Posts Tagged Exoskeleton

[ARTICLE] Post-stroke Rehabilitation Training with a Motor-Imagery-Based Brain-Computer Interface (BCI)-Controlled Hand Exoskeleton: A Randomized Controlled Multicenter Trial – Full Text

Repeated use of brain-computer interfaces (BCIs) providing contingent sensory feedback of brain activity was recently proposed as a rehabilitation approach to restore motor function after stroke or spinal cord lesions. However, there are only a few clinical studies that investigate feasibility and effectiveness of such an approach. Here we report on a placebo-controlled, multicenter clinical trial that investigated whether stroke survivors with severe upper limb (UL) paralysis benefit from 10 BCI training sessions each lasting up to 40 min. A total of 74 patients participated: median time since stroke is 8 months, 25 and 75% quartiles [3.0; 13.0]; median severity of UL paralysis is 4.5 points [0.0; 30.0] as measured by the Action Research Arm Test, ARAT, and 19.5 points [11.0; 40.0] as measured by the Fugl-Meyer Motor Assessment, FMMA. Patients in the BCI group (n = 55) performed motor imagery of opening their affected hand. Motor imagery-related brain electroencephalographic activity was translated into contingent hand exoskeleton-driven opening movements of the affected hand. In a control group (n = 19), hand exoskeleton-driven opening movements of the affected hand were independent of brain electroencephalographic activity. Evaluation of the UL clinical assessments indicated that both groups improved, but only the BCI group showed an improvement in the ARAT’s grasp score from 0 [0.0; 14.0] to 3.0 [0.0; 15.0] points (p < 0.01) and pinch scores from 0.0 [0.0; 7.0] to 1.0 [0.0; 12.0] points (p < 0.01). Upon training completion, 21.8% and 36.4% of the patients in the BCI group improved their ARAT and FMMA scores respectively. The corresponding numbers for the control group were 5.1% (ARAT) and 15.8% (FMMA). These results suggests that adding BCI control to exoskeleton-assisted physical therapy can improve post-stroke rehabilitation outcomes. Both maximum and mean values of the percentage of successfully decoded imagery-related EEG activity, were higher than chance level. A correlation between the classification accuracy and the improvement in the upper extremity function was found. An improvement of motor function was found for patients with different duration, severity and location of the stroke.

Introduction

Motor imagery (Page et al., 2001), or mental practice, attracted considerable interest as a potential neurorehabilitation technique improving motor recovery following stroke (Jackson et al., 2001). According to the Guidelines for adult stroke rehabilitation and recovery (Winstein et al., 2016), mental practice may proof beneficial as an adjunct to upper extremity rehabilitation services (Winstein et al., 2016). Several studies suggest that motor imagery can trigger neuroplasticity in ipsilesional motor cortical areas despite severe paralysis after stroke (Grosse-Wentrup et al., 2011Shih et al., 2012Mokienko et al., 2013bSoekadar et al., 2015).

The effect of motor imagery on motor function and neuroplasticity has been demonstrated in numerous neurophysiological studies in healthy subjects. Motor imagery has been shown to activate the primary motor cortex (M1) and brain structures involved in planning and control of voluntary movements (Shih et al., 2012Mokienko et al., 2013a,bFrolov et al., 2014). For example, it was shown that motor imagery of fist clenching reduces the excitation threshold of motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) delivered to M1 (Mokienko et al., 2013b).

As motor imagery results in specific modulations of brain electroencephalographic (EEG) signals, e.g., sensorimotor rhythms (SMR) (Pfurtscheller and Aranibar, 1979), it can be used to voluntarily control an external device, e.g., a robot or exoskeleton using a brain-computer interface (BCI) (Nicolas-Alonso and Gomez-Gil, 2012). Such system allowing for voluntary control of an exoskeleton moving a paralyzed limb can be used as an assistive device restoring lost function (Maciejasz et al., 2014). Besides receiving visual feedback, the user receives haptic and kinesthetic feedback which is contingent upon the imagination of a specific movement.

Several BCI studies involving this type of haptic and kinesthetic feedback have demonstrated improvements in clinical parameters of post-stroke motor recovery (Ramos-Murguialday et al., 2013Ang et al., 20142015Ono et al., 2014). The number of subjects with post-stroke upper extremity paresis included in these studies was, however, relatively low [from 12 (Ono et al., 2014) to 32 (Ramos-Murguialday et al., 2013) patients]. As BCI-driven external devices, a haptic knob (Ang et al., 2014), MIT-Manus (Ang et al., 2015), or a custom-made orthotic device (Ramos-Murguialday et al., 2013Ono et al., 2014) were used. Furthermore, several other studies reported on using BCI-driven exoskeletons in patients with post-stroke hand paresis (Biryukova et al., 2016Kotov et al., 2016Mokienko et al., 2016), but these reports did not test for clinical efficacy and did not include a control group. While very promising, it still remains unclear whether BCI training is an effective tool to facilitate motor recovery after stroke or other lesions of the central nervous system (CNS) (Teo and Chew, 2014).

Here we report a randomized and controlled multicenter study investigating whether 10 sessions of BCI-controlled hand-exoskeleton active training after subacute and chronic stroke yields a better clinical outcome than 10 sessions in which hand-exoskeleton induced passive movements were not controlled by motor imagery-related modulations of brain activity. Besides assessing the effect of BCI training on clinical scores such as the ARAT and FMMA, we tested whether improvements in the upper extremity function correlates with the patient’s ability to generate motor imagery-related modulations of EEG activity.[…]

Continue —> Frontiers | Post-stroke Rehabilitation Training with a Motor-Imagery-Based Brain-Computer Interface (BCI)-Controlled Hand Exoskeleton: A Randomized Controlled Multicenter Trial | Neuroscience

 

Figure 1. The subject flow diagram from recruitment through analysis (Consolidated Standards of Reporting Trials flow diagram).

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[WEB SITE] Study Examines Exoskeleton’s Ability to Improve Walking for Stroke Patients

Conor Walsh and his graduate student, Jaehyun Bae, fine-tune an ankle-assisting exosuit. (Photo courtesy of Rolex Awards/Fred Merz)

A study published recently in Science Translational Medicine suggests that the use of a soft suit exoskeleton system helps aid in the facilitation of walking ability among ambulatory patients following a stroke.

Researchers from Harvard University’s Wyss Institute for Biologically Inspired Engineering, the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), and Boston University’s (BU) College of Health & Rehabilitation Sciences: Sargent College developed the lightweight, soft, wearable ankle-assisting exosuit, and they they suggest in the study that it could help reinforce normal gait in people with hemiparesis after stroke.

The study centers on the use of the exosuit among nine participants, each of whom recently experienced a stroke, and examines the immediate improvements in walking capability that could be obtained when wearing the suit, dubbed the Restore system, according to a media release from ReWalk Robotics Ltd.

According to the release, the study concludes that improvements in paretic limb function contributed to a 20 +/- 4% reduction in forward propulsion interlimb asymmetry and a 10 +/- 3% reduction in the energy cost of walking, which is equivalent to a 32+/- 9% reduction in the metabolic burden associated with poststroke walking.  Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke.

“This foundational study shows that soft wearable robots can have significant positive impact on gait functions in patients post-stroke, and it is the result of a translational-focused multidisciplinary team of engineers, designers, biomechanists, physical therapists, and most importantly patients who volunteered for this study and gave valuable feedback that guided our research,” says Wyss Core Faculty member Conor Walsh, who is also the John L. Loeb Associate Professor of Engineering and Applied Sciences at SEAS and the Founder of the Harvard Biodesign Lab, in the release.

ReWalk is working with the Wyss Institute on the development of lightweight designs to complete clinical studies, pursue regulatory approvals, and commercialize the systems on a global scale. The first commercial application will be for stroke survivors, followed by Multiple Sclerosis patients and then additional applications.

“Exoskeletons are now a commercially available, disruptive technology that have changed the lives of many individuals in the paraplegic community,” states ReWalk CEO Larry Jasinski, in the release. “The ongoing research at the Wyss Institute on soft exosuits adds a new dimension to exoskeletons that can potentially meet the needs of individuals that have had a stroke, as well as for those diagnosed with Multiple Sclerosis, Parkinson’s disease or people who have limitations in walking.”

[Source(s): ReWalk Robotics Ltd, PR Newswire, Science Daily]

Source: Study Examines Exoskeleton’s Ability to Improve Walking for Stroke Patients – Rehab Managment

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[Conference paper] ERRSE: Elbow Robotic Rehabilitation System with an EMG-Based Force Control – Abstract+References

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. 

References

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Source: ERRSE: Elbow Robotic Rehabilitation System with an EMG-Based Force Control | SpringerLink

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[Abstract] A survey on sEMG control strategies of wearable hand exoskeleton for rehabilitation

Abstract:

Surface electromyographic (sEMG) signals is one most commonly used control source of exoskeleton for hand rehabilitation. Due to the characteristics of non-invasive, convenient collection and safety, sEMG can conform to the particularity of hemiplegic patients’ physiological state and directly reflect human’s neuromuscular activity. By way of collecting, analyzing and processing, sEMG signals corresponding to identify the target movement model would be translated into robot movement control instructions and input into hand rehabilitation exoskeleton controller. Then patients’ hand can be directed to achieve the realization of the similar action finally. In this paper, the recent key technologies of sEMG-based control for hand rehabilitation robots are reviewed. Then a summarization of controlling technology principle and methods of sEMG signal processing employed by the hand rehabilitation exoskeletons is presented. Finally suitable processing methods of multi-channel sEMG signals for the controlling of hand rehabilitation exoskeleton are put forward tentatively and the practical application in hand exoskeleton control is commented also.

Source: A survey on sEMG control strategies of wearable hand exoskeleton for rehabilitation – IEEE Xplore Document

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[REVIEW] Robotic Devices and Brain Machine Interfaces for Hand Rehabilitation Post-stroke: Current State and Future Potentials – Full Text PDF

Abstract

This paper reviews the current state of the art in robotic-aided hand physiotherapy for post-stroke rehabilitation, including the use of brain machine interfaces (BMI). The main focus is on the technical specifications required for these devices to achieve their goals. From the literature reviewed, it is clear that these rehabilitation devices can increase the functionality of the human hand post-stroke. However, there are still several challenges to be overcome before they can be fully deployed. Further clinical trials are needed to ensure that substantial improvement can be made in limb functionality for stroke survivors, particularly as part of a programme of frequent at-home high-intensity training over an extended period.

This review serves the purpose of providing valuable insights into robotics rehabilitation techniques in particular for those that could explore the synergy between BMI and the novel area of soft robotics.

Introduction

Strokes are a global issue affecting people of all ethnicities, genders and ages [1]; approximately 20 million people per year worldwide suffer a stroke [2, 3]. Five million of those patients remain severely handicapped and dependent on assistance in daily life [4]. Once a stroke has occurred the patient may be left with mild to severe disabilities, depending on the type and severity of the stroke. This paper will focus on the primary issues experienced which are the clawing of the hand and stiffening of the wrist. In recent years, several new forms of rehabilitation have been proposed using robot-aided therapy. This work reviews the current state-ofthe-art robotic devices and brain-machine interfaces (BMI) for post-stroke hand rehabilitation, analysing current challenges, highlighting the future potential and addressing any inherent ethical issues.[…]

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[ARTICLE] Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy? – Full Text

Abstract

Background

Contrary to common belief of clinicians that hemorrhagic stroke survivors have better functional prognoses than ischemic, recent studies show that ischemic survivors could experience similar or even better functional improvements. However, the influence of stroke subtype on gait and posture outcomes following an intervention blending conventional physiotherapy with robotic-assisted gait therapy is missing.

Objective

This study compared gait and posture outcome measures between ambulatory hemorrhagic patients and ischemic patients, who received a similar 4 weeks’ intervention blending a conventional bottom-up physiotherapy approach and an exoskeleton top-down robotic-assisted gait training (RAGT) approach with Lokomat.

Methods

Forty adult hemiparetic stroke inpatient subjects were recruited: 20 hemorrhagic and 20 ischemic, matched by age, gender, side of hemisphere lesion, stroke severity, and locomotor impairments. Functional Ambulation Category, Postural Assessment Scale for Stroke, Tinetti Performance Oriented Mobility Assessment, 6 Minutes Walk Test, Timed Up and Go and 10-Meter Walk Test were performed before and after a 4-week long intervention. Functional gains were calculated for all tests.

Results

Hemorrhagic and ischemic subjects showed significant improvements in Functional Ambulation Category (P<0.001 and P = 0.008, respectively), Postural Assessment Scale for Stroke (P<0.001 and P = 0.003), 6 Minutes Walk Test (P = 0.003 and P = 0.015) and 10-Meter Walk Test (P = 0.001 and P = 0.024). Ischemic patients also showed significant improvements in Timed Up and Go. Significantly greater mean Functional Ambulation Category and Tinetti Performance Oriented Mobility Assessment gains were observed for hemorrhagic compared to ischemic, with large (dz = 0.81) and medium (dz = 0.66) effect sizes, respectively.

Conclusion

Overall, both groups exhibited quasi similar functional improvements and benefits from the same type, length and frequency of blended conventional physiotherapy and RAGT protocol. The use of intensive treatment plans blending top-down physiotherapy and bottom-up robotic approaches is promising for post-stroke rehabilitation.

Continue —>  Hemorrhagic versus ischemic stroke: Who can best benefit from blended conventional physiotherapy with robotic-assisted gait therapy?

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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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[ARTICLE] A wearable exoskeleton suit for motion assistance to paralysed patients – Full Text

Summary

Background/Objective

The number of patients paralysed due to stroke, spinal cord injury, or other related diseases is increasing. In order to improve the physical and mental health of these patients, robotic devices that can help them to regain the mobility to stand and walk are highly desirable. The aim of this study is to develop a wearable exoskeleton suit to help paralysed patients regain the ability to stand up/sit down (STS) and walk.

Methods

A lower extremity exoskeleton named CUHK-EXO was developed with considerations of ergonomics, user-friendly interface, safety, and comfort. The mechanical structure, human-machine interface, reference trajectories of the exoskeleton hip and knee joints, and control architecture of CUHK-EXO were designed. Clinical trials with a paralysed patient were performed to validate the effectiveness of the whole system design.

Results

With the assistance provided by CUHK-EXO, the paralysed patient was able to STS and walk. As designed, the actual joint angles of the exoskeleton well followed the designed reference trajectories, and assistive torques generated from the exoskeleton actuators were able to support the patient’s STS and walking motions.

Conclusion

The whole system design of CUHK-EXO is effective and can be optimised for clinical application. The exoskeleton can provide proper assistance in enabling paralysed patients to STS and walk.

Continue —> A wearable exoskeleton suit for motion assistance to paralysed patients

 

Figure 1

Figure 1. The wearable exoskeleton suit CUHK-EXO. (A) A patient with the wearable exoskeleton suit CUHK-EXO supported by a pair of smart crutches; (B) diagram of the overall mechanical structure of CUHK-EXO; (C) waist structure of CUHK-EXO; (D) thigh structure of CUHK-EXO; (E) shank structure of CUHK-EXO. (F) foot structure of CUHK-EXO.

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[WEB SITE] One step at a time

IMAGE: DR. KIM (LEFT) WITH DR. SHARMA AND A HYBRID EXOSKELETON PROTOTYPE IN THE NEUROMUSCULAR CONTROL AND ROBOTICS LABORATORY IN THE SWANSON SCHOOL OF ENGINEERING. view more CREDIT: SWANSON SCHOOL OF ENGINEERING

PITTSBURGH (March 7, 2017) … The promise of exoskeleton technology that would allow individuals with motor impairment to walk has been a challenge for decades. A major difficulty to overcome is that even though a patient is unable to control leg muscles, a powered exoskeleton could still cause muscle fatigue and potential injury.

However, an award from the National Science Foundation’s Cyber-Physical Systems (CPS) program will enable researchers at the University of Pittsburgh to develop an ultrasound sensor system at the heart of a hybrid exoskeleton that utilizes both electrical nerve stimulation and external motors.

Principal investigator of the three year, $400,000 award is Nitin Sharma, assistant professor of mechanical engineering and materials science at Pitt’s Swanson School of Engineering. Co-PI is Kang Kim, associate professor of medicine and bioengineering. The Pitt team is collaborating with researchers led by Siddhartha Sikdar, associate professor of bioengineering and electrical and computer engineering at George Mason University, who also received a $400,000 award for the CPS proposal, “Synergy: Collaborative Research: Closed-loop Hybrid Exoskeleton utilizing Wearable Ultrasound Imaging Sensors for Measuring Fatigue.”

This latest funding furthers Dr. Sharma’s development of hybrid exoskeletons that combine functional electrical stimulation (FES), which uses low-level electrical currents to activate leg muscles, with powered exoskeletons, which use electric motors mounted on an external frame to move the wearer’s joints.

“One of the most serious impediments to developing a human exoskeleton is determining how a person who has lost gait function knows whether his or her muscles are fatigued. An exoskeleton has no interface with a human neuromuscular system, and the patient doesn’t necessarily know if the leg muscles are tired, and that can lead to injury,” Dr. Sharma explained. “Electromyography (EMG), the current method to measure muscle fatigue, is not reliable because there is a great deal of electrical “cross-talk” between muscles and so differentiating signals in the forearm or thigh is a challenge.”

To overcome the low signal-to-noise ratio of traditional EMG, Dr. Sharma partnered with Dr. Kim, whose research in ultrasound focuses on analyzing muscle fatigue.

“An exoskeleton biosensor needs to be noninvasive, but systems like EMG aren’t sensitive enough to distinguish signals in complex muscle groups,” Dr. Kim said. “Ultrasound provides image-based, real-time sensing of complex physical phenomena like neuromuscular activity and fatigue. This allows Nitin’s hybrid exoskeleton to switch between joint actuators and FES, depending upon the patient’s muscle fatigue.”

In addition to mating Dr. Sharma’s hybrid exoskeleton to Dr. Kim’s ultrasound sensors, the research group will develop computational algorithms for real-time sensing of muscle function and fatigue. Human subjects using a leg-extension machine will enable detailed measurement of strain rates, transition to fatigue, and full fatigue to create a novel muscle-fatigue prediction model. Future phases will allow the Pitt and George Mason researchers to develop a wearable device for patients with motor impairment.

“Right now an exoskeleton combined with ultrasound sensors is just a big machine, and you don’t want to weigh down a patient with a backpack of computer systems and batteries,” Dr. Sharma said. “The translational research with George Mason will enable us to integrate a wearable ultrasound sensor with a hybrid exoskeleton, and develop a fully functional system that will aid in rehabilitation and mobility for individuals who have suffered spinal cord injuries or strokes.”

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Source: One step at a time | EurekAlert! Science News

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[ARTICLE] The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View – Full Text

Abstract

To date, rehabilitation robotics has come a long way effectively aiding the rehabilitation process of the patients suffering from paraplegia or hemiplegia due to spinal cord injury (SCI) or stroke respectively, through partial or even full functional recovery of the affected limb. The increased therapeutic outcome primarily results from a combination of increased patient independence and as well as reduced physical burden on the therapist. Especially for the case of gait rehabilitation following SCI or stroke, the rehab robots have the potential to significantly increase the independence of the patient during the rehabilitation process without the patient’s safety being compromised. An intensive gait-oriented rehabilitation therapy is often effective irrespective of the type of rehabilitation paradigm. However, eventually overground gait training, in comparison with body-weight supported treadmill training (BWSTT), has the potential of higher therapeutic outcome due its associated biomechanics being very close to that of the natural gait. Recognizing the apparent superiority of the overground gait training paradigms, a through literature survey on all the major overground robotic gait rehabilitation approaches was carried out and is presented in this paper. The survey includes an in-depth comparative study amongst these robotic approaches in terms of gait rehabilitation efficacy.

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Source: The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View

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