most effective for large deformation of the structure.

Inexpensive Vision-Based System for the Direct Measurement of Ankle Stiffness During Quiet Standing

We created a sensor-fusion suite for the acquisition of biometric information that can be used for the estimation of human control strategy in a variety of everyday tasks. This work focuses on the experimental validation of the integrated motion capture subsystem based on raster images. Understanding human control strategies utilized in everyday activity requires measurement of several variables that can be grouped as kinematic, dynamic, and biological-feedback variables. Hence, there is a strong need for the acquisition, analysis, and synchronization of the information measured by a variety of transducers. Our system was able to capture the complex dynamics of a flexible robot by means of two inexpensive web cameras without compromising accuracy. After validating the vision system by means of the robotic device, a direct measure of the center of gravity (COG) position during the recovery from a fall was performed on two groups of human subjects separated by age. The instrumental setup was used to estimate how ankle operational stiffness changes as function of age. The results indicate a statistical increase of stiffness for the older group.

Haptic recognition of dystonia and spasticity in simulated multi-joint hypertonia

This paper investigates the capability of naïve individuals to recognize dystonic- or spastic- like conditions through physical manipulation of a virtual arm. Subjects physically interact with a two-joint, six-muscle hypertonic arm model, rendered on a two degrees-of-freedom robotic manipulandum. This paradigm aims to identify the limitation of manual manipulation during diagnosis of hypertonia. Our results indicate that there are difficulties to discriminate between the two conditions at low to medium level of severity. We found that the sample entropy of the executed motion and the force experienced during physical manipulation, tended to be higher during incorrectly identified trials than in those correctly assessed.

Experimental measure of arm stiffness during single reaching movements with a time-frequency analysis

We tested an innovative method to estimate joint stiffness and damping during multijoint unfettered arm movements. The technique employs impulsive perturbations and a time-frequency analysis to estimate the arm's mechanical properties along a reaching trajectory. Each single impulsive perturbation provides a continuous estimation on a single-reach basis, making our method ideal to investigate motor adaptation in the presence of force fields and to study the control of movement in impaired individuals with limited kinematic repeatability. In contrast with previous dynamic stiffness studies, we found that stiffness varies during movement, achieving levels higher than during static postural control. High stiffness was associated with elevated reflexive activity. We observed a decrease in stiffness and a marked reduction in long-latency reflexes around the reaching movement velocity peak. This pattern could partly explain the difference between the high stiffness reported in postural studies and the low stiffness measured in dynamic estimation studies, where perturbations are typically applied near the peak velocity point.

Haptic perception of multi-joint hypertonia during simulated patient-therapist physical tele-interaction

A potential solution to provide individualized physical therapy in remote areas is tele-interaction via robotic devices. To maintain stability during tele-interaction, transmission delay-compensation algorithms bound the impedance between the patient and the therapist. This can compromise the haptic perception of the patient being assessed, which can in turn lead to a bad diagnosis or intervention. We investigated how the perception of the severity of hypertonia (a common condition after neurological disorders) varied by modifying the connection impedance on a physical simulator. We found that assessing hypetonia using a low impedance connection may result in an overestimation of mild impairments.