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Valadez-Roque G, Cantillo-Negrete J, Carino-Escobar RI, Torres-Chávez A. [Paresis of an upper extremity. Action observation and motor imagery in recovery of patients with chronic stroke]. Rev Neurol 2024; 78:307-315. [PMID: 38813788 PMCID: PMC11407457 DOI: 10.33588/rn.7811.2024017] [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: 05/31/2024]
Abstract
INTRODUCTION Action observation (AO) and motor imagery (MI) are considered functionally equivalent forms of motor representation related to movement execution (ME). Because of their characteristics, AO and MI have been proposed as techniques to facilitate the recovery of post-stroke hemiparesis in the upper extremities. PATIENTS AND METHODS An experimental, longitudinal, prospective, single-blinded design was undertaken. Eleven patients participated, and were randomly assigned to each study group. Both groups received 10 to 12 sessions of physical therapy. Five patients were assigned to the control treatment group, and six patients to the experimental treatment group (AO + MI). All were assessed before and after treatment for function, strength (newtons) and mobility (percentage) in the affected limb, as well as alpha desynchronisation (8-13 Hz) in the supplementary motor area, the premotor cortex and primary motor cortex while performing AO + MI tasks and action observation plus motor execution (AO + ME). RESULTS The experimental group presented improvement in function and strength. A negative correlation was found between desynchronisation in the supplementary motor area and function, as well as a post-treatment increase in desynchronisation in the premotor cortex of the injured hemisphere in the experimental group only. CONCLUSIONS An AO + MI-based intervention positively impacts recovery of the paretic upper extremity by stimulating the supplementary motor area, a cortex involved in movement preparation and learning. AO + MI therapy can be used as adjunctive treatment in patients with upper extremity paresis following chronic stroke.
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Affiliation(s)
- G Valadez-Roque
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - J Cantillo-Negrete
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - R I Carino-Escobar
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - A Torres-Chávez
- Universidad Nacional Autónoma de México, Ciudad de México, México
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Proietti T, Nuckols K, Grupper J, Schwerz de Lucena D, Inirio B, Porazinski K, Wagner D, Cole T, Glover C, Mendelowitz S, Herman M, Breen J, Lin D, Walsh C. Combining soft robotics and telerehabilitation for improving motor function after stroke. WEARABLE TECHNOLOGIES 2024; 5:e1. [PMID: 38510985 PMCID: PMC10952055 DOI: 10.1017/wtc.2023.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/07/2023] [Accepted: 12/02/2023] [Indexed: 03/22/2024]
Abstract
Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients' home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.
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Affiliation(s)
- Tommaso Proietti
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kristin Nuckols
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Jesse Grupper
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Diogo Schwerz de Lucena
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Bianca Inirio
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | | | - Diana Wagner
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Tazzy Cole
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Christina Glover
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Sarah Mendelowitz
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Maxwell Herman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Joan Breen
- Whittier Rehabilitation Hospital, Bradford, MA, USA
| | - David Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, USA
| | - Conor Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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Barria P, Riquelme M, Reppich H, Cisnal A, Fraile JC, Pérez-Turiel J, Sierra D, Aguilar R, Andrade A, Nuñez-Espinosa C. Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study. Front Robot AI 2023; 10:1146018. [PMID: 37033674 PMCID: PMC10073561 DOI: 10.3389/frobt.2023.1146018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.
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Affiliation(s)
- Patricio Barria
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
- *Correspondence: Patricio Barria,
| | - Matías Riquelme
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
| | - Hannah Reppich
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Juan-Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Javier Pérez-Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - David Sierra
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Rolando Aguilar
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Cristian Nuñez-Espinosa
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
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Serrano-López Terradas PA, Criado Ferrer T, Jakob I, Calvo-Arenillas JI. Quo Vadis, Amadeo Hand Robot? A Randomized Study with a Hand Recovery Predictive Model in Subacute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:690. [PMID: 36613027 PMCID: PMC9820043 DOI: 10.3390/ijerph20010690] [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: 08/31/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Early identification of hand-prognosis-factors at patient's admission could help to select optimal synergistic rehabilitation programs based on conventional (COHT) or robot-assisted (RAT) therapies. METHODS In this bi-phase cross-over prospective study, 58 stroke patients were enrolled in two randomized groups. Both groups received same treatments A + B (A = 36 COHT sessions for 10 weeks; B = 36 RAT sessions for 10 weeks; 45 min/session; 3 to 5 times per week). Outcome repeated measures by blinded assessors included FMUL, BBT, NHPT, Amadeo Robot (AHR) and AMPS. Statistical comparisons by Pearson's rank correlations and one-way analyses of variance (ANOVA) with Bonferroni posthoc tests, with size effects and statistic power, were reported. Multiple backward linear regression models were used to predict the variability of sensorimotor and functional outcomes. RESULTS Isolated COHT or RAT treatments improved hand function at 3 months. While "higher hand paresis at admission" affected to sensorimotor and functional outcomes, "laterality of injury" did not seem to affect the recovery of the hand. Kinetic-kinematic parameters of robot allowed creating a predictive model of hand recovery at 3 and 6 months from 1st session. CONCLUSIONS Hand impairment is an important factor in define sensorimotor and functional outcomes, but not lesion laterality, to predict hand recovery.
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Affiliation(s)
- Pedro Amalio Serrano-López Terradas
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Occupational Thinks Research Group, Occupational Therapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Teresa Criado Ferrer
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
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Coskunsu DK, Akcay S, Ogul OE, Akyol DK, Ozturk N, Zileli F, Tuzun BB, Krespi Y. Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study. Acta Neurol Scand 2022; 146:499-511. [PMID: 35855628 DOI: 10.1111/ane.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. MATERIALS & METHOD A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke (<1 month after cerebrovascular accident) and randomly allocated to experimental group (EG) and control group (CG). Neurophysiological rehabilitation program was performed to both EG and CG for 5 days a week and totally 15 sessions. The EG also received robotic rehabilitation with the EMG-driven exoskeleton hand robot (Hand of Hope®, Rehab-Robotics Company) 15 sessions over 3 weeks. Hand motor functions (Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT)), activities of daily living (Motor Activity Log (MAL)), force and EMG activities of extensor and flexor muscles for the cup test were evaluated before treatment (pretreatment) and after the 15th session (posttreatment). RESULTS Eleven patients (59.91 ± 14.20 yr) in the EG and 9 patients (70 ± 14.06 yr) in the CG completed the study. EG did not provide a significant advantage compared with the CG in FMA-UE, ARAT and MAL scores and cup-force and EMG activities (p > .05 for all). CONCLUSION In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.
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Affiliation(s)
- Dilber Karagozoglu Coskunsu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey.,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
| | - Sumeyye Akcay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey
| | - Ozden Erkan Ogul
- Faculty of Health Sciences, Department of Ergotherapy, Medipol University, Istanbul, Turkey
| | - D Kubra Akyol
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul-Cerrahpasa University, Istanbul, Turkey
| | - Necla Ozturk
- Faculty of Medicine, Department of Biophysics, Maltepe University, Istanbul, Turkey
| | - Füsun Zileli
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Birgul Baştan Tuzun
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Yakup Krespi
- Faculty of Medicine, Department of Neurology, Istinye University, Istanbul, Turkey
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6
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Adjustable Stiffness-Based Supination–Pronation Forearm Physical Rehabilitator. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
This paper reports a new medical device together with a control strategy that focuses on the following tasks: (1) a trajectory tracking problem associated with the supination–pronation motion of the wrist–forearm for purposes of rehabilitation and (2) the adjustment of the system’s stiffness associated with the applied torque guaranteeing the angular motion of the rehabilitator as well as the resistance that potential users must overcome. These two tasks are oriented to regain the range of motion (ROM) of the wrist–forearm and to improve the strength of the associated muscles. It is worth mentioning that this device has not been clinically validated. However, the performance of the closed-loop medical device is validated with preliminary experiments with a healthy subject based on movement patterns involving passive, assisted-resisted, and active phases of rehabilitation protocols.
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Laparidou D, Curtis F, Akanuwe J, Goher K, Niroshan Siriwardena A, Kucukyilmaz A. Patient, carer, and staff perceptions of robotics in motor rehabilitation: a systematic review and qualitative meta-synthesis. J Neuroeng Rehabil 2021; 18:181. [PMID: 34953497 PMCID: PMC8710022 DOI: 10.1186/s12984-021-00976-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In recent years, robotic rehabilitation devices have often been used for motor training. However, to date, no systematic reviews of qualitative studies exploring the end-user experiences of robotic devices in motor rehabilitation have been published. The aim of this study was to review end-users' (patients, carers and healthcare professionals) experiences with robotic devices in motor rehabilitation, by conducting a systematic review and thematic meta-synthesis of qualitative studies concerning the users' experiences with such robotic devices. METHODS Qualitative studies and mixed-methods studies with a qualitative element were eligible for inclusion. Nine electronic databases were searched from inception to August 2020, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. RESULTS The search strategy identified a total of 13,556 citations and after removing duplicates and excluding citations based on title and abstract, and full text screening, 30 studies were included. All studies were considered of acceptable quality. We developed six analytical themes: logistic barriers; technological challenges; appeal and engagement; supportive interactions and relationships; benefits for physical, psychological, and social function(ing); and expanding and sustaining therapeutic options. CONCLUSIONS Despite experiencing technological and logistic challenges, participants found robotic devices acceptable, useful and beneficial (physically, psychologically, and socially), as well as fun and interesting. Having supportive relationships with significant others and positive therapeutic relationships with healthcare staff were considered the foundation for successful rehabilitation and recovery.
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Affiliation(s)
- Despina Laparidou
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Ffion Curtis
- grid.412934.90000 0004 0400 6629Diabetes Research Centre, College of Medicine, Biological Sciences and Psychology, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW UK
| | - Joseph Akanuwe
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Khaled Goher
- grid.36511.300000 0004 0420 4262School of Engineering, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7DQ UK
| | - A. Niroshan Siriwardena
- grid.36511.300000 0004 0420 4262Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Brayford Pool, Lincolnshire, Lincoln, LN6 7TS UK
| | - Ayse Kucukyilmaz
- grid.4563.40000 0004 1936 8868School of Computer Science, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 2DU UK
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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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ÇEKMECE Ç, SADE I. İnmeli Hastalarda Robotik Rehabilitasyonun El Fonksiyonları ve Günlük Yaşam Aktiviteleri Üzerine Etkisi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.756705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cheng N, Phua KS, Lai HS, Tam PK, Tang KY, Cheng KK, Yeow RCH, Ang KK, Guan C, Lim JH. Brain-Computer Interface-Based Soft Robotic Glove Rehabilitation for Stroke. IEEE Trans Biomed Eng 2020; 67:3339-3351. [DOI: 10.1109/tbme.2020.2984003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Korzeniewska E, Krawczyk A, Mróz J, Wyszyńska E, Zawiślak R. Applications of Smart Textiles in Post-Stroke Rehabilitation. SENSORS 2020; 20:s20082370. [PMID: 32331218 PMCID: PMC7219331 DOI: 10.3390/s20082370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/25/2022]
Abstract
Stroke is a disease affecting a large part of our society. According to WHO data, it is the second world’s biggest killer, accounting for near six million deaths in 2016 and it is about 30% of the total number of strokes per year. Other patients affected by such a disease should be rehabilitated as soon as possible. As a result of this phenomenon, paresis may occur. Among the devices available on the market there are many rehabilitation robots, but the method of electrostimulation can be used. The authors focused their attention on electrostimulation and commercially available therapies. Using this method, application to people with large hand muscle contracture is difficult. The authors of the work present a solution dedicated to exactly such people. A solution of textronic sensors manufactured on a textile substrate using the technology of physical vapor deposition is presented in the article. As a result of the conducted research, an electroconductive structure was obtained with a low surface resistance value of 1 Ω/□ and high flexibility. It can alternatively be used in hand rehabilitation for electrostimulation of fingertips. The solution is dedicated to people with high hands spasticity for whom it is impossible to put on a rehabilitation glove.
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Affiliation(s)
- Ewa Korzeniewska
- Institute of Electrical Engineering Systems, Faculty of Electrical Engineering, Electronics, Computer and Control Engineering, Lodz University of Technology, 90-924 Lodz, Poland
- Correspondence:
| | - Andrzej Krawczyk
- Faculty of Transport and Computer Science, University of Economy and Innovations, 20-209 Lublin, Poland;
| | - Józef Mróz
- Military Institute of Medicine, Clinic of Rehabilitation, 04-141 Warsaw, Poland; (J.M.); (E.W.)
| | - Elżbieta Wyszyńska
- Military Institute of Medicine, Clinic of Rehabilitation, 04-141 Warsaw, Poland; (J.M.); (E.W.)
| | - Rafał Zawiślak
- Institute of Automatic Control, Lodz University of Technology, 90-924 Lodz, Poland;
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Design of a Two-DOFs Driving Mechanism for a Motion-Assisted Finger Exoskeleton. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10072619] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents a novel exoskeleton mechanism for finger motion assistance. The exoskeleton is designed as a serial 2-degrees-of-freedom wearable mechanism that is able to guide human finger motion. The design process starts by analyzing the motion of healthy human fingers by video motion tracking. The experimental data are used to obtain the kinematics of a human finger. Then, a graphic/geometric synthesis procedure is implemented for achieving the dimensional synthesis of the proposed novel 2 degrees of freedom linkage mechanism for the finger exoskeleton. The proposed linkage mechanism can drive the three finger phalanxes by using two independent actuators that are both installed on the back of the hand palm. A prototype is designed based on the proposed design by using additive manufacturing. Results of numerical simulations and experimental tests are reported and discussed to prove the feasibility and the operational effectiveness of the proposed design solution that can assist a wide range of finger motions with proper adaptability to a variety of human fingers.
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Robotics in Health Care: Perspectives of Robot-Aided Interventions in Clinical Practice for Rehabilitation of Upper Limbs. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132586] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice.
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A Systematic Review on Existing Measures for the Subjective Assessment of Rehabilitation and Assistive Robot Devices. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2016:1048964. [PMID: 27196802 PMCID: PMC5058569 DOI: 10.1155/2016/1048964] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/06/2016] [Indexed: 11/29/2022]
Abstract
The objective of the current study is to identify and classify outcome measures currently used for the assessment of rehabilitation or assistive robot devices. We conducted a systematic review of the literature using PubMed, MEDLINE, CIRRIE, and Scopus databases for studies that assessed rehabilitation or assistive robot devices from 1980 through January 2016. In all, 31 articles met all inclusion criteria. Tailor-made questionnaires were the most commonly used tool at 66.7%, while the great majority (93.9%) of the studies used nonvalidated instruments. The study reveals the absence of a standard scale which makes it difficult to compare the results from different researchers. There is a great need, therefore, for a valid and reliable instrument to be available for use by the intended end users for the subjective assessment of robot devices. The study concludes by identifying two scales that have been validated in general assistive technology devices and could support the scope of subjective assessment in rehabilitation or assistive robots (however, with limited coverage) and a new one called PYTHEIA, recently published. The latter intends to close the gap and help researchers and developers to evaluate, assess, and produce products that satisfy the real needs of the end users.
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Almassri AMM, Wan Hasan WZ, Ahmad SA, Shafie S, Wada C, Horio K. Self-Calibration Algorithm for a Pressure Sensor with a Real-Time Approach Based on an Artificial Neural Network. SENSORS 2018; 18:s18082561. [PMID: 30081581 PMCID: PMC6111596 DOI: 10.3390/s18082561] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022]
Abstract
This paper presents a novel approach to predicting self-calibration in a pressure sensor using a proposed Levenberg Marquardt Back Propagation Artificial Neural Network (LMBP-ANN) model. The self-calibration algorithm should be able to fix major problems in the pressure sensor such as hysteresis, variation in gain and lack of linearity with high accuracy. The traditional calibration process for this kind of sensor is a time-consuming task because it is usually done through manual and repetitive identification. Furthermore, a traditional computational method is inadequate for solving the problem since it is extremely difficult to resolve the mathematical formula among multiple confounding pressure variables. Accordingly, this paper describes a new self-calibration methodology for nonlinear pressure sensors based on an LMBP-ANN model. The proposed method was achieved using a collected dataset from pressure sensors in real time. The load cell will be used as a reference for measuring the applied force. The proposed method was validated by comparing the output pressure of the trained network with the experimental target pressure (reference). This paper also shows that the proposed model exhibited a remarkable performance than traditional methods with a max mean square error of 0.17325 and an R-value over 0.99 for the total response of training, testing and validation. To verify the proposed model's capability to build a self-calibration algorithm, the model was tested using an untrained input data set. As a result, the proposed LMBP-ANN model for self-calibration purposes is able to successfully predict the desired pressure over time, even the uncertain behaviour of the pressure sensors due to its material creep. This means that the proposed model overcomes the problems of hysteresis, variation in gain and lack of linearity over time. In return, this can be used to enhance the durability of the grasping mechanism, leading to a more robust and secure grasp for paralyzed hands. Furthermore, the exposed analysis approach in this paper can be a useful methodology for the user to evaluate the performance of any measurement system in a real-time environment.
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Affiliation(s)
- Ahmed M M Almassri
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, 2⁻4 Hibikino, Wakamatsu-ku, Kitakyushu 808-0196, Japan.
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Wan Zuha Wan Hasan
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
- Institute of Advanced Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Suhaidi Shafie
- Department of Electrical and Electronic Engineering, Faculty of Engineering, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
- Institute of Advanced Technology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia.
| | - Chikamune Wada
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, 2⁻4 Hibikino, Wakamatsu-ku, Kitakyushu 808-0196, Japan.
| | - Keiichi Horio
- Graduate School of Life Science and Systems Engineering, Kyushu Institute of Technology, 2⁻4 Hibikino, Wakamatsu-ku, Kitakyushu 808-0196, Japan.
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Weber LM, Stein J. The use of robots in stroke rehabilitation: A narrative review. NeuroRehabilitation 2018; 43:99-110. [DOI: 10.3233/nre-172408] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Lynne M. Weber
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
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Dziemian K, Kiper A, Baba A, Baldan F, Alhelou M, Agostini M, Turolla A, Kiper P. The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0011.7401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Hemiparesis caused by a stroke negatively limits a patient’s motor function. Nowadays, innovative technologies such as robots are commonly used in upper limb rehabilitation. The main goal of robot-aided therapy is to provide a maximum number of stimuli in order to stimulate brain neuroplasticity. Treatment applied in this study via the AMADEO robot aimed to improve finger flexion and extension.
Aim: To assess the effect of rehabilitation assisted by a robot and enhanced by surface EMG.
Research project: Before-after study design.
Materials and methods: The study group consisted of 10 post-stroke patients enrolled for therapy with the AMADEO robot for at least 15 sessions. At the beginning and at the end of treatment, the following tests were used for clinical assessment: Fugl-Meyer scale, Box and Block test and Nine Hole Peg test. In the present study, we used surface electromyography (sEMG) to maintain optimal kinematics of hand motion. Whereas sensorial feedback, provided by the robot, was vital in obtaining closed-loop control. Thus, muscle contraction was transmitted to the amplifier through sEMG, activating the mechanism of the robot. Consequentially, sensorial feedback was provided to the patient.
Results: Statistically significant improvement of upper limb function was observed in: Fugl-Meyer (p = 0.38) and Box and Block (p = 0.27). The Nine Hole Peg Test did not show statistically significant changes in motor skills of the hand. However, the functional improvement was observed at the level of 6% in the Fugl-Meyer, 15% in the Box and Block, and 2% in the Nine Hole Peg test.
Conclusions: Results showed improvement in hand grasp and overall function of the upper limb. Due to sEMG, it was possible to implement robot therapy in the treatment of patients with severe hand impairment.
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Affiliation(s)
- Katarzyna Dziemian
- Uniwersytet Medyczny w Białymstoku, Wydział Nauk o Zdrowiu, Białystok / Faculty of Health Sciences, Medical University of Bialystok, Białystok, Poland
| | - Aleksandra Kiper
- Uniwersytet Rzeszowski, Wydział Medyczny, Rzeszów / Faculty of Medicine, University of Rzeszow, Rzeszów, Poland
| | - Alfonc Baba
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Francesca Baldan
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Mahmoud Alhelou
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Michela Agostini
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
| | - Pawel Kiper
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, Venice, Italy
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A Review of Robotics in Neurorehabilitation: Towards an Automated Process for Upper Limb. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9758939. [PMID: 29707189 PMCID: PMC5901488 DOI: 10.1155/2018/9758939] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 11/17/2022]
Abstract
Robot-mediated neurorehabilitation is a growing field that seeks to incorporate advances in robotics combined with neuroscience and rehabilitation to define new methods for treating problems related with neurological diseases. In this paper, a systematic literature review is conducted to identify the contribution of robotics for upper limb neurorehabilitation, highlighting its relation with the rehabilitation cycle, and to clarify the prospective research directions in the development of more autonomous rehabilitation processes. With this aim, first, a study and definition of a general rehabilitation process are made, and then, it is particularized for the case of neurorehabilitation, identifying the components involved in the cycle and their degree of interaction between them. Next, this generic process is compared with the current literature in robotics focused on upper limb treatment, analyzing which components of this rehabilitation cycle are being investigated. Finally, the challenges and opportunities to obtain more autonomous rehabilitation processes are discussed. In addition, based on this study, a series of technical requirements that should be taken into account when designing and implementing autonomous robotic systems for rehabilitation is presented and discussed.
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study. J Stroke Cerebrovasc Dis 2018; 27:221-228. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
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Yue Z, Zhang X, Wang J. Hand Rehabilitation Robotics on Poststroke Motor Recovery. Behav Neurol 2017; 2017:3908135. [PMID: 29230081 PMCID: PMC5688261 DOI: 10.1155/2017/3908135] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers' view or on the training paradigms on the clinicians' view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.
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Affiliation(s)
- Zan Yue
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Xue Zhang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Jing Wang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
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Wattchow KA, McDonnell MN, Hillier SL. Rehabilitation Interventions for Upper Limb Function in the First Four Weeks Following Stroke: A Systematic Review and Meta-Analysis of the Evidence. Arch Phys Med Rehabil 2017; 99:367-382. [PMID: 28734936 DOI: 10.1016/j.apmr.2017.06.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/10/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the therapeutic interventions reported in the research literature and synthesize their effectiveness in improving upper limb (UL) function in the first 4 weeks poststroke. DATA SOURCES Electronic databases and trial registries were searched from inception until June 2016, in addition to searching systematic reviews by hand. STUDY SELECTION Randomized controlled trials (RCTs), controlled trials, and interventional studies with pre/posttest design were included for adults within 4 weeks of any type of stroke with UL impairment. Participants all received an intervention of any physiotherapeutic or occupational therapeutic technique designed to address impairment or activity of the affected UL, which could be compared with usual care, sham, or another technique. DATA EXTRACTION Two reviewers independently assessed eligibility of full texts, and methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool. DATA SYNTHESIS A total of 104 trials (83 RCTs, 21 nonrandomized studies) were included (N=5225 participants). Meta-analyses of RCTs only (20 comparisons) and narrative syntheses were completed. Key findings included significant positive effects for modified constraint-induced movement therapy (mCIMT) (standardized mean difference [SMD]=1.09; 95% confidence interval [CI], .21-1.97) and task-specific training (SMD=.37; 95% CI, .05-.68). Evidence was found to support supplementary use of biofeedback and electrical stimulation. Use of Bobath therapy was not supported. CONCLUSIONS Use of mCIMT and task-specific training was supported, as was supplementary use of biofeedback and electrical simulation, within the acute phase poststroke. Further high-quality studies into the initial 4 weeks poststroke are needed to determine therapies for targeted functional UL outcomes.
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Affiliation(s)
- Kimberley A Wattchow
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Michelle N McDonnell
- Stroke and Rehabilitation Research Group, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia.
| | - Susan L Hillier
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
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Ostadabbas S, Housley SN, Sebkhi N, Richards K, Wu D, Zhang Z, Rodriguez MG, Warthen L, Yarbrough C, Belagaje S, Butler AJ, Ghovanloo M. Tongue-controlled robotic rehabilitation: A feasibility study in people with stroke. ACTA ACUST UNITED AC 2017; 53:989-1006. [PMID: 28475207 DOI: 10.1682/jrrd.2015.06.0122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/25/2016] [Indexed: 11/05/2022]
Abstract
Stroke survivors with severe upper limb (UL) impairment face years of therapy to recover function. Robot-assisted therapy (RT) is increasingly used in the field for goal-oriented rehabilitation as a means to improve function in ULs. To be used effectively for wrist and hand therapy, the current RT systems require the patient to have a minimal active range of movement in the UL, and those that do not have active voluntary movement cannot use these systems. We have overcome this limitation by harnessing tongue motion to allow patients to control a robot using synchronous tongue and hand movement. This novel RT device combines a commercially available UL exoskeleton, the Hand Mentor, and our custom-designed Tongue Drive System as its controller. We conducted a proof-of-concept study on six nondisabled participants to evaluate the system usability and a case series on three participants with movement limitations from poststroke hemiparesis. Data from two stroke survivors indicate that for patients with chronic, moderate UL impairment following stroke, a 15-session training regimen resulted in modest decreases in impairment, with functional improvement and improved quality of life. The improvement met the standard of minimal clinically important difference for activities of daily living, mobility, and strength assessments.
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Affiliation(s)
- Sarah Ostadabbas
- Electrical and Computer Engineering Department, Northeastern University, Boston, MA
| | - Stephen N Housley
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA
| | - Nordine Sebkhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Kimberly Richards
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA
| | - David Wu
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA
| | - Zhenxuan Zhang
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | | | - Lindsey Warthen
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA
| | - Crystal Yarbrough
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA
| | | | - Andrew J Butler
- School of Nursing & Health Professions, Georgia State University, Atlanta, GA.,Department of Physical Therapy, Georgia State University, Atlanta, GA
| | - Maysam Ghovanloo
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
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Agarwal P, Yun Y, Fox J, Madden K, Deshpande AD. Design, control, and testing of a thumb exoskeleton with series elastic actuation. Int J Rob Res 2017. [DOI: 10.1177/0278364917694428] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present an exoskeleton capable of assisting the human thumb through a large range of motion. Our novel thumb exoskeleton has the following unique features: (i) an underlying kinematic mechanism that is optimized to achieve a large range of motion, (ii) a design that actuates four degrees of freedom of the thumb, and (iii) a series elastic actuation based on a Bowden cable, allowing for bidirectional torque control of each thumb joint individually. We present a kinematic model of the coupled thumb exoskeleton system and use it to maximize the range of motion of the thumb. Finally, we carry out tests with the designed device on four subjects to evaluate its workspace and kinematic transparency using a motion capture system and torque control performance. Results show that the device allows for a large workspace with the thumb, is kinematically transparent to natural thumb motion to a high degree, and is capable of accurate torque control.
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Affiliation(s)
- Priyanshu Agarwal
- Mechanical Engineering Department, University of Texas at Austin, USA
| | - Youngmok Yun
- Mechanical Engineering Department, University of Texas at Austin, USA
| | - Jonas Fox
- Mechanical Engineering Department, University of Texas at Austin, USA
| | - Kaci Madden
- Mechanical Engineering Department, University of Texas at Austin, USA
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractRecent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.
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The Three Laws of Neurorobotics: A Review on What Neurorehabilitation Robots Should Do for Patients and Clinicians. J Med Biol Eng 2016; 36:1-11. [PMID: 27069459 PMCID: PMC4791450 DOI: 10.1007/s40846-016-0115-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/11/2015] [Indexed: 01/10/2023]
Abstract
Most studies and reviews on robots for neurorehabilitation focus on their effectiveness. These studies often report inconsistent results. This and many other reasons limit the credit given to these robots by therapists and patients. Further, neurorehabilitation is often still based on therapists' expertise, with competition among different schools of thought, generating substantial uncertainty about what exactly a neurorehabilitation robot should do. Little attention has been given to ethics. This review adopts a new approach, inspired by Asimov's three laws of robotics and based on the most recent studies in neurorobotics, for proposing new guidelines for designing and using robots for neurorehabilitation. We propose three laws of neurorobotics based on the ethical need for safe and effective robots, the redefinition of their role as therapist helpers, and the need for clear and transparent human-machine interfaces. These laws may allow engineers and clinicians to work closely together on a new generation of neurorobots.
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26
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Thielbar KO, Lord TJ, Fischer HC, Lazzaro EC, Barth KC, Stoykov ME, Triandafilou KM, Kamper DG. Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke. J Neuroeng Rehabil 2014; 11:171. [PMID: 25542201 PMCID: PMC4292811 DOI: 10.1186/1743-0003-11-171] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
Background Dexterous manipulation of the hand, one of the features of human motor control, is often compromised after stroke, to the detriment of basic functions. Despite the importance of independent movement of the digits to activities of daily living, relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on hand rehabilitation. The purpose of this study was to investigate the impact of such finger individuation training, by means of a novel mechatronic-virtual reality system, on fine motor control after stroke. Methods An actuated virtual keypad (AVK) system was developed in which the impaired hand controls a virtual hand playing a set of keys. Creation of individuated digit movements is assisted by a pneumatically actuated glove, the PneuGlove. A study examining efficacy of the AVK system was subsequently performed. Participants had chronic, moderate hand impairment resulting from a single stroke incurred at least 6 months prior. Each subject underwent 18 hour-long sessions of extensive therapy (3x per week for 6 weeks) targeted at finger individuation. Subjects were randomly divided into two groups: the first group (Keypad: N = 7) utilized the AVK system while the other group (OT: N = 7) received a similarly intensive dose of occupational therapy; both groups worked directly with a licensed occupational therapist. Outcome measures such as the Jebsen-Taylor Hand Function Test (JTHFT), Action research Arm Test (ARAT), Fugl-Meyer Upper Extremity Motor Assessment/Hand subcomponent (FMUE/FMH), grip and pinch strengths were collected at baseline, post-treatment and one-month post-treatment. Results While both groups exhibited some signs of change after the training sessions, only the Keypad group displayed statistically significant improvement both for measures of impairment (FMH: p = 0.048) and measures of task performance (JTHFT: p = 0.021). Additionally, the finger individuation index – a measure of finger independence – improved only for the Keypad group after training (p = 0.05) in the subset (Keypad: N = 4; OT: N = 5) of these participants for which it was measured. Conclusions Actively assisted individuation therapy comprised of non task-specific modalities, such as can be achieved with virtual platforms like the AVK described here, may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke. Electronic supplementary material The online version of this article (doi:10.1186/1743-0003-11-171) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Kristen M Triandafilou
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, 345 E Superior Street, Suite 1406, Chicago, IL 60611, USA.
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Basteris A, Nijenhuis SM, Stienen AHA, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil 2014; 11:111. [PMID: 25012864 PMCID: PMC4108977 DOI: 10.1186/1743-0003-11-111] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.
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Affiliation(s)
- Angelo Basteris
- Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire, College Lane, AL95HX Hatfield, United Kingdom.
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Action observation therapy in the subacute phase promotes dexterity recovery in right-hemisphere stroke patients. BIOMED RESEARCH INTERNATIONAL 2014; 2014:457538. [PMID: 24967372 PMCID: PMC4054881 DOI: 10.1155/2014/457538] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/17/2022]
Abstract
The clinical impact of action observation (AO) on upper limb functional recovery in subacute stroke patients is recent evidence. We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one. Sixty-seven first-ever ischemic stroke subjects were randomly assigned to receive upper limb training coupled with AO tasks or standard rehabilitation. The groups were matched by age and gender, Bamford category, and interval from stroke and lesion side. Fugl-Meyer (FM) and Box and Block Test (BBT) were used to measure hand function recovery at the end (T1) and 4-5 months after the treatment (T2). At T1, FM was increased by 31% (±26%), of maximum achievable recovery, whereas BBT was increased by 17% (±18%); at T2, FM had reached 43% (±45%) of maximum recovery, while BBT had reached 25% (±22%). Combining the effects of treatment to those of lesion side revealed significantly higher gains, in both FM and BBT scores, in left hemiparetic subjects when exposed to AO as compared to standard rehabilitation alone (P < .01). The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients.
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Maciejasz P, Eschweiler J, Gerlach-Hahn K, Jansen-Troy A, Leonhardt S. A survey on robotic devices for upper limb rehabilitation. J Neuroeng Rehabil 2014; 11:3. [PMID: 24401110 PMCID: PMC4029785 DOI: 10.1186/1743-0003-11-3] [Citation(s) in RCA: 396] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/03/2014] [Indexed: 11/10/2022] Open
Abstract
The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future. The patient population needing physical rehabilitation of the upper extremity is also constantly increasing. Robotic devices have the potential to address this problem as noted by the results of recent research studies. However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement. The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices. In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation. This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems.
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Affiliation(s)
- Paweł Maciejasz
- DEMAR - LIRMM, INRIA, University of Montpellier 2, CNRS, Montpellier, 161 rue Ada, 34095 Montpellier, France
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, ul. Św. A. Boboli 8, 02-525 Warszawa, Poland
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Jörg Eschweiler
- Chair of Medical Engineering (mediTEC), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Kurt Gerlach-Hahn
- Philips Chair of Medical Information Technology (MedIT), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Arne Jansen-Troy
- Chair of Medical Engineering (mediTEC), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Steffen Leonhardt
- Philips Chair of Medical Information Technology (MedIT), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
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Robotic technologies and rehabilitation: new tools for stroke patients' therapy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:153872. [PMID: 24350244 PMCID: PMC3852950 DOI: 10.1155/2013/153872] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/18/2013] [Indexed: 11/23/2022]
Abstract
Introduction. The role of robotics in poststroke patients' rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients' rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient's characteristics to be successfully enrolled to this treatment.
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Meyer-Heim A, van Hedel HJA. Robot-assisted and computer-enhanced therapies for children with cerebral palsy: current state and clinical implementation. Semin Pediatr Neurol 2013; 20:139-45. [PMID: 23948688 DOI: 10.1016/j.spen.2013.06.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The field of pediatric neurorehabilitation has rapidly evolved with the introduction of technological advancements over recent years. Rehabilitation robotics and computer-assisted systems can complement conventional physiotherapeutics or occupational therapies. These systems appear promising, especially in children, where exciting and challenging virtual reality scenarios could increase motivation to train intensely in a playful therapeutic environment. Despite promising experience and a large acceptance by the patients and parents, so far, only a few therapy systems have been evaluated in children, and well-designed randomized controlled studies in this field are still lacking. This narrative review aims to provide an overview about the to-date robot-assisted and computer-based therapies and the current level of evidence and to share the authors experience about the clinical implication of these new technologies available for children with cerebral palsy.
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Affiliation(s)
- Andreas Meyer-Heim
- Head Division of Paediatric Rehabilitation and Rehabilitation Centre, Rehabilitation Centre Affoltern am Albis, University Children's Hospital, Zurich, Switzerland.
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