Robotics in Health Care: Perspectives of Robot-Aided Interventions in Clinical Practice for Rehabilitation of Upper Limbs

Investigations of motor performance with neuromodulation and exoskeleton using leader-follower modality: a tDCS study

This study investigates how the combination of robot-mediated haptic interaction and cerebellar neuromodulation can improve task performance and promote motor skill development in healthy individuals using a robotic exoskeleton worn on the index finger. The authors propose a leader-follower type of mirror game where participants can follow a leader in a two-dimensional virtual reality environment while the exoskeleton tracks the index finger motion using an admittance filter. The game requires two primary learning phases: the initial phase focuses on mastering the pinching interface, while the second phase centers on predicting the leader's movements. Cerebral transcranial direct current stimulation (tDCS) with anodal polarity is applied to the subjects during the game. It is shown that the subjects' performance improves as they play the game. The combination of tDCS with finger exoskeleton significantly enhances task performance. Our research indicates that modulation of the cerebellum during the mirror game improves the motor skills of healthy individuals. The results also indicate potential uses for motor neurorehabilitation in hemiplegia patients.

Neural interfaces: Bridging the brain to the world beyond healthcare

Neural interfaces, emerging at the intersection of neurotechnology and urban planning, promise to transform how we interact with our surroundings and communicate. By recording and decoding neural signals, these interfaces facilitate direct connections between the brain and external devices, enabling seamless information exchange and shared experiences. Nevertheless, their development is challenged by complexities in materials science, electrochemistry, and algorithmic design. Electrophysiological crosstalk and the mismatch between electrode rigidity and tissue flexibility further complicate signal fidelity and biocompatibility. Recent closed-loop brain-computer interfaces, while promising for mood regulation and cognitive enhancement, are limited by decoding accuracy and the adaptability of user interfaces. This perspective outlines these challenges and discusses the progress in neural interfaces, contrasting non-invasive and invasive approaches, and explores the dynamics between stimulation and direct interfacing. Emphasis is placed on applications beyond healthcare, highlighting the need for implantable interfaces with high-resolution recording and stimulation capabilities.

A meta-analysis of postoperative wound complications at the surgical site in prostate cancer patients undergoing robotic surgery

This meta-analysis critically evaluates the role of robotic surgery in reducing postoperative wound complications in prostate cancer patients, comparing it with traditional open and laparoscopic approaches. Our extensive literature search resulted in 9 studies comprising 2063 patients. The results highlighted a significant reduction in the incidence of wound complications, with an 84% heterogeneity index and a standardized mean difference (SMD) of 0.49 (95% Confidence Intervals: 0.42 to 0.58, p < 0.01) in favour of robotic surgery. Additionally, a notable decrease in wound infection rates was observed, marked by a 94% heterogeneity index and a SMD of 0.26 (95% CIs: 0.19 to 0.35, p < 0.01). A considerable reduction in wound dehiscence events was also noted, particularly in a subset of studies, reflecting a 70% heterogeneity index and a SMD of 0.23 (95% CIs: 0.12 to 0.45, p < 0.01). These findings suggest that robotic surgery may offer significant advantages in managing wound-related outcomes in prostate cancer surgeries. However, the variability among the studies warrants cautious interpretation of the results and underscores the need for more targeted research in this area.

Simulation of a control method for active kinesiotherapy with an upper extremity rehabilitation exoskeleton without force sensor

Exoskeleton-aided active rehabilitation is a process that requires sensing and acting upon the motion intentions of the user. Typically, force sensors are used for this. However, they increase the weight and cost of these wearable devices. This paper presents the methodology for detecting users' intentions only with encoders integrated with the drives. It is unique compared to other algorithms, as enables active kinesiotherapy while adding no sensory systems. The method is based on comparing the measured motion with the one computed with the idealised model of the multibody system. The investigation assesses the method's performance and its robustness to model and measurement inaccuracies, as well as patients' unintended motions. Moreover, the PID parameters are selected to provide the optimal regulation based on the dynamics requirements. The research proves the presented concept of the control approach. For all the tests with the final settings, the system reacts to a change in the user's intention below one second and minimises the changes in proportion between the system's acceleration and the generated user's joint torque. The results are comparable to those obtained by EMG-based systems and significantly better than low-cost force sensors.

Improving Outcomes in People with Spinal Cord Injury: Encouraging Results from a Multidisciplinary Advanced Rehabilitation Pathway

Spinal cord injury (SCI) consists of damage to any segment of the spinal cord extending to potential harm to nerves in the cauda equina. Rehabilitative efforts for SCI can involve conventional physiotherapy, innovative technologies, as well as cognitive treatment and psychological support. The aim of this study is to evaluate the feasibility of a dedicated, multidisciplinary, and integrated intervention path for SCI, encompassing both conventional and technological interventions, while observing their impact on cognitive, motor, and behavioral outcomes and the overall quality of life for individuals with SCI. Forty-two patients with SCI were included in the analysis utilizing electronic recovery system data. The treatment regimen included multidisciplinary rehabilitation approaches, such as traditional physiotherapy sessions, speech therapy, psychological support, robotic devices, advanced cognitive rehabilitation, and other interventions. Pre-post comparisons showed a significant improvement in lower limb function (Fugl Meyer Assessment-FMA < 0.001), global cognitive functioning (Montreal Cognitive Assessment-MoCA p < 0.001), and perceived quality of life at both a physical and mental level (Short Form-12-SF-12 p < 0.001). Furthermore, we found a significant reduction in depressive state (Beck Depression Inventory-BDI p < 0.001). In addition, we assessed patient satisfaction using the Short Form of the Patient Satisfaction Questionnaire (PSQ), offering insights into the subjective evaluation of the intervention. In conclusion, this retrospective study provides positive results in terms of improvements in motor function, cognitive functions, and quality of life, highlighting the importance of exploring multidisciplinary approaches.

Exo Supportive Devices: Summary of Technical Aspects

Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement (for rehabilitation applications). There have been several studies on using exosuits with this purpose in mind. So, the current review offers a critical perspective and a detailed analysis of the steps and key decisions involved in the conception of an exoskeleton. Choices such as design aspects, base materials (structure), actuators (force and motion), energy sources (actuation), and control systems will be discussed, pointing out their advantages and disadvantages. Moreover, examples of exosuits (full-body, upper-body, and lower-body devices) will be presented and described, including their use cases and outcomes. The future of exoskeletons as possible assisted movement solutions will be discussed-pointing to the best options for rehabilitation.

NeuroSuitUp: System Architecture and Validation of a Motor Rehabilitation Wearable Robotics and Serious Game Platform

BACKGROUND

This article presents the system architecture and validation of the NeuroSuitUp body-machine interface (BMI). The platform consists of wearable robotics jacket and gloves in combination with a serious game application for self-paced neurorehabilitation in spinal cord injury and chronic stroke.

METHODS

The wearable robotics implement a sensor layer, to approximate kinematic chain segment orientation, and an actuation layer. Sensors consist of commercial magnetic, angular rate and gravity (MARG), surface electromyography (sEMG), and flex sensors, while actuation is achieved through electrical muscle stimulation (EMS) and pneumatic actuators. On-board electronics connect to a Robot Operating System environment-based parser/controller and to a Unity-based live avatar representation game. BMI subsystems validation was performed using exercises through a Stereoscopic camera Computer Vision approach for the jacket and through multiple grip activities for the glove. Ten healthy subjects participated in system validation trials, performing three arm and three hand exercises (each 10 motor task trials) and completing user experience questionnaires.

RESULTS

Acceptable correlation was observed in 23/30 arm exercises performed with the jacket. No significant differences in glove sensor data during actuation state were observed. No difficulty to use, discomfort, or negative robotics perception were reported.

CONCLUSIONS

Subsequent design improvements will implement additional absolute orientation sensors, MARG/EMG based biofeedback to the game, improved immersion through Augmented Reality and improvements towards system robustness.

The-state-of-the-art of soft robotics to assist mobility: a review of physiotherapist and patient identified limitations of current lower-limb exoskeletons and the potential soft-robotic solutions

BACKGROUND

Soft, wearable, powered exoskeletons are novel devices that may assist rehabilitation, allowing users to walk further or carry out activities of daily living. However, soft robotic exoskeletons, and the more commonly used rigid exoskeletons, are not widely adopted clinically. The available evidence highlights a disconnect between the needs of exoskeleton users and the engineers designing devices. This review aimed to explore the literature on physiotherapist and patient perspectives of the longer-standing, and therefore greater evidenced, rigid exoskeleton limitations. It then offered potential solutions to these limitations, including soft robotics, from an engineering standpoint.

METHODS

A state-of-the-art review was carried out which included both qualitative and quantitative research papers regarding patient and/or physiotherapist perspectives of rigid exoskeletons. Papers were themed and themes formed the review's framework.

RESULTS

Six main themes regarding the limitations of soft exoskeletons were important to physiotherapists and patients: safety; a one-size-fits approach; ease of device use; weight and placement of device; cost of device; and, specific to patients only, appearance of the device. Potential soft-robotics solutions to address these limitations were offered, including compliant actuators, sensors, suit attachments fitting to user's body, and the use of control algorithms.

CONCLUSIONS

It is evident that current exoskeletons are not meeting the needs of their users. Solutions to the limitations offered may inform device development. However, the solutions are not infallible and thus further research and development is required.

Development and Validation of a System for the Assessment and Recovery of Grip Force Control

The ability to finely control hand grip forces can be compromised by neuromuscular or musculoskeletal disorders. Therefore, it is recommended to include the training and assessment of grip force control in rehabilitation therapy. The benefits of robot-mediated therapy have been widely reported in the literature, and its combination with virtual reality and biofeedback can improve rehabilitation outcomes. However, the existing systems for hand rehabilitation do not allow both monitoring/training forces exerted by single fingers and providing biofeedback. This paper describes the development of a system for the assessment and recovery of grip force control. An exoskeleton for hand rehabilitation was instrumented to sense grip forces at the fingertips, and two operation modalities are proposed: (i) an active-assisted training to assist the user in reaching target force values and (ii) virtual reality games, in the form of tracking tasks, to train and assess the user's grip force control. For the active-assisted modality, the control of the exoskeleton motors allowed generating additional grip force at the fingertips, confirming the feasibility of this modality. The developed virtual reality games were positively accepted by the volunteers and allowed evaluating the performance of healthy and pathological users.

Research on Movement Intentions of Human's Left and Right Legs Based on EEG Signals

Active rehabilitation training method can help stroke patients recover better and faster. However, the lower limb rehabilitation robot based on electroencephalogram (EEG) has low recognition accuracy now. A classification method based on EEG signals of motor imagery is proposed to enable patients to accurately control their left and right legs. Firstly, aiming at the unstable characteristics of EEG signals, an experimental protocl of motor imagery was constructed based on multi-joint motion coupling of left and right legs. The signals with time-frequency analysis and ERD/S analysis have proved the reliability and validity of the collected EEG signals. Then, the EEG signals generated by the protocol were preprocessed and Common Space Pattern (CSP) was used to extract their features. Support Vector Machine (SVM) and Linear Discriminant Analysis (LDA) are adapted and their accuracy of classification results are compared. Finally, on the basis of the proposed classifier with excellent performance, the classifier is used in the active control strategy of the lower limb rehabilitation robot, and the experiment verified that the average accuracy of two volunteers in controlling the lower limb rehabilitation robot reached 95.1%. This research provides a good theoretical basis for the realization and application of brain-computer interface in rehabilitation training.

Evaluation of the implementation of Armeo®Spring in a specialized neurorehabilitation center

Rehabilitation of the upper extremity (UE) is an essential part of the process following an acquired brain injury, where robot technologies have the potential of making the rehabilitation more intensive and effective. However, the implementation of robot technologies in a clinical setting can be complicated and not always successful. The aim of this study was to evaluate the implementation of the robot technology Armeo®Spring (Hocoma, Volketswil, Switzerland) at a specialized neurorehabilitation center, and to propose a list of actions for further implementation of the technology.The Study, Act and Plan phases of the Plan-Do-Study-Act (PDSA) model for structuring technology implementations was applied as the methodological framework in this study. In the Study-phase, nine semi-structured interviews with therapists, using Armeo®Spring, were conducted to evaluate the current implementation. In the Act-phase, a workshop was held with 13 participants to discuss the findings of the Study-phase and to find possible solutions to the identified problems. The results were incorporated into a list of actions (Plan-phase) for further implementation of Armeo®Spring.Facilitating and inhibiting factors for the implementation of Armeo®Spring were identified. Facilitating factors were the practical "hands-on" approach during training, support from the management, support and sparring with colleagues as well as a positive work culture. The inhibiting factors were related to the retention of the therapists' acquired competencies, the identification of the type of patient that can benefit from this form of training, challenges due to the technical use of Armeo®Spring, and prioritization of the rehabilitation needs of the patients.Several solutions were proposed in the Act-phase, which subsequently resulted in eight concrete actions to facilitate the further implementation of Armeo®Spring. It is expected that these actions will contribute to the further implementation of Armeo®Spring at the neurorehabilitation center. As a first step, an Armeo®Spring group with therapists from all relevant wards was established.

User perspectives on the future of mobility assistive devices: Understanding users' assistive device experiences and needs

Introduction

Current assistive devices are inadequate in addressing the needs of some people living with impaired mobility. This study explored the experiences of living with impaired mobility in relation to how wearable assistive adaptive and rehabilitative technologies may improve their quality of life.

Methods

A cross-case study approach was adopted; the case being defined as the experience of impaired mobility. Semi-structured interviews were utilised. The sample (n = 8) was purposefully selected to have impaired mobility due to stroke, age-related frailty, or lower limb amputation. From the interview transcripts, in-depth case illustrations were written to provide personal stories and thematic analysis was carried out to provide a cross-case analysis.

Results

There were two overarching themes: lifestyle changes; and wishes and desires for assistive devices. There were shared experiences across participant groups, such as falls and fear of falling. All participants identified a wish for increased speed of walking. However, the reasons for their difficulties differed depending on personal factors and their condition. Participants wanted devices to be adjustable to their perceived ability on a day-to-day basis.

Conclusions

Although common concerns and impacts of living with impaired mobility were apparent, individuals have unique requirements that should inform the design of assistive technology devices.

Kinematic of the Position and Orientation Synchronization of the Posture of a n DoF Upper-Limb Exoskeleton with a Virtual Object in an Immersive Virtual Reality Environment

Exoskeletons are an external structural mechanism with joints and links that work in tandem with the user, which increases, reinforces, or restores human performance. Virtual Reality can be used to produce environments, in which the intensity of practice and feedback on performance can be manipulated to provide tailored motor training. Will it be possible to combine both technologies and have them synchronized to reach better performance? This paper consists of the kinematics analysis for the position and orientation synchronization between an n DoF upper-limb exoskeleton pose and a projected object in an immersive virtual reality environment using a VR headset. To achieve this goal, the exoskeletal mechanism is analyzed using Euler angles and the Pieper technique to obtain the equations that lead to its orientation, forward, and inverse kinematic models. This paper extends the author’s previous work by using an early stage upper-limb exoskeleton prototype for the synchronization process.

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human-machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals-namely, family members and professional carers-to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.

A Robotic System with EMG-Triggered Functional Eletrical Stimulation for Restoring Arm Functions in Stroke Survivors

BACKGROUND

Robotic systems combined with Functional Electrical Stimulation (FES) showed promising results on upper-limb motor recovery after stroke, but adequately-sized randomized controlled trials (RCTs) are still missing.

OBJECTIVE

To evaluate whether arm training supported by RETRAINER, a passive exoskeleton integrated with electromyograph-triggered functional electrical stimulation, is superior to advanced conventional therapy (ACT) of equal intensity in the recovery of arm functions, dexterity, strength, activities of daily living, and quality of life after stroke.

METHODS

A single-blind RCT recruiting 72 patients was conducted. Patients, randomly allocated to 2 groups, were trained for 9 weeks, 3 times per week: the experimental group performed task-oriented exercises assisted by RETRAINER for 30 minutes plus ACT (60 minutes), whereas the control group performed only ACT (90 minutes). Patients were assessed before, soon after, and 1 month after the end of the intervention. Outcome measures were as follows: Action Research Arm Test (ARAT), Motricity Index, Motor Activity Log, Box and Blocks Test (BBT), Stroke Specific Quality of Life Scale (SSQoL), and Muscle Research Council.

RESULTS

All outcomes but SSQoL significantly improved over time in both groups (P < .001); a significant interaction effect in favor of the experimental group was found for ARAT and BBT. ARAT showed a between-group change of 11.5 points (P = .010) at the end of the intervention, which increased to 13.6 points 1 month after. Patients considered RETRAINER moderately usable (System Usability Score of 61.5 ± 22.8).

CONCLUSIONS

Hybrid robotic systems, allowing to perform personalized, intensive, and task-oriented training, with an enriched sensory feedback, was superior to ACT in improving arm functions and dexterity after stroke.

Lower limb rehabilitation robotics: The current understanding and technology

BACKGROUND

With the increasing rate of ambulatory disabilities and rise in the elderly population, advance methods to deliver the rehabilitation and assistive services to patients have become important. Lower limb robotic therapeutic and assistive aids have been found to improve the rehabilitation outcome.

OBJECTIVE

The article aims to present the updated understanding in the field of lower limb rehabilitation robotics and identify future research avenues.

METHODS

Groups of keywords relating to assistive technology, rehabilitation robotics, and lower limb were combined and searched in EMBASE, IEEE Xplore Digital Library, Scopus, Web of Science and Google Scholar database.

RESULTS

Based on the literature collected from the databases we provide an overview of the understanding of robotics in rehabilitation and state of the art devices for lower limb rehabilitation. Technological advancements in rehabilitation robotic architecture (sensing, actuation and control) and biomechanical considerations in design have been discussed. Finally, a discussion on the major advances, research directions, and challenges is presented.

CONCLUSIONS

Although the use of robotics has shown a promising approach to rehabilitation and reducing the burden on caregivers, extensive and innovative research is still required in both cognitive and physical human-robot interaction to achieve treatment efficacy and efficiency.

Service Robots in Catering Applications: A Review and Future Challenges

“Hello, I’m the TERMINATOR, and I’ll be your server today”. Diners might soon be feeling this greeting, with Optimus Prime in the kitchen and Wall-E then sending your order to C-3PO. In our daily lives, a version of that future is already showing up. Robotics companies are designing robots to handle tasks, including serving, interacting, collaborating, and helping. These service robots are intended to coexist with humans and engage in relationships that lead them to a better quality of life in our society. Their constant evolution and the arising of new challenges lead to an update of the existing systems. This update provides a generic vision of two questions: the advance of service robots, and more importantly, how these robots are applied in society (professional and personal) based on the market application. In this update, a new category is proposed: catering robotics. This proposal is based on the technological advances that generate new multidisciplinary application fields and challenges. Waiter robots is an example of the catering robotics. These robotic platforms might have social capacities to interact with the consumer and other robots, and at the same time, might have physical skills to perform complex tasks in professional environments such as restaurants. This paper explains the guidelines to develop a waiter robot, considering aspects such as architecture, interaction, planning, and execution.

Robotics in Simulated COVID-19 Patient Room for Health Care Worker Effector Tasks: Preliminary, Feasibility Experiments

The coronavirus disease 2019 (COVID-19) pandemic has strained health care systems and personal protective equipment (PPE) supplies globally. We hypothesized that a collaborative robot system could perform health care worker effector tasks inside a simulated intensive care unit (ICU) patient room, which could theoretically reduce both PPE use and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposures. We planned a prospective proof-of-concept feasibility and design pilot study to test 5 discrete medical tasks in a simulated ICU room of a COVID-19 patient using a collaborative robot: push a button on intravenous pole machine when alert occurs for downstream occlusion, adjust ventilator knob, push button on ICU monitor to silence false alerts, increase oxygen flow on wall-mounted flow meter to allow the patient to walk to the bathroom and back (dial-up and dial-down oxygen flow), and push wall-mounted nurse call button. Feasibility was defined as task completion robotically. A training period of 45 minutes to 1 hour was needed to program the system de novo for each task. In less than 30 days, the team completed 5 simple effector task experiments robotically. Selected collaborative robotic effector tasks appear feasible in a simulated ICU room of the COVID-19 patient. Theoretically, this robotic approach could reduce PPE use and staff SARS-CoV-2 exposure. It requires future validation and health care worker learning similar to other ICU device training.

The realization of robotic neurorehabilitation in clinical: use of computational intelligence and future prospects analysis

Introduction: Although there is a need for rehabilitation treatment with the increase in the aging population, the shortage of skilled physicians frustrates this necessity. Robotic technology has been advocated as one of the most viable methods with the potential to replace humans in providing physical rehabilitation of patients with neurological impairment. However, because the pioneering robot devices suffer several reservations such as safety and comfort concerns in clinical practice, there is an urgent need to provide upgraded replacements. The rapid development of intelligent computing has attracted the attention of researchers concerning the utilization of computational intelligence algorithms for robots in rehabilitation. Areas covered: This article reviews the state of the art and advances of robotic neurorehabilitation with computational intelligence. We classified advances into two categories: mechanical structures and control methods. Prospective outlooks of rehabilitation robots also have been discussed. Expert opinion: The aggravation of global aging has promoted the application of robotic technology in neurorehabilitation. However, this approach is not mature enough to guarantee the safety of patients. Our critical review summarizes multiple computation algorithms which have been proved to be valuable for better robotic use in clinical settings and guide the possible future advances in this industry.

Physiotherapy students' perspectives on the use and implementation of exoskeletons as a rehabilitative technology in clinical settings

PURPOSE

Wearable lower body robotic exoskeletons are an emerging technology used in gait rehabilitation to facilitate task-specific overground walking. Despite their proposed utility as a rehabilitation intervention, exoskeletons have not been widely implemented into clinical practice by physiotherapists. This study aims to inform future development of exoskeleton technology through the exploration of physiotherapy student perspectives on the use of the H2 robotic exoskeleton and the implementation of exoskeletons as a therapeutic technology in neurological gait rehabilitation.

METHODS

A qualitative descriptive study, including fifteen physiotherapy students, was conducted using three equally sized focus groups. A collaborative data analysis process was employed using the DEPICT model.

RESULTS

Five themes were identified during data analysis: developing evidence-informed practice, clinical considerations for exoskeleton use, resource demands, device-specific challenges for implementation, and future development. The results suggest there are several barriers limiting novel clinicians' future use of exoskeletons.

CONCLUSION

This study highlights current challenges surrounding exoskeleton implementation into clinical practice and provides direction for future exoskeleton development.Implications for rehabilitationPhysiotherapy students view exoskeletons as a potentially valuable rehabilitation tool once perceived limitations are addressed.This study encourages collaboration between physiotherapists and biomedical engineers for future exoskeleton development.More research is needed to inform treatment parameters and appropriate client criteria to guide exoskeleton use for gait rehabilitation.

Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review

Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician's subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.

Design Methodology for Rehabilitation Robots: Application in an Exoskeleton for Upper Limb Rehabilitation

This article presents a methodology for the design of rehabilitation devices that considers factors involved in a clinical environment. This methodology integrates different disciplines that work together. The methodology is composed by three phases and 13 stages with specific tasks, the first phase includes the clinical context considering the requirements of the patient and therapist during the rehabilitation, the second phase is focused in engineering based on the philosophy of digital twin, and in the third phase is evaluated the device. This article explains the characteristics of the methodology and how it was applied in the design of an exoskeleton for passive rehabilitation of upper limb.

Fuzzy Logic-Based Risk Assessment of a Parallel Robot for Elbow and Wrist Rehabilitation

A few decades ago, robotics started to be implemented in the medical field, especially in the rehabilitation of patients with different neurological diseases that have led to neuromuscular disorders. The main concern regarding medical robots is their safety assurance in the medical environment. The goal of this paper is to assess the risk of a medical robotic system for elbow and wrist rehabilitation in terms of robot and patient safety. The approached risk assessment follows the ISO12100:2010 risk management chart in order to determine, identify, estimate, and evaluate the possible risk that can occur during the use of the robotic system. The result of the risk assessment process is further analyzed using a fuzzy logic system in order to determine the safety degree conferred during the use of the robotic system. The innovative process concerning the risk assessment allows the achievement of a reliable medical robotic system both for the patient and the clinicians as well. The clinical trials performed on a group of 18 patients validated the functionality and the safe behavior of the robotic system.