The occurrence of strokes has been progressively increasing. Upper limb recovery after stroke is more difficult than lower limb. One of the rapidly expanding technologies in post-stroke rehabilitation is robot-aided therapy. The advantage of robots is that they are able to deliver highly repetitive therapeutic tasks with minimal supervision of a therapist. However, from the literature, the focus of robotic design in stroke rehabilitation has been technology-driven. Clinical and therapeutic requirements were not seriously considered in the design of rehabilitation robots. The purpose of this study was twofold: (1) demonstrate the missing elements of current robot-aided therapy; (2) identify design factors and opportunities of rehabilitation robots (in upper-limb training after stroke). In this study, we performed a literature review on articles relevant to rehabilitation robots in upper-limb training after stroke. We identified the design foci of current rehabilitation robots for upper limb stroke recovery. Using the therapeutic framework for stroke rehabilitation in occupational therapy, we highlighted design factors and opportunities of rehabilitation robots. The outcomes of this study benefit the robotics design community in the design of rehabilitation robots.
A robot is defined as a machine programmable to perform and modify tasks in response to changes in the environment . The benefits of robots are noticeable in productivity, safety, and in saving time and money. The advancement of robot technologies in the past decade caused the wide adoption of robots in our lives and in the society. For instance, in education, robots were implemented in undergraduate courses to teach core artificial intelligence concepts, e.g., algorithms for searching tree data structures . In agriculture, robotic milking systems (being able to reduce labor/operational costs) were installed to replace conventional milking that gave cows the freedom to be milked throughout the day . In healthcare, service robots were implemented to provide functional assistance for the elderly in home environments, e.g., bringing medication for the emergency and picking up heavy objects low on the ground .
Source: Design factors and opportunities of rehabilitation robots in upper-limb training after stroke – IEEE Xplore Document
Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-in-one robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.
Non-communicable diseases, especially cardiovascular diseases, are the leading cause of death and disability in the world. An increase in their prevalence often leads to higher incidences of stroke and consequently, an increase in the number of persons living with permanent disability due to stroke.1,2 Stroke is the leading cause of disability worldwide. Over 6.8 million adults live in the USA with disabilities due to a stroke, and by 2030, this number will grow by 4 million.3,4Seventy-five percent of adults recovering from stroke have residual impairment in their limbs, with only about 25% achieving recovery with minor impairments, and only 10% achieving full recovery.5–7 Greater than 30% are unable to walk without some assistance and 26% remain dependent in activities of daily living.8
The issues influencing rehabilitation outcomes are complex; some examples of these issues are poverty, increase in health costs, short length of stays, insurance limitations, and physical constraints on rehabilitation services (e.g. time).3,6 In low- and middle-income countries (LMIC), rehabilitation outcomes are worse since a disproportionate number of the population is without easy access to rehabilitation technologies, services and skilled clinicians.1,3,9,10 Improved stroke rehabilitation approaches can maximize the functional independence of stroke survivors discharged after inpatient and outpatient services and improve access to rehabilitation for low-resource environments in USA or other LMICs.
Our long-term goal is to develop and use affordable robot technologies to improve access to rehabilitation and ultimately improve the health and function of persons with persistent motor deficits due to a stroke in the USA and worldwide, especially in LMICs where more than 80% of those living with a stroke reside. Specifically, we desire to target stroke survivors who are diagnosed with hemiparesis, are living with severe to moderate motor function impairment, and are without easy access to rehabilitation. Research efforts are needed to develop cost-effective robot devices that can do the above and function in harsher environments characterized by extreme economic hardship (per country), intermittent energy and limited expert supervisors.
Our main approach to delivering rehabilitation has always promoted robot/computer-assisted motivating rehabilitation systems for stroke therapy.31 We have proposed the use and development of mechatronic devices alone or within a suite of devices for upper limb stroke therapy. This paper summarizes lessons learned regarding the delivery of affordable and accessible stroke therapy in HICs and LMICs. We illustrate these lessons via the use of Theradrive, alone (TD-1),28–32 its development into a 1DOF Haptic Robot called Haptic Theradrive,36–38 a therapy gym in Mexico (TD-2),33–35 where Theradrive was one of six devices aimed at improving motor function after stroke. The paper then presents how a stronger and more compact version of the Theradrive is re-designed and leveraged in the development of a new low-cost, all-in-one robot gym called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S) with four exercise stations for upper and lower limb therapy. The prototype of the system is described along with strategies for control and new results from testing on exercise station 2. Finally, we discuss implications for deploying such a system in LMICs. […]
Continue —> Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gymJournal of Rehabilitation and Assistive Technologies Engineering – Michelle Jillian Johnson, Roshan Rai, Sarath Barathi, Rochelle Mendonca, Karla Bustamante-Valles, 2017
Figure 1. Theradrive (TD-1), Mexico Theradrive (TD-2), and Haptic Theradrive (TD-3). The Mexico Theradrive has a similar platform to TD-1. Note: Figure 1 used with permission from reference 37.
Assisted motor therapies play a critical role in enhancing functional musculoskeletal recovery and neurological rehabilitation. Our long term goal is to assist and automate the performance of repetitive motor-therapy of the human lower limbs. Hence, in this paper, we examine the viability of a light-weight and reconfigurable hybrid (articulated-multibody and cable) robotic system for assisting lower-extremity rehabilitation and analyze its performance. A hybrid cable-actuated articulated multibody system is formed when multiple cables are attached from a ground-frame to various locations on an articulated-linkage based orthosis. Our efforts initially focus on developing an analysis and simulation framework for the kinematics and dynamics of the cable-driven lower limb orthosis. A Monte Carlo approach is employed to select configuration parameters including cuff sizes, cuff locations, and the position of fixed winches. The desired motions for the rehabilitative exercises are prescribed based upon motion patterns from a normative subject cohort. We examine the viability of using two controllers — a joint-space feedback linearized PD controller and a task-space force-control strategy — to realize trajectory- and path- tracking of the desired motions within a simulation environment. In particular, we examine performance in terms of (i) coordinated control of the redundant system; (ii) reducing internal stresses within the lower-extremity joints; and (iii) continued satisfaction of the unilateral cable-tension constraints throughout the workspace.
People live their lives in an ongoing relationship with the physical environment. In the following review, a range of factors which may influence the design and construction as well as the occupation of an environmental setting for people with acquired brain injury (ABI), are described.
During a person’s rehabilitation, the environment may support his or her protection, while simultaneously promoting independence and learning. In a discussion regarding the design of built environments for people with ABI, medical, or allied health perspectives usually dominate. To design settings that support these objectives, the designer perspectives, be they interior, architectural, or landscape, must be identified.
Typically, designers and architects do not adopt a linear approach to creating environments, but rather they integrate what Nigel Cross calls a designerly way of knowing. A designer-stance may broaden possibilities while supporting the appropriate models of care or philosophy of rehabilitation.
The aim of this review is to map and summarize the breadth of current literature that involves or could inform the design of facilities for people with ABI. Such a review is necessary to consolidate what is known, in order to build upon it. The overall aim is to inform design professionals of the breadth of considerations when designing for people with ABI. In addition, it will inform managers, carers and allied health professionals of current understandings. Conceptualizations from different disciplinary perspectives of designing for rehabilitation of people with ABI are discussed.
Source: Design as a Rehabilitative Tool for People with Acquired Brain Injury: Mapping the Field