Voluntary-Driven Elbow Orthosis with Speed-Controlled Tremor Suppression

FiMec tremor stabilization spoon: design and active stabilization control of two DoF robotic eating devices for hand tremor patients

This article is about vibration-damping robotic eating devices designed for use by people who have difficulty in eating due to hand tremors due to neuromuscular system disorder. The robotic eating device has two degrees of freedom (DoF). It contains an active controller structure to absorb vibrations in the y- and z-directions. In the handle part of the robotic eating device, there are two DC motors placed on the y- and z-axis, a three-axis IMU inertia sensor, an embedded system board, and a power unit. To absorb the vibration measured from the IMU sensor, the position control of the two motors to which the spoon is connected is provided by PID controllers. The part of the spoon (the pit surface) where the food is placed is tried to be kept constant. To test the vibration-damping performance of the control method, the dynamic model of the spoon along the eating kinematic trajectory was simulated in the SimMechanics environment using vibration data from ten tremor patients. The results show that the stabilization method can absorb the vibration in the hand of the person in the range of 84-99.409% and successfully provide the stabilization of the spoon tip. This damping rate is promising for providing a healthy diet for hand tremor patients.

Diagnosis and Treatment of Tremor in Parkinson's Disease Using Mechanical Devices

BACKGROUND

Parkinsonian tremors are sometimes confused with essential tremors or other conditions. Recently, researchers conducted several studies on tremor evaluation using wearable sensors and devices, which may support accurate diagnosis. Mechanical devices are also commonly used to treat tremors and have been actively researched and developed. Here, we aimed to review recent progress and the efficacy of the devices related to Parkinsonian tremors.

METHODS

The PubMed and Scopus databases were searched for articles. We searched for "Parkinson disease" and "tremor" and "device".

RESULTS

Eighty-six articles were selected by our systematic approach. Many studies demonstrated that the diagnosis and evaluation of tremors in patients with PD can be done accurately by machine learning algorithms. Mechanical devices for tremor suppression include deep brain stimulation (DBS), electrical muscle stimulation, and orthosis. In recent years, adaptive DBS and optimization of stimulation parameters have been studied to further improve treatment efficacy.

CONCLUSIONS

Due to developments using state-of-the-art techniques, effectiveness in diagnosing and evaluating tremor and suppressing it using these devices is satisfactorily high in many studies. However, other than DBS, no devices are in practical use. To acquire high-level evidence, large-scale studies and randomized controlled trials are needed for these devices.

Mechatronic Design of a Prototype Orthosis to Support Elbow Joint Rehabilitation

Injuries in the elbow area, such as lateral and medial epicondylitis, are the leading causes of consultation with health specialists. Therefore, this research proposes the mechatronic design of an orthosis with a graphic interface that supports professionals in the rehabilitation of the elbow joint through the execution of flexion–extension and pronation–supination movements. For the development of the rehabilitation prototype, mechatronic design, co-design, and IDEF0 methodologies are used, performing activities such as actuator characterization, simulations, and modeling, among others. Through the execution of a case study in a real environment, the device was validated, where the results suggest a functional and workable prototype that supports the treatment of pathologies in the elbow area through the execution of the mentioned movements, supposing that this is a low-cost alternative with elements to improve, such as the industrial design and new functionalities. The developed proposal shows potential as an economical product that health professionals can use. However, some limitations related to the design and functionalities in the application domain were identified.

Optimal Trajectory Planning of the Variable-Stiffness Flexible Manipulator Based on CADE Algorithm for Vibration Reduction Control

Robotic manipulators are widely used for precise operation in the medical field. Vibration suppression control of robotic manipulators has become a key issue affecting work stability and safety. In this paper an optimal trajectory planning control method to suppress the vibration of a variable-stiffness flexible manipulator considering the rigid-flexible coupling is proposed. Through analyzing the elastic deformation of the variable-stiffness flexible manipulator, a distributed dynamic physical model of the flexible manipulator is constructed based on the Hamilton theory. Based on the mathematical model of the system, the design of the vibration damping controller of the flexible manipulator is proposed, and the control system with nonlinear input is considered for numerical analysis. According to the boundary conditions, the vibration suppression effect of the conventional and the variable-stiffness flexible manipulator is compared. The motion trajectory of the variable-stiffness flexible manipulator and compare the vibration response from different trajectories. Then, with minimum vibration displacement, minimum energy consumption and minimum trajectory tracking deviation as performance goals, the trajectory planning of the variable-stiffness flexible manipulator movement is carried out based on the cloud adaptive differential evolution (CADE) optimization algorithm. The validity of the proposed trajectory planning method is verified by numerical simulation.

A Review on Wearable Technologies for Tremor Suppression

Tremor is defined as a rhythmic, involuntary oscillatory movement of a body part. Although everyone exhibits a certain degree of tremor, some pathologies lead to very disabling tremors. These pathological tremors constitute the most prevalent movement disorder, and they imply severe difficulties in performing activities of daily living. Although tremors are currently managed through pharmacotherapy or surgery, these treatments present significant associated drawbacks: drugs often induce side effects and show decreased effectiveness over years of use, while surgery is a hazardous procedure for a very low percentage of eligible patients. In this context, recent research demonstrated the feasibility of managing upper limb tremors through wearable technologies that suppress tremors by modifying limb biomechanics or applying counteracting forces. Furthermore, recent experiments with transcutaneous afferent stimulation showed significant tremor attenuation. In this regard, this article reviews the devices developed following these tremor management paradigms, such as robotic exoskeletons, soft robotic exoskeletons, and transcutaneous neurostimulators. These works are presented, and their effectiveness is discussed. The article also evaluates the different metrics used for the validation of these devices and the lack of a standard validation procedure that allows the comparison among them.

3D Scanning of the Forearm for Orthosis and HMI Applications

The rise of rehabilitation robotics has ignited a global investigation into the human machine interface (HMI) between device and user. Previous research on wearable robotics has primarily focused on robotic kinematics and controls but rarely on the actual design of the physical HMI (pHMI). This paper presents a data-driven statistical forearm surface model for designing a forearm orthosis in exoskeleton applications. The forearms of 6 subjects were 3D scanned in a custom-built jig to capture data in extreme pronation and supination poses, creating 3D point clouds of the forearm surface. Resulting data was characterized into a series of ellipses from 20 to 100% of the forearm length. Key ellipse parameters in the model include: normalized major and minor axis length, normalized center point location, tilt angle, and circularity ratio. Single-subject (SS) ellipse parameters were normalized with respect to forearm radiale-stylion (RS) length and circumference and then averaged over the 6 subjects. Averaged parameter profiles were fit with 3rd-order polynomials to create combined-subjects (CS) elliptical models of the forearm. CS models were created in the jig as-is (CS1) and after alignment to ellipse centers at 20 and 100% of the forearm length (CS2). Normalized curve fits of ellipse major and minor axes in model CS2 achieve R² values ranging from 0.898 to 0.980 indicating a high degree of correlation between cross-sectional size and position along the forearm. Most other parameters showed poor correlation with forearm position (0.005 < R² < 0.391) with the exception of tilt angle in pronation (0.877) and circularity in supination (0.657). Normalized RMSE of the CS2 ellipse-fit model ranged from 0.21 to 0.64% of forearm circumference and 0.22 to 0.46% of forearm length. The average and peak surface deviation between the scaled CS2 model and individual scans along the forearm varied from 0.56 to 2.86 mm (subject averages) and 3.86 to 7.16 (subject maximums), with the peak deviation occurring between 45 and 50% RS length. The developed equations allow reconstruction of a scalable 3D model that can be sized based on two user measures, RS length and forearm circumference, or based on generic arm measurements taken from existing anthropometric databases.

Medical Devices for Tremor Suppression: Current Status and Future Directions

Tremors are the most prevalent movement disorder that interferes with the patient’s daily living, and physical activities, ultimately leading to a reduced quality of life. Due to the pathophysiology of tremor, developing effective pharmacotherapies, which are only suboptimal in the management of tremor, has many challenges. Thus, a range of therapies are necessary in managing this progressive, aging-associated disorder. Surgical interventions such as deep brain stimulation are able to provide durable tremor control. However, due to high costs, patient and practitioner preference, and perceived high risks, their utilization is minimized. Medical devices are placed in a unique position to bridge this gap between lifestyle interventions, pharmacotherapies, and surgical treatments to provide safe and effective tremor suppression. Herein, we review the mechanisms of action, safety and efficacy profiles, and clinical applications of different medical devices that are currently available or have been previously investigated for tremor suppression. These devices are primarily noninvasive, which can be a beneficial addition to the patient’s existing pharmacotherapy and/or lifestyle intervention.

Tremor Control Devices for Essential Tremor: A Systematic Literature Review

Background

There is a growing interest in nonpharmacological approaches for essential tremor (ET), including tremor cancelation devices. However, the true efficacy of such devices in ET remains unclear.

Methods

A systematic literature review was conducted using standardized criteria regarding efficacy and comfortability. Devices focused on design or experimental testing in which tremor was simulated in a robot were excluded.

Results

Out of 324 articles initially identified, 12 articles were included. Orthoses using biomechanical loading and neuromodulation with electrical stimulation, and external tremor cancelation devices, were the main interventions used to suppress tremor. All devices were designed to control tremor of the upper limbs at different anatomical locations. Overall, an average tremor attenuation of 50–98% was reported (level of evidence III). Interference with voluntary movements and portability was described as the main drawback.

Discussion

In conclusion, this review highlights the growing interest in emerging tremor control devices and the importance of assessing comfort without affecting voluntary movements. However, the level of evidence regarding the efficacy of these tremor control devices remains low. An integrated multidisciplinary combination approach of engineering, robotics, physiology, physiotherapy, and clinical assessment is needed to improve the quality of non-pharmacological interventions for ET.

Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review

INTRODUCTION

Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson's disease or essential tremor over the age of 65. Conventionally, tremor diseases like Parkinson's are treated with medication. An alternative non-invasive symptom treatment is the mechanical suppression of the oscillation movement. The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments.

METHOD

A systematic literature search was conducted by performing a keyword combination search of the title, abstract and keyword sections in the four databases Web of Science, MedLine, Scopus, and ProQuest. Initially, the retrieved articles were selected by title and abstract using selection criteria. The same criteria were then applied to the full publication text. After the selection process, relevant information on the retrieved orthoses was isolated, sorted and analysed systematically.

RESULTS

Forty-six papers, representing 21 orthoses, were identified and analysed according to the mechanical and ergonomic properties. The identified orthoses can be divided into 5 concepts and 16 functional prototypes, then subdivided further based upon their use of passive, semi-active, or active suppression mechanisms. Most of the orthoses concentrate on the wrist and elbow flexion and extension. They mainly rely on rigid structures and actuators while having tremor-suppression efficacies for tremorous subjects from 30 to 98% using power spectral density or other methods.

CONCLUSION

The comparison of tremor-suppression orthoses considered and mapped their various mechanical and ergonomic properties, including the degrees of freedom, weight, suppression characteristics, and efficacies. This review shows that most of the orthoses are bulky and heavy, with a non-adapted human-machine interface which can cause rejection by the user. The main challenge of the design of an effective, minimally intrusive and portable tremor-suppressing orthosis is the integration of compact, powerful, lightweight, and non-cumbersome suppression mechanisms. None of the existing prototypes combine all the desired characteristics. Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance.

Controlling a motorized orthosis to follow elbow volitional movement: tests with individuals with pathological tremor

BACKGROUND

There is a need for alternative treatment options for tremor patients who do not respond well to medications or surgery, either due to side effects or poor efficacy, or that are excluded from surgery. The study aims to evaluate feasibility of a voluntary-driven, speed-controlled tremor rejection approach with individuals with pathological tremor. The suppression approach was investigated using a robotic orthosis for suppression of elbow tremor. Importantly, the study emphasizes the performance in relation to the voluntary motion.

METHODS

Nine participants with either Essential Tremor (ET) or Parkinson's disease (PD) were recruited and tested off medication. The participants performed computerized pursuit tracking tasks following a sinusoid and a random target, both with and without the suppressive orthosis. The impact of the Tremor Suppression Orthosis (TSO) at the tremor and voluntary frequencies was determined by the relative power change calculated from the Power Spectral Density (PSD). Voluntary motion was, in addition, assessed by position and velocity tracking errors.

RESULTS

The suppressive orthosis resulted in a 94.4% mean power reduction of the tremor (p < 0.001) - a substantial improvement over reports in the literature. As for the impact to the voluntary motion, paired difference tests revealed no statistical effect of the TSO on the relative power change (p = 0.346) and velocity tracking error (p = 0.283). A marginal effect was observed for the position tracking error (p = 0.05). The interaction torque with the robotic orthosis was small (0.62 Nm) when compared to the maximum voluntary torque that can be exerted by adult individuals at the elbow joint.

CONCLUSIONS

Two key contributions of this work are first, a recently proposed approach is evaluated with individuals with tremor demonstrating high levels of tremor suppression; second, the impact of the approach to the voluntary motion is analyzed comprehensively, showing limited inhibition. This study also seeks to address a gap in studies with individuals with tremor where the impact of engineering solutions on voluntary motion is unreported. This study demonstrates feasibility of the wearable technology as an effective treatment that removes tremor with limited impediment to intentional motion. The goal for such wearable technology is to help individuals with pathological tremor regain independence in activities affected by the tremor condition. Further investigations are needed to validate the technology.

Design of a noninvasive and smart hand tremor attenuation system with active control: a simulation study

This paper presents the design and simulation of a handheld device for people with hand tremor, such as Parkinson's and essential tremor patients. This device can be used as a pen for smartphones or as a spoon. The designed system includes two links, which are connected to two servomotors, which are mounted in orthogonal directions. To attenuate the effect of hand tremor on the tip of device, PID and computed torque methods are used to actively control the system. These controllers are used to control the rotation of the motors for moving the links in opposite directions of the hand tremor. Performance of the device with mentioned controllers is studied for different applications and finally, the results of both controllers are discussed and compared. Based on the presented results in this study, the designed device is able to suppress the hand tremor up to 75% during eating and 65% during following a spiral pattern. Graphical abstract Design of a noninvasive and smart hand tremor attenuation system: a simulation study.

Vib-bracelet: a passive absorber for attenuating forearm tremor

Tremor is a rhythmic, involuntary, oscillatory movement of a limb produced by alternating contractions of reciprocally innervated muscles. More than 4% of the population over 40 years old suffer from tremor. There is no cure for most tremors, and while psychological therapy is sometimes helpful, tremors are usually treated with either medication or invasive surgery including thalamotomy and deep brain stimulation. Both medications and surgery may have adverse effects, and thus, there is a growing interest in developing non-invasive vibration attenuation devices. This paper presents a passive absorber device for attenuating pronation/supination tremor, dubbed Vib-bracelet. It is based on the principles of dynamic vibration absorption and is tuned to the frequency of the tremor. Prototypes were manufactured and tested on a mechanical model of the human forearm. Simulations and experiments demonstrate the efficiency of the device in attenuating vibrations in the range of 4-6 Hz, which is the range of frequency of observed tremor, with maximum amplitude attenuation of 85%.