Posts Tagged elbow
Abstract
Robotic devices for rehabilitation purposes have been increasingly studied in the past two decades and are becoming more and more diffused, due to their effective support to the traditional therapy. They allow to automate in a repeatable manner the rehabilitative exercises and to quantify outcomes, giving important feedback to the therapist. This paper deals with the design, development and preliminary characterization of a robotic system, with an exoskeleton device, for assisted upper-limb rehabilitation, in which surface EMG measurements are used to implement a force-based active and resistive control. A prototype of the system has been realized, measurements of important parameters of the motion permitted to optimize the design and preliminary tests on the control strategy were carried out.
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Source: ERRSE: Elbow Robotic Rehabilitation System with an EMG-Based Force Control | SpringerLink
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elbow, EMG-Based, Exoskeleton, Robotic, UE, UL, Upper Extremity, upper limb
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 [2, 3]. 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 [4, 5]. 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 [2, 6]. 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 [12, 13]. 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 [10, 14]. In our previous studies, we designed a series of voluntary intention-driven rehabilitation robotics for physical training at the elbow, the wrist and fingers [14, 15, 16, 17, 18]. 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 [15, 17]. 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 [16, 19]. 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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elbow, Fingers, Neuromuscular electrical stimulation, NMES, robot, Stroke, UE, UL, Upper Extremity, upper limb, Wrist
Abstract.
[Purpose] The aim of this study was to investigate the effects of repeated vibratory stimulation to muscles related to hand functions on dexterity, strength, and sensory function in patients with chronic stroke.
[Subjects and Methods] A total of 10 stroke patients with hemiplegia participated in this study. They were divided into two groups: a) Experimental and b) Control, with five randomly selected subjects for each group. The experimental group received vibratory stimulation, while the control group received the traditional physical therapy. Both interventions were performed for 30 minutes each session, three times a week for four weeks.
[Results] There was a significant within-group improvement in the box and block test results in both groups for dexterity. Grip strength improved in both groups but the improvement was not statistically significant.
[Conclusion] The vibratory stimulation activated the biceps brachii and flexor carpi radialis, which increased dexterity to grasp and lift the box and block from the surface. Therefore, repeated vibratory stimulation to muscles related to hand functions improved hand dexterity equality to the traditional physical therapy in patients with chronic stroke.
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chronic stroke, dexterity, elbow, Hand dexterity, hand strength, Vibratory stimulation, Wrist
Abstract
In the rehabilitation training and assessment of upper limbs, the conventional kinematic model treats the arm as a serial manipulator and maps the rotations in the joint space to movements in the Cartesian space. While this model brings simplicity and convenience, and thus has been overwhelming used, its accuracy is limited, especially for the distal parts of the upper limb that execute dexterous movements.
In this paper, a novel kinematic model of the arm has been proposed, which has been inspired by the biomechanical analysis of the forearm and wrist anatomy. One additional parameter is introduced into the conventional arm model, and then both the forward and inverse kinematic models of five parameters are derived for the motion of upper arm medial/lateral rotation, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension and ulnar/radial deviation. Then, experiments with an advanced haptic interface have been designed and performed to examine the presented arm kinematic model. Data analysis revealed that accuracy and robustness can be significantly improved with the new model.
This extended arm kinematic model will help device development, movement training and assessment of upper limb rehabilitation.
Published in: Advanced Robotics and Mechatronics (ICARM), International Conference on
Source: An extended kinematic model for arm rehabilitation training and assessment – IEEE Xplore Document
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arm rehabilitation, biomechanics, elbow, haptic interfaces, Joints, Kinematic Model, Kinematics., manipulator kinematics, Training, UE, UL, Upper Extremity, upper limb, Wrist
Abstract:
This paper investigates Kinect device application during rehabilitation of people with an ischemic stroke. There are many similar application using Kinect as a tool during rehabilitation. This paper is focused on measurement of Kinect’s spatial accuracy and proposition of body states and exercises according to the Motor assessment scale for stroke (MAS). The system observes the whole rehabilitation process and objectively compares ranges of movement during each exercise. Angles between limbs are computed in the skeletal body joints projection to three anatomical planes, which enables a better insight to subject performance. The system is easily implemented with a consumer-grade computer and a low-cost Kinect device. Selected exercises are presented together with the angles evolution, body states recognition and the MAS Scale after the stroke classification.
Source: Kinect V2 as a tool for stroke recovery: Pilot study of motion scale monitoring – IEEE Xplore Document
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elbow, Hip, Kinect, MAS, Monitoring, motion capture, Performance evaluation, Sensors, stroke recovery, Three-dimensional displays, Virtual Reality Rehabilitation
Abstract:
The growing importance of Kinect as a tool for clinical assessment and rehabilitation is due to its portability, low cost and markerless system for human motion capture. However, the accuracy of Kinect in measuring three-dimensional body joint center locations often fails to meet clinical standards of accuracy when compared to marker-based motion capture systems such as Vicon. The length of the body segment connecting any two joints, measured as the distance between three-dimensional Kinect skeleton joint coordinates, has been observed to vary with time. The orientation of the line connecting adjoining Kinect skeletal coordinates has also been seen to differ from the actual orientation of the physical body segment. Hence we have proposed an optimization method that utilizes Kinect Depth and RGB information to search for the joint center location that satisfies constraints on body segment length and as well as orientation. An experimental study have been carried out on ten healthy participants performing upper body range of motion exercises. The results report 72% reduction in body segment length variance and 2° improvement in Range of Motion (ROM) angle hence enabling to more accurate measurements for upper limb exercises.
I. Introduction
Body joint movement analysis is extremely essential for health monitoring and treatment of patients with neurological disorders and stroke. Chronic hemiparesis of the upper extremity following a stroke causes major hand movement limitations. There is possibility of permanent reduction in muscle coactivation and corresponding joint torque patterns due to stroke [1]. Several studies suggest that abnormal coupling of shoulder adductors with elbow extensors and shoulder abductors with elbow flexors often leads to some stereotypical movement characteristics exhibited by severe stroke patients [2]. Therefore continuous and effective rehabilitation therapy is absolutely essential to monitor and control such abnormalities. There is a substantial need for home-based rehabilitation post-clinical therapy.
Source: Accurate upper body rehabilitation system using kinect – IEEE Xplore Document
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biomedical measurement, body segment orientation, Cameras, elbow, Gait Analysis, Kinect, Kinect Depth, Length measurement, Motion measurement, Motion segmentation, optimization method, patient rehabilitation, physical body segment, RGB information, Shoulder, Skeleton, upper body, upper limb exercises, VICON
Abstract:
We developed a tele-rehabilitation system to improve community rehabilitation for patients who are discharged early from hospital. The developed tele-rehabilitation system consists of devices designed to reduce the physical and economic burden on users while promoting optimum user movement. A Backend-as-a-Service cloud computing service was used for the communication between terminals. A non-contact sensor, Kinect, was used to measure movement. In addition, we used a three-dimensional (3D) display to present 3D images using binocular parallax, to encourage smooth movement of patients. We used this system for stroke patients and found improvements in task-performance time, smoothness of movements, and range of motion in all patients. No major issues occurred during the tele-rehabilitation. These results demonstrated the high operability and efficacy of our cloud service-based 3D virtual reality tele-rehabilitation system.
Source: IEEE Xplore Document – Trial operation of a cloud service-based three-dimensional virtual reality tele-rehabilitation system for stroke patients
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3D display, BaaS, cloud computing, Economics, elbow, Hospitals, Shoulder, Tele-rehabilitation, Three-dimensional displays, Virtual Reality Rehabilitation
Abstract
Background
The aim of this study was to develop and validate a novel self-administered questionnaire for assessing the patient’s own range of motion (ROM) of the wrist and the elbow.
Methods
In a prospective clinical study from January 2015 to June 2015, 101 consecutive patients were evaluated with a novel, self-administered, diagram-based, wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS). The questionnaire was statistically evaluated for test-retest reliability, patient-physician agreement, comparison with healthy population, and influence of covariates (age, gender, affected side and involvement in workers’ compensation cases).
Results
Assessment of patient-physician agreement demonstrated almost perfect agreement (k > 0.80) with regard to six out of eight items. There was substantial agreement with regard to two items: elbow extension (k = 0.76) and pronation (k = 0.75). The assessment of the test-retest reliability revealed at least substantial agreement (k = 0.70). The questionnaire revealed a high discriminative power when comparing the healthy population with the study group (p = 0.007 or lower for every item). Age, gender, affected side and involvement in workers’ compensation cases did not in general significantly influence the patient-physician agreement for the questionnaire.
Conclusion
The W-MAS and E-MAS are valid and reliable self-administered questionnaires that provide a high level of patient-physician agreement for the assessments of wrist and elbow ROM.
Level of evidence: Diagnostic study, Level II
Background
Assessing the patient’s outcome and satisfaction is important in modern orthopedic practice [1, 2, 3]. Using questionnaires to evaluate patients with wrist and elbow disorders is widespread and has been shown to be valid and reproducible [4, 5, 6, 7, 8, 9]. Self-reported outcome measures allow outcomes to be assessed from the patient’s perspective and do not require time in clinic or medical staff for data collection.
Common self-administered questionnaires for the determination of hand- and upper limp specific results of the wrist (e.g. patient-rated wrist evaluation, PRWE [8]) and of the elbow (e.g. The American Shoulder and Elbow Surgeons-Elbow, ASES-E [1]) enable the patient to assess the functional impairment of the joint, but they do not formally assess the range of motion, and patients have to attend clinic for this to be measured [10]. Therefore important data regarding the ROM would be lost in patients who are unable or unwilling to come to the outpatient clinic at the regular follow-up or for clinical research.
To our knowledge no validated self-assessment questionnaire for the ROM of the wrist or the elbow exists, which compares the agreement of the patient’s outcome with the examination by a physician.
Therefore, the aim of the current study was to develop a self-administered, diagram-based wrist motion assessment score (W-MAS) and elbow motion assessment score (E-MAS) to enable the patients to assess their own ROM of the wrist and the elbow. We further evaluated validity and reliability of this novel questionnaire with respect to the accuracy of self-determination of the wrist and elbow ROM.
Continue —> Development and validation of a novel questionnaire for self-determination of the range of motion of wrist and elbow | BMC Musculoskeletal Disorders | Full Text
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elbow, Measurement tool, Questionnaire, range of motion., Reliability, Self-assessment, validity, Wrist
HB Hands
Source: HB Hands
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elbow, finger, Forearm, Hand, Hand Therapist, Putty, UE, UL, Upper Extremity, upper limb, Wrist
TBI Rehabilitation 