Archive for June, 2016
The development of dynamic hand orthoses is a fast-growing field of research and has resulted in many different devices. A large and diverse solution space is formed by the various mechatronic components which are used in these devices. They are the result of making complex design choices within the constraints imposed by the application, the environment and the patient’s individual needs. Several review studies exist that cover the details of specific disciplines which play a part in the developmental cycle. However, a general collection of all endeavors around the world and a structured overview of the solution space which integrates these disciplines is missing. In this study, a total of 165 individual dynamic hand orthoses were collected and their mechatronic components were categorized into a framework with a signal, energy and mechanical domain. Its hierarchical structure allows it to reach out towards the different disciplines while connecting them with common properties. Additionally, available arguments behind design choices were collected and related to the trends in the solution space. As a result, a comprehensive overview of the used mechatronic components in dynamic hand orthoses is presented.
Human hands are complex and versatile instruments. They play an essential role in the interaction between a person and the environment. Many people suffer from hand impairments like spasticity, lack of control or muscle weakness, which may be due to the consequences of stroke, paralysis, injuries or muscular diseases. Such impairments may limit an individual’s independence in performing activities of daily living (ADL) and the ability to socially interact (e.g. non-verbal communication). Devices like hand exoskeletons, rehabilitation robots and assistive devices, here collectively termed as dynamic hand orthoses, aim to overcome these limitations. Their development is a fast-growing field of research and has already resulted in a large variety of devices [1, 2, 3, 4].
Each individual has different demands for a dynamic hand orthoses. Some patients benefit from rehabilitation therapy (e.g. stroke patients ) while others would more likely benefit from daily assistance (e.g. Duchenne Muscular Dystrophy ). The resulting diversity between the different devices can be illustrated by the elaborate overviews on robotic devices , training modalities  and intention detection systems  they use. Clearly, there are many mechatronic components to choose from and are often the result of making particular design choices within the imposed design constraints. However, not everybody has the resources (i.e. time, accessibility) to investigate all possible design choices within these constraints. Moreover, not always are design choices reported in literature and are therefore hard to retrieve. The full potential of learning from each other’s endeavors is therefore not yet fully exploited, leaving several questions in this field of research unanswered. For example, there is the discussion whether pneumatic or electric actuation is better for some applications.
The goal of this study is to collect a high quantity of dynamic hand orthoses and extract the mechatronic components which are used. Their collective properties are analyzed by using a framework which uses a generic categorization applicable for any mechatronic system: a signal domain (e.g. controllers, sensors), energy domain (e.g. energy sources, actuators) and mechanical domain (e.g. cables, linkages). Additionally, feasible technologies from other, but similar, disciplines are included (e.g. prosthetics, haptics). Trends are then visualized using bar charts and compared to available arguments behind design choices. This not only includes arguments from often-cited success-stories, but also from small-scale projects. Referring to the case of using pneumatic or electric actuation, this approach can answer how often each method is used and what arguments are reported, which may help in scoping further research and making a well-considered choice.
This paper is structured in different sections. The “Scope” section describes the boundaries and limitations of this study and Framework introduces the basis of the framework structure that is proposed. The “Results” section describes the quantitative results which illustrate the trends. How this relates to the functionality of the components, is discussed and summarized in the “Discussion” and “Conclusion” section, respectively.
Acta Neurol Scand. 2016 Mar 15. doi: 10.1111/ane.12587.
OBJECTIVES: Traumatic brain injury (TBI) may cause long-lasting post-concussive symptoms, such as mental fatigue and concentration difficulties, and this may become the main hindrance for returning to work and studies. There is currently no effective treatment for long-lasting mental fatigue. In this hypothesis generating study, the long-term effects of methylphenidate on mental fatigue, cognitive function, and safety were assessed.
MATERIALS & METHODS: Thirty participants who suffered from long-term post-concussion symptoms after a mild TBI or moderate TBI and who had reported positive effects with methylphenidate during an initial phase of this follow-up study were treated with methylphenidate for a further six months.
RESULTS: After six-month follow-up, effects on Mental Fatigue Scale (MFS), depression, anxiety, and cognitive function (processing speed, attention, working memory) were significantly improved compared to baseline data (P < 0.001, respectively). Heart rate was significantly increased (P = 0.01), while blood pressure was not changed.
CONCLUSIONS: Individuals suffering from prolonged symptoms after TBI reported reduced mental fatigue and improved cognitive functions with long-term methylphenidate treatment. It is suggested that methylphenidate can be a treatment option for long-term mental fatigue and cognitive impairment after a TBI, but further randomized control research is warranted.
[WEB SITE] New head-scanning ultrasound technology could help diagnose brain injuries – Medical News Today
Software being developed by the University of Aberdeen and funded by the Defence Science and Technology Laboratory’s (Dstl) Centre for Defence Enterprise- part of the United Kingdom’s Ministry of Defence – could help battlefield medics create 3-D models of soldiers brains while on location, which can then be sent to an expert for swift diagnosis.
The technology is still at an early stage of development but has already been trialed on real hospital patients to test its viability.
In addition to military applications, the software could also be helpful in civilian life, helping paramedics record head ultrasound to diagnose brain hemorrhage as a result ofstroke or other causes. This could be particularly useful for patients living remotely, with a long distance to travel to hospital.
“Closed” brain injuries – for example, internal bleeding or other damage caused to the head by explosions or knocks – can cause death or have severe long-term implications. If identified early enough, emergency steps can be taken to prevent long-term damage, including drilling holes in the skull to relieve pressure, or taking medication.
Dr. Leila Eadie, a researcher at the Centre for Rural Health at the University of Aberdeen, said: “There is a clear need for this technology, as outlined by Dstl. Traumatic brain injury [TBI] is a big problem for the military, especially because it can be difficult to spot in the field and if left untreated, it can have long-term effects.”
“Ultrasound is not normally used for imaging the brain, but we hope to prove through further investigations that it is a viable method of making an early diagnosis of head injury whilst in the field,” she adds.
“Battlefield medics will not have CT or MRI scanners which are bulky and expensive, but they are likely to have ultrasound equipment already, so it is a case of extending the use of the kit they already have.”
Diagnosis in the field
The ultrasound image of the brain is acquired using existing hardware as found in any hospital. The information is captured using a movement sensor attached to an ultrasound probe, which is used to scan the brain from certain points on the skull where the bone is thinnest.
The probe captures up to 40 images per second, and the resulting 3-D image can be built up from around 2,000 individual photos.
The software is designed to guide a medic with only basic training in ultrasound to produce as detailed a scan of the brain as possible, by showing the user where it has already scanned, and where has yet to be scanned. Once completed, the file containing the brain scan can be sent to an expert for analysis and appropriate advice is fed back to the medical staff on the ground.
Because of the nature of battlefield scenarios, soldiers with “invisible” injuries could be overlooked, so having a relatively simple means of scanning the head for any problematic signs would be extremely helpful.
“U.K. Armed Forces operate in many remote locations and where personnel are injured we need to ensure that all conditions can be rapidly and correctly diagnosed to provide the best possible treatment and care.
Devices which are lightweight, easy to deploy and easy to use, such as the portable ultrasound scanning support system being developed by the University of Aberdeen, have the potential to enhance our capabilities on operations and enhance patient care.”
Neal Smith, Dstl’s capability advisor for medical sciences.
Written by Matthew Driver, managing editor of The Journal of mHealth
Rehabilitation is dedicated to helping people not only survive, but also thrive. Despite this complex goal, the organizing principles of rehabilitation still rely on biomedicine to construct disability as a problem of impaired bodies. Rehabilitation professionals are committed to helping to enhance people’s lives, but many struggle with how to do so in light of the bigger questions regarding their roles in, for example, working to maintain hope for recovery and/or promoting greater acceptance of diverse abilities. A key problem is the lack of theoretical tools for working through the function of rehabilitation in the lives of disabled people. Rehabilitation, for the most part, reflects a narrow mechanistic conception of movement. It considers movements of body structures such as joints, functional movements such as walking, or more recently, how movement and mobility facilitate participation in social roles. Despite a nascent concern with the environmental factors contributing to disablement, movement is still focused primarily on mobilizing people’s bodies. Rehabilitation: A Post-critical Approach reexamines the philosophical foundations of rehabilitation, expanding the concept of movement beyond the physical body. Drawing from disability studies, sociology, anthropology, philosophy, cultural studies, and bioethics, this theoretically rigorous yet accessibly styled text: Explores the limitations of biomedicine as the organizing framework of rehabilitation Evaluates new directions to diversify contemporary rehabilitation practice Establishes the parameters for a reconfigured ethics of rehabilitation By embracing multiple ideas of movement—not only physical, but also social, emotional, and political—alternative approaches to rehabilitation are revealed.
[THESIS] AUGMENTED REALITY SYSTEM FOR REHABILITATION: NEW APPROACH BASED ON HUMAN INTERACTION AND BIOFEEDBACK – Full Text PDF
Rehabilitation is the process of training for someone in order to recover or improve their lost functions caused by neurological deficits. The upper limb rehabilitation system provides relearning of motor skills that are lost due to any neurological injuries via motor rehabilitation training. The process of motor rehabilitation is a form of motor learning via practice or experience. It requires thorough understanding and examination of neural processes involved in producing movement and learning as well as the medical aspects that may affect the central nervous system (CNS) or peripheral nervous system (PNS) in order to develop an effective treatment system. Although there are numerous rehabilitation systems which have been proposed in literatures, a low cost upper limb rehabilitation system that maximizes the functional recovery by stimulating the neural plasticity is not widely available. This is due to lack of motivation during rehabilitation training, lack of real time biofeedback information with complete database, the requirement of one to one attention between physiotherapist and patient, the technique to stimulate human neural plasticity. Therefore, the main objective of this thesis is to develop a novel low cost rehabilitation system that helps recovery not only from loss of physical functions, but also from loss of cognitive functions to fulfill the aforementioned gaps via multimodal technologies such as augmented reality (AR), computer vision and signal processing. In order to fulfill such ambitious objectives, the following contributions have been implemented. Firstly, since improvements in physical functions are targeted, the Rehabilitation system with Biofeedback simulation (RehaBio) is developed. The system enhances user’s motivation via game based therapeutic exercises and biofeedback. For this, AR based therapeutic games are developed to provide eye-hand coordination with inspiration in motivation via immediate audio and visual feedback. All the exercises in RehaBio are developed in a safe training environment for paralyzed patients. In addition to that, realtime biofeedback simulation is developed and integrated to serve in two ways: (1) from the patient’s point of view, the biofeedback simulation motivates the user to execute the movements since it will animate the different muscles in different colors, and (2) from the therapist’s point of view, the muscle simulations and EMG threshold level can be evaluated as patient’s muscle performance throughout the rehabilitation process. Secondly, a new technique that stimulates the human neural plasticity is proposed. This is a virtual human arm (VHA) model that driven by proposed continuous joint angle prediction in real time based on human biological signal, Electromyogram (EMG). The VHA model simulation aims to create the illusion environment in Augmented Realitybased Illusion System (ARIS). Finally, a complete novel upper limb rehabilitation system, Augmented Reality-based Illusion System (ARIS) is developed. The system incorporates some of the developments in RehaBio and real time VHA model to develop the illusion environment. By conducting the rehabilitation training with ARIS, user’s neural plasticity will be stimulated to reestablish the neural pathways and synapses that are able to control mobility. This is achieved via an illusion concept where an illusion scene is created in AR environment to remove the impaired real arm virtually and replace it with VHA model to be perceived as part of the user’s own body. The job of the VHA model in ARIS is when the real arm cannot perform the required task, it will take over the job of the real one and will let the user perceive the sense that the user is still able to perform the reaching movement by their own effort to the destination point. Integration with AR based therapeutic exercises and motivated immediate intrinsic and extrinsic feedback in ARIS leads to serve as a novel upper limb rehabilitation system in a clinical setting. The usability tests and verification process of the proposed systems are conducted and provided with very encouraging results. Furthermore, the developments have been demonstrated to the clinical experts in the rehabilitation field at Port Kembla Hospital. The feedback from the professionals is very positive for both the RehaBio and ARIS systems and they have been recommended to be used in the clinical setting for paralyzed patients.
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ARTICLE] tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke – Full Text
Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors.
Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL).Results. Both groups reported a significant improvement in FMA-UE score after treatment (). No significant between-groups differences were found in motor function. However, when the analysis was adjusted for stroke type and duration, a significant interaction effect () was detected, showing that stroke duration (acute versus chronic) and type (cortical versus subcortical) modify the effect of tDCS and robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes.
Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.
Stroke is a common primary cause of motor impairments and disability. Only about 15% of those with initial complete upper limb paralysis after stroke recover a functional use of their affected arm in daily life [1, 2]. Greater intensity of upper extremity training after stroke improves functional recovery  as well as repetitive task training . Motor practice, in turn, favors motor cortical reorganization, which is correlated with the degree of functional recovery . Robotic devices for upper extremity rehabilitation after stroke have been shown to improve arm function [6–9]. They may enhance conventional motor therapy, increasing repetitions of well-defined motor tasks (massed practice) with an improvement of motivation due to the feedback of the device; they can be programmed to perform in different functional modalities according to the subject level of motor impairment. Robotic assistance may increase sensory inputs and reduce muscle tone with an overall improved patients’ confidence in performing movements and tasks that, without assistance, might be frustrating or even impossible to achieve . In the past decade, neuromodulation approaches have been proposed with the aim of optimizing stroke motor rehabilitation. Among these, transcranial direct current stimulation (tDCS) represents a noninvasive tool to modulate motor cortical excitability inducing a brain polarization through the application of weak direct electrical currents on the scalp via sponge electrodes . Transient, bidirectional, polarity-dependent modifications in motor cortical excitability can be elicited: anodal stimulation increases it, whereas cathodal stimulation decreases it [12, 13]. Moreover, on a behavioral viewpoint, tDCS can promote skilled motor function in chronic stroke survivors .
After a stroke, changes in motor cortex excitability occur leading to an unbalanced interhemispheric inhibition , because the depression of the contralesional hemisphere on the affected one is not balanced by a similar level of inhibition of the lesional hemisphere onto the unaffected one. It has been hypothesized that this phenomenon represents a potential maladaptive process with detrimental effects on arm motor function . On this basis, to increase paretic arm function, an “interhemispheric competition model” has been adopted in noninvasive brain stimulation stroke research [11, 16]. Specifically, researchers applied anodal tDCS over the affected primary motor cortex (M1) , cathodal stimulation over the unaffected M1 , or, more recently, a combination of the two stimulation paradigms through a bilateral tDCS montage . How noninvasive brain stimulation effects are relevant when coupled with a peripheral stimulation as rehabilitative interventions is now well established . So far, tDCS effects on motor learning and arm function in stroke population have been extensively addressed in recent systematic reviews and meta-analysis reporting mixed conclusions [20–24]. Indeed, the effectiveness and timing of these new rehabilitative techniques need to be defined by further investigations. We can hypothesize that tDCS primes motor cortex circuits, increasing motor cortex excitability that is sustained after a robot-assisted training . Furthermore, the combination of these techniques enhances synaptic plasticity and motor relearning through long-term potentiation- (LTP-) and long-term depression- (LTD-) like phenomena on M1 .
The aims of this exploratory pilot study were twofold. Firstly, we wanted to test the effects of a bilateral tDCS montage combined with upper extremity robot-assisted training (RAT) compared to RAT alone on motor recovery, gross motor function, and arm functional use in a heterogeneous sample of stroke survivors. Secondly, we explored whether additional factors such as stroke duration and type could modify and also be predictors of tDCS and RAT response.
SEFRE (Shoulder-Elbow-Forearm Robotics Economic) rehabilitation system is presented in this paper. SEFRE Rehab System is composed of a robotic manipulator and an exoskeleton, which so called Forearm Supportive Mechanism (FSM). The controller of the system is developed as the Master PC consisting of five modules, i.e. Intelligent Control (IC), Patient Communication (PC), Training with Game (TG), Progress Monitoring (PM), and Patient Supervision (PS). These modules support a patient to exercise with SEFRE in six modes, i.e. Passive, Passive Stretching, Passive Guiding, Initiating Active, Active Assisted, and Active Resisted. To validate the advantages of the system, the pre-clinical trial was carried out at a national rehabilitation center. Here, the implement of the system and the pre-clinical results are presented as the verifications of SEFRE.
Aging era is now. Based on Thai Aging Status Report, now the elders are around 12% of Thai population, and the percentage can be double in year 2030 . More elderly require more caretakers to support their declined physical abilities, e.g. low vision, hearing problem, weakened muscles etc. Regarding to these physical impairments, there is not only dysfunction from the aging phenomena, but also the disability that caused by chronic diseases, or an accident, must be concerned. In most cases, unusable limbs might be a result for all.
An impaired ability plagues their daily life. Thus relieving any of those impairments is always a great help for them. In general, recovering functions of limbs is practicable. Therefore we focus our research on the rehabilitation of arm and leg. Since recently there are an inadequate number of caretakers, so we believe that employing robotic systems in the rehabilitation process is a must…
[ARTICLE] A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol – Full Text PDF
Background. In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted.
Objectives. To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke.
Methods. Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient’s tolerance to robotic therapy.
Results. After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p < 0.00001), Motricity Index scale (p < 0.004) and Functional Independence Measure (p < 0.001). A lesser degree of improvement was achieved using conventional rehabilitation, the Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p < 0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p < 0.023).
Conclusions. Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.
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[Abstract] Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation
Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies.
Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer.
Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context.
Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.