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Mang J, Xu Z, Qi Y, Zhang T. Favoring the cognitive-motor process in the closed-loop of BCI mediated post stroke motor function recovery: challenges and approaches. Front Neurorobot 2023; 17:1271967. [PMID: 37881517 PMCID: PMC10595019 DOI: 10.3389/fnbot.2023.1271967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
The brain-computer interface (BCI)-mediated rehabilitation is emerging as a solution to restore motor skills in paretic patients after stroke. In the human brain, cortical motor neurons not only fire when actions are carried out but are also activated in a wired manner through many cognitive processes related to movement such as imagining, perceiving, and observing the actions. Moreover, the recruitment of motor cortexes can usually be regulated by environmental conditions, forming a closed-loop through neurofeedback. However, this cognitive-motor control loop is often interrupted by the impairment of stroke. The requirement to bridge the stroke-induced gap in the motor control loop is promoting the evolution of the BCI-based motor rehabilitation system and, notably posing many challenges regarding the disease-specific process of post stroke motor function recovery. This review aimed to map the current literature surrounding the new progress in BCI-mediated post stroke motor function recovery involved with cognitive aspect, particularly in how it refired and rewired the neural circuit of motor control through motor learning along with the BCI-centric closed-loop.
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Affiliation(s)
- Jing Mang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhuo Xu
- Department of Rehabilitation, China-Japan Union Hospital of Jilin University, Changchun, China
| | - YingBin Qi
- Department of Neurology, Jilin Province People's Hospital, Changchun, China
| | - Ting Zhang
- Rehabilitation Therapeutics, School of Nursing, Jilin University, Changchun, China
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Chen R, Zhang Y, Wang X, Zhao Y, Fan S, Xue Y, Zhao J, Liu Y, Wang P. Treatment effects of low-frequency repetitive transcranial magnetic stimulation combined with motor relearning procedure on spasticity and limb motor function in stroke patients. Front Neurol 2023; 14:1213624. [PMID: 37638202 PMCID: PMC10456998 DOI: 10.3389/fneur.2023.1213624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023] Open
Abstract
Objective Limb paralysis, which is a sequela of stroke, limits patients' activities of daily living and lowers their quality of life. The purpose of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with a motor relearning procedure (MRP) on motor function and limb spasticity in stroke patients. Methods Stroke patients were randomly divided into a combined treatment group (rTMS + MRP) and a control group (MRP) (n = 30 per group). The control group was given MRP in addition to conventional rehabilitation, and the combined treatment group was given 1 Hz rTMS combined with MRP. The treatment efficacy was assessed by the modified Ashworth scale (MAS), Fugl-Meyer motor function scale, and motor evoked potential (MEP) testing. Results After 4 weeks of treatment, the Brunnstrom score, Fugl-Meyer lower extremity motor function, and Fugl-Meyer balance function were significantly higher in the combination treatment group compared to the control group, while the MAS score was lower in the combination treatment group compared to the control group. The MEP extraction rate was higher in the combined treatment group compared to the control group, while the threshold and central motor conduction time (CMCT) were lower in the combined treatment group compared to the control group. Conclusion Low-frequency rTMS combined with MRP had better efficacy on spasticity and motor function in stroke patients with hemiparesis than MRP alone.
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Affiliation(s)
- Ruijun Chen
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Zhang
- Department of Traditional Chinese Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Traditional Chinese Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaocheng Wang
- Department of Medical Record and Statistics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yunfei Zhao
- College of Sports Rehabilitation, Shanxi Medical University, Jinzhong, China
| | - Shasha Fan
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanping Xue
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhao
- Department of Medical Record Management, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Medical Record Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinlian Liu
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pingzhi Wang
- Department of Rehabilitation, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ahmed I, Mustafaoglu R, Benkhalifa N, Yakhoub YH. Does noninvasive brain stimulation combined with other therapies improve upper extremity motor impairment, functional performance, and participation in activities of daily living after stroke? A systematic review and meta-analysis of randomized controlled trial. Top Stroke Rehabil 2023; 30:213-234. [PMID: 35112659 DOI: 10.1080/10749357.2022.2026278] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several studies have investigated the effect of noninvasive brain stimulation (NIBS) on upper limb motor function in stroke, but the evidence so far is conflicting. OBJECTIVE We aimed to determine the effect of NIBS on upper limb motor impairment, functional performance, and participation in activities of daily living after stroke. METHOD Literature search was conducted for randomized controlled trials (RCTs) assessing the effect of "tDCS" or "rTMS" combined with other therapies on upper extremity motor recovery after stroke. The outcome measures were Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI). The mean difference (MD) and 95%CI were estimated for motor outcomes. Cochrane risk of bias tool was used to assess the quality of evidence. RESULT Twenty-five RCTs involving 1102 participants were included in the review. Compared to sham stimulation, NIBS combined with other therapies has effectively improved FMA-UE (MD0.97 [95%CI, 0.09 to 1.86; p = .03]) and BI score (MD9.11 [95%CI, 2.27 to 15.95; p = .009]) in acute/sub-acute stroke (MD1.73 [95%CI, 0.61 to 2.85; p = .003]) but unable to modify FMA-UE score in chronic stroke (MD-0.31 [95%CI, -1.77 to 1.15; p = .68]). Only inhibitory (MD3.04 [95%CI, 1.76 to 4.31; I2 = 82%, p < .001] protocol is associated with improved FMA-UE score. Twenty minutes of stimulation/session for ≥20 sessions was found to be effective in improving FMA-UE score (Stimulation time: ES0.45; p ≤ .001; Sessions: ES0.33; p ≤ .001). The NIBS did not produce any significant improvement in WMFT as compared to sham NIBS (MD0.91 [95% CI, -0.89 to 2.70; p = .32]). CONCLUSION Moderate to high-quality evidence suggested that NIBS combined with other therapies is effective in improving upper extremity motor impairment and participation in activities of daily living after acute/sub-acute stroke.
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Affiliation(s)
- Ishtiaq Ahmed
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nesrine Benkhalifa
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yakhoub Hassan Yakhoub
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Falkowski P, Osiak T, Wilk J, Prokopiuk N, Leczkowski B, Pilat Z, Rzymkowski C. Study on the Applicability of Digital Twins for Home Remote Motor Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:911. [PMID: 36679706 PMCID: PMC9864302 DOI: 10.3390/s23020911] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/07/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic created the need for telerehabilitation development, while Industry 4.0 brought the key technology. As motor therapy often requires the physical support of a patient's motion, combining robot-aided workouts with remote control is a promising solution. This may be realised with the use of the device's digital twin, so as to give it an immersive operation. This paper presents an extensive overview of this technology's applications within the fields of industry and health. It is followed by the in-depth analysis of needs in rehabilitation based on questionnaire research and bibliography review. As a result of these sections, the original concept of controlling a rehabilitation exoskeleton via its digital twin in the virtual reality is presented. The idea is assessed in terms of benefits and significant challenges regarding its application in real life. The presented aspects prove that it may be potentially used for manual remote kinesiotherapy, combined with the safety systems predicting potentially harmful situations. The concept is universally applicable to rehabilitation robots.
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Affiliation(s)
- Piotr Falkowski
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Tomasz Osiak
- Chair of Clinical Physiotherapy, Faculty of Rehabilitation, The Józef Piłsudski University of Physical Education in Warsaw, 00-809 Warszawa, Poland
| | - Julia Wilk
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Norbert Prokopiuk
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Bazyli Leczkowski
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
| | - Zbigniew Pilat
- Łukasiewicz Research Network—Industrial Research Institute for Automation and Measurements PIAP, 02-486 Warsaw, Poland
| | - Cezary Rzymkowski
- Institute of Aeronautics and Applied Mechanics, Faculty of Power and Aeronautical Engineering, Warsaw University of Technology, 00-665 Warszawa, Poland
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Tohanean N, Tucan P, Vanta OM, Abrudan C, Pintea S, Gherman B, Burz A, Banica A, Vaida C, Neguran DA, Ordog A, Tarnita D, Pisla D. The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study. J Clin Med 2023; 12:jcm12020425. [PMID: 36675354 PMCID: PMC9866490 DOI: 10.3390/jcm12020425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.
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Affiliation(s)
- Nicoleta Tohanean
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Oana-Maria Vanta
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Cristian Abrudan
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Neurosurgery Department, Cluj-Napoca Emergency Clinical County Hospital, 400349 Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babes-Bolyai University, 400029 Cluj-Napoca, Romania
| | - Bogdan Gherman
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Alin Burz
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Alexandru Banica
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Calin Vaida
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Deborah Alice Neguran
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Andreea Ordog
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Daniela Tarnita
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Doina Pisla
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
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Cho W, Vidaurre C, An J, Birbaumer N, Ramos-Murguialday A. Cortical processing during robot and functional electrical stimulation. Front Syst Neurosci 2023; 17:1045396. [PMID: 37025164 PMCID: PMC10070684 DOI: 10.3389/fnsys.2023.1045396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Like alpha rhythm, the somatosensory mu rhythm is suppressed in the presence of somatosensory inputs by implying cortical excitation. Sensorimotor rhythm (SMR) can be classified into two oscillatory frequency components: mu rhythm (8-13 Hz) and beta rhythm (14-25 Hz). The suppressed/enhanced SMR is a neural correlate of cortical activation related to efferent and afferent movement information. Therefore, it would be necessary to understand cortical information processing in diverse movement situations for clinical applications. Methods In this work, the EEG of 10 healthy volunteers was recorded while fingers were moved passively under different kinetic and kinematic conditions for proprioceptive stimulation. For the kinetics aspect, afferent brain activity (no simultaneous volition) was compared under two conditions of finger extension: (1) generated by an orthosis and (2) generated by the orthosis simultaneously combined and assisted with functional electrical stimulation (FES) applied at the forearm muscles related to finger extension. For the kinematic aspect, the finger extension was divided into two phases: (1) dynamic extension and (2) static extension (holding the extended position). Results In the kinematic aspect, both mu and beta rhythms were more suppressed during a dynamic than a static condition. However, only the mu rhythm showed a significant difference between kinetic conditions (with and without FES) affected by attention to proprioception after transitioning from dynamic to static state, but the beta rhythm was not. Discussion Our results indicate that mu rhythm was influenced considerably by muscle kinetics during finger movement produced by external devices, which has relevant implications for the design of neuromodulation and neurorehabilitation interventions.
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Affiliation(s)
- Woosang Cho
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
- *Correspondence: Woosang Cho,
| | - Carmen Vidaurre
- TECNALIA, Basque Research and Technology Alliance, Neurotechnology Laboratory, San Sebastián, Spain
- Ikerbasque-Basque Foundation for Science, Bilbao, Spain
| | - Jinung An
- Interdisciplinary Studies, Graduate School, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Republic of Korea
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- San Camillo Hospital, Institute for Hospitalization and Scientific Care, Venice Lido, Italy
| | - Ander Ramos-Murguialday
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- TECNALIA, Basque Research and Technology Alliance, Neurotechnology Laboratory, San Sebastián, Spain
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Zhu Y, Wang C, Li J, Zeng L, Zhang P. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials. Front Neurol 2023; 14:1125172. [PMID: 37139055 PMCID: PMC10150552 DOI: 10.3389/fneur.2023.1125172] [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: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions. Methods From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction. Results We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability. Conclusions The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration. Systematic review registration www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.
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Affiliation(s)
- Yu Zhu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Linfen Central Hospital, Linfen, Shanxi, China
| | - Chen Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Peizhen Zhang
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Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091248. [PMID: 36143925 PMCID: PMC9505091 DOI: 10.3390/medicina58091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.
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Zuccon G, Lenzo B, Bottin M, Rosati G. Rehabilitation robotics after stroke: a bibliometric literature review. Expert Rev Med Devices 2022; 19:405-421. [PMID: 35786139 DOI: 10.1080/17434440.2022.2096438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is the leading cause of long-term disability in developed countries. Due to population aging, the number of people requiring rehabilitation after stroke is going to rise in the coming decades. Robot-mediated neurorehabilitation has the potential to improve clinical outcomes of rehabilitation treatments. A statistical analysis of the literature aims to focus on the main trend of this topic. AREAS COVERED A bibliometric survey on post-stroke robotic rehabilitation was performed through a database collection of scientific publications in the field of rehabilitation robotics. By covering the last 20 years, 17429 sources were collected. Relevant patterns and statistics concerning the main research areas were analyzed. Leading journals and conferences which publish and disseminate knowledge in the field were identified. A detailed nomenclature study was carried out. The time trends of the research field were captured. Opinions and predictions of future trends that are expected to shape the near future of the field were discussed. EXPERT OPINION Data analysis reveals the continuous expansion of the research field over the last two decades, which is expected to rise considerably in near future. More attention will be paid to the lower limbs rehabilitation and disease/design specific applications in early-stage patients.
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Affiliation(s)
- Giacomo Zuccon
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Basilio Lenzo
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Matteo Bottin
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Giulio Rosati
- Department of Industrial Engineering, University of Padua, Padua, Italy
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Mashayekhi M, Moghaddam MM. Emg-driven Fatigue-based Self-adapting Admittance Control of a Hand Rehabilitation Robot. J Biomech 2022; 138:111104. [DOI: 10.1016/j.jbiomech.2022.111104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/31/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
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Naro A, Billeri L, Balletta T, Lauria P, Onesta MP, Calabrò RS. Finding the Way to Improve Motor Recovery of Patients with Spinal Cord Lesions: A Case-Control Pilot Study on a Novel Neuromodulation Approach. Brain Sci 2022; 12:119. [PMID: 35053862 PMCID: PMC8773706 DOI: 10.3390/brainsci12010119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/16/2022] Open
Abstract
Robot-assisted rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are interventions that, both individually and combined, can significantly enhance motor performance after spinal cord injury (SCI). We sought to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with active transvertebral direct current stimulation (tvDCS) (namely, NIBS) in association with RAR (RAR + NIBS) improves lower extremity motor function more than RAR alone in subjects with motor incomplete SCI (iSCI). Fifteen adults with iSCI received one daily session of RAR+NIBS in the early afternoon, six sessions weekly, for eight consecutive weeks. Outcome measures included the 6 min walk test (6MWT), the 10 m walk test (10MWT), the timed up and go (TUG) to test mobility and balance, the Walking Index for Spinal Cord Injury (WISCI II), the Functional Independence Measure-Locomotion (FIM-L), the manual muscle testing for lower extremity motor score (LEMS), the modified Ashworth scale for lower limbs (MAS), and the visual analog scale (VAS) for pain. The data of these subjects were compared with those of 20 individuals matched for clinical and demographic features who previously received the same amount or RAR without NIBS (RAR - NIBS). All patients completed the trial, and none reported any side effects either during or following the training. The 10MWT improved in both groups, but the increase was significantly greater following RAR + NIBS than RAR - NIBS. The same occurred for the FIM-L, LEMS, and WISCI II. No significant differences were appreciable concerning the 6MWT and TUG. Conversely, RAR - NIBS outperformed RAR + NIBS regarding the MAS and VAS. Pairing tvDCS with rTMS during RAR can improve lower extremity motor function more than RAR alone can do. Future research with a larger sample size is recommended to determine longer-term effects on motor function and activities of daily living.
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Affiliation(s)
- Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Luana Billeri
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | - Paola Lauria
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
| | | | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo Piemonte, Via Palermo, SS 113, Ctr. Casazza, 98124 Messina, Italy; (A.N.); (L.B.); (T.B.); (P.L.)
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12
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New Rehabilitation Assessment Method of the End-Effector Finger Rehabilitation Robot Based on Multi-Sensor Source. Healthcare (Basel) 2021; 9:healthcare9101251. [PMID: 34682931 PMCID: PMC8535290 DOI: 10.3390/healthcare9101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
In the process of rehabilitation, the objectivity and the accuracy of rehabilitation assessment have an obvious impact on the follow-up training. To improve this problem, using a multi-sensor source, this paper attempts to establish a comprehensive assessment method of the finger rehabilitation effect, including three indicators of finger muscle strength, muscle fatigue degree, and range of motion. Firstly, on the basis of the fingertip pressure sensor of the End-Effector Finger Rehabilitation Robot, a mathematical model of finger muscle strength estimation was established, and the estimated muscle strength was scored using the entropy weight method. Secondly, using an sEMG signal sensor, a fatigue monitoring system was designed in the training process, and the fatigue degree was determined on the basis of the change trend of the eigenvalues of MAV and RMS. Lastly, a human-machine motion coupling model was established, and the joint range of motion acquisition and scoring model were obtained on the basis of the motor encoder. According to the above three indicators, using the AHP assessment method to establish a comprehensive rehabilitation assessment method, the effectiveness of the method was verified by experiments. This paper provides a potential new idea and method for objective, accurate, and convenient assessment of finger function rehabilitation, which is of positive significance for alleviating the burden on rehabilitation doctors and improving rehabilitation efficiency.
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13
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Lee JJ, Shin JH. Predicting Clinically Significant Improvement After Robot-Assisted Upper Limb Rehabilitation in Subacute and Chronic Stroke. Front Neurol 2021; 12:668923. [PMID: 34276535 PMCID: PMC8281036 DOI: 10.3389/fneur.2021.668923] [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: 02/17/2021] [Accepted: 06/01/2021] [Indexed: 12/11/2022] Open
Abstract
Prior studies examining predictors of favorable clinical outcomes after upper limb robot-assisted therapy (RT) have many shortcomings. Therefore, the aim of this study was to identify meaningful predictors and a prediction model for clinically significant motor improvement in upper limb impairment after RT for each stroke phase. This retrospective, single-center study enrolled patients with stroke who received RT using InMotion2 along with conventional therapy (CT) from January 2015 to September 2019. Demographic characteristics, clinical measures, and robotic kinematic measures were evaluated. The primary outcome measure was the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and we classified patients with improvement more than the minimal clinically important difference as responders for each stroke phase. Univariable and multivariable logistic regression analyses were performed to assess the relationship between potential predictors and RT responders and determine meaningful predictors. Subsequently, meaningful predictors were included in the final prediction model. One hundred forty-four patients were enrolled. The Hand Movement Scale and time since onset were significant predictors of clinically significant improvement in upper limb impairment (P = 0.045 and 0.043, respectively), as represented by the FMA-UE score after RT along with CT, in patients with subacute stroke. These variables were also meaningful predictors with borderline statistical significance in patients with chronic stroke (P = 0.076 and 0.066, respectively). Better hand movement and a shorter time since onset can be used as realistic predictors of clinically significant motor improvement in upper limb impairment after RT with InMotion2 alongside CT in patients with subacute and chronic stroke. This information may help healthcare professionals discern optimal patients for RT and accurately inform patients and caregivers about outcomes of RT.
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Affiliation(s)
- Jae Joon Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea.,Translational Research Center for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
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14
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Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6631835. [PMID: 33815554 PMCID: PMC7990546 DOI: 10.1155/2021/6631835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 11/25/2022]
Abstract
Interdisciplinary combinations of medicine and engineering are part of the strategic plan of many universities aiming to be world-class institutions. One area in which these interactions have been prominent is rehabilitation of stroke hemiplegia. This article reviews advances in the last five years of stroke hemiplegia rehabilitation via interdisciplinary combination of medicine and engineering. Examples of these technologies include VR, RT, mHealth, BCI, tDCS, rTMS, and TCM rehabilitation. In this article, we will summarize the latest research in these areas and discuss the advantages and disadvantages of each to examine the frontiers of interdisciplinary medicine and engineering advances.
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15
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Chen Z, Xia N, He C, Gu M, Xu J, Han X, Huang X. Action observation treatment-based exoskeleton (AOT-EXO) for upper extremity after stroke: study protocol for a randomized controlled trial. Trials 2021; 22:222. [PMID: 33743788 PMCID: PMC7981809 DOI: 10.1186/s13063-021-05176-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Stroke produces multiple symptoms, including sensory, motor, cognitive and psychological dysfunctions, among which motor deficit is the most common and is widely recognized as a major contributor to long-term functional disability. Robot-assisted training is effective in promoting upper extremity muscle strength and motor impairment recovery after stroke. Additionally, action observation treatment can enhance the effects of physical and occupational therapy by increasing neural activation. The AOT-EXO trial aims to investigate whether action observation treatment coupled with robot-assisted training could enhance motor circuit activation and improve upper extremity motor outcomes. Methods The AOT-EXO trial is a multicentre, prospective, three-group randomized controlled trial (RCT). We will screen and enrol 132 eligible patients in the trial implemented in the Department of Rehabilitation Medicine of Tongji Hospital, Optical Valley Branch of Tongji Hospital and Hubei Province Hospital of Integrated Chinese & Western Medicine in Wuhan, China. Prior to study participation, written informed consent will be obtained from eligible patients in accordance with the Declaration of Helsinki. The enrolled stroke patients will be randomized to three groups: the CT group (conventional therapy); EXO group (exoskeleton therapy) and AOT-EXO group (action observation treatment-based exoskeleton therapy). The patients will undergo blinded assessments at baseline, post-intervention (after 4 weeks) and follow-up (after 12 weeks). The primary outcome will be the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcomes will include the Action Research Arm Test (ARAT), modified Barthel Index (MBI), kinematic metrics assessed by inertial measurement unit (IMU), resting motor threshold (rMT), motor evoked potentials (MEP), functional magnetic resonance imaging (fMRI) and safety outcomes. Discussion This trial will provide evidence regarding the feasibility and efficacy of the action observation treatment-based exoskeleton (AOT-EXO) for post-stroke upper extremity rehabilitation and elucidate the potential underlying kinematic and neurological mechanisms. Trial registration Chinese Clinical Trial Registry ChiCTR1900026656. Registered on 17 October 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05176-x.
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Affiliation(s)
- Zejian Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Chang He
- Institute of Rehabilitation and Medical Robotics, State Key Lab of Digital Manufacturing Equipment and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Minghui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Jiang Xu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China
| | - Xiaohua Han
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China.
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. .,World Health Organization Cooperative Training and Research Center in Rehabilitation, Wuhan, China.
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16
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Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges. SENSORS 2021; 21:s21062084. [PMID: 33809721 PMCID: PMC8002299 DOI: 10.3390/s21062084] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022]
Abstract
Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human-machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals-namely, family members and professional carers-to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.
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17
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Perini G, Bertoni R, Thorsen R, Carpinella I, Lencioni T, Ferrarin M, Jonsdottir J. Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study. Technol Health Care 2021; 29:419-429. [PMID: 33386831 DOI: 10.3233/thc-202371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement, and robotic therapy which allows many repetitions of movements. OBJECTIVE Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upper extremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10-point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37-0.56). CONCLUSIONS Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.
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18
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Design and Analysis of a Flexible, Elastic, and Rope-Driven Parallel Mechanism for Wrist Rehabilitation. Appl Bionics Biomech 2020; 2020:8841400. [PMID: 33273965 PMCID: PMC7676981 DOI: 10.1155/2020/8841400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 12/03/2022] Open
Abstract
This paper proposes a bionic flexible wrist parallel mechanism to simulate human wrist joints, which is characterized by a rope-driven, compression spring-supported hybrid mechanism. Specifically, to realize the movement of the wrist mechanism, a parallel structure is adopted to support the mobile platform and is controlled by a cable, which plays the role of wrist muscles. Because the compression spring is elastic, it is difficult to directly solve inverse kinematics. To address this problem, the external force acting on the moving platform is firstly equivalent to the vector force and torque at the center of the moving platform. Then, based on inverse kinematic and static analyses, the inverse motion of the robot model can be solved according to the force and torque balance conditions and the lateral spring bending equation of the compression spring. In order to verify the proposed method, kinematics, statics, and parallel mechanism workspace are further analyzed by the software MATLAB. The obtained results demonstrate the effectiveness and feasibility of the designed parallel mechanism. This work offers new insights into the parallel mechanism with flexible joints in replicating the movements of the human wrist, thus promoting the development of rehabilitation robots and rope-driven technology to some extent.
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19
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Zhang C, Dong M, Li J, Cao Q. A Modified Kinematic Model of Shoulder Complex Based on Vicon Motion Capturing System: Generalized GH Joint with Floating Centre. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3713. [PMID: 32630828 PMCID: PMC7374450 DOI: 10.3390/s20133713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
Due to the complex coupling motion of shoulder mechanism, only a small amount of quantitative information is available in the existing literature, although various kinematic models of the shoulder complex have been proposed. This study focused on the specific motion coupling relationship between glenohumeral (GH) joint center displacement variable quantity relative to the thorax coordinate system and humeral elevation angle to describe the shoulder complex. The mechanism model of shoulder complex was proposed with an algorithm designed. Subsequently, twelve healthy subjects performed right arm raising, lowering, as well as raising and lowering (RAL) movements in sixteen elevation planes, and the motion information of the markers attached to the thorax, scapula, and humerus was captured by using Vicon motion capturing system. Then, experimental data was processed and the generalized GH joint with floating center was quantized. Simultaneously, different coupling characteristics were detected during humerus raising as well as lowering movements. The motion coupling relationships in different phases were acquired, and a modified kinematic model was established, with the description of overall motion characteristics of shoulder complex validated by comparing the results with a prior kinematic model from literature, showing enough accuracy for the design of upper limb rehabilitation robots.
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Affiliation(s)
| | | | - Jianfeng Li
- Beijing Key Laboratory of Advanced Manufacturing Technology, Faculty of Materials and Manufacturing, Beijing University of Technology, Beijing 100124, China; (C.Z.); (M.D.); (Q.C.)
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20
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Baccinelli W, Bulgheroni M, Frigo CA. Using UHF RFID Properties to Develop and Optimize an Upper-Limb Rehabilitation System. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3224. [PMID: 32517139 PMCID: PMC7309084 DOI: 10.3390/s20113224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
Rehabilitation of the upper limb is an important aspect of the therapy for people affected by neuromotor diseases for the recovery of the capability to perform activities of daily living (ADLs). Nonetheless, the costs associated with the administration of rehabilitation therapy and the increasing number of patients highlight the need for new solutions. Technology-based solutions and, in particular, telerehabilitation could strongly impact in this field. In this paper, a new system based on radiofrequency (RF) technology is presented which is able to effectively provide home-based telerehabilitation and extract meaningful information on the therapy execution performance. The technology has been tuned to the needs of the rehabilitation system, optimizing the hardware, the communication protocol and the software control. A methodology for extracting the execution time of the rehabilitation tasks, the distance covered by the patient's hand in each subtask and the velocity profile is presented. The results show that a highly usable system for the rehabilitation of the upper limb has been developed using the RF technology and that performance metrics can be reliably extracted by the acquired signals.
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Affiliation(s)
- Walter Baccinelli
- R&D Department, Ab.Acus Srl, via F. Caracciolo 77, 20155 Milano, Italy;
- Movement Biomechanics and Motor Control Lab, DEIB, Politecnico di Milano, 20133 Milano, Italy;
| | - Maria Bulgheroni
- R&D Department, Ab.Acus Srl, via F. Caracciolo 77, 20155 Milano, Italy;
| | - Carlo Albino Frigo
- Movement Biomechanics and Motor Control Lab, DEIB, Politecnico di Milano, 20133 Milano, Italy;
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21
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Oga K, Yozu A, Kume Y, Seki H, Tsuchiya N, Nakai K, Matsushita A, Mutsuzaki H, Kohno Y. Robotic rehabilitation of the paralyzed upper limb for a stroke patient using the single-joint hybrid assistive limb: a case study assessed by accelerometer on the wrist. J Phys Ther Sci 2020; 32:192-196. [PMID: 32158083 PMCID: PMC7032986 DOI: 10.1589/jpts.32.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/04/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of
paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive
Limb has been shown to improve upper limb impairments. However, limited data are available
on the effectiveness of robotic rehabilitation of the upper limb with regards to daily
living. In this case study, an accelerometer was adopted to examine whether rehabilitation
using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily
living in a stroke patient. [Participant and Methods] The participant was a 69-year-old
male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb
was applied to the participant’s elbow on the paralyzed side. The participant wore an
accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests
of the paralyzed upper limb were also performed. [Results] The activity of the paralytic
limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than
before the intervention. On the other hand, none of the results of the clinical tests
changed beyond a clinically important difference. [Conclusion] The Single-Joint Hybrid
Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily
living. In addition, an accelerometer could be especially useful for evaluating the
effects of robotic rehabilitation.
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Affiliation(s)
- Kenya Oga
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Arito Yozu
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
| | - Yu Kume
- Department of Occupational Therapy, Doctorial Course in Health Sciences, Graduate School of Medicine, Akita University, Japan
| | - Hiroyuki Seki
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Nobuhito Tsuchiya
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Kei Nakai
- Faculty of Medicine, University of Tsukuba, Japan
| | - Akira Matsushita
- Neurorehabilitation, Ibaraki Prefectural University of Health Sciences Hospital, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences: 4669-2 Ami, Ami-machi, Inashiki, Ibaraki 300-0394, Japan
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Ma Y, Zhang P, Tang Y, Pan C, Li G, Liu N, Hu Y, Tang Z. Artificial intelligence: The dawn of a new era for cutting-edge technology based diagnosis and treatment for stroke. BRAIN HEMORRHAGES 2020. [DOI: 10.1016/j.hest.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Vision-Assisted Interactive Human-in-the-Loop Distal Upper Limb Rehabilitation Robot and its Clinical Usability Test. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9153106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the context of stroke rehabilitation, simple structures and user-intent driven actuation are relevant features to facilitate neuroplasticity as well as deliver a sufficient number of repetitions during a single therapy session. A novel robotic treatment device for distal upper limb rehabilitation in stroke patients was developed, and a usability test was performed to assess its clinical feasibility. The rehabilitation robot was designed as a two-axis exoskeleton actuated by electric motors, consisting of forearm supination/pronation and hand grasp/release, which were selected based on a kinematic analysis of essential daily activities. A vision-assisted algorithm was utilized for user-intent extraction in a human-in-the-loop concept. A usability test was performed on six physiatrists, five biomedical engineers, five rehabilitation therapists, two chronic stroke patients, and two caregivers of the patients. After sufficient instruction, all subjects tested the robot for a minimum of 10 min and completed the evaluation form using a 7-point Likert scale. The participants found the device interesting (5.7 ± 1.2), motivating (5.8 ± 0.9), and as having less possibility of causing injury or safety issues (6.1 ± 1.1); however, the appropriateness of difficulty (4.8 ± 1.9) and comfort level (4.9 ± 1.3) were found to be relatively low. Further development of the current device would provide a good treatment option as a simple, low-cost, and clinically feasible rehabilitation robot for stroke.
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Nizamis K, Stienen AHA, Kamper DG, Keller T, Plettenburg DH, Rouse EJ, Farina D, Koopman BFJM, Sartori M. Transferrable Expertise From Bionic Arms to Robotic Exoskeletons: Perspectives for Stroke and Duchenne Muscular Dystrophy. ACTA ACUST UNITED AC 2019. [DOI: 10.1109/tmrb.2019.2912453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Dehem S, Gilliaux M, Stoquart G, Detrembleur C, Jacquemin G, Palumbo S, Frederick A, Lejeune T. Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial. Ann Phys Rehabil Med 2019; 62:313-320. [PMID: 31028900 DOI: 10.1016/j.rehab.2019.04.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF). OBJECTIVE This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains. METHODS We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction. RESULTS In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patient social participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups. CONCLUSION For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.
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Affiliation(s)
- Stéphanie Dehem
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium.
| | - Maxime Gilliaux
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium; Institut de Formation en Masso-Kinésithérapie La Musse, Allée Louis Martin, CS 20119, 27180 Saint-Sébastien-de-Morsent, France; Hôpital La Musse, Allée Louis Martin, CS 20119, 27180 Saint-Sébastien-de-Morsent, France
| | - Gaëtan Stoquart
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium; Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Christine Detrembleur
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium
| | - Géraldine Jacquemin
- Centre Hospitalier Valida, Service de médecine physique et réadaptation, Avenue Josse Goffin 180, B-1082 Brussels, Belgium; Université de Montréal, Institut de Réadaptation Gingras-Lindsay de Montreal, Montreal, Canada
| | - Sara Palumbo
- Centre Hospitalier Valida, Service de médecine physique et réadaptation, Avenue Josse Goffin 180, B-1082 Brussels, Belgium
| | - Anne Frederick
- Centre Hospitalier Neurologique William Lennox, Service de neurologie, Allée de Clerlande 6, B1340 Ottignies, Belgium
| | - Thierry Lejeune
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Université catholique de Louvain, Louvain Bionics, B-1348 Louvain-la-Neuve, Belgium; Cliniques universitaires Saint-Luc, Service de médecine physique et réadaptation, Avenue Hippocrate 10, B-1200 Brussels, Belgium
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Gandolfi M, Valè N, Dimitrova EK, Mazzoleni S, Battini E, Filippetti M, Picelli A, Santamato A, Gravina M, Saltuari L, Smania N. Effectiveness of Robot-Assisted Upper Limb Training on Spasticity, Function and Muscle Activity in Chronic Stroke Patients Treated With Botulinum Toxin: A Randomized Single-Blinded Controlled Trial. Front Neurol 2019; 10:41. [PMID: 30766508 PMCID: PMC6365972 DOI: 10.3389/fneur.2019.00041] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The combined use of Robot-assisted UL training and Botulinum toxin (BoNT) appear to be a promising therapeutic synergism to improve UL function in chronic stroke patients. Objective: To evaluate the effects of Robot-assisted UL training on UL spasticity, function, muscle strength and the electromyographic UL muscles activity in chronic stroke patients treated with Botulinum toxin. Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with UL spastic hemiparesis. The experimental group (n = 16) received robot-assisted UL training and BoNT treatment. The control group (n = 16) received conventional treatment combined with BoNT treatment. Training protocols lasted for 5 weeks (45 min/session, two sessions/week). Before and after rehabilitation, a blinded rater evaluated patients. The primary outcome was the Modified Ashworth Scale (MAS). Secondary outcomes were the Fugl-Meyer Assessment Scale (FMA) and the Medical Research Council Scale (MRC). The electromyographic activity of 5 UL muscles during the “hand-to-mouth” task was explored only in the experimental group and 14 healthy age-matched controls using a surface Electromyography (EMGs). Results: No significant between-group differences on the MAS and FMA were measured. The experimental group reported significantly greater improvements on UL muscle strength (p = 0.004; Cohen's d = 0.49), shoulder abduction (p = 0.039; Cohen's d = 0.42), external rotation (p = 0.019; Cohen's d = 0.72), and elbow flexion (p = 0.043; Cohen's d = 1.15) than the control group. Preliminary observation of muscular activity showed a different enhancement of the biceps brachii activation after the robot-assisted training. Conclusions: Robot-assisted training is as effective as conventional training on muscle tone reduction when combined with Botulinum toxin in chronic stroke patients with UL spasticity. However, only the robot-assisted UL training contributed to improving muscle strength. The single-group analysis and the qualitative inspection of sEMG data performed in the experimental group showed improvement in the agonist muscles activity during the hand-to-mouth task. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03590314
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Nicola Valè
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Eleonora Kirilova Dimitrova
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Stefano Mazzoleni
- Polo Sant' Anna Valdera, Scuola Superiore Sant' Anna, The BioRobotics Institute, Pontedera, Italy
| | - Elena Battini
- Polo Sant' Anna Valdera, Scuola Superiore Sant' Anna, The BioRobotics Institute, Pontedera, Italy
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, Foggia, Italy
| | - Michele Gravina
- Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, Foggia, Italy
| | - Leopold Saltuari
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.,Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
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27
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Onose G, Popescu N, Munteanu C, Ciobanu V, Sporea C, Mirea MD, Daia C, Andone I, Spînu A, Mirea A. Mobile Mechatronic/Robotic Orthotic Devices to Assist-Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review. Front Neurosci 2018; 12:577. [PMID: 30233289 PMCID: PMC6134072 DOI: 10.3389/fnins.2018.00577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Abstract
This paper overviews the state-of-the-art in upper limb robot-supported approaches, focusing on advancements in the related mechatronic devices for the patients' rehabilitation and/or assistance. Dedicated to the technical, comprehensively methodological and global effectiveness and improvement in this inter-disciplinary field of research, it includes information beyond the therapy administrated in clinical settings-but with no diminished safety requirements. Our systematic review, based on PRISMA guidelines, searched articles published between January 2001 and November 2017 from the following databases: Cochrane, Medline/PubMed, PMC, Elsevier, PEDro, and ISI Web of Knowledge/Science. Then we have applied a new innovative PEDro-inspired technique to classify the relevant articles. The article focuses on the main indications, current technologies, categories of intervention and outcome assessment modalities. It includes also, in tabular form, the main characteristics of the most relevant mobile (wearable and/or portable) mechatronic/robotic orthoses/exoskeletons prototype devices used to assist-rehabilitate neuromotor impairments in the upper limb.
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Affiliation(s)
- Gelu Onose
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Nirvana Popescu
- Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
| | | | - Vlad Ciobanu
- Computer Science Department, Politehnica University of Bucharest, Bucharest, Romania
| | - Corina Sporea
- National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
| | - Marian-Daniel Mirea
- National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
| | - Cristina Daia
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Ioana Andone
- Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Aura Spînu
- Emergency Clinical Hospital Bagdasar Arseni, Bucharest, Romania
| | - Andrada Mirea
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Teaching Center for Neuro-Psyhomotor Rehabilitation in Children N. Robanescu, Bucharest, Romania
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Mekki M, Delgado AD, Fry A, Putrino D, Huang V. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review. Neurotherapeutics 2018; 15:604-617. [PMID: 29987763 PMCID: PMC6095795 DOI: 10.1007/s13311-018-0642-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mobility after spinal cord injury (SCI) is among the top goals of recovery and improvement in quality of life. Those with tetraplegia rank hand function as the most important area of recovery in their lives, and those with paraplegia, walking. Without hand function, emphasis in rehabilitation is placed on accessing one's environment through technology. However, there is still much reliance on caretakers for many activities of daily living. For those with paraplegia, if incomplete, orthoses exist to augment walking function, but they require a significant amount of baseline strength and significant energy expenditure to use. Options for those with motor complete paraplegia have traditionally been limited to the wheelchair. While wheelchairs provide a modified level of independence, wheelchair users continue to face difficulties in access and mobility. In the past decade, research in SCI rehabilitation has expanded to include external motorized or robotic devices that initiate or augment movement. These robotic devices are used with 2 goals: to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to provide benefits to the secondary medical conditions after SCI such as pain, spasticity, decreased bone density, and neurogenic bowel. In this review, we discuss advances in robot-guided rehabilitation after SCI for the upper and lower extremities, as well as potential adjuncts to robotics.
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Affiliation(s)
- Marwa Mekki
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew D Delgado
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Fry
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Putrino
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vincent Huang
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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