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Ranzani R, Razzoli M, Sanson P, Song J, Galati S, Ferrarese C, Lambercy O, Kaelin-Lang A, Gassert R. Feasibility of Adjunct Therapy with a Robotic Hand Orthosis after Botulinum Toxin Injections in Persons with Spasticity: A Pilot Study. Toxins (Basel) 2024; 16:346. [PMID: 39195756 PMCID: PMC11360205 DOI: 10.3390/toxins16080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Upper-limb spasticity, frequent after central nervous system lesions, is typically treated with botulinum neurotoxin type A (BoNT-A) injections to reduce muscle tone and increase range of motion. However, performing adjunct physical therapy post-BoNT-A can be challenging due to residual weakness or spasticity. This study evaluates the feasibility of hand therapy using a robotic hand orthosis (RELab tenoexo) with a mobile phone application as an adjunct to BoNT-A injections. Five chronic spastic patients participated in a two-session pilot study. Functional (Box and Block Test (BBT), Action Research Arm Test (ARAT)), and muscle tone (Modified Ashworth Scale (MAS)) assessments were conducted to assess functional abilities and impairment, along with usability evaluations. In the first session, subjects received BoNT-A injections, and then they performed a simulated unsupervised therapy session with the RELab tenoexo in a second session a month later. Results showed that BoNT-A reduced muscle tone (from 12.2 to 7.4 MAS points). The addition of RELab tenoexo therapy was safe, led to functional improvements in four subjects (two-cube increase in BBT as well as 2.8 points in grasp and 1.3 points in grip on ARAT). Usability results indicate that, with minor improvements, adjunct RELab tenoexo therapy could enhance therapy doses and, potentially, long-term outcomes.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
- Cereneo, Center for Neurology and Rehabilitation, Seestrasse 18, 6354 Vitznau, Switzerland
| | - Margherita Razzoli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Pierre Sanson
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Jaeyong Song
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Salvatore Galati
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Alain Kaelin-Lang
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
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Dittli J, Goikoetxea-Sotelo G, Lieber J, Gassert R, Meyer-Heim A, Van Hedel HJA, Lambercy O. A Tailorable Robotic Hand Orthosis to Support Children with Neurological Hand Impairments: a Case Study in a Child's Home. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941220 DOI: 10.1109/icorr58425.2023.10304752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Neurological disorders such as traumatic brain injuries (TBI) can lead to hand impairments in children, negatively impacting their quality of life. Fully wearable robotic hand orthoses (RHO) have been proposed to actively support children and promote the use of the impaired limb in daily life. Here we report a case study on the feasibility of using the pediatric RHO PEXO for assistance at home in a 13- year-old child with hand impairment after TBI. The size and functionalities of the RHO were first fully tailored to the child's needs. We trained the child and their parent on independently using the RHO before taking it home for a period of two weeks. The use of the RHO improved hand ability. Additionally, the tailoring and training benefited the unimanual capacity (Box and Block Test score +2 after tailoring) and bimanual performance (Assisting Hand Assessment score +4) of the child with PEXO. Further, it increased device acceptance by the child and the parent. The child used PEXO at home for 76 minutes distributed over three days during eating and drinking tasks. Personal and environmental factors caused the moderate use. No adverse events or safety-related issues occurred. This study highlights the value of tailoring an assistive RHO and, for the first time, demonstrates the feasibility of home use of a pediatric RHO by children with neurological hand impairments.
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Design and Development of a Multi-Functional Bioinspired Soft Robotic Actuator via Additive Manufacturing. Biomimetics (Basel) 2022; 7:biomimetics7030105. [PMID: 35997425 PMCID: PMC9397060 DOI: 10.3390/biomimetics7030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
The industrial revolution 4.0 has led to a burst in the development of robotic automation and platforms to increase productivity in the industrial and health domains. Hence, there is a necessity for the design and production of smart and multi-functional tools, which combine several cutting-edge technologies, including additive manufacturing and smart control systems. In the current article, a novel multi-functional biomimetic soft actuator with a pneumatic motion system was designed and fabricated by combining different additive manufacturing techniques. The developed actuator was bioinspired by the natural kinematics, namely the motion mechanism of worms, and was designed to imitate the movement of a human finger. Furthermore, due to its modular design and the ability to adapt the actuator’s external covers depending on the requested task, this actuator is suitable for a wide range of applications, from soft (i.e., fruit grasping) or industrial grippers to medical exoskeletons for patients with mobility difficulties and neurological disorders. In detail, the motion system operates with two pneumatic chambers bonded to each other and fabricated from silicone rubber compounds molded with additively manufactured dies made of polymers. Moreover, the pneumatic system offers multiple-degrees-of-freedom motion and it is capable of bending in the range of −180° to 180°. The overall pneumatic system is protected by external covers made of 3D printed components whose material could be changed from rigid polymer for industrial applications to thermoplastic elastomer for complete soft robotic applications. In addition, these 3D printed parts control the angular range of the actuator in order to avoid the reaching of extreme configurations. Finally, the bio-robotic actuator is electronically controlled by PID controllers and its real-time position is monitored by a one-axis soft flex sensor which is embedded in the actuator’s configuration.
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Cardoso LRL, Bochkezanian V, Forner-Cordero A, Melendez-Calderon A, Bo APL. Soft robotics and functional electrical stimulation advances for restoring hand function in people with SCI: a narrative review, clinical guidelines and future directions. J Neuroeng Rehabil 2022; 19:66. [PMID: 35773733 PMCID: PMC9245887 DOI: 10.1186/s12984-022-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recovery of hand function is crucial for the independence of people with spinal cord injury (SCI). Wearable devices based on soft robotics (SR) or functional electrical stimulation (FES) have been employed to assist the recovery of hand function both during activities of daily living (ADLs) and during therapy. However, the implementation of these wearable devices has not been compiled in a review focusing on the functional outcomes they can activate/elicit/stimulate/potentiate. This narrative review aims at providing a guide both for engineers to help in the development of new technologies and for clinicians to serve as clinical guidelines based on the available technology in order to assist and/or recover hand function in people with SCI. Methods A literature search was performed in Scopus, Pubmed and IEEE Xplore for articles involving SR devices or FES systems designed for hand therapy or assistance, published since 2010. Only studies that reported functional outcomes from individuals with SCI were selected. The final collections of both groups (SR and FES) were analysed based on the technical aspects and reported functional outcomes. Results A total of 37 out of 1101 articles were selected, 12 regarding SR and 25 involving FES devices. Most studies were limited to research prototypes, designed either for assistance or therapy. From an engineering perspective, technological improvements for home-based use such as portability, donning/doffing and the time spent with calibration were identified. From the clinician point of view, the most suitable technical features (e.g., user intent detection) and assessment tools should be determined according to the particular patient condition. A wide range of functional assessment tests were adopted, moreover, most studies used non-standardized tests. Conclusion SR and FES wearable devices are promising technologies to support hand function recovery in subjects with SCI. Technical improvements in aspects such as the user intent detection, portability or calibration as well as consistent assessment of functional outcomes were the main identified limitations. These limitations seem to be be preventing the translation into clinical practice of these technological devices created in the laboratory.
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Affiliation(s)
- Lucas R L Cardoso
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.
| | - Vanesa Bochkezanian
- College of Health Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory, Escola Politecnica, University of São Paulo, São Paulo, Brazil
| | - Alejandro Melendez-Calderon
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Antonio P L Bo
- Biomedical Engineering, School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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Senk S, Ulbricht M, Tsokalo I, Rischke J, Li SC, Speidel S, Nguyen GT, Seeling P, Fitzek FHP. Healing Hands: The Tactile Internet in Future Tele-Healthcare. SENSORS 2022; 22:s22041404. [PMID: 35214306 PMCID: PMC8963047 DOI: 10.3390/s22041404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023]
Abstract
In the early 2020s, the coronavirus pandemic brought the notion of remotely connected care to the general population across the globe. Oftentimes, the timely provisioning of access to and the implementation of affordable care are drivers behind tele-healthcare initiatives. Tele-healthcare has already garnered significant momentum in research and implementations in the years preceding the worldwide challenge of 2020, supported by the emerging capabilities of communication networks. The Tactile Internet (TI) with human-in-the-loop is one of those developments, leading to the democratization of skills and expertise that will significantly impact the long-term developments of the provisioning of care. However, significant challenges remain that require today’s communication networks to adapt to support the ultra-low latency required. The resulting latency challenge necessitates trans-disciplinary research efforts combining psychophysiological as well as technological solutions to achieve one millisecond and below round-trip times. The objective of this paper is to provide an overview of the benefits enabled by solving this network latency reduction challenge by employing state-of-the-art Time-Sensitive Networking (TSN) devices in a testbed, realizing the service differentiation required for the multi-modal human-machine interface. With completely new types of services and use cases resulting from the TI, we describe the potential impacts on remote surgery and remote rehabilitation as examples, with a focus on the future of tele-healthcare in rural settings.
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Affiliation(s)
- Stefan Senk
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Deutsche Telekom Chair of Communication Network, 01062 Dresden, Germany; (S.S.); (M.U.); (J.R.); (F.H.P.F.)
| | - Marian Ulbricht
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Deutsche Telekom Chair of Communication Network, 01062 Dresden, Germany; (S.S.); (M.U.); (J.R.); (F.H.P.F.)
| | | | - Justus Rischke
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Deutsche Telekom Chair of Communication Network, 01062 Dresden, Germany; (S.S.); (M.U.); (J.R.); (F.H.P.F.)
| | - Shu-Chen Li
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Faculty of Psychology, Technische Universität Dresden, 01062 Dresden, Germany;
| | - Stefanie Speidel
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), National Center for Tumor Diseases, Technische Universität Dresden, 01062 Dresden, Germany;
| | - Giang T. Nguyen
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Chair of Haptic Communication Systems, 01062 Dresden, Germany;
| | - Patrick Seeling
- Department of Computer Science, Central Michigan University, Mount Pleasant, MI 48859, USA
- Correspondence:
| | - Frank H. P. Fitzek
- Centre for Tactile Internet with Human-in-the-Loop (CeTI), Technische Universität Dresden, Deutsche Telekom Chair of Communication Network, 01062 Dresden, Germany; (S.S.); (M.U.); (J.R.); (F.H.P.F.)
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