Attention Enhancement for Exoskeleton-Assisted Hand Rehabilitation Using Fingertip Haptic Stimulation

Emerging Biomedical and Clinical Applications of 3D-Printed Poly(Lactic Acid)-Based Devices and Delivery Systems

Poly(lactic acid) (PLA) is widely used in the field of medicine due to its biocompatibility, versatility, and cost-effectiveness. Three-dimensional (3D) printing or the systematic deposition of PLA in layers has enabled the fabrication of customized scaffolds for various biomedical and clinical applications. In tissue engineering and regenerative medicine, 3D-printed PLA has been mostly used to generate bone tissue scaffolds, typically in combination with different polymers and ceramics. PLA's versatility has also allowed the development of drug-eluting constructs for the controlled release of various agents, such as antibiotics, antivirals, anti-hypertensives, chemotherapeutics, hormones, and vitamins. Additionally, 3D-printed PLA has recently been used to develop diagnostic electrodes, prostheses, orthoses, surgical instruments, and radiotherapy devices. PLA has provided a cost-effective, accessible, and safer means of improving patient care through surgical and dosimetry guides, as well as enhancing medical education through training models and simulators. Overall, the widespread use of 3D-printed PLA in biomedical and clinical settings is expected to persistently stimulate biomedical innovation and revolutionize patient care and healthcare delivery.

Soft pneumatic muscles for post-stroke lower limb ankle rehabilitation: leveraging the potential of soft robotics to optimize functional outcomes

Introduction: A soft pneumatic muscle was developed to replicate intricate ankle motions essential for rehabilitation, with a specific focus on rotational movement along the x-axis, crucial for walking. The design incorporated precise geometrical parameters and air pressure regulation to enable controlled expansion and motion. Methods: The muscle's response was evaluated under pressure conditions ranging from 100-145 kPa. To optimize the muscle design, finite element simulation was employed to analyze its performance in terms of motion range, force generation, and energy efficiency. An experimental platform was created to assess the muscle's deformation, utilizing advanced techniques such as high-resolution imaging and deep-learning position estimation models for accurate measurements. The fabrication process involved silicone-based materials and 3D-printed molds, enabling precise control and customization of muscle expansion and contraction. Results: The experimental results demonstrated that, under a pressure of 145 kPa, the y-axis deformation (y-def) reached 165 mm, while the x-axis and z-axis deformations were significantly smaller at 0.056 mm and 0.0376 mm, respectively, highlighting the predominant elongation in the y-axis resulting from pressure actuation. The soft muscle model featured a single chamber constructed from silicone rubber, and the visually illustrated and detailed geometrical parameters played a critical role in its functionality, allowing systematic manipulation to meet specific application requirements. Discussion: The simulation and experimental results provided compelling evidence of the soft muscle design's adaptability, controllability, and effectiveness, thus establishing a solid foundation for further advancements in ankle rehabilitation and soft robotics. Incorporating this soft muscle into rehabilitation protocols holds significant promise for enhancing ankle mobility and overall ambulatory function, offering new opportunities to tailor rehabilitation interventions and improve motor function restoration.

Stimulation enhancement effect of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation

Introduction

Providing stimulation enhancements to existing hand rehabilitation training methods may help stroke survivors achieve better treatment outcomes. This paper presents a comparison study to explore the stimulation enhancement effects of the combination of exoskeleton-assisted hand rehabilitation and fingertip haptic stimulation by analyzing behavioral data and event-related potentials.

Methods

The stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are also investigated. Fingertip haptic stimulation was combined with exoskeleton-assisted hand rehabilitation while the haptic stimulation was synchronized with the motion of our hand exoskeleton. In the experiments, three experimental modes, including exoskeleton-assisted grasping motion without haptic stimulation (Mode 1), exoskeleton-assisted grasping motion with haptic stimulation (Mode 2), and exoskeleton-assisted grasping motion with a water bottle (Mode 3), were compared.

Results

The behavioral analysis results showed that the change of experimental modes had no significant effect on the recognition accuracy of stimulation levels (p = 0.658), while regarding the response time, exoskeleton-assisted grasping motion with haptic stimulation was the same as grasping a water bottle (p = 0.441) but significantly different from that without haptic stimulation (p = 0.006). The analysis of event-related potentials showed that the primary motor cortex, premotor cortex, and primary somatosensory areas of the brain were more activated when both the hand motion assistance and fingertip haptic feedback were provided using our proposed method (P300 amplitude 9.46 μV). Compared to only applying exoskeleton-assisted hand motion, the P300 amplitude was significantly improved by providing both exoskeleton-assisted hand motion and fingertip haptic stimulation (p = 0.006), but no significant differences were found between any other two modes (Mode 2 vs. Mode 3: p = 0.227, Mode 1 vs. Mode 3: p = 0.918). Different modes did not significantly affect the P300 latency (p = 0.102). Stimulation intensity had no effect on the P300 amplitude (p = 0.295, 0.414, 0.867) and latency (p = 0.417, 0.197, 0.607).

Discussion

Thus, we conclude that combining exoskeleton-assisted hand motion and fingertip haptic stimulation provided stronger stimulation on the motor cortex and somatosensory cortex of the brain simultaneously; the stimulation effects of the touch sensations created by a water bottle and that created by cutaneous fingertip stimulation with pneumatic actuators are similar.

Vibrotactile enhancement in hand rehabilitation has a reinforcing effect on sensorimotor brain activities

Objective

Stroke patients often suffer from hand dysfunction or loss of tactile perception, which in turn interferes with hand rehabilitation. Tactile-enhanced multi-sensory feedback rehabilitation is an approach worth considering, but its effectiveness has not been well studied. By using functional near-infrared spectroscopy (fNIRS) to analyze the causal activity patterns in the sensorimotor cortex, the present study aims to investigate the cortical hemodynamic effects of hand rehabilitation training when tactile stimulation is applied, and to provide a basis for rehabilitation program development.

Methods

A vibrotactile enhanced pneumatically actuated hand rehabilitation device was tested on the less-preferred hand of 14 healthy right-handed subjects. The training tasks consisted of move hand and observe video (MO), move hand and vibration stimulation (MV), move hand, observe video, and vibration stimulation (MOV), and a contrast resting task. Region of interest (ROI), a laterality index (LI), and causal brain network analysis methods were used to explore the brain’s cortical blood flow response to a multi-sensory feedback rehabilitation task from multiple perspectives.

Results

(1) A more pronounced contralateral activation in the right-brain region occurred under the MOV stimulation. Rehabilitation tasks containing vibrotactile enhancement (MV and MOV) had significantly more oxyhemoglobin than the MO task at 5 s after the task starts, indicating faster contralateral activation in sensorimotor brain regions. (2) Five significant lateralized channel connections were generated under the MV and MOV tasks (p < 0.05), one significant lateralized channel connection was generated by the MO task, and the Rest were not, showing that MV and MOV caused stronger lateralization activation. (3) We investigated all thresholds of granger causality (GC) resulting in consistent relative numbers of effect connections. MV elicited stronger causal interactions between the left and right cerebral hemispheres, and at the GC threshold of 0.4, there were 13 causal network connection pairs for MV, 7 for MO, and 9 for MOV.

Conclusion

Vibrotactile cutaneous stimulation as a tactile enhancement can produce a stronger stimulation of the brain’s sensorimotor brain areas, promoting the establishment of neural pathways, and causing a richer effect between the left and right cerebral hemispheres. The combination of kinesthetic, vibrotactile, and visual stimulation can achieve a more prominent training efficiency from the perspective of functional cerebral hemodynamics.

A Real-Time EMG-Based Fixed-Bandwidth Frequency-Domain Embedded System for Robotic Hand

The signals from electromyography (EMG) have been used for volitional control of robotic assistive devices with the challenges of performance improvement. Currently, the most common method of EMG signal processing for robot control is RMS (root mean square)-based algorithm, but system performance accuracy can be affected by noise or artifacts. This study hypothesized that the frequency bandwidths of noise and artifacts are beyond the main EMG signal frequency bandwidth, hence the fixed-bandwidth frequency-domain signal processing methods can filter off the noise and artifacts only by processing the main frequency bandwidth of EMG signals for robot control. The purpose of this study was to develop a cost-effective embedded system and short-time Fourier transform (STFT) method for an EMG-controlled robotic hand. Healthy volunteers were recruited in this study to identify the optimal myoelectric signal frequency bandwidth of muscle contractions. The STFT embedded system was developed using the STM32 microcontroller unit (MCU). The performance of the STFT embedded system was compared with RMS embedded system. The results showed that the optimal myoelectric signal frequency band responding to muscle contractions was between 60 and 80 Hz. The STFT embedded system was more stable than the RMS embedded system in detecting muscle contraction. Onsite calibration was required for RMS embedded system. The average accuracy of the STFT embedded system is 91.55%. This study presents a novel approach for developing a cost-effective and less complex embedded myoelectric signal processing system for robot control.

Utility of a wearable robot for the fingers that uses pneumatic artificial muscles for patients with post-stroke spasticity

Mita M, Suzumori K, Kudo D, Saito K, Chida S, Hatakeyama K, Shimada Y, Miyakoshi N. Utility of a wearable robot for the fingers that uses pneumatic artificial muscles for patients with post-stroke spasticity. Jpn J Compr Rehabil Sci 2022; 13: 12-16.

Objective

We investigated the utility of a wearable robot for the fingers that we developed using pneumatic artificial muscles for rehabilitation of patients with post-stroke spasticity.

Methods

Three patients with post-stroke finger spasticity underwent rehabilitation for 20 minutes a day, 5 days a week, for 3 weeks. Passive range of motion, Modified Ashworth Scale (MAS), and circumference of each finger were measured before and after training and compared.

Results

The range of motion and finger circumference increased when using a wearable robot. The MAS improved partially, and no exacerbation was observed.

Conclusions

The wearable robot we developed is useful for rehabilitation of post-stroke spasticity and may improve venous return.