Posts Tagged exoskeletons
[WEB] Wearable robotics in the rehabilitation continuum of care: assessment, treatment and home assistance: Editorial
Posted by Kostas Pantremenos in REHABILITATION, Rehabilitation robotics, Tele/Home Rehabilitation on November 1, 2023
Editorial on the Research Topic
Wearable robotics in the rehabilitation continuum of care: assessment, treatment, and home assistance
Global population aging is posing long-term challenges to societal welfare and sustainability. The prevalence of age-associated chronic diseases is causing a growing demand for physical and cognitive rehabilitation. Healthcare providers are faced with the challenge of guaranteeing a continuum of care after hospital discharge, and the management and delivery of outpatient and home rehabilitation has become critical (Gonzaga et al., 2023).
Wearable robotics can support people affected by neurological conditions in recovering their motor functions by aiding therapists in providing customized, task-specific rehabilitation training, or by augmenting human movement capabilities in activities of daily living (ADLs). The number of commercially available wearable robotics is rising across different application domains, predominantly in the healthcare and industry sectors. Nevertheless, several open challenges remain regarding actuation, sensing, and control, which limit the wide adoption of these devices outside the controlled laboratory environment (Babič et al., 2021).
Exoskeletons made of physically compliant structures, usually referred to as soft exoskeletons or exosuits, are promising for their capability to assist users with mild to moderate impairments while maintaining a lightweight and compact structure. Maldonado-Mejía et al. presented a fabric-based hand exoskeleton with pneumatic actuation (ExHand), designed for assisting grasping tasks in ADLs. The capability of the device to maintain stable contact with different objects was verified on 10 participants without any hand impairments. Di Natali et al. developed a modular lower-limb exosuit for walking assistance (XoSoft). The exosuit uses soft pneumatic quasi-passive actuators, which can modulate the forces generated by the deformation of an elastic tendon via a variable stiffness textile-based clutch. This approach mimics the behavior of the human muscle and tendons and allows the injection of positive energy into the gait cycle without requiring powerful actuators.
Over the last few years, hybrid neuroprostheses combining low-power robotic actuation with functional electrical stimulation (FES) have also been proposed. Such hybrid systems provide biomimetic assistance by distributing the power resources between the user’s muscles and the robotic actuator. A recent review paper analyzed the efficacy of hybrid neuroprostheses employed in randomized controlled trials for upper-limb impairment after stroke, showing their positive effects in the recovery of upper-limb motor function (Höhler et al., 2023). Still, most of the current hybrid devices use both actuation types to address separate functions for each (e.g., distal or proximal joint actuation). Dunkelberger et al. presented a controller based on model predictive control for a hybrid upper-limb powered exoskeleton to assist individuals with spinal cord injuries. The controller was designed to provide an optimal distribution of power at the same joint, favoring FES over robotic actuation to assist in tracking movements.
Physical training, either via FES or via robotic devices, can also be combined with cognitive training by means of serious games based on virtual or augmented reality. Such hybrid combinations are suggested to increase patients’ engagement, motivation, and adherence to the treatment. Höhler et al. recruited 18 patients after stroke in a randomized crossover trial to investigate the feasibility and benefits of combining serious games with contralaterally electromyography-triggered FES. The results of this study also provide valuable insight into the potential translation of such systems to the home environment.
To ensure a continuum of care from hospital to home rehabilitation, it is paramount to develop devices that are intuitive, portable, and easy to use. These devices should be designed in a way that allows them to be worn and used without the supervision of the therapist, gathering at the same time quantitative measures to monitor the progress of the therapy. Bressi et al. investigated the use of a robotic end-effector type device (iCONE, Heaxel, Italy) for the home-based rehabilitation of chronic stroke patients. The study encourages the exploration of possible correlations between the clinical evaluation scales and the metrics obtained via the robot sensors, with the inclusion of a larger pool of participants. Urrutia et al. investigated the correlation between the scores of the Modified Ashwort Scale and the measurements obtained with the Amadeo® (Tyromotion, Austria) finger-hand rehabilitation device for the assessment of joint spasticity. Making a reliable and standardized robotic assessment of joint spasticity is still an open challenge due to the need to capture an intricate interaction of neurophysiological mechanisms (Pilla et al., 2020).
Longitudinal assessment protocols merging clinical evaluations with the quantitative measurement of physiological and biomechanical parameters are crucial for achieving more efficient and cost-effective rehabilitation programs. Such assessments would be extremely valuable for the stratification of patients into groups with similar characteristics to identify the most appropriate and customized treatment plan for each individual. Tesfazgi et al. analyzed the sources of uncertainty in the estimation of the human arm impedance using upper-limb wearable robotics. These uncertainties arise from the physical human–robot interaction, and their identification plays a pivotal role in the reliable and automated estimation of the user’s neuromechanical state. This, in turn, can open new possibilities for true customization of rehabilitation treatments. Das et al. proposed a method for the online classification of compensatory movement strategies based on kinematic information. The automatic detection of compensatory motion could be exploited to inform the patient about the correct execution of the task, e.g., during home training without the therapist’s supervision. In addition, such information could be used to adjust the assistance profiles of robotic devices to enforce the proper movement kinematics. Finally, Wu et al. demonstrated the benefits of closed-loop cueing training for people with Parkinson’s disease. This strategy can provide patients with adaptive, optimized cues to improve their gait performance by learning a personalized model of the user’s responsiveness to the cues.
Overall, the articles in this Research Topic provide different insights for the further development of wearable technologies across the rehabilitation continuum of care. These insights revolve around three main pillars: the need for customization of the rehabilitation treatment, the importance of an objective quantification and characterization of the patient’s conditions, and the value of smart mechatronic designs to guarantee the seamless and intuitive use of wearable robotics. Further advancements in each of these three pillars will be paramount to ultimately enable the translation of wearable robotics into our daily lives.
[ARTICLE] Development and simulation of a device for upper limb rehabilitation – Full Text
Posted by Kostas Pantremenos in Assistive Technology, Paretic Hand, REHABILITATION, Rehabilitation robotics on March 20, 2023
Abstract
Robotics with exoskeletons has opened a new era of research in the field of modern rehabilitation and assistive technologies. The technology promises to improve the functionality of the upper limbs, which are necessary for daily operations. Exoskeleton technology is developing rapidly but requires interdisciplinary research to solve technical problems such as kinematic compatibility and the development of effective human-robot interaction. This article presents a new design of a device that helps to rehabilitate the upper extremities. The proposed design is characterized by a lightweight structure with an adaptable geometry for various users with low cost and easy to wear characteristics. The CAD model is developed for design details and for modeling, the results of which provide data on the feasibility of the proposed design and its characteristics in the main operational characteristics.
1. Introduction
Currently, rehabilitation technologies are part of strategies that facilitate the integration of people with trauma that generates disability, this is a harmonious understanding of technology, technology, and health [1]. James Reswick describes rehabilitation engineering as the application of science and technology to reduce the limitations of people with disabilities [2]. Rehabilitation engineering is interdisciplinary and unites specialists such as doctors, nurses, physiotherapists, occupational therapists, biologists, engineers, physicists, and chemists. Indeed, rehabilitation devices are developed by a group of specialized professionals with interdisciplinary training, as in the case of bioengineering, which is the application of knowledge gathered in a fruitful balance between engineering and medical science [3]. For this reason, many researchers are currently working intensively on the creation of universal robots that can be worn on the body. Today, research in this area has made it possible to obtain various solid exoskeletons that move synchronously with human limbs. Many of them can support the weight of the human body and even the additional load that comes from lifting weights by a person. In some cases, such exoskeletons can also replace human muscles or bones. However, this type of robot has two obvious drawbacks: it is rigid and very heavy, so a person may have difficulty carrying it. In practice, in addition to this, there are various soft and flexible exosuits that help to perform individual movements of parts of the human body, while consuming less energy. Another advantage of such exo costumes: they do not damage ligaments, tendons, and joints. These robots are capable not only of normalizing partially damaged motor functions, but also of performing lost motor functions, if we take, for example, the elderly or disabled. Another part of people who need exoskeletons includes people with muscle weakness or other degenerative diseases [4].
The goal of this research project is to create one or more complex structures called harmonious exoskeletons that can help people with muscle weakness or other degenerative diseases. In particular, the emphasis is on structures designed to support daily movements of a person with hands (for example, holding a glass of water) and rehabilitation of muscle movements.
This article is organized as follows. The section physical model and design of the human hand describes a methodology that includes the physical model and design of the human hand. The conceptual design section shows the implementation of the methodology for designing an exoskeleton for passive rehabilitation of the upper limb with a detailed description of each stage. The conclusion and further work are presented in Section 3.[…]
[Abstract] AGREE: A compliant-controlled upper-limb exoskeleton for physical rehabilitation of neurological patients
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on February 1, 2023
Abstract
In this work, we introduce the Agree exoskeleton, a robotic device designed to assist in upper-limb physical rehabilitation for post-stroke survivors. We detail the exoskeleton design at the mechatronic, actuation, and control levels. The Agree exoskeleton features a lightweight and adaptable mechanical design, which can be used with both the right and left arm, supporting three active degrees-of-freedom at the shoulder and one at the elbow. The device embodies a spring-pulley anti-gravity system to minimize torque requirements and has torque sensors on each joint for safe and smooth interaction with the user. The Agree control system, which employs a loadcell-based impedance control method, offers various modes of human-robot interaction, such as passive-assisted, active-assisted, and active-resistive exercises. Results from our experimental characterization demonstrate that the exoskeleton is capable of both compliant and rigid behavior, providing a wide range of haptic impedance and transparent behavior to both user-generated and therapist-generated forces. Our findings indicate that the Agree exoskeleton may be a viable option for safely assisting patients with neurological conditions.
[Abstract + References] Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis
Posted by Kostas Pantremenos in Depression, Gait Rehabilitation - Foot Drop, Rehabilitation robotics on January 30, 2023
Abstract
Objective
Robot-assisted gait training (RAGT) is often used as a rehabilitation tool for neurological impairments. The purpose of this study is to investigate the effects of rehabilitation with robotic devices on quality of life and depression.
Data sources
Two electronic databases (MEDLINE and Scopus) were searched for studies from inception up to December 2022.
Review methods
Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses, studying each one’s mental and physical health and depression. Random effect meta-analyses were run using standardized mean difference and 95% confidence interval (CI).
Results
A total of 853 studies were identified from the literature search. 31 studies (17 RCTs and 14 non-RCTs) including 1151 subjects met the inclusion criteria. 31 studies were selected for the systematic review and 27 studies for the meta-analysis. The outcome measure of mental health significantly improved in favor of the RAGT group in RCTs and non-RCTs (adjusted Hedges’g 0.72, 95% CI: 0.34–1.10, adjusted Hedges g = 0.80, 95% CI 0.21-1.39, respectively). We observed a significant effect of RAGT on physical health in RCTs and non-RCTs (adjusted Hedges’g 0.58, 95% CI 0.28, 0.88, adjusted Hedges g = 0.73, 95% CI 0.12, 1.33). After realizing a sensitivity analysis in RCTs, a positive impact on depression is observed (Hedges’ g of −0.66, 95% CI −1.08 to −0.24).
Conclusion
This study suggests that RAGT could improve the quality of life of patients with neurological impairments. A positive impact on depression is also observed in the short term. Further studies are needed to differentiate grounded and overgrounded exoskeletons as well as RCT comparing overground exoskeletons with a control group.
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[Abstract + References] Development and evaluation of a hand exoskeleton for finger rehabilitation – Conference Publication
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on January 26, 2023
Abstract:
Exoskeleton robots are now prevalent in hand rehabilitation medical training, and they can effectively drive a variety of rehabilitative movements in a hand that has lost its motor ability. To adapt to the hand’s physiological structure and motion characteristics, a hybrid-driven exoskeleton hand based on tendon rope and linkage and its validation experiments are proposed in this paper. The exoskeleton hand can assist one to five fingers independently or even assist a joint alone. Wearing the robot retains the physiological touch of the hand to the maximum extent, which is beneficial to rehabilitation. In addition, patients can also carry out rehabilitation training independently, and the control mode is simple and practical. To verify whether the exoskeleton can reach the grip standard of healthy hands, the Leap Motion Controller is also used to conduct experimental verification of finger movement wearing the exoskeleton. The results show that the maximum average differences between the angles of the finger flexion motion joints (MCP and PIP) with and without the exoskeleton are 10.33 degrees and 11.06 degrees. It was verified that the exoskeleton could meet the requirements of finger flexion and extension for assisted motion within a specific error range.
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Published in: 2022 IEEE International Conference on Robotics and Biomimetics (ROBIO)
[Abstract + References] An adaptive upper-limb stroke rehabilitation system – AIP Conference Proceedings
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on January 18, 2023
ABSTRACT
People having disability is not uncommon in the world that we live in today. The number kept on increasing each year. People with disability are either born with it or they may have suffered from stroke or other similar illness which result in losing motor function. With the increasing number of patients, rehabilitation centres are shortage of therapist to cater the overwhelming number of patients. It should be noted that therapy has to be done as early and as frequent as possible for it to be effective. This causes therapists to suffer from fatigue due to handling a large amount of patient daily to ensure all are treated. With the advancement of technology, various types of robots have been developed to help the disabled community. These exoskeleton robots typically operate alongside human limbs. Thus, a study in this field based on engineering concept is vital. It should be noted that rehabilitation robot is not replacing therapist but are built with the purpose of assisting. In this project, an upper limb robot is developed to help in the rehabilitation process. A controller is used to control the speed of the motors to which is important for therapy. In the process, the patients are required to complete the task given by the therapist accordingly. If the patient is able to move the upper limb voluntarily, the speed of the motor would decrease accordingly up to 50% of the actual speed. By decreasing the speed, naturally the muscle would resist the motion therefore it exercise the muscle by encouraging it to move more.
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[Abstract] Clinical Evaluation of a New Mechatronic Glove for Hand Rehabilitation
Posted by Kostas Pantremenos in Paretic Hand on January 17, 2023
Abstract:
This paper presents the validation and the improvements of a glove-type mechatronic recovery system through clinical testing for patients with neurological disorders. This system, called MANUTEX, evaluates the flexion and extension of the hand, stimulates the increase of muscle strength, as well as the coordination of fine movements of the patient’s hand. Fine motor skills such as precision, dexterity and coordination of the hand are improved too. The use of an exoskeleton type system for passive mobilization and functional electrical stimulation (FES), with surface electrodes, improves the remaining voluntary movement the patients may perform. A comprehensive testing of the MANUTEX functionality was carried out in a technical laboratory of the technical university, as a preamble for a first set of clinical trials at the Neurology Department of the Clinical Rehabilitation Hospital of Iasi. The purpose of this paper is to present the overall validation process and clinical results of using a new mechatronic glove with in the rehabilitation process for post stroke neurological patients.
Published in: 2022 E-Health and Bioengineering Conference (EHB)
[Abstract] Soft Exoskeleton for Hand Rehabilitation: An Overview
Posted by Kostas Pantremenos in Paretic Hand, Rehabilitation robotics on January 17, 2023
Abstract:
Robotics based rehabilitation have attracted much attention during the past two decades. Recent intensive research publications in the area indicates that soft exoskeleton is one of the promising technologies for robotic-based rehabilitation. This paper aims to review the up-to-date research work in soft exoskeletons material, manufacturing, sensing and control for hand rehabilitation. Applied materials, its preferred properties, and manufacturing technologies of soft exoskeletons are reviewed. Different position and force sensing technologies as well as recent control techniques applying bio-signals as control signals are reviewed. The major challenges, which are also recommendations for future research work, are highlighted.
[Abstract] Hybrid FES & Mechatronic Hand Control Method for Upper Limb Rehabilitation Systems
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Paretic Hand, Rehabilitation robotics on January 17, 2023
Abstract
This paper aims to describe a control concept algorithm developed as a new software for controlling both functional electrical stimulation (FES) and mechatronic components, inherited in an upper limb rehabilitation system for stroke people, but not limited to this specific affection. The main principle of the algorithm is to achieve a balanced control between FES and mechatronic exoskeleton, based on the input of the healthy hand via a sensory hand glove in order to help affected stroke patients to recover their affected hand mobility during the therapy.
Published in: 2022 E-Health and Bioengineering Conference (EHB)
TBI Rehabilitation 