Archive for category Robotics

[Abstract] Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects  

Abstract:

Rehabilitation robots have become increasingly popular for stroke rehabilitation. However, the high cost of robots hampers their implementation on a large scale. This study implements the concept of a modular and reconfigurable robot, reducing its cost and size by adopting different therapeutic end effectors for different training movements using a single robot. The challenge is to increase the robot’s portability and identify appropriate kinds of modular tools and configurations. Because literature on the effectiveness of this kind of rehabilitation robot is still scarce, this paper presents the design of a portable and reconfigurable rehabilitation robot and describes its use with a group of post-stroke patients for wrist and forearm training. Seven stroke subjects received training using a reconfigurable robot for 30 sessions, lasting 30 minutes per session. Post-training, statistical analysis showed significant improvement of 3.29 points (16.20%, p = 0.027) on the Fugl-Meyer Assessment Scale for forearm and wrist components (FMA-FW). Significant improvement of active range of motion (AROM) was detected in both pronation-supination (75.59%, p = 0.018) and wrist flexion-extension (56.12%, p = 0.018) after the training. These preliminary results demonstrate that the developed reconfigurable robot could improve subjects’ wrist and forearm movement.

Source: Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects – IEEE Xplore Document

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[ARTICLE] Exercising daily living activities in robot-mediated therapy – Full Text PDF

Abstract

[Purpose] Investigation of the efficacy of robot-mediated therapy of the upper limb in patients with chronic stroke, in task-oriented training activities of daily living in real environment.

[Subjects and Methods] 20 patients, each more than one year post-stroke (13–71 months) received 20 sessions of upper limb robot-mediated therapy. No other treatment was given. Each therapy session consisted of a passive motion and an active task therapy. During the active therapy, subjects exercised 5 activities of daily living. Assessments of the subjects were blind, and conducted one month prior to, at the start, at the end, and three months after the therapy course. The following outcome measures were recorded: Fugl-Meyer Scale—upper extremity subsection, Modified Ashworth Scale, Action Research Arm Test, Functional Independence Measure, Barthel Index.

[Results] Significant improvements were observed between the start and the end of the therapy, except for Modified Ashworth Scale and Barthel Index. Results still held up at the follow-up visit three months later.

[Conclusion] Practicing activities of daily living in real environment with robot-mediated physical therapy can improve the motor and functional ability of patients, even with relatively good initial functions, and even years post-stroke.

Full Text Pdf

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[WEB SITE] Regain Use of Arm After Stroke – National Stroke Association

Regain Use of Arm After Stroke
Technology Now Widely Available Means Moderately to Severely Weakened Arms and Hands May Function Again

Experiencing a stroke can be devastating.  Many are left with an arm so weak it seems useless.  The biggest loss can be your independence.

But for many, regaining use of your arm and hand and your independence is possible.  Myomo, a medical robotics company, has developed the MyoPro—a lightweight, non-invasive powered brace (orthosis). It is the only orthosis that, sensing a patient’s own neurological signals through sensors on the surface of the skin, can restore their ability to use their arms and hands so that they can return to work, live independently and reduce their cost of care.

Hundreds of patients have used it successfully.  It is recommended by clinicians at leading rehabilitation facilities and 20 VA hospitals. (MyoPro is not for everyone and your results may vary.)

Read the whitepaper Technology Giving Hope to Stroke Patients Now Widely Available and see videos of patients and physicians describing their experience with MyoPro.

LEARN MORE

Source: National Stroke Association

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[ARTICLE] A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke – Full Text

Abstract

Background

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs.

Method

In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training.

Results

In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT).

Conclusions

The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers.

Background

Stroke is a main cause of long-term disability in adults [1]. Approximately 70 to 80% stroke survivors experienced impairments in their upper extremity, which greatly affects the independency of their daily living [23]. In the upper limb rehabilitation, it also has been found that the recovery of the proximal joints, e.g., the shoulder and the elbow, is much better than the distal, e.g., the wrist and fingers [45]. The main possible reasons are: 1) The spontaneous motor recovery in early stage after stroke is from the proximal to the distal; and 2) the proximal joints experienced more effective physical practices than the distal joints throughout the whole rehabilitation process, since the proximal joints are easier to be handled by a human therapist and are more voluntarily controllable by most of stroke survivors [2]. However, improved proximal functions in the upper limb without the synchronized recovery at the distal makes it hard to apply the improvements into meaningful daily activities, such as reaching out and grasping objects, which requires the coordination among the joints of the upper limb, including the hand. More effective rehabilitation methods which may benefit the functional restoration at both the proximal and the distal are desired for post-stroke upper limb rehabilitation.

Besides the weakness and spasticity of muscles in the paretic upper limb, discoordination among muscles is also one of the major impairments after stroke, mainly reflected as abnormal muscular co-activating patterns and loss of independent joint control [26]. Stereotyped movements of the entire limb with compensation from the proximal joints are commonly observed in most of persons with chronic stroke who have passed six months after the onset of the stroke, during which abnormal motor synergies were gradually developed. Neuromuscular electrical stimulation (NMES) is a technique that can generate limb movements by applying electrical current on the paretic muscles [7]. Post-stroke rehabilitation assisted with NMES has been found to effectively prevent muscle atrophy and improve muscle strength [7], and the stimulation also evokes sensory feedback to the brain during muscle contraction to facilitate motor relearning [8]. It has been found that NMES can improve muscular coordination in a paralysed limb by limiting ‘learned disuse’ that stroke survivors are gradually accustomed to managing their daily activities without using certain muscles, which has been considered as a significant barrier to maximizing the recovery of post-stroke motor function [9]. However, difficulties have been found in NMES alone to precisely activate groups of muscles for dynamic and coordinated limb movements with desired accuracy in kinematics, for example, speeds and trajectories. It is because most of the NMES systems adopted transcutaneous stimulation with surface electrodes only recruiting muscles located closely to the skin surface with limited stimulation channels [8]. Therefore, the muscular force evoked may not be enough to achieve the precise limb motions. However, limb motions with repeated and close-to-normal kinematic experiences are necessary to enhance the sensorimotor pathways in rehabilitation, which has been found to contribute to the motor recovery after stroke [10]. Furthermore, faster muscular fatigue would be experienced when using NMES with intensive stimuli, in comparison with the muscle contraction by biological neural stimulation [11].

The use of rehabilitation robots is one of the solutions to the shortage of affordable professional manpower in the industry of physical therapy, to cope with the long-term and labour-demanding physical practices [10]. In comparison with the NMES, robots can well control the limb movements with electrical motors. Various robots have been proposed for upper limb training after stroke [1213]. Among them, the robots with the involvement of voluntary efforts from persons after stroke demonstrated better rehabilitation effects than those with passive limb motions, i.e., the limb movements are totally dominated by the robots [10]. Physical training with passive motions only contributed to the temporary release of muscle spasticity; whereas, voluntary practices could improve the motor functions of the limb with longer sustainability [1014]. In our previous studies, we designed a series of voluntary intention-driven rehabilitation robotics for physical training at the elbow, the wrist and fingers [1415161718]. Residual electromyography (EMG) from the paretic muscles was used to control the robots to provide assistive torques to the limb for desired motions. The results of applying these robots in post-stroke physical training showed that the target joint could obtain motor improvements after the training; however, more significant improvements usually appeared at its neighbouring proximal joint mainly due to the compensatory exercises from the proximal muscles [1517]. In order to improve the muscle coordination during robot-assisted training, we integrated NMES into the EMG-driven robot as an intact system for wrist rehabilitation [1619]. It has been found that the combined assistance with both robot and NMES could reduce the excessive muscular activities at the elbow and improve the muscle activation levels related to the wrist, which was absent in the pure robot assisted training [16]. More recently, combined treatment with robot and NMES for the wrist by other research group also demonstrated more promising rehabilitation effectiveness in the upper limb functions than pure robot training [20]. However, most of the proposed devices are for single joint treatment, and cannot be used for multi-joint coordinated upper limb training. Furthermore, the training tasks provided by these devices are not easy to be directly translated into daily activities. We hypothesized that multi-joint coordinated upper limb training assisted by both NMES and robot could improve the muscular coordination in the whole upper limb and promote the synchronized recovery at both the proximal and distal joints. In this work, we designed a multi-joint robot and NMES hybrid system for the coordinated upper limb physical practice at the elbow, wrist and fingers. Then, the rehabilitation effectiveness with the assistance of the device was evaluated by a pilot single-group trial. EMG signals from target muscles were used for voluntary intention control for both the robot and NMES parts.

Methods

The NMES-robot system

The system developed is a wearable device as shown in Fig. 1. It can support a stroke subject to perform sequencing limb movements, i.e., 1) elbow extension, 2) wrist extension associated with hand open, 3) wrist flexion and 4) elbow flexion, with the purpose of simulating the coordination of the joints in arm reaching out, hand open for grasping, and withdrawing in daily activities. The starting position of the motion cycle was set at the elbow joint extended at 180° and the wrist extended at 45°, which is also the end point for a motion cycle. In each phase of the motion, visual guidance on a computer screen was provided to a subject by following a moving cursor on the computer screen with a constant angular velocity at 10°/s for the movement of the wrist and the elbow. The subject was asked to minimize the target and actual joint positions during the tracking. In the limb tasks, assistances would be provided from the mechanical motors and NMES at the same time related to the wrist and elbow flexion/extension. NMES alone was applied for finger extension, and there was no assistance from the system for finger flexion (hand grasp). It is because that the main impairment in the hand for persons with chronic stroke is hand open, and the hand grasp can be achieved passively due to spasticity in finger flexors, and one channel NMES has demonstrated the capacity to achieve the gross open of the hand with finger extensions in clinical practices [2]. With the attempt to reduce the overall weight of the system, especially at the distal joints, for the coordinated multi-joint training of the whole upper limb, finger motions were only supported by the NMES in this work. The robot and NMES combined effects on individual finger motions in chronic stroke have been investigated in our previous work [21]. A hanging system was used to lift up the testing limb to a horizontal level (Fig. 1), to compensate the limb gravity and the weight of the wearable part of the system (totally 895 g).

Fig. 1 a The schematic diagram of the experimental setup, b a photo of a subject who is conducting the tracking task with the NMES-robot, c a photo of a subject wearing the mechanical parts of the system, d the configuration of the NMES electrodes and EMG electrodes on a driving muscle. The driving muscles in the study are BIC, TRI, FCR and the muscle union of ECU-ED

Continue —> A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

 

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[ARTICLE] Quantification of task-dependent cortical activation evoked by robotic continuous wrist joint manipulation in chronic hemiparetic stroke – Full Text

Abstract

Background

Cortical damage after stroke can drastically impair sensory and motor function of the upper limb, affecting the execution of activities of daily living and quality of life. Motor impairment after stroke has been thoroughly studied, however sensory impairment and its relation to movement control has received less attention. Integrity of the somatosensory system is essential for feedback control of human movement, and compromised integrity due to stroke has been linked to sensory impairment.

Methods

The goal of this study is to assess the integrity of the somatosensory system in individuals with chronic hemiparetic stroke with different levels of sensory impairment, through a combination of robotic joint manipulation and high-density electroencephalogram (EEG). A robotic wrist manipulator applied continuous periodic disturbances to the affected limb, providing somatosensory (proprioceptive and tactile) stimulation while challenging task execution. The integrity of the somatosensory system was evaluated during passive and active tasks, defined as ‘relaxed wrist’ and ‘maintaining 20% maximum wrist flexion’, respectively. The evoked cortical responses in the EEG were quantified using the power in the averaged responses and their signal-to-noise ratio.

Results

Thirty individuals with chronic hemiparetic stroke and ten unimpaired individuals without stroke participated in this study. Participants with stroke were classified as having severe, mild, or no sensory impairment, based on the Erasmus modification of the Nottingham Sensory Assessment. Under passive conditions, wrist manipulation resulted in contralateral cortical responses in unimpaired and chronic stroke participants with mild and no sensory impairment. In participants with severe sensory impairment the cortical responses were strongly reduced in amplitude, which related to anatomical damage. Under active conditions, participants with mild sensory impairment showed reduced responses compared to the passive condition, whereas unimpaired and chronic stroke participants without sensory impairment did not show this reduction.

Conclusions

Robotic continuous joint manipulation allows studying somatosensory cortical evoked responses during the execution of meaningful upper limb control tasks. Using such an approach it is possible to quantitatively assess the integrity of sensory pathways; in the context of movement control this provides additional information required to develop more effective neurorehabilitation therapies.

Background

The cerebral cortex plays an important role in feedforward (i.e. voluntary motor drive) and feedback control (i.e. reflexes and modulation of spinal reflexes) of human movement [1]. Cortical damage after stroke impairs both feedforward and feedback control. Altered feedforward control after stroke has been thoroughly studied and may lead to motor impairments such as weakness and abnormal synergy-dependent motor control [23].

Cortical involvement in feedback control (including sensorimotor integration and spinal reflex modulation) requires connectivity between somatosensory receptors in the periphery and the sensorimotor cortex, yet compromised integrity of this somatosensory system after stroke has received little attention in the literature. Understanding the impact of sensory impairment, as well as motor impairment, is highly relevant for the development and selection of neurorehabilitation therapies aimed to enhance and normalize motor control [4567] and for evaluating their effectiveness.

Proprioceptive and tactile information are required for feedback control of a joint, and can be studied in an experimental setting by disturbing the joint via a robotic manipulator during motor control tasks. This robotic joint manipulation results in activation of spinal reflex loops [8910] as well as in activation of the somatosensory cortex via high-resolution sensory pathways [11]. However, the cortical activity evoked by joint manipulation and consequently the cortical involvement in feedback control have received less attention.

In able-bodied individuals, evoked cortical responses to robotic joint manipulation have been studied with transient [1213] and continuous disturbances [141516]. Continuous disturbances uninterruptedly provide input to the sensory system, allowing for studying movement control and somatosensory cortical activity during meaningful motor tasks. This study determines the cortical representation of afferent (proprioceptive and tactile) information in individuals with chronic hemiparetic stroke under different upper limb control conditions, relying on objective metrics derived from the electroencephalogram (EEG). Here, the goal is to quantify evoked cortical activation in individuals with chronic hemiparetic stroke, through a combination of robotic continuous joint manipulation of the paretic limb and high-density EEG. The evoked cortical activation reveals the integrity of the connections between sensory receptors in the periphery and the sensorimotor cortices.

It is hypothesized that, due to stroke-induced damage to the somatosensory system, individuals with clinically assessed proprioceptive and tactile impairment will show decreased cortical evoked responses to continuous joint manipulation in the absence of voluntary motor activity of the affected upper limb, as compared to unimpaired persons. In general, when voluntary motor activity of the affected upper limb is required, individuals with hemiparesis have been shown to recruit their contralesional brain hemisphere, i.e. ipsilateral to the movement [17181920]. It is unclear, however, what this recruitment means with regard to somatosensory (i.e. afferent) evoked cortical activity, as the anatomical pathways conducting proprioceptive and tactile information mainly connect to the contralateral hemisphere [21]; thus, increased evoked cortical activation of the ipsilateral hemisphere is not expected.

Continue —> Quantification of task-dependent cortical activation evoked by robotic continuous wrist joint manipulation in chronic hemiparetic stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Experimental setup. a The forearm of the participant is strapped into an armrest and the hand is strapped to the handle of the robotic manipulator, requiring no hand force to hold the handle. b Visual feedback as presented to the participant. The circle and crosshairs are always visible. The yellow arrow is only visible during the active task and points up if the target torque is applied. c Close-up of the arm in the robotic manipulator. The wrist joint is aligned with the axis of the motor and is placed in the neutral angle, defined as 20° wrist flexion. d One period of the disturbance signal applied to the wrist (root-mean-square of 0.02 rad). Zero radians corresponds to the neutral angle of the wrist

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[WEB SITE] Press Release: New Move to Use Robots for Stroke Rehabilitation – scriptproject.eu

Due to the high costs of clinical neuro-rehabilitation, post stroke treatments are limited in all countries to only a few weeks to months after the stroke event. Any system aimed at pro-longing neuro-rehabilitation out of the clinics, for example at patients’ homes; that can use low cost treatments, addresses a major issue in our current health care management systems.

How SCRIPT will contribute:

The SCRIPT project will produce two prototype robotic devices, a passive‐actuated device and one actuated actively, both of which can be used in the stroke patient’s home. Provision of motivating and challenging therapeutic activities using a robotic hand and wrist rehabilitation device at home, will provide a chance for more frequent therapies and interactions. It is thought that such frequent interaction will further influence recovery at chronic phases of stroke rehabilitation.

The principal aims of SCRIPT are to:

• use such rehabilitative technologies at patient’s home to enable better management of chronic stroke patients
• focus on hand and wrist exercise; as this presents the least researched area with the most functional relevance and potential for contribution to personal independence.
• look at differences between passive and active actuated devices.
• provide an educational, motivational and engaging interaction, therefore making a therapy session more enjoyable for patients.
• focus on remote management and support of the patient.
• deduce from summative evaluation in this project, the impact on health and recovery and its potential cost implications.

The SCRIPT multidisciplinary team has existing expertise in all aspects of robot‐mediated therapy, clinical evaluation and interface design and usability. After their discharge from the hospital a patient can begin using the SCRIPT developed robotic tools at home. SCRIPT systems will be adaptive to the user requirements and provide immediate feedback to a patient on their performance. The feedback will also be provided to an “off-site” health care professional with in‐depth considerations for security and confidentiality, who can remotely monitor progress, making adjustments to the support that the device provides.

We believe that the SCRIPT systems will be beneficial to patient recovery and can assist with improving their quality of life. SCRIPT will reduce hospital and home visits for patients & carers, and therefore have a large impact on reducing hospital costs; improving the quality and standard of care.

The SCRIPT project is partially funded by the European Commission under the 7th Framework Programme. The project activities will last for 36 months.

The Project partners are:

Coordinator: UNIVERSITY OF HERTFORDSHIRE HIGHER EDUCATION CORPORATION (UH), UK

R.U.ROBOTS LIMITED (RUR), United Kingdom
THE UNIVERSITY OF SHEFFIELD (USFD), United Kingdom
UNIVERSITEIT TWENTE (UT), Netherlands
ROESSINGH RESEARCH AND DEVELOPMENT BV (RRD),Netherlands
MOOG BV (MOOG), Netherlands
SAN RAFFAELE S.p.A. (SRS), Italy
USER INTERFACE DESIGN GMBH (UID), Germany

For any further information about project development and implementation, please contact:

Dr.Farshid Amirabdollahian
School of Computer Science
University of Hertfordshire
College Lane
Hatfield Herts AL10 9AB
United Kingdom
Ph: +44-1707286125
Fax:+44-1707-286-423

Further information can be found at:

http://cordis.europa.eu/fp7/ict/
http://ec.europa.eu/information_society

See our links section for other media coverage from the press release

Source: Press Release: New Move to Use Robots for Stroke Rehabilitation | scriptproject.eu

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[Abstract] A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation

Abstract

In this paper, we present the combination of our soft supernumerary robotic finger i.e. Soft-SixthFinger with a commercially available zero gravity arm support, the SaeboMAS. The overall proposed system can provide the needed assistance during paretic upper limb rehabilitation involving both grasping and arm mobility to solve task-oriented activities. The Soft-SixthFinger is a wearable robotic supernumerary finger designed to be used as an active assistive device by post stroke patients to compensate the paretic hand grasp. The device works jointly with the paretic hand/arm to grasp an object similarly to the two parts of a robotic gripper. The SaeboMAS is a commercially available mobile arm support to neutralize gravity effects on the paretic arm specifically designed to facilitate and challenge the weakened shoulder muscles during functional tasks. The proposed system has been designed to be used during the rehabilitation phase when the arm is potentially able to recover its functionality, but the hand is still not able to perform a grasp due to the lack of an efficient thumb opposition. The overall system also act as a motivation tool for the patients to perform task-oriented rehabilitation activities.

With the aid of proposed system, the patient can closely simulate the desired motion with the non-functional arm for rehabilitation purposes, while performing a grasp with the help of the Soft-SixthFinger. As a pilot study we tested the proposed system with a chronic stroke patient to evaluate how the mobile arm support in conjunction with a robotic supernumerary finger can help in performing the tasks requiring the manipulation of grasped object through the paretic arm. In particular, we performed the Frenchay Arm Test (FAT) and Box and Block Test (BBT). The proposed system successfully enabled the patient to complete tasks which were previously impossible to perform.

Source: A soft supernumerary robotic finger and mobile arm support for grasping compensation and hemiparetic upper limb rehabilitation

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[VIDEO] Fourier X1 Exoskeleton – Fourier Intelligence – YouTube

Δημοσιεύτηκε στις 23 Μαρ 2017

At Fourier Intelligence, we do not believe these people are fated to sit on the wheelchair in their rest life. To let them stand up, and to allow them to walk again, we started to develop a genuinely new exoskeleton products- The Fourier X1

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[Abstract+References] A Novel Human-Robot Cooperative Method for Upper Extremity Rehabilitation

Abstract

There are a certain number of arm dysfunction patients whose legs could move. Considering the neuronal coupling between arms and legs during locomotion, this paper proposes a novel human-robot cooperative method for upper extremity rehabilitation. Legs motion is considered at the passive rehabilitation training of disabled arm, and its traversed trajectory is represented by the patient trunk motion. A Kinect based vision module, two computers and a WAM robot construct the human-robot cooperative upper extremity rehabilitation system. The vision module is employed to track the position of the subject trunk in horizontal; the WAM robot is used to guide the arm of post-stroke patient to do passive training with the predefined trajectory, and meanwhile the robot follows the patient trunk movement which is tracked by Kinect in real-time. A hierarchical fuzzy control strategy is proposed to improve the position tracking performance and stability of the system, which consists of an external fuzzy dynamic interpolation strategy and an internal fuzzy PD position controller. Four experiments were conducted to test the proposed method and strategy. The experimental results show that the patient felt more natural and comfortable when the human-robot cooperative method was applied; the subject could walk as he/she wished in the visual range of Kinect. The hierarchical fuzzy control strategy performed well in the experiments. This indicates the high potential of the proposed human-robot cooperative method for upper extremity rehabilitation.

Source: A Novel Human-Robot Cooperative Method for Upper Extremity Rehabilitation | SpringerLink

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[ARTICLE] Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review protocol – Full Text

Abstract

Review question/objective: The objective of this review is to synthesize the best available evidence on the effectiveness of robotic assistive devices in the rehabilitation of adult stroke patients for recovery of impairments in the upper and lower limbs. The secondary objective is to investigate the sustainability of treatment effects associated with use of robotic devices.

The specific review question to be addressed is: can robotic assistive devices help adult stroke patients regain motor movement of their upper and lower limbs?

Background

Stroke is a leading cause of long-term disability and is the third most common cause of mortality in developed countries with 15 million people suffering a stroke yearly.1 Different parts of the brain control different bodily functions. If a person survives a stroke, the effects can vary, depending on the location of brain damage, severity and duration of the stroke. Broadly, the effects of stroke can be physical, cognitive or emotional in nature. In terms of the physical effects of stroke, the loss of motor abilities of the limbs presents significant challenges for patients, as their mobility and activities of daily living (ADLs) are affected. The upper or lower limbs can experience weakness (paresis) or paralysis (plegia), with the most common type of limb impairment being hemiparesis, which affects eight out of 10 stroke survivors.2 Other physical effects of stroke are loss of visual fields, vision perception, difficulty swallowing (dysphagia), apraxia of speech, incontinence, joint pain or neuropathic pain (caused by inability of the brain to correctly interpret sensory signals in response to stimuli on the affected limbs). Cognitive effects of stroke are aphasia, memory loss and vascular dementia. Stroke patients can lose the ability to understand speech or the capacity to read, think or reason, and normal mental tasks can present big challenges, affecting their quality of life. The drastic changes in physical and cognitive abilities caused by stroke also lead to emotional effects for stroke patients. Stroke survivors can experience depression when they encounter problems in doing tasks that they can easily do pre-stroke. Along with depression, they can experience a lack of motivation and mental fatigue.

For stroke patients, rehabilitation is the pathway to regaining or managing their impaired functions. There is no definite end to recovery but the most rapid improvement is within the first six months post stroke.3 Before a patient undergoes rehabilitation, an assessment is first done to determine if a patient is medically stable and fit for a rehabilitation program. If the patient is assessed to be suitable, then depending on the level of rehabilitative supervision required, the patient could undergo rehabilitation in various settings – as an in-patient/outpatient (at either a hospital or nursing facility) or at home.3,4Rehabilitation should be administered by a multi-disciplinary team of physiotherapists, occupational therapist, speech therapist and neuropsychologists, who work together to offer an integrated, holistic rehabilitation therapy.4 Depending on the type of impairment, rehabilitation specialists will assess the appropriate therapies needed and set realistic goals for patients to achieve. Generally, stroke patients should be given a minimum of 45 min for each therapy session over at least five days per week, as long as the patient can tolerate the rehabilitation regimen.3

One of the main goals in stroke rehabilitation is the restoration of motor skills, and this involves patients undergoing repetitive, high-intensity, task-specific exercises that enable them to regain their motor and functional abilities.5,6 It is theorized that the brain is plastic in nature and that repetitive exercises over long periods can enable the brain to adapt and regain the motor functionality that has been repeatedly stimulated.7This involves the formation of new neuronal interconnections that enable the re-transmission of motor signals.8

Source: Effectiveness of robotic assisted rehabilitation for mobilit… : JBI Database of Systematic Reviews and Implementation Reports

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