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Bonello M, Buhagiar N, Farrugia P, Mercieca J. Unveiling the impact of the SMARTCLAP project on habilitation. Comput Struct Biotechnol J 2024; 24:451-463. [PMID: 38975288 PMCID: PMC11226891 DOI: 10.1016/j.csbj.2024.06.001] [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: 05/31/2024] [Accepted: 06/01/2024] [Indexed: 07/09/2024] Open
Abstract
This report summarises the SMARTCLAP research project, which employs a user-centred design approach to develop a revolutionary smart product service system. The system offers personalised motivation to encourage children with cerebral palsy to actively participate more during their occupational therapy sessions, while providing paediatric occupational therapists with an optimal tool to monitor children's progress from one session to another. The product service system developed includes of a smart wearable device called DigiClap used to interact with a serious game in an Augmented Reality environment. The report highlights the research methodology used to advance the technology readiness level from 4 to 6, acknowledging the contribution of the consortium team and funding source. As part of the technology's maturity process, DigiClap and the respective serious game were evaluated with target users, to identify the system's impact in supporting the children's overall participation and hand function, and to gather feedback from occupational therapists and caregivers on this novel technology. The outcomes of this study are discussed, highlighting limitations and lessons learned. The report also outlines future work and further funding for the sustainability of the project and to reach other individuals who have upper limb limitations. Ultimately, the potential of DigiClap and the overall achievements of this project are discussed.
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Vora I, Gochyyev P, Engineer N, Wolf SL, Kimberley TJ. Distal Versus Proximal Arm Improvement After Paired Vagus Nerve Stimulation Therapy After Chronic Stroke. Arch Phys Med Rehabil 2024; 105:1709-1717. [PMID: 38815953 PMCID: PMC11374485 DOI: 10.1016/j.apmr.2024.05.018] [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: 10/11/2023] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To evaluate differences in upper-extremity (UE) segment-specific (proximal or distal segment) recovery after vagus nerve stimulation (VNS) paired with UE rehabilitation (Paired-VNS) compared with rehabilitation with sham-VNS (Control). We also assessed whether gains in specific UE segments predicted clinically meaningful improvement. DESIGN This study reports on a secondary analysis of Vagus nerve stimulation paired with rehabilitation for UE motor function after chronic ischemic stroke (VNS-REHAB), a randomized, triple-blinded, sham-controlled pivotal trial. A Rasch latent regression was used to determine differences between Paired-VNS and Controls for distal and proximal UE changes after in-clinic therapy and 3 months later. Subsequently, we ran a random forest model to assess candidate predictors of meaningful improvement. Each item of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) was evaluated as a predictor of response to treatment. SETTING Nineteen stroke rehabilitation centers in the USA and UK. PARTICIPANTS Dataset included 108 participants (N=108) with chronic ischemic stroke and moderate-to-severe UE impairments. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES FMA-UE and WMFT. RESULTS Distal UE improvement was significantly greater in the Paired-VNS group than in Controls immediately after therapy (95% confidence interval, 0.27-0.73; P≤.001) and after 3 months (95% confidence interval, 0.16-0.75; P=.003). Both groups showed similar improvement in proximal UE at both time points. A subset of both distal and proximal items from the FMA-UE and WMFT were predictors of meaningful improvement. CONCLUSIONS Paired-VNS improved distal UE impairment in chronic stroke to a greater degree than intensive rehabilitation alone. Proximal improvements were equally responsive to either treatment. Given that meaningful UE recovery is predicted by improvements across both proximal and distal segments, Paired-VNS may facilitate improvement that is otherwise elusive.
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Affiliation(s)
- Isha Vora
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA
| | - Perman Gochyyev
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Berkeley Evaluation and Assessment Research Center, University of California, Berkeley, Berkeley, CA
| | | | - Steven L Wolf
- Division of Physical Therapy, Center for Physical Therapy and Movement Science, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - Teresa J Kimberley
- Department of Rehabilitation Science, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA; Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA.
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Kottink AIR, Nikamp CDM, Bos FP, Sluis CKVD, Broek MVD, Onneweer B, Stolwijk-Swüste JM, Brink SM, Voet NBM, Rietman JS, Prange-Lasonder GB. Therapy effect on hand function after home use of a wearable assistive soft-robotic glove supporting grip strength. PLoS One 2024; 19:e0306713. [PMID: 38990858 PMCID: PMC11239026 DOI: 10.1371/journal.pone.0306713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 06/20/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Soft-robotic gloves with an assist-as-needed control have the ability to assist daily activities where needed, while stimulating active and highly functional movements within the user's possibilities. Employment of hand activities with glove support might act as training for unsupported hand function. OBJECTIVE To evaluate the therapeutic effect of a grip-supporting soft-robotic glove as an assistive device at home during daily activities. METHODS This multicentre intervention trial consisted of 3 pre-assessments (averaged if steady state = PRE), one post-assessment (POST), and one follow-up assessment (FU). Participants with chronic hand function limitations were included. Participants used the Carbonhand glove during six weeks in their home environment on their most affected hand. They were free to choose which activities to use the glove with and for how long. The primary outcome measure was grip strength, secondary outcome measures were pinch strength, hand function and glove use time. RESULTS 63 patients with limitations in hand function resulting from various disorders were included. Significant improvements (difference PRE-POST) were found for grip strength (+1.9 kg, CI 0.8 to 3.1; p = 0.002) and hand function, as measured by Jebson-Taylor Hand Function Test (-7.7 s, CI -13.4 to -1.9; p = 0.002) and Action Research Arm Test (+1.0 point, IQR 2.0; p≤0.001). Improvements persisted at FU. Pinch strength improved slightly in all fingers over six-week glove use, however these differences didn't achieve significance. Participants used the soft-robotic glove for a total average of 33.0 hours (SD 35.3), equivalent to 330 min/week (SD 354) or 47 min/day (SD 51). No serious adverse events occurred. CONCLUSION The present findings showed that six weeks use of a grip-supporting soft-robotic glove as an assistive device at home resulted in a therapeutic effect on unsupported grip strength and hand function. The glove use time also showed that this wearable, lightweight glove was able to assist participants with the performance of daily tasks for prolonged periods.
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Affiliation(s)
- Anke I R Kottink
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Corien D M Nikamp
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Foskea P Bos
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Bram Onneweer
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Janneke M Stolwijk-Swüste
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sander M Brink
- Department of Rehabilitation Medicine, Isala, Zwolle, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Radboud University Medical Centre, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Roessingh Centre for Rehabilitation, Enschede, The Netherlands
| | - Gerdienke B Prange-Lasonder
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
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Hwang S, Min KC, Song CS. Assistive technology on upper extremity function for stroke patients: A systematic review with meta-analysis. J Hand Ther 2024:S0894-1130(23)00202-8. [PMID: 38796397 DOI: 10.1016/j.jht.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 05/28/2024]
Abstract
BACKGROUND In stroke rehabilitation, the selection of appropriate assistive devices is of paramount importance for patients. Specifically, the choice of device can significantly influence the functional recovery of the upper limb, impacting their overall activities or functional tasks. OBJECTIVES This review aimed to comprehensively analyze and summarize the clinical evidence from randomized controlled trials (RCTs) regarding the therapeutic effects of commonly used assistive devices on upper extremity function in patients with stroke. METHODS To evaluate assistive devices for patients with stroke, we summarized qualitatively throughout synthesis of results, such as therapeutic intervention, intensity, outcome, and summary of results, and examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. To analyze, we used RoB 2 and RevMan 5.4. RESULTS The qualitative synthesis included 31 RCTs. The randomization process and the reporting of results showed minimal bias, but there were issues with bias from intended interventions, and missing outcome data presented some concerns. The quantitative synthesis included 16 RCTs. There was a significant difference in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between the groups, with a total mean difference (95% confidence interval) of 2.40 (0.21, 4.60), heterogeneity values were Tau2 = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I2 = 3% for FMA-UE and the test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. However, there was no significant difference in all other outcome measures. CONCLUSIONS Upper-limb robots did not demonstrate significant superiority over conventional treatments in improving function of upper limbs, with the exception of FMA-UE scores for patients with chronic stroke. The mean difference of FMA-UE was also lower than minimally important difference. Nonetheless, the usage of upper-limb robots may contribute to enhanced function for patients with stroke, as those devices support clinicians and enable a greater number of movement repetitions within specific time frames.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Republic of Korea; Graduate School of Health Welfare, Baekseok University, Seoul, Republic of Korea
| | - Kyoung-Chul Min
- Department of Occupational Therpay, Wonkwang University, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju, Republic of Korea.
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Vanoglio F, Comini L, Gaiani M, Bonometti GP, Luisa A, Bernocchi P. A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2574. [PMID: 38676190 PMCID: PMC11054364 DOI: 10.3390/s24082574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.
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Affiliation(s)
- Fabio Vanoglio
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Laura Comini
- Scientific Direction of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy;
| | - Marta Gaiani
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Gian Pietro Bonometti
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Alberto Luisa
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Palmira Bernocchi
- Continuity of Care Service of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy
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Zhang Y, Li T, Tao H, Liu F, Hu B, Wu M, Yu H. Research on adaptive impedance control technology of upper limb rehabilitation robot based on impedance parameter prediction. Front Bioeng Biotechnol 2024; 11:1332689. [PMID: 38234302 PMCID: PMC10792012 DOI: 10.3389/fbioe.2023.1332689] [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: 11/03/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024] Open
Abstract
Introduction: With the aggravation of aging and the growing number of stroke patients suffering from hemiplegia in China, rehabilitation robots have become an integral part of rehabilitation training. However, traditional rehabilitation robots cannot modify the training parameters adaptively to match the upper limbs' rehabilitation status automatically and apply them in rehabilitation training effectively, which will improve the efficacy of rehabilitation training. Methods: In this study, a two-degree-of-freedom flexible drive joint rehabilitation robot platform was built. The forgetting factor recursive least squares method (FFRLS) was utilized to estimate the impedance parameters of human upper limb end. A reward function was established to select the optimal stiffness parameters of the rehabilitation robot. Results: The results confirmed the effectiveness of the adaptive impedance control strategy. The findings of the adaptive impedance control studies showed that the adaptive impedance control had a significantly greater reward than the constant impedance control, which was in line with the simulation results of the variable impedance control. Moreover, it was observed that the levels of robot assistance could be suitably modified based on the subject's different participation. Discussion: The results facilitated stroke patients' upper limb rehabilitation by enabling the rehabilitation robot to adaptively change the impedance parameters according to the functional status of the affected limb. In clinic therapy, the proposed control strategy may help to adjust the reward function for different patients to improve the rehabilitation efficacy eventually.
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Affiliation(s)
- Yuling Zhang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Tong Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Haoran Tao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Fengchen Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Bingshan Hu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
| | - Minghui Wu
- School of Mechanical and Automotive Engineering, Shanghai University of Engineering Science, Shanghai, China
| | - Hongliu Yu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
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Arantes AP, Bressan N, Borges LR, McGibbon CA. Evaluation of a novel real-time adaptive assist-as-needed controller for robot-assisted upper extremity rehabilitation following stroke. PLoS One 2023; 18:e0292627. [PMID: 37819932 PMCID: PMC10566685 DOI: 10.1371/journal.pone.0292627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
Rehabilitation therapy plays an essential role in assisting people with stroke regain arm function. Upper extremity robot therapy offers a number of advantages over manual therapies, but can suffer from slacking behavior, where the user lets the robot guide their movements even when they are capable of doing so by themselves, representing a major barrier to reaching the full potential of robot-assist rehabilitation. This is a pilot clinical study that investigates the use of an electromyography-based adaptive assist-as-needed controller to avoid slacking behavior during robotic rehabilitation for people with stroke. The study involved a convenience sample of five individuals with chronic stroke who underwent a robot therapy program utilizing horizontal arm tasks. The Fugl-Meyer assessment (FM) was used to document motor impairment status at baseline. Velocity, time, and position were quantified as performance parameters during the training. Arm and shoulder surface electromyography (EMG) and electroencephalography (EEG) were used to assess the controller's performance. The cross-sectional results showed strong second-order relationships between FM score and outcome measures, where performance metrics (path length and accuracy) were sensitive to change in participants with lower functional status. In comparison, speed, EMG and EEG metrics were more sensitive to change in participants with higher functional status. EEG signal amplitude increased when the robot suggested that the robot was inducing a challenge during the training tasks. This study highlights the importance of multi-sensor integration to monitor and improve upper-extremity robotic therapy.
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Affiliation(s)
- Ana P. Arantes
- Hotchkiss Brain Institute (HBI), Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Nadja Bressan
- Faculty of Sustainable Engineering Design, University of Prince Edward Island, Charlottetown, Canada
| | - Ludymila R. Borges
- Assistive Technology Laboratory (NTA), Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Chris A. McGibbon
- Institute of Biomedical Engineering and Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
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Lim DYL, Lai HS, Yeow RCH. A bidirectional fabric-based soft robotic glove for hand function assistance in patients with chronic stroke. J Neuroeng Rehabil 2023; 20:120. [PMID: 37735679 PMCID: PMC10512630 DOI: 10.1186/s12984-023-01250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Chronic stroke patients usually experience reduced hand functions, impeding their ability to perform activities of daily living (ADLs) independently. Additionally, improvements in hand functions by physical therapy beyond six months after the initial onset of stroke are much slower than in the earlier months. As such, chronic stroke patients could benefit from an assistive device to enhance their hand functions, allowing them to perform ADLs independently daily. In recent years, soft robotics has provided a novel approach to assistive devices for motor impaired individuals, offering more compliant and lightweight alternatives to traditional robotic devices. The scope of this study is to demonstrate the viability of a fabric-based soft robotic (SR) glove with bidirectional actuators in assisting chronic stroke study participants with hand impairments in performing ADLs. METHODS Force and torque measurement tests were conducted to characterize the SR Glove, and hand functional tasks were given to eight chronic stroke patients to assess the efficacy of the SR Glove as an assistive device. The tasks involved object manipulation tasks that simulate ADLs, and the series of tasks was done by the participants once without assistance for baseline data, and once while using the SR Glove. A usability questionnaire was also given to each participant after the tasks were done to gain insight into how the SR Glove impacts their confidence and reliance on support while performing ADLs. RESULTS The SR Glove improved the participants' manipulation of objects in ADL tasks. The difference in mean scores between the unassisted and assisted conditions was significant across all participants. Additionally, the usability questionnaire showed the participants felt more confident and less reliant on support while using the SR Glove to perform ADLs than without the SR Glove. CONCLUSIONS The results from this study demonstrated that the SR Glove is a viable option to assist hand function in chronic stroke patients who suffer from hand motor impairments.
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Affiliation(s)
- Daniel Yuan-Lee Lim
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Hwa-Sen Lai
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Raye Chen-Hua Yeow
- Evolution Innovation Lab, Advanced Robotics Centre, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore.
- Computer Science & Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, USA.
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Klobucká S, Klobucký R, Valovičová K, Šiarnik P, Kollár B. Cost-effectiveness analysis of robot-assisted gait training in patients with bilateral spastic cerebral palsy. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:60. [PMID: 37697377 PMCID: PMC10496243 DOI: 10.1186/s12962-023-00475-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/04/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND To date, there have been no published studies evaluating the cost-effectiveness of robot-assisted gait training (RAGT) in adolescent and adult patients with cerebral palsy (CP). The study´s aim was to analyse the cost-effectiveness of RAGT versus conventional kinesiotherapy (CON) from the health care provider's perspective. METHODS We expressed the cost-effectiveness of RAGT in the Lokomat® system after analysing the costs and effects of RAGT and conventional therapy through the Incremental Cost-Effectiveness Ratio (ICER) based on a bicentric randomized controlled study, in which we demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP. RESULTS According to the calculated ICER ratio for Lokomat®, an additional improvement per unit of effect (1% in GMFM), compared to conventional therapy, results in an average cost increase of EUR70.38 per patient in a therapeutic block consisting of 20 TUs (Therapeutic Units). CONCLUSION However, from the comprehensive analysis of the results and evaluation of the long-term effects, it follows that RAGT applied in adolescent and adult patients with bilateral spastic CP is not only more effective in terms of evaluation of monitored clinical parameters, but in the long term it is also more cost-effective compared to conventional therapy.
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Affiliation(s)
- Stanislava Klobucká
- Rehabilitation Centre Harmony, Bratislava, Slovakia.
- Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
| | - Robert Klobucký
- Institute for Sociology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Katarína Valovičová
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Pavol Šiarnik
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Branislav Kollár
- 1st Department of Neurology, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
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Fischer AK, Mühlbacher AC. Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment. JMIR Res Protoc 2023; 12:e46056. [PMID: 37561559 PMCID: PMC10450540 DOI: 10.2196/46056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. OBJECTIVE This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. METHODS To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. RESULTS The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. CONCLUSIONS Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46056.
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Affiliation(s)
- Ann-Kathrin Fischer
- Department of Health, Care, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Axel C Mühlbacher
- Department of Health, Care, Management, University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
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Ko MJ, Chuang YC, Ou-Yang LJ, Cheng YY, Tsai YL, Lee YC. The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:900. [PMID: 37371378 PMCID: PMC10295999 DOI: 10.3390/brainsci13060900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities in patients with post-stroke hemiparesis. Five major bibliographic databases, PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, were all reviewed for enrollment regarding comparative trials prior to 7 March 2023. We included adults with stroke and compared their rehabilitation using SRGs to conventional rehabilitation (CR) on hand function in terms of the Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE), Fugl-Meyer Distal Upper Extremity Motor Assessment (FMA-distal UE), box and blocks test score, grip strength test, and the Jebsen-Taylor hand function test (JTT). A total of 8 studies, comprising 309 participants, were included in the analysis. Compared to CR, rehabilitation involving SRGs achieved better FMA-UE (MD 6.52, 95% CI: 3.65~9.39), FMA-distal UE (MD 3.27, 95% CI: 1.50~5.04), and JJT (MD 13.34, CI: 5.16~21.53) results. Subgroup analysis showed that stroke latency of more than 6 months and training for more than 30 min offered a better effect as well. In conclusion, for patients with stroke, rehabilitation using SRGs is recommended to promote the functional abilities of the upper extremities.
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Affiliation(s)
- Ming-Jian Ko
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.C.); (Y.-Y.C.)
| | - Liang-Jun Ou-Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan;
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.C.); (Y.-Y.C.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.C.); (Y.-Y.C.)
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.C.); (Y.-Y.C.)
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung 404401, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407224, Taiwan
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12
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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Rizvi A, Parveen S, Bazigha F, Noohu MM. Effect of transcranial direct current stimulation in combination with robotic therapy in upper limb impairments in people with stroke: a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Stroke is a devastating condition, which not only affects patients’ activity, but also is a primary reason for the psychosocial impact on them, their caregivers, and the healthcare system. Transcranial direct current stimulation (tDCS) modulates cortical activity, encouraging neuro-modulation and motor recovery in stroke rehabilitation. Robotic therapy (RT) provides repetitive, high-intensity, interactive, task-specific intervention and can measure changes while providing feedback to people with stroke.
Objectives
This study aimed to evaluate and summarize the scientific literature systematically to investigate the combined effect of tDCS and RT in patients with stroke.
Methods
Four databases (MEDLINE, Web of Science, ScienceDirect, & PEDro) were searched for clinical trials investigating the effect of RT and tDCS in stroke patients with upper limb impairment. PEDro scale was used for the quality assessment of included studies.
Results
The search yielded 208 articles. A total of 213 patients with stroke who had upper limb impairment were studied. In the majority of the trials, RT combined with tDCS lead to positive improvement in various measures of upper limb function and spasticity.
Conclusions
RT along with tDCS is an effective mode of rehabilitation, although no additional effects of tDCS plus RT in comparison with RT alone were reported. Large, robust studies are needed, so that health care providers and researchers can make better decisions about merging tDCS and RT in stroke rehabilitation settings in the future.
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Bressi F, Cricenti L, Bravi M, Pannunzio F, Cordella F, Lapresa M, Miccinilli S, Santacaterina F, Zollo L, Sterzi S, Campagnola B. Treatment of the Paretic Hand with a Robotic Glove Combined with Physiotherapy in a Patient Suffering from Traumatic Tetraparesis: A Case Report. SENSORS (BASEL, SWITZERLAND) 2023; 23:3484. [PMID: 37050544 PMCID: PMC10099243 DOI: 10.3390/s23073484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND cervical spinal cord injury leads to loss of upper limb functionality, which causes a decrease in autonomy to perform activities of daily living. The use of robotic technologies in rehabilitation could contribute to improving upper limb functionality and treatment quality. This case report aims to describe the potential of robotic hand treatment with Gloreha Sinfonia, in combination with conventional rehabilitation, in a tetraparetic patient. MATERIAL fifteen rehabilitative sessions were performed. Evaluations were conducted pre-treatment (T0), post-treatment (T1), and at two-months follow-up (T2) based on: the upper-limb range of motion and force assessment, the FMA-UE, the 9-Hole Peg Test (9HPT), and the DASH questionnaire. A virtual reality game-based rating system was used to evaluate the force control and modulation ability. RESULTS the patient reported greater ability to use hands with less compensation at T1 and T2 assessments. Improvements in clinical scales were reported in both hands at T1, however, at T2 only did the dominant hand show further improvement. Improved grip strength control and modulation ability were reported for T1. However a worsening was found in both hands at T2, significant only for the non-dominant hand. The maximum force exerted increased from T0 to T2 in both hands. CONCLUSION hand treatment combining physical therapy and Gloreha Sinfonia seems to have benefits in functionality and dexterity in tetraparetic patient in the short term. Further studies are needed to confirm these findings, to verify long-term results, and to identify the most appropriate modalities of robotic rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Fabiana Pannunzio
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Francesca Cordella
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Martina Lapresa
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
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Barria P, Riquelme M, Reppich H, Cisnal A, Fraile JC, Pérez-Turiel J, Sierra D, Aguilar R, Andrade A, Nuñez-Espinosa C. Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study. Front Robot AI 2023; 10:1146018. [PMID: 37033674 PMCID: PMC10073561 DOI: 10.3389/frobt.2023.1146018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.
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Affiliation(s)
- Patricio Barria
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
- *Correspondence: Patricio Barria,
| | - Matías Riquelme
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
| | - Hannah Reppich
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Juan-Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Javier Pérez-Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - David Sierra
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Rolando Aguilar
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Cristian Nuñez-Espinosa
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
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16
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Hernández Echarren A, Sánchez Cabeza Á. [Hand robotic devices in neurorehabilitation: A systematic review on the feasibility and effectiveness of stroke rehabilitation]. Rehabilitacion (Madr) 2023; 57:100758. [PMID: 36319483 DOI: 10.1016/j.rh.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
Robot-assisted therapy is a relatively new intervention, increasingly used in the rehabilitation treatment of stroke patients. It allows to increase the number of repetitions in the performance of specific tasks movements. For this review, a search was carried out between August and October 2021 in the PubMed, Web of Science, Scopus, Cochrane, PEDro and OTseeker databases, selecting a total of six randomized controlled trials where robot-assisted hand therapy was used in stroke rehabilitation. Studies agree that robot-assisted hand therapy has benefits in all phases of stroke rehabilitation that translate into motor and functional improvements of the upper limb and improvements in hemispatial neglect.
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Affiliation(s)
- A Hernández Echarren
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España.
| | - Á Sánchez Cabeza
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
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17
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [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] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Kabir R, Sunny MSH, Ahmed HU, Rahman MH. Hand Rehabilitation Devices: A Comprehensive Systematic Review. MICROMACHINES 2022; 13:1033. [PMID: 35888850 PMCID: PMC9325203 DOI: 10.3390/mi13071033] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 12/20/2022]
Abstract
A cerebrovascular accident, or a stroke, can cause significant neurological damage, inflicting the patient with loss of motor function in their hands. Standard rehabilitation therapy for the hand increases demands on clinics, creating an avenue for powered hand rehabilitation devices. Hand rehabilitation devices (HRDs) are devices designed to provide the hand with passive, active, and active-assisted rehabilitation therapy; however, HRDs do not have any standards in terms of development or design. Although the categorization of an injury's severity can guide a patient into seeking proper assistance, rehabilitation devices do not have a set standard to provide a solution from the beginning to the end stages of recovery. In this paper, HRDs are defined and compared by their mechanical designs, actuation mechanisms, control systems, and therapeutic strategies. Furthermore, devices with conducted clinical trials are used to determine the future development of HRDs. After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.
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Affiliation(s)
- Ryan Kabir
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
| | - Md Samiul Haque Sunny
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
| | - Helal Uddin Ahmed
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
| | - Mohammad Habibur Rahman
- Department of Mechanical Engineering, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA; (H.U.A.); (M.H.R.)
- Department of Computer Science, BioRobotics Lab, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA;
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Song X, van de Ven SS, Chen S, Kang P, Gao Q, Jia J, Shull PB. Proposal of a Wearable Multimodal Sensing-Based Serious Games Approach for Hand Movement Training After Stroke. Front Physiol 2022; 13:811950. [PMID: 35721546 PMCID: PMC9204487 DOI: 10.3389/fphys.2022.811950] [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: 11/09/2021] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Stroke often leads to hand motor dysfunction, and effective rehabilitation requires keeping patients engaged and motivated. Among the existing automated rehabilitation approaches, data glove-based systems are not easy to wear for patients due to spasticity, and single sensor-based approaches generally provided prohibitively limited information. We thus propose a wearable multimodal serious games approach for hand movement training after stroke. A force myography (FMG), electromyography (EMG), and inertial measurement unit (IMU)-based multi-sensor fusion model was proposed for hand movement classification, which was worn on the user’s affected arm. Two movement recognition-based serious games were developed for hand movement and cognition training. Ten stroke patients with mild to moderate motor impairments (Brunnstrom Stage for Hand II-VI) performed experiments while playing interactive serious games requiring 12 activities-of-daily-living (ADLs) hand movements taken from the Fugl Meyer Assessment. Feasibility was evaluated by movement classification accuracy and qualitative patient questionnaires. The offline classification accuracy using combined FMG-EMG-IMU was 81.0% for the 12 movements, which was significantly higher than any single sensing modality; only EMG, only FMG, and only IMU were 69.6, 63.2, and 47.8%, respectively. Patients reported that they were more enthusiastic about hand movement training while playing the serious games as compared to conventional methods and strongly agreed that they subjectively felt that the proposed training could be beneficial for improving upper limb motor function. These results showed that multimodal-sensor fusion improved hand gesture classification accuracy for stroke patients and demonstrated the potential of this proposed approach to be used as upper limb movement training after stroke.
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Affiliation(s)
- Xinyu Song
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Shirdi Shankara van de Ven
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Shugeng Chen
- The Department of Rehabilitation Medicine, The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peiqi Kang
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Qinghua Gao
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Jia
- The Department of Rehabilitation Medicine, The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Peter B Shull
- The State Key Laboratory of Mechanical System and Vibration, Shanghai Jiao Tong University, Shanghai, China
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The effect of adding robot-assisted hand rehabilitation to conventional rehabilitation program following stroke: A randomized-controlled study. Turk J Phys Med Rehabil 2022; 68:254-261. [PMID: 35989963 PMCID: PMC9366479 DOI: 10.5606/tftrd.2022.8705] [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: 03/30/2021] [Accepted: 01/03/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: This study aimed to investigate the effectiveness of adding robot-assisted hand therapy (HandTutor) to conventional rehabilitation program compared to a conventional rehabilitation program alone in stroke survivors.
Patients and methods: Between March 2012 and December 2012, a total of 33 stroke patients (21 males, 12 females; median age: 56 years; range, 38 to 73 years) were included in this prospective, randomized-controlled study. The patients were randomly divided into two groups as experimental (n=16) and control (n=17). Both groups received conventional rehabilitation for 3 h/day, for two days/week, totally for five weeks, while the experimental group received additional 1-hour robot-assisted hand therapy during each session. Outcome measures were the Fugl-Meyer Assessment, Box and Block Test, Nine-Hole Peg Test, Jebsen-Taylor Hand Function Test, grip strength, and pinch strength. All patients were assessed at baseline, at the end of the treatment, and three months after the treatment.
Results: Both groups showed statistically significant improvements in all the parameters (p<0.05). No significant differences were observed between the groups at any time points (p>0.05). The changes between baseline and three-month follow-up after the treatment revealed that adding robot-aided hand therapy led to greater changes in all the parameters related to functional activities and muscle strength, except for the Fugl-Meyer Assessment.
Conclusion: Adding robot-assisted therapy to conventional rehabilitation may provide greater changes in upper extremity rehabilitation of subacute stroke patients compared to conventional rehabilitation program alone.
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Effectiveness of a Soft Robotic Glove to Assist Hand Function in Stroke Patients: A Cross-Sectional Pilot Study. Rehabil Res Pract 2022; 2022:3738219. [PMID: 35509444 PMCID: PMC9061070 DOI: 10.1155/2022/3738219] [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: 01/24/2022] [Revised: 03/17/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Stroke patients have difficulty performing tasks using their paretic hands. There are limited data on the effects of using a soft robotic glove to assist with hand function. The objective of this study was to investigate the effectiveness of a soft robotic glove in assisting hand function in stroke patients. Methods This study was a cross-sectional pilot study. Twenty stroke patients with partial or complete hand weakness were recruited from a rehabilitation centre. The Box and Block Test (BBT) and the Action Research Arm Test (ARAT) were performed under two conditions: with and without use of the soft robotic glove. The order of the conditions was randomly assigned by a computer-generated program. Results BBT scores increased 6.4 blocks when using the soft robotic glove (p < 0.001). ARAT grasp, grip, pinch, and overall scores increased by 27.08% (p < 0.01), 28.75% (p < 0.001), 15.89% (p < 0.01), and 21.15% (p < 0.001), respectively, using the glove versus not using the glove. Conclusions The findings of this study suggest that using a soft robotic glove can assist a poststroke paretic hand in executing grasp, grip, and pinch.
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Zhao M, Wang G, Wang A, Cheng LJ, Lau Y. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 2022; 43:1641-1657. [PMID: 35089447 DOI: 10.1007/s10072-022-05913-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.
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Affiliation(s)
- Menglu Zhao
- The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | | | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Essa M, Taj MA, Khan MH, Amjad Bashir M, Farooq H, Alajmi RA, Hashem M, Alamri S, El-Zohri MA, Ullah K. Awareness and perception of malaria and dengue at school and college level in the district of Multan. PLoS One 2022; 17:e0260868. [PMID: 35143507 PMCID: PMC8830651 DOI: 10.1371/journal.pone.0260868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study is to examine the awareness and perception of malaria and dengue fever in Multan Punjab, Pakistan while taking into account the important role of government policies and other variables. The goal of this study is to examine the awareness of students in Multan, Pakistan on malaria and dengue. This study is based on a quantitative approach of secondary evidence from scientific journals and questionnaire surveys. It is also based on observational evidence gathered in Multan Punjab Pakistan, in a field study. The survey with school children, teachers and healthcare professionals were both formal and semi-structuralize. Studies have found that malaria and dengue mainly affect children's schooling through their absence, but can also induce brain loss and cognitive disability. In questionnaires, students were seen to have different understanding of the illness, but also to be able to serve as agents of health reform only through teachers. A sample size of 500 respondents has been selected from different colleges of district Multan Punjab, Pakistan. Correlation technique is used for the data analysis. According to our results it is concluded that the students at college level are aware of malaria and dengue diseases, but they are not capable of engaging and serving as agents for health reform. On the basis of results it is recommended that students must teach about epidemics diseases regarding how to handle these diseases.
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Affiliation(s)
- Muhammad Essa
- Medical Officer Basic Health Unit, Health Department, Talpur Kot Chuta Dera Ghazi Khan, Punjab, Pakistan
| | - Muhammad Ahmed Taj
- Health Department, Rural Health Center 222EB, District Vehari, Punjab, Pakistan
| | - Muhammad Hakim Khan
- Medical Officer Rural Health Unit, Health Department, Kalur Kot, District Bakhar, Punjab, Pakistan
| | - Muhammad Amjad Bashir
- Department of Plant Protection, Faculty of Agricultural Sciences, Ghazi University, Dera Ghazi Khan, Punjab, Pakistan
| | - Hasnain Farooq
- Department of Environmental Sciences, University of California, Riverside, CA, United States of America
- Department of Forestry, Faculty of Agricultural Sciences, Ghazi University, Dera Ghazi Khan, Pakistan
| | - Reem A. Alajmi
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabi
| | - Mohamed Hashem
- Botany and Microbiology Department, Faculty of Science, Assiut University, Assiut, Egypt
| | - Saad Alamri
- Botany and Microbiology Department, Faculty of Science, Assiut University, Assiut, Egypt
| | - Manal A. El-Zohri
- Botany and Microbiology Department, Faculty of Science, Assiut University, Assiut, Egypt
| | - Kaleem Ullah
- Department of Zoology, Faculty of Sciences, Ghazi University, Dera Ghazi Khan, Punjab, Pakistan
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Kim SH, Ji DM, Kim CY, Choi SB, Joo MC, Kim MS. Therapeutic Effects of a Newly Developed 3D Magnetic Finger Rehabilitation Device in Subacute Stroke Patients: A Pilot Study. Brain Sci 2022; 12:brainsci12010113. [PMID: 35053855 PMCID: PMC8773930 DOI: 10.3390/brainsci12010113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
We developed a magnetic-force-based three-dimensional (3D) rehabilitation device that can perform motor rehabilitation treatment for paralyzed fingers, regardless of upper extremity movement and position, and investigated the therapeutic effects of the device. An end-effector type rehabilitation device that can generate magnetic fields in three directions was developed using electromagnets and permanent magnetics. A double-blinded randomized controlled pilot study was conducted with a total of 12 patients. The intervention group had rehabilitation treatment using the developed magnetic finger rehabilitation device for 30 min a day for four weeks. The control group underwent exercise rehabilitation treatment. The control group received conventional occupational therapy on the upper limbs, including hands, from an occupational therapist, for the same amount of time. Adverse effects were monitored, and the patient’s sensory or proprioceptive deficits were examined before the intervention. No participants reported safety concerns while the intervention was conducted. The Wolf Motor Function Test (WMFT) scores were significantly improved in the intervention group (from 13.4 ± 3.6 to 20.9 ± 4.0 points) compared to the control group (from 13.1 ± 4.0 to 15.2 ± 3.8 points) (p = 0.016). The patients in the intervention group (from 88 ± 12 to 67 ± 13 s) showed greater improvement of WMFT times compared to the control group (from 89 ± 10 to 73 ± 11 s) (p = 0.042). The Manual Function Test and the upper limb score of the Fugl-Meyer Assessment were significantly improved in the intervention group compared with the control group (p = 0.038 and p = 0.042). The patients in the intervention group also showed significantly greater enhancement of the Korean version of the modified Barthel Index than the control group (p = 0.042). Rehabilitation treatment using the 3D magnetic-force-driven finger rehabilitation device helped improve finger motor function and activities of daily living in subacute stroke patients.
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Affiliation(s)
- Sung-Hoon Kim
- Department of Electronics Convergence Engineering, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (S.-H.K.); (D.-M.J.)
| | - Dong-Min Ji
- Department of Electronics Convergence Engineering, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (S.-H.K.); (D.-M.J.)
| | - Chan-Yong Kim
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Sung-Bok Choi
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Min-Cheol Joo
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 460 Iksandae-ro, Iksan 54538, Korea; (C.-Y.K.); (S.-B.C.); (M.-C.J.)
- Correspondence: ; Tel.: +82-6-3859-1610; Fax: +82-6-3859-2128
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Morone G, de Sire A, Martino Cinnera A, Paci M, Perrero L, Invernizzi M, Lippi L, Agostini M, Aprile I, Casanova E, Marino D, La Rosa G, Bressi F, Sterzi S, Giansanti D, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Gandolfi M, Posteraro F, Senatore M, Turchetti G, Straudi S. Upper Limb Robotic Rehabilitation for Patients with Cervical Spinal Cord Injury: A Comprehensive Review. Brain Sci 2021; 11:1630. [PMID: 34942935 PMCID: PMC8699455 DOI: 10.3390/brainsci11121630] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on "Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin" (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.
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Affiliation(s)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company), 50123 Florence, Italy;
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 10121 Novara, Italy; (M.I.); (L.L.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 10121 Novara, Italy; (M.I.); (L.L.)
| | - Michela Agostini
- Section of Rehabilitation, Department of Neuroscience, University General Hospital of Padova, 35128 Padua, Italy;
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50123 Florence, Italy;
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy; (E.C.); (A.B.)
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, 98124 Messina, Italy;
| | - Giuseppe La Rosa
- C.S.R.—Consorzio Siciliano di Riabilitazione, 95123 Catania, Italy;
| | - Federica Bressi
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Silvia Sterzi
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, 00161 Rome, Italy; (D.G.); (M.G.)
| | - Alberto Battistini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy; (E.C.); (A.B.)
| | - Sandra Miccinilli
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Center, San Giovanni Rotondo 71013, Italy;
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.S.); (S.P.)
| | - Salvatore Petrozzino
- A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.S.); (S.P.)
| | | | | | - Paolo Benanti
- Department of Moral Theology, Pontifical Gregorian University, 00187 Rome, Italy;
| | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), 00198 Rome, Italy; (P.B.); (D.B.)
| | - Donatella Bonaiuti
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), 00198 Rome, Italy; (P.B.); (D.B.)
| | - Enrico Castelli
- Paediatric Neurorehabilitation Department, IRCCS Bambino Gesù Children’s Hospital, 00163 Rome, Italy;
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy;
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), 00195 Rome, Italy;
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
| | - Francesca Gimigliano
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, 00161 Rome, Italy; (D.G.); (M.G.)
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, 70125 Bari, Italy;
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova, Rehabilitation Department, 35128 Padua, Italy;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Department of Rehabilitation Medicine, Valduce Hospital, 23845 Costa Masnaga, Italy;
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory MARlab, IRCCS Bambino Gesù Children’s Hospital, 00163 Rome, Italy;
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (A.P.); (M.G.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (A.P.); (M.G.)
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, Versilia Hospital AUSL Toscana Nord Ovest, 55049 Lido di Camaiore, Italy;
| | - Michele Senatore
- AITO (Associazione Italiana Terapisti Occupazionali), 00136 Rome, Italy;
| | - Giuseppe Turchetti
- Management Institute, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy;
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44121 Ferrara, Italy;
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Modeling and Evaluation of a Novel Hybrid-Driven Compliant Hand Exoskeleton Based on Human-Machine Coupling Model. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112210825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This paper presents the modeling design method for a novel hybrid-driven compliant hand exoskeleton based on the human-machine coupling model for the patients who have requirements on training and assisting. Firstly, the human-machine coupling model is established based on the kinematics characteristics of human fingers and the Bernoulli beam formula. On this basis, the variable stiffness flexible hinge (VSFH) is used to drive the finger extension and the cable-driven mechanism is used to implement the movement of the finger flexion. Here, a hand orthosis is designed in the proposed hand exoskeleton to act as the base and maintain the function position of the hand for patients with hand dysfunction. Then, a final design prototype is fabricated to evaluate the proposed modeling method. In the end, a series of experiments based on the prototype is proceeded to evaluate its capabilities on stretching force for extension, bio-imitability, finger flexion capability, and fingertip force. The results show that the prototype has a significant improvement in all aspects of the ability mentioned above, and has good bionics. The proposed design method can be utilized to implement the rapid design of the hybrid-driven compliant hand exoskeleton with the changed requirements. The novel modeling method can be easily applied in personalized design in rehabilitation engineering.
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Beyond motor recovery after stroke: The role of hand robotic rehabilitation plus virtual reality in improving cognitive function. J Clin Neurosci 2021; 92:11-16. [PMID: 34509235 DOI: 10.1016/j.jocn.2021.07.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022]
Abstract
Robot-assisted hand training adopting end-effector devices results in an additional reduction of motor impairment in comparison to usual care alone in different stages of stroke recovery. These devices often allow the patient to perform practical, attentive, and visual-spatial tasks in a semi-virtual reality (VR) setting. We aimed to investigate whether the hand end-effector robotic device AmadeoTM could improve cognitive performance, beyond the motor deficit, as compared to the same amount of occupational treatment focused on the hand. Forty-eight patients (aged 54.3 ± 10.5 years, 62.5% female) affected by either ischemic or hemorrhagic stroke in the chronic phase were enrolled in the study. The experimental group (EG) underwent AmadeoTM robotic training, while the control group (CG) performed occupational therapy involving the upper limb. Patients were assessed at the beginning and at the end of the rehabilitation protocol using a specific neuropsychological battery, as well as motor function tests. The EG showed greater improvements in different cognitive domains, including attentive abilities and executive functions, as well as in hand motor function, as compared to CG. Our study showed that task-oriented VR-based robotic rehabilitation enhanced not only motor function in the paretic arm but also global and specific cognitive abilities in post-stroke patients. We may argue that the hand robotic plus VR-based training may provide patients with an integration of cognitive and motor skill rehabilitation, thus amplifying the functional outcome achievement.
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28
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Mirdamadi JL, Seigel CR, Husch SD, Block HJ. Somatotopic Specificity of Perceptual and Neurophysiological Changes Associated with Visuo-proprioceptive Realignment. Cereb Cortex 2021; 32:1184-1199. [PMID: 34424950 DOI: 10.1093/cercor/bhab280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/26/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
When visual and proprioceptive estimates of hand position disagree (e.g., viewing the hand underwater), the brain realigns them to reduce mismatch. This perceptual change is reflected in primary motor cortex (M1) excitability, suggesting potential relevance for hand movement. Here, we asked whether fingertip visuo-proprioceptive misalignment affects only the brain's representation of that finger (somatotopically focal), or extends to other parts of the limb that would be needed to move the misaligned finger (somatotopically broad). In Experiments 1 and 2, before and after misaligned or veridical visuo-proprioceptive training at the index finger, we used transcranial magnetic stimulation to assess M1 representation of five hand and arm muscles. The index finger representation showed an association between M1 excitability and visuo-proprioceptive realignment, as did the pinkie finger representation to a lesser extent. Forearm flexors, forearm extensors, and biceps did not show any such relationship. In Experiment 3, participants indicated their proprioceptive estimate of the fingertip, knuckle, wrist, and elbow, before and after misalignment at the fingertip. Proprioceptive realignment at the knuckle, but not the wrist or elbow, was correlated with realignment at the fingertip. These results suggest the effects of visuo-proprioceptive mismatch are somatotopically focal in both sensory and motor domains.
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Affiliation(s)
- Jasmine L Mirdamadi
- Program in Neuroscience, Indiana University Bloomington, Bloomington, IN 47405, USA.,Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Courtney R Seigel
- Program in Neuroscience, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Stephen D Husch
- Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Hannah J Block
- Program in Neuroscience, Indiana University Bloomington, Bloomington, IN 47405, USA.,Department of Kinesiology, School of Public Health, Indiana University Bloomington, Bloomington, IN 47405, USA
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Moggio L, de Sire A, Marotta N, Demeco A, Ammendolia A. Exoskeleton versus end-effector robot-assisted therapy for finger-hand motor recovery in stroke survivors: systematic review and meta-analysis. Top Stroke Rehabil 2021; 29:539-550. [PMID: 34420498 DOI: 10.1080/10749357.2021.1967657] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The growing number of stroke survivors with residual hand disabilities requires the development of efficient recovery therapy, and robotic rehabilitation can play an important role. OBJECTIVE The study aims to compare the relative effects of end-effector (EE) and exoskeleton (EXO) hand devices in motor recovery of patients with finger-hand motor impairment stroke. METHODS We identified randomized controlled trials (RCTs) through search in database on PubMed, Embase, MEDLINE, Cochrane library until October 2020. We included as outcomes: motricity index (MI), quick version of disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire, and Fugl-Meyer assessment for upper extremity (FMAUE). We performed a systematic review, a meta-analysis, and a surface under the cumulative ranking analysis (SUCRA). RESULTS We included five RTCs and 149 subjects. MI showed a signifìcant improvement (p < .05) in robotic intervention group compared to control group (effect size, ES: 9.47; confidence interval, CI: 3.91, 15.03). QuickDASH reported a significant reduction (p < .05) in EXO group (ES: -6.71; CI: -9.17, -4.25). FMAUE showed a significant improvement (p < .05) in the EE group (ES:3; CI:1.97, 4.04). SUCRA analysis of MI demonstrated that robotic interventions are more likely to be the best option for motor recovery (97.3% of probability EXO; 48.3% EE; 4.4% control). CONCLUSION Despite the limited number of studies included, exoskeleton robotic devices might be a better option than end-effector devices in the treatment of fingers motor impairment in stroke patients. Further studies are still needed to confirm the findings and should focus on a direct comparison of the two devices.
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Affiliation(s)
- Lucrezia Moggio
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Andrea Demeco
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
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Kraaijkamp JJM, van Dam van Isselt EF, Persoon A, Versluis A, Chavannes NH, Achterberg WP. eHealth in Geriatric Rehabilitation: Systematic Review of Effectiveness, Feasibility, and Usability. J Med Internet Res 2021; 23:e24015. [PMID: 34420918 PMCID: PMC8414304 DOI: 10.2196/24015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/11/2021] [Accepted: 05/16/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND eHealth has the potential to improve outcomes such as physical activity or balance in older adults receiving geriatric rehabilitation. However, several challenges such as scarce evidence on effectiveness, feasibility, and usability hinder the successful implementation of eHealth in geriatric rehabilitation. OBJECTIVE The aim of this systematic review was to assess evidence on the effectiveness, feasibility, and usability of eHealth interventions in older adults in geriatric rehabilitation. METHODS We searched 7 databases for randomized controlled trials, nonrandomized studies, quantitative descriptive studies, qualitative research, and mixed methods studies that applied eHealth interventions during geriatric rehabilitation. Included studies investigated a combination of effectiveness, usability, and feasibility of eHealth in older patients who received geriatric rehabilitation, with a mean age of ≥70 years. Quality was assessed using the Mixed Methods Appraisal Tool and a narrative synthesis was conducted using a harvest plot. RESULTS In total, 40 studies were selected, with clinical heterogeneity across studies. Of 40 studies, 15 studies (38%) found eHealth was at least as effective as non-eHealth interventions (56% of the 27 studies with a control group), 11 studies (41%) found eHealth interventions were more effective than non-eHealth interventions, and 1 study (4%) reported beneficial outcomes in favor of the non-eHealth interventions. Of 17 studies, 16 (94%) concluded that eHealth was feasible. However, high exclusion rates were reported in 7 studies of 40 (18%). Of 40 studies, 4 (10%) included outcomes related to usability and indicated that there were certain aging-related barriers to cognitive ability, physical ability, or perception, which led to difficulties in using eHealth. CONCLUSIONS eHealth can potentially improve rehabilitation outcomes for older patients receiving geriatric rehabilitation. Simple eHealth interventions were more likely to be feasible for older patients receiving geriatric rehabilitation, especially, in combination with another non-eHealth intervention. However, a lack of evidence on usability might hamper the implementation of eHealth. eHealth applications in geriatric rehabilitation show promise, but more research is required, including research with a focus on usability and participation.
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Affiliation(s)
- Jules J M Kraaijkamp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- ZZG Zorggroep, Nijmegen, Netherlands
| | | | - Anke Persoon
- Department of Primary and Community Care, Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Budhota A, Chua KSG, Hussain A, Kager S, Cherpin A, Contu S, Vishwanath D, Kuah CWK, Ng CY, Yam LHL, Loh YJ, Rajeswaran DK, Xiang L, Burdet E, Campolo D. Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands. Front Neurol 2021; 12:622014. [PMID: 34149587 PMCID: PMC8206540 DOI: 10.3389/fneur.2021.622014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/23/2021] [Indexed: 01/31/2023] Open
Abstract
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628.
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Affiliation(s)
- Aamani Budhota
- Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.,Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Karen S G Chua
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Asif Hussain
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Adèle Cherpin
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sara Contu
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Deshmukh Vishwanath
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher W K Kuah
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chwee Yin Ng
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Lester H L Yam
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Yong Joo Loh
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Domenico Campolo
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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32
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A Hand Motor Skills Rehabilitation for the Injured Implemented on a Social Robot. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11072943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this work, we introduce HaReS, a hand rehabilitation system. Our proposal integrates a series of exercises, jointly developed with a foundation for those with motor and cognitive injuries, that are aimed at improving the skills of patients and the adherence to the rehabilitation plan. Our system takes advantage of a low-cost hand-tracking device to provide a quantitative analysis of the performance of the patient. It also integrates a low-cost surface electromyography (sEMG) sensor in order to provide insight about which muscles are being activated while completing the exercises. It is also modular and can be deployed on a social robot. We tested our proposal in two different facilities for rehabilitation with high success. The therapists and patients felt more motivation while using HaReS, which improved the adherence to the rehabilitation plan. In addition, the therapists were able to provide services to more patients than when they used their traditional methodology.
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TAŞAR BEYDA, TATAR AHMETBURAK, TANYILDIZI ALPERKADIR, YAKUT OGUZ. DESIGN, DYNAMIC MODELING AND CONTROL OF WEARABLE FINGER ORTHOSIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Human hands and fingers are of significant importance in people’s capacity to perform daily tasks (touching, feeling, holding, gripping, writing). However, about 1.5 million people around the world are suffering from injuries, muscle and neurological disorders, a loss of hand function, or a few fingers due to stroke. This paper focuses on newly developed finger orthotics, which is thin, adaptable to the length of each finger and low energy costs. The aim of the study is to design and control a new robotic orthosis using for daily rehabilitation therapy. Kinematic and dynamic analysis of orthosis was calculated and the joint regulation of orthosis was obtained. The Lagrange method was used to obtain dynamics, and the Denavit–Hartenberg (D–H) method was used for kinematic analysis of hand. In order to understand its behavior, the robotic finger orthotics model was simulated in MatLab/Simulink. The simulation results show that the efficiency and robustness of proportional integral derivative (PID) controller are appropriate for the use of robotic finger orthotics.
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Affiliation(s)
- BEYDA TAŞAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - AHMET BURAK TATAR
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - ALPER KADIR TANYILDIZI
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
| | - OGUZ YAKUT
- Department of Mechatronics Engineering, Faculty of Engineering, Firat University, Elazig, Turkey
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Upper Limb Robotic Rehabilitation After Stroke: A Multicenter, Randomized Clinical Trial. J Neurol Phys Ther 2021; 44:3-14. [PMID: 31834217 DOI: 10.1097/npt.0000000000000295] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE After stroke, only 12% of survivors obtain complete upper limb (UL) functional recovery, while in 30% to 60% UL deficits persist. Despite the complexity of the UL, prior robot-mediated therapy research has used only one robot in comparisons to conventional therapy. We evaluated the efficacy of robotic UL treatment using a set of 4 devices, compared with conventional therapy. METHODS In a multicenter, randomized controlled trial, 247 subjects with subacute stroke were assigned either to robotic (using a set of 4 devices) or to conventional treatment, each consisting of 30 sessions. Subjects were evaluated before and after treatment, with follow-up assessment after 3 months. The primary outcome measure was change from baseline in the Fugl-Meyer Assessment (FMA) score. Secondary outcome measures were selected to assess motor function, activities, and participation. RESULTS One hundred ninety subjects completed the posttreatment assessment, with a subset (n = 122) returning for follow-up evaluation. Mean FMA score improvement in the robotic group was 8.50 (confidence interval: 6.82 to 10.17), versus 8.57 (confidence interval: 6.97 to 10.18) in the conventional group, with no significant between-groups difference (adjusted mean difference -0.08, P = 0.948). Both groups also had similar change in secondary measures, except for the Motricity Index, with better results for the robotic group (adjusted mean difference 4.42, P = 0.037). At follow-up, subjects continued to improve with no between-groups differences. DISCUSSION AND CONCLUSIONS Robotic treatment using a set of 4 devices significantly improved UL motor function, activities, and participation in subjects with subacute stroke to the same extent as a similar amount of conventional therapy. Video Abstract is available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A291).
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Yang L, Zhang F, Zhu J, Fu Y. A Portable Device for Hand Rehabilitation with Force Cognition: Design, Interaction and Experiment. IEEE Trans Cogn Dev Syst 2021. [DOI: 10.1109/tcds.2021.3055626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jankowski N, Ivanova E, Wiehe L, Wahl M. Long-term changes in technology acceptance of a robotic system in stroke treatment: a pilot study. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1515/cdbme-2020-2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
This pilot field study aimed to detect long-term changes in technology acceptance (TAM), user experience (UX) during use of an experimental demonstrator Bi-Manu-Interact (BMI) in stroke rehabilitation.
Methods
In 10 therapy sessions, patients performed a 20 min workout per session with the BMI. Patients with stroke were interviewed after the first (T0) and the 10th training session (T1) with a structured questionnaire about UX, TAM and potential to use the BMI at home. Nine patients (n=4 females) aged 33–78 years (M=60.22; SD=13.17) participated in the study.
Results
After using the BMI no statistically significant differences have been found in UX and TAM (T0 vs. T1). But small to large effect sizes have been found which imply a practical relevance of the differences. The potential to use the BMI at home showed an increase in readiness for at T1 compared to T0.
Conclusion
Descriptive data suggest that familiarity gained through repetitive training sessions. The findings are coherent with previous studies.
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Affiliation(s)
- Natalie Jankowski
- Institut für Rehabilitationswissenschaften , Humboldt-Universität zu Berlin , Berlin , Germany
| | - Ekaterina Ivanova
- Department of Industrial Automation (FG IAT) , Technical University Berlin , Berlin , Germany
| | - Lea Wiehe
- Institut für Rehabilitationswissenschaften , Humboldt-Universität zu Berlin , Berlin , Germany
| | - Michael Wahl
- Institut für Rehabilitationswissenschaften , Humboldt-Universität zu Berlin , Berlin , Germany
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Lo K, Stephenson M, Lockwood C. Extending the hierarchical decision matrix to incorporate a dominance ranking score for economic systematic reviews. MethodsX 2020; 7:101047. [PMID: 32983920 PMCID: PMC7498707 DOI: 10.1016/j.mex.2020.101047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/24/2020] [Indexed: 11/09/2022] Open
Abstract
As the base of clinical evidence grows, it is increasingly common to conduct economic evaluations in addition to clinical evaluations of effectiveness in order to inform health policies. For economic systematic reviews there is currently no agreed-upon quantitative method to obtain a pooled economic effect size. With no suitable quantitative method available, the hierarchical decision matrix stands out as a tool that enables a visual summary of different types of economic studies, but there are limitations with the hierarchical decision matrix. We extended the hierarchical decision matrix with a weighted scoring system (termed dominance ranking score) to allow for useful information of a study design to be incorporated. The scoring system of the dominance ranking score incorporates weighting factors that are based on sample size and effect size of a study. The dominance ranking score enables a more differentiating analysis of dominance levels. For systematic reviews that include partial economic studies, both the hierarchical decision matrix and the dominance ranking score assist to indicate the level of economic potential for a particular intervention, which facilitates the conduct of subsequent full economic studies.
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Affiliation(s)
- Kenneth Lo
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia.,College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Australia
| | - Matthew Stephenson
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia
| | - Craig Lockwood
- Faculty of Health and Medical Sciences, The Joanna Briggs Institute (JBI), The University of Adelaide, Australia
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Park S, Fraser M, Weber LM, Meeker C, Bishop L, Geller D, Stein J, Ciocarlie M. User-Driven Functional Movement Training With a Wearable Hand Robot After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2265-2275. [PMID: 32886611 DOI: 10.1109/tnsre.2020.3021691] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We studied the performance of a robotic orthosis designed to assist the paretic hand after stroke. It is wearable and fully user-controlled, serving two possible roles: as a therapeutic tool that facilitates device-mediated hand exercises to recover neuromuscular function or as an assistive device for use in everyday activities to aid functional use of the hand. We present the clinical outcomes of a pilot study designed as a feasibility test for these hypotheses. 11 chronic stroke (>2 years) patients with moderate muscle tone (Modified Ashworth Scale ≤ 2 in upper extremity) engaged in a month-long training protocol using the orthosis. Individuals were evaluated using standardized outcome measures, both with and without orthosis assistance. Fugl-Meyer post intervention scores without robotic assistance showed improvement focused specifically at the distal joints of the upper limb, suggesting the use of the orthosis as a rehabilitative device for the hand. Action Research Arm Test scores post intervention with robotic assistance showed that the device may serve an assistive role in grasping tasks. These results highlight the potential for wearable and user-driven robotic hand orthoses to extend the use and training of the affected upper limb after stroke.
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Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke. J Neuroeng Rehabil 2020; 17:115. [PMID: 32831097 PMCID: PMC7444058 DOI: 10.1186/s12984-020-00746-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hand function is often impaired after stroke, strongly affecting the ability to perform daily activities. Upper limb robotic devices have been developed to complement rehabilitation therapy offered to persons who suffered a stroke, but they rarely focus on the training of hand sensorimotor function. The primary goal of this study was to evaluate whether robot-assisted therapy of hand function following a neurocognitive approach (i.e., combining motor training with somatosensory and cognitive tasks) produces an equivalent decrease in upper limb motor impairment compared to dose-matched conventional neurocognitive therapy, when embedded in the rehabilitation program of inpatients in the subacute stage after stroke. Methods A parallel-group, randomized controlled trial was conducted on subjects with subacute stroke receiving either conventional or robot-assisted neurocognitive hand therapy using a haptic device. Therapy was provided for 15, 45-min sessions over four weeks, nested within the standard therapy program. Primary outcome was the change from baseline in the upper extremity part of the Fugl-Meyer Assessment (FMA-UE) after the intervention, which was compared between groups using equivalence testing. Secondary outcome measures included upper limb motor, sensory and cognitive assessments, delivered therapy dose, as well as questionnaires on user technology acceptance. Results Thirty-three participants with stroke were enrolled. 14 subjects in the robot-assisted and 13 subjects in the conventional therapy group completed the study. At the end of intervention, week 8 and week 32, the robot-assisted/conventional therapy group improved by 7.14/6.85, 7.79/7.31, and 8.64/8.08 points on the FMA-UE, respectively, establishing that motor recovery in the robot-assisted group is non-inferior to that in the control group. Conclusions Neurocognitive robot-assisted therapy of hand function allows for a non-inferior motor recovery compared to conventional dose-matched neurocognitive therapy when performed during inpatient rehabilitation in the subacute stage. This allows the early familiarization of subjects with stroke to the use of such technologies, as a first step towards minimal therapist supervision in the clinic, or directly at home after hospital discharge, to help increase the dose of hand therapy for persons with stroke. Trial registration EUDAMED database (CIV-13-02-009921), clinicaltrials.gov (NCT02096445). Registered 26 March 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02096445
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Dávila-Vilchis JM, Ávila-Vilchis JC, Vilchis-González AH, LAZ-Avilés. Design Criteria of Soft Exogloves for Hand Rehabilitation-Assistance Tasks. Appl Bionics Biomech 2020; 2020:2724783. [PMID: 32802156 PMCID: PMC7416241 DOI: 10.1155/2020/2724783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
This paper establishes design criteria for soft exogloves (SEG) to be used as rehabilitation or assistance devices. This research consists in identifying, selecting, and grouping SEG features based on the analysis of 91 systems that have been proposed during the last decade. Thus, function, mobility, and usability criteria are defined and explicitly discussed to highlight SEG design guidelines. Additionally, this study provides a detailed description of each system that was analysed including application, functional task, palm design, actuation type, assistance mode, degrees of freedom (DOF), target fingers, motions, material, weight, force, pressure (only for fluids), control strategy, and assessment. Such characteristics have been reported according to specific design methodologies and operating principles. Technological trends are contemplated in this contribution with emphasis on SEG design opportunity areas. In this review, suggestions, limitations, and implications are also discussed in order to enhance future SEG developments aimed at stroke survivors or people with hand disabilities.
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Affiliation(s)
| | - Juan C. Ávila-Vilchis
- Faculty of Engineering, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
| | | | - LAZ-Avilés
- Faculty of Engineering, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
- Cátedras CONACYT, Universidad Autónoma del Estado de México, Toluca 50130, Mexico
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Kim B, Ryu J, Cho KJ. Joint Angle Estimation of a Tendon-Driven Soft Wearable Robot through a Tension and Stroke Measurement. SENSORS 2020; 20:s20102852. [PMID: 32429530 PMCID: PMC7288088 DOI: 10.3390/s20102852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022]
Abstract
The size of a device and its adaptability to human properties are important factors in developing a wearable device. In wearable robot research, therefore, soft materials and tendon transmissions have been utilized to make robots compact and adaptable to the human body. However, when used for wearable robots, these methods sometimes cause uncertainties that originate from elongation of the soft material or from undefined human properties. In this research, to consider these uncertainties, we propose a data-driven method that identifies both kinematic and stiffness parameters using tension and wire stroke of the actuators. Through kinematic identification, a method is proposed to find the exact joint position as a function of the joint angle. Through stiffness identification, the relationship between the actuation force and the joint angle is obtained using Gaussian Process Regression (GPR). As a result, by applying the proposed method to a specific robot, the research outlined in this paper verifies how the proposed method can be used in wearable robot applications. This work examines a novel wearable robot named Exo-Index, which assists a human’s index finger through the use of three actuators. The proposed identification methods enable control of the wearable robot to result in appropriate postures for grasping objects of different shapes and sizes.
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Affiliation(s)
- Byungchul Kim
- Biorobotics Laboratory, School of Mechanical and Aerospace Engineering, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea; (B.K.); (J.R.)
- Soft Robotics Research Center, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea
| | - Jiwon Ryu
- Biorobotics Laboratory, School of Mechanical and Aerospace Engineering, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea; (B.K.); (J.R.)
- Soft Robotics Research Center, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea
| | - Kyu-Jin Cho
- Biorobotics Laboratory, School of Mechanical and Aerospace Engineering, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea; (B.K.); (J.R.)
- Soft Robotics Research Center, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul 08826, Korea
- Correspondence: ; Tel.: +82-880-1663
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Proulx CE, Beaulac M, David M, Deguire C, Haché C, Klug F, Kupnik M, Higgins J, Gagnon DH. Review of the effects of soft robotic gloves for activity-based rehabilitation in individuals with reduced hand function and manual dexterity following a neurological event. J Rehabil Assist Technol Eng 2020; 7:2055668320918130. [PMID: 32435506 PMCID: PMC7223210 DOI: 10.1177/2055668320918130] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022] Open
Abstract
Despite limited scientific evidence, there is an increasing interest in soft robotic gloves to optimize hand- and finger-related functional abilities following a neurological event. This review maps evidence on the effects and effectiveness of soft robotic gloves for hand rehabilitation and, whenever possible, patients' satisfaction. A systematized search of the literature was conducted using keywords structured around three areas: technology attributes, anatomy, and rehabilitation. A total of 272 titles, abstracts, and keywords were initially retrieved, and data were extracted out of 13 articles. Six articles investigated the effects of wearing a soft robotic glove and eight studied the effect or effectiveness of an intervention with it. Some statistically significant and meaningful beneficial effects were confirmed with the 29 outcome measures used. Finally, 11 articles also confirmed users' satisfaction with regard to the soft robotic glove, while some articles also noticed an increased engagement in the rehabilitation program with this technology. Despite the heterogeneity across studies, soft robotic gloves stand out as a safe and promising technology to improve hand- and finger-related dexterity and functional performance. However, strengthened evidence of the effects or effectiveness of such devices is needed before their transition from laboratory to clinical practice.
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Affiliation(s)
- Camille E Proulx
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Myrka Beaulac
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Mélissa David
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catryne Deguire
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Catherine Haché
- School of Rehabilitation, Université de Montréal, Montréal, Canada
| | - Florian Klug
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Mario Kupnik
- Technischen Universität Darmstadt, Darmstaadt, Germany
| | - Johanne Higgins
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montréal, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
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Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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Kuo FL, Lee HC, Hsiao HY, Lin JC. Robotic-assisted hand therapy for improvement of hand function in children with cerebral palsy: a case series study. Eur J Phys Rehabil Med 2020; 56:237-242. [PMID: 31939267 DOI: 10.23736/s1973-9087.20.05926-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most types of robot-assisted training (RT) have been used in Cerebral Palsy (CP) patients only focus on proximal upper extremity. Few of study investigated the effect of distal upper extremity training. CASE REPORT Pediatric CP patients (N.=7) participated the RT sessions for 6 weeks (12 60-min sessions 2 times a week). Performance was assessed at 3 time points (pretest, posttest, and 1-month follow-up). RT significantly improved in body structure and function domains: FMA-UE scores (P=0.002). On electromyography, significant improvements in the mean brachioradialis muscle amplitude (P=0.015) and electrical agonist-antagonist muscle ratio (P=0.041) in the 1-inch cube-grasping task. The effects were maintained after 1 month. CLINICAL REHABILITATION IMPACT RT using a Gloreha device which focuses on the distal part of the upper limb benefit on body structure and function, including upper-extremity motor function, brachioradialis muscle recruitment, and coordination in children with cerebral palsy.
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Affiliation(s)
- Fen-Ling Kuo
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Chieh Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Yun Hsiao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chi Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan -
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Parker J, Powell L, Mawson S. Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review. J Med Internet Res 2020; 22:e15981. [PMID: 31913131 PMCID: PMC6996755 DOI: 10.2196/15981] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.
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Pedersini P, Valdes K, Cantero-Tellez R, Cleland JA, Bishop MD, Villafañe JH. Effects of Neurodynamic Mobilizations on Pain Hypersensitivity in Patients With Hand Osteoarthritis Compared to Robotic Assisted Mobilization: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2019; 73:232-239. [PMID: 31675184 DOI: 10.1002/acr.24103] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/29/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the neurodynamic mobilization techniques compared with passive robotic physiologic movement in patients with hand osteoarthritis (OA). METHODS We conducted a randomized controlled trial. A total of 72 patients (mean ± SD age 71 ± 11 years) with dominant symptomatic hand OA were randomized in 2 groups, and both received 12 treatment sessions over 4 weeks. The experimental group received neurodynamic mobilization of the median, radial, and ulnar nerves, and the control group received robotic-assisted passive movement treatment. Both groups also participated in a program of hand stability exercises. Outcome measures included pain intensity, pressure pain thresholds (PPTs), and strength measurements. Group-by-time effects were compared using mixed-model analyses of variance. RESULTS After the intervention, the experimental group had statistically significant, higher PPTs than the control group at the thumb carpometacarpal joint by 0.7 kg/cm2 (95% confidence interval [95% CI] 0.6, 0.8), the median nerve by 0.7 kg/cm2 (95% CI 0.6, 0.7), and the radial nerve by 0.5 kg/cm2 (95% CI 0.3, 0.6); however, the difference was not statistically significant at 3 months postintervention. Although mean values in the experimental group were higher than in the control group at all PPT sites at both assessments, these differences were not statistically significant. The experimental group experienced a statistically significant reduction in pain immediately postintervention, but this was not present at the 3-month follow-up. There were no statistically significant differences in pinch or grip strength between groups. CONCLUSION We found that neurodynamic mobilizations decreased hypersensitivity in patients with hand OA immediately after the intervention; however, differences were no longer present at 3 months. The results suggest that these techniques may have some limited value in the short term but do not have lasting effects.
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Affiliation(s)
| | | | | | | | - Mark D Bishop
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
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Ivanescu M, Popescu N, Popescu D, Channa A, Poboroniuc M. Exoskeleton Hand Control by Fractional Order Models. SENSORS 2019; 19:s19214608. [PMID: 31652753 PMCID: PMC6864683 DOI: 10.3390/s19214608] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/16/2019] [Accepted: 10/20/2019] [Indexed: 11/16/2022]
Abstract
This paper deals with the fractional order control for the complex systems, hand exoskeleton and sensors, that monitor and control the human behavior. The control laws based on physical significance variables, for fractional order models, with delays or without delays, are proposed and discussed. Lyapunov techniques and the methods that derive from Yakubovici-Kalman-Popov lemma are used and the frequency criterions that ensure asymptotic stability of the closed loop system are inferred. An observer control is proposed for the complex models, exoskeleton and sensors. The asymptotic stability of the system, exoskeleton hand-observer, is studied for sector control laws. Numerical simulations for an intelligent haptic robot-glove are presented. Several examples regarding these models, with delays or without delays, by using sector control laws or an observer control, are analyzed. The experimental platform is presented.
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Affiliation(s)
- Mircea Ivanescu
- Department of Mechatronics, University of Craiova, 200585 Craiova, Romania.
| | - Nirvana Popescu
- Department of Computer Science, University Politehnica of Bucharest, 060042 Bucharest, Romania.
| | - Decebal Popescu
- Department of Computer Science, University Politehnica of Bucharest, 060042 Bucharest, Romania.
| | - Asma Channa
- Department of Computer Science, University Politehnica of Bucharest, 060042 Bucharest, Romania.
| | - Marian Poboroniuc
- Department of Electrical Engineering, Technical University of Iasi, 700050 Iași, Romania.
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Radder B, Prange-Lasonder GB, Kottink AIR, Holmberg J, Sletta K, van Dijk M, Meyer T, Melendez-Calderon A, Buurke JH, Rietman JS. Home rehabilitation supported by a wearable soft-robotic device for improving hand function in older adults: A pilot randomized controlled trial. PLoS One 2019; 14:e0220544. [PMID: 31386685 PMCID: PMC6684161 DOI: 10.1371/journal.pone.0220544] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/17/2019] [Indexed: 01/19/2023] Open
Abstract
Background New developments, based on the concept of wearable soft-robotic devices, make it possible to support impaired hand function during the performance of daily activities and intensive task-specific training. The wearable soft-robotic ironHand glove is such a system that supports grip strength during the performance of daily activities and hand training exercises at home. Design This pilot randomized controlled clinical study explored the effect of prolonged use of the assistive ironHand glove during daily activities at home, in comparison to its use as a trainings tool at home, on functional performance of the hand. Methods In total, 91 older adults with self-perceived decline of hand function participated in this study. They were randomly assigned to a 4-weeks intervention of either assistive or therapeutic ironHand use, or control group (received no additional exercise or treatment). All participants performed a maximal pinch grip test, Box and Blocks test (BBT), Jebsen-Taylor Hand Function Test (JTHFT) at baseline and after 4-weeks of intervention. Only participants of the assistive and therapeutic group completed the System Usability Scale (SUS) after the intervention period. Results Participants of the assistive and therapeutic group reported high scores on the SUS (mean = 73, SEM = 2). The therapeutic group showed improvements in unsupported handgrip strength (mean Δ = 3) and pinch strength (mean Δ = 0.5) after 4 weeks of ironHand use (p≤0.039). Scores on the BBT and JTHFT improved not only after 4 weeks of ironHand use (assistive and therapeutic), but also in the control group. Only handgrip strength improved more in the therapeutic group compared to the assistive and control group. No significant correlations were found between changes in performance and assistive or therapeutic ironHand use (p≥0.062). Conclusion This study showed that support of the wearable soft-robotic ironHand system either as assistive device or as training tool may be a promising way to counter functional hand function decline associated with ageing.
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Affiliation(s)
- Bob Radder
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
- * E-mail:
| | - Gerdienke B. Prange-Lasonder
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Anke I. R. Kottink
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands
| | - Johnny Holmberg
- Eskilstuna Kommun Vård- och omsorgsförvaltningen, Eskilstuna, Sweden
| | - Kristin Sletta
- Eskilstuna Kommun Vård- och omsorgsförvaltningen, Eskilstuna, Sweden
| | - Manon van Dijk
- National Foundation for the Elderly, Bunnik, the Netherlands
| | | | - Alejandro Melendez-Calderon
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
- Cereneo Advanced Rehabilitation Institute, Vitznau, Switzerland
| | - Jaap H. Buurke
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biosystems and Signals, University of Twente, Enschede, the Netherlands
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
| | - Johan S. Rietman
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
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Design of an Active and Passive Control System of Hand Exoskeleton for Rehabilitation. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9112291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aiming at stroke patients’ hand rehabilitation training, we present a hand exoskeleton with both active and passive control modes for neural rehabilitation. The exoskeleton control system is designed as a human–robot interaction control system based on field-programmable gate array (FPGA) and Android mobile terminal with good portability and openness. Passive rehabilitation pattern based on proportional derivative (PD) inverse dynamic control method and active rehabilitation pattern based on impedance method, are established respectively. By the comparison of the threshold value and the force on the fingertip of the exoskeleton from the sensor, the automatic switch between active and passive rehabilitation mode is accomplished. The hand model is built in Android environment that can synchronize the movement of the hand. It can also induce patients to participate in rehabilitation training actively. To verify the proposed control approach, we set up and conduct an experiment to do the passive rehabilitation mode, active rehabilitation mode, and active plus passive mode experimental researches. The experiment results effectively verify the feasibility of the exoskeleton system fulfilling the proposed control strategy.
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Yurkewich A, Hebert D, Wang RH, Mihailidis A. Hand Extension Robot Orthosis (HERO) Glove: Development and Testing With Stroke Survivors With Severe Hand Impairment. IEEE Trans Neural Syst Rehabil Eng 2019; 27:916-926. [DOI: 10.1109/tnsre.2019.2910011] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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