Posts Tagged hemiplegia

[ARTICLE] Upper Limb Rehabilitation Robot System Based on Internet of Things Remote Control – Full Text


Modern technology has been improving, as is medical technology. Over the years, rehabilitation medicine is developing and growing. The use of rehabilitation robots to achieve the upper limb motor function of patients with hemiplegia has also become a popular research in academia. Under this background, this paper proposes an upper limb robot rehabilitation system based on Internet of Things remote control. The upper limb robotic rehabilitation system based on the Internet of Things in this paper is composed of upper computer and lower computer. Information is collected by pressure sensor. The transmission process is realized by STM32 controller, which is first transmitted to the upper computer, and then the information needs to be processed After processing, it sends control commands to the lower computer controller to control the motor drive of the rehabilitation robot, so as to realize the rehabilitation training of the patient. In order to verify the reliability of the system in this paper, this paper conducted a motion test and system dynamic performance test. The research results of this paper show that the passive motion accuracy of the system in this paper has reached more than 97%, and the active motion accuracy has reached more than 98%. In addition, the maximum speed response time of the upper limb rehabilitation robot system based on the remote control of the Internet of Things in this paper is 5.7ms. The amount of adjustment is 5.32%, and the dynamic performance is good. The research results of this paper show that the upper limb rehabilitation robot system based on the Internet of Things remote control in this paper has excellent performance, which can provide a certain reference value for the research of rehabilitation robot.


Science and technology and people’s living standards are gradually improving, whether it is China or other countries in the world, and these changes will bring about an aging population problem. In recent years, due to the impact of cardiovascular and cerebrovascular diseases, there have been some changes in middle-aged and elderly patients with hemiplegia. The number of patients has increased and the trend of becoming younger. At the same time, on the other hand, due to the rapid growth of the number of transportation vehicles, more and more The more people suffer from nervous system injuries or limb injuries due to traffic accidents [1]. Strictly speaking, according to medical theory and clinical medicine, in addition to early surgical treatment and necessary medical care, correct and scientific rehabilitation education is also very important for the recovery and improvement of limb motor ability, but these patients have exercise Obstacles, can’t do rehabilitation training alone, and someone needs help, but in view of the fact that there are not enough medical staff in our country, these patients will be in an embarrassing situation. In this respect, the development of a remotely controlled upper limb rehabilitation robot is of great significance for solving the problem of unattended patients with hemiplegia.

Sanja Vukićević once designed a robust controller of a two-degree-of-freedom upper limb rehabilitation robot for the motion characteristics of rehabilitation training and the inherent properties of the robot, so that the robot can drive the precise trajectory of hemiplegic patients according to the given trajectory, ensuring Under the system dynamics model with zero error, the modeling error bounded error remains consistent and bounded, and the tracking error is zero. The simulation results of Sanja Vukićević show that the robust control strategy can make the system tracking error tend to under certain conditions Zero, has a good control effect, although Sanja Vukićević’s method improves the robustness of rehabilitation training robots, but the reliability has decreased [2][3]. Dobkin BH used the hemiplegic rehabilitation theory and upper limb physiological structure as the basis, combined with biological science, mechanical engineering, automatic control and other disciplines to design the upper limb functional rehabilitation robot. The control system of impedance control, and Simulink software was used to establish the simulation model of the control system, and the influence of the control parameters based on position impedance on the upper limb function control of rehabilitation robot was analyzed. The results of Dobkin B H show that the rehabilitation robot’s control effect on the upper limb function changes with the change of movement speed. The upper limb rehabilitation robot designed by Dobkin B H has good stability but its accuracy is lacking, and it needs to be improved [4][5]. Naranjo-Hernández David once proposed a new upper limb rehabilitation robot system based on virtual reality, which fully utilizes many advantages of robots participating in stroke upper limb rehabilitation. The system has the advantages of small size, light weight and rehabilitation interaction. Naranjo-Hernández David’s system is mainly composed of a haptic device called Phantom Premium, Upper Extremity Exoskeleton Rehabilitation Device (ULERD) and virtual reality environment. It has been experimentally proved that Naranjo-Hernández David’s method is accurate and convenient during the rehabilitation process However, the economy is not strong and needs to be strengthened [6][7].

This article adopts the Internet of Things remote control technology and designs the upper limb rehabilitation robot system. In this paper, the relevant theory of the remote control of the Internet of Things is first elaborated, then from the perspective of human kinematics, the motion model of the upper limb rehabilitation robot is constructed, and finally, the upper limb rehabilitation robot system based on the Internet of Things remote control is designed and set The corresponding experiment was carried out to test the system. The test results show that the system in this paper has good accuracy and dynamic performance.SECTION II.

Internet of Things Remote Control

The so-called remote control technology refers to the technology that the Internet controls and manages remote devices to control and manage signals based on signals. Its software usually includes client-side and server-side programs. As the Internet of Things becomes more and more popular, remote control technology is also popularized. It can achieve the effect of unconventional remote control through IoT media [8][9].

A. Internet of Things

The Internet of Things realizes the mutual exchange, mutual knowledge, and interactive information exchange between “machines and machines”. It can also be understood that through a variety of communication technologies, the Internet of Things is a very complex and diverse system technology.. According to the principles of information generation, transmission, processing and application, the Internet of Things can be divided into four levels: perception recognition layer, network construction layer, management service layer and integrated application layer [10][11].

1) Perception Recognition Layer

What is the core technology of the Internet of Things? It is perception and recognition, so the perception recognition layer is very important for the Internet of Things. So let’s take a look at what the perceptual recognition layer includes. The level of perceptual recognition includes radio frequency identification, wireless sensors and automatic information production equipment. Not only that, but also includes a variety of intelligent information used to artificially produce electronic products. It can be said that as an emerging technology, wireless sensor networks mainly use different types of sensors to obtain large-scale, long-term, real-time information on environmental status and behavior patterns [12].

2) Network Building Layer

The main function of this layer is to connect lower-level data (perceived recognition-level data) to higher levels such as the Internet for its use. The Internet and next-generation Internet (including IPv6 and other technologies) are the core networks of the Internet of Things. Various wireless networks on the edge can provide network access services anytime and anywhere. The existing WIMAX technology is included in the scope of the wireless metropolitan area network, and its role is to provide high-speed data transmission services in the metro area (about 100 km). On the other hand, the wireless local area network also includes the WIFI that almost every household is currently trying. The use of WIFI is very wide. The main function is to provide network access services for users in a certain area (family, campus, restaurant, airport, etc.). Not only that, the wireless personal area network also includes Bluetooth, ZigBee and other communication protocols. These several things have a common feature, that is, low power consumption, low transmission rate, short distance, generally used for personal electronic product interconnection, industrial equipment Control and other fields. The various types of wireless networks listed above are suitable for different environments and work together to provide convenient network access so that the Internet of Things can be achieved [13].

3) Management Service Layer

By supporting high-performance computer technology and large-capacity storage, the management service level can efficiently and reliably organize large-scale data and provide an intelligent support platform for high-level industry applications. Storage is the first step in information processing. The database system and various mass storage technologies developed later, even including network storage (such as data centers), have now been widely used in information technology, finance, telecommunications, automation, etc. These industries. Faced with massive amounts of information, how to organize and search for effective data is a key issue. Therefore, the main feature of the management service layer is “wisdom”. Through rich and detailed data, mechanical learning, data mining, expert systems and other means, it serves the management ’s The function is increasingly powerful [14].

4) Comprehensive Application Layer

What was the original role of the Internet? It is used to achieve computer-to-computer communication, and then developed into a connection between users and people as the main body, and the times are changing. Now, it is moving towards the goal of connecting things-things-people. Not only that, along with this process, network applications have also undergone tremendous changes, from the initial transmission of files and emails with basic functions of data services to user-centric applications. In addition, the layers of the Internet of Things are relatively independent but closely connected. Below the integrated application layer, different technologies at the same layer are complementary and suitable for different environments, forming a complete set of response strategies for this level of technology, and at different levels, providing different technical compositions and combinations to Create a complete solution according to the requirements of the implementation [15].

The network topology diagrams of the mobile communication network and the wireless sensor network are shown in Figure 1 and Figure 2, respectively.

FIGURE 1. - Mobile communication network topology.


Mobile communication network topology.

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FIGURE 2. - Wireless sensor network topology.


Wireless sensor network topology.

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From Figure 1 and Figure 2 we can see the network topology of the mobile communication network and wireless sensor network. The sensor is the first basic link to realize the automatic monitoring function of the system.It is generally composed of sensitive components, conversion originals, conversion circuits and auxiliary power sources.It can convert the sensed information into electrical signals or other output forms according to certain rules. So as to transmit and process information [16].

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[Abstract] Effects of electromechanically assisted gait trainer with Exowalk® in patients with chronic stroke: A randomized controlled trial


Objective: To assess the effect on walking ability of electromechanically assisted gait training with a gait trainer (Exowalk®) for patients with chronic stroke.

Design: Randomized controlled trial.

Subjects: Forty patients with hemiplegia after stroke.

Methods: Patients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training and the experimental group underwent electromechanically assisted gait training. Interventions were provided for 60 min, 5 days a week, for a period of 2 weeks. Primary outcome was change in Functional Ambulatory Category. Secondary outcomes were walking speed, walking capacity, leg muscle strength and balance. All outcomes were measured before and after the intervention.

Results: Although the Functional Ambulatory Category improved significantly after gait training in both groups, the change in Functional Ambulatory Category did not differ between groups. In both groups most secondary outcomes also improved after gait training, but the changes in secondary outcomes did not differ between groups.

Conclusion: In patients with chronic stroke, walking improved after gait training with or without electromechanical assistance. Electromechanically assisted gait training was not superior to conventional physiotherapy.


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Background: Developing countries like India are facing a double burden of communicable and non-communicable diseases. Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/ 100,000 in urban areas. Depression is characterized by persistent feelings of sadness accompanied by feelings of hopelessness, worthlessness and helplessness. Depressed patients can experiences loss of energy or fatigue, inability to concentrate and decreased interest in daily living activity with changes in sleep and weight, and thoughts of death and suicide.

Objectives: To measure the prevalence of depression in chronic stroke patients.

Study design: Observational study

Methods:  A total of 85 participants were recruited in this observational study. Each participant was given BDI scale.

Results:  About 85 participants, 52.9% were moderately depressed, 18.85% of severely depressed, 16.5 % of mild mood disturbance, and 11.85% of borderline depressed chronic stroke patients.

Conclusion: This study concluded that prevalence of depression ranges from moderate to severe percentage in chronic stroke patients.

via PREVALENCE OF DEPRESSION IN CHRONIC STROKE PATIENTS | International Journal of Medical Science And Diagnosis Research

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[Abstract + References] FES for abnormal movement of upper limb during walking in post-stroke subjects


BACKGROUND: Hemiplegia can cause accidental falls, as the patients place their arms in front of their chests or next to the hips when they walk. This is due to limitations in the ability to swing their arms during walking.

OBJECTIVE: This study proposes a functional electrical stimulator approach in order to improve the foot drop and abnormal movement of the upper limbs during walking. The goal of this study is to verify the feasibility of improving the foot drop and arm swing problems of hemiplegic patients using electrical stimulators in a clinical trial.

METHODS: The present study utilizes a functional electrical stimulator found on the market. The stimulator is controlling the gait and arm swing of the patient while the patient is walking. It can help him or her restore regular gait cycles and arm swings. The FES device can also train the patient to walk safely and regain control of his or her arm swing. After the four-week training, the subjects had to walk 10 meters without the FES system. The step length, step time, and joint goniograms were recorded in order to determine whether there was any improvement.

RESULTS: After the four-week training was concluded, the three post-stroke patients showed an improvement in arm swing angle when walking. The improvement was found to be 7.16% in the first patient, 43.06% in the second, and 54.66% in the third. These results are all statistically significant. The t-test had a p-value 0.012 (p< 0.05), which demonstrated that the method used in the present study had the potential to significantly improve the arm swing of post-stroke patients.

CONCLUSIONS: The present study showed that a traditional foot drop functional electrical stimulator providing stimulation also to the patient’s upper limbs, while being triggered by a foot switch under his or her heel, can help the patient to swing the arms and reduce the foot drop. The method has significant effect on traditional foot drop therapy. The subjects’ high degree of acceptance and willingness to commit to long-term use showed that the method is indeed worthy of further research.


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via FES for abnormal movement of upper limb during walking in post-stroke subjects | Technology and Health Care

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[Abstract] Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized, Controlled Trial



The purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke.


Thirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention.


The non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001).


Our results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.

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[ARTICLE] Exercises with action observation contribute to upper limb recovery in chronic stroke patients: a controlled clinical trial – Full Text



To investigate the effects of an exercise program with action observation versus conventional physical therapy on upper limb functionality in chronic stroke subjects.


In this controlled clinical trial, thirty-five stroke patients were divided into two groups, experimental group, comprising eighteen patients that received an exercise program with action observation; and a control group, comprising seventeen patients that received conventional exercise program. Functional recovery was assessed with the Fugl-Meyer Scale, manual dexterity was assessed with the Box and Blocks test, and the functional use of the affected upper limb was assessed with the Reach scale. Evaluations occurred at baseline, after three and six months of intervention. Statistical analyses were performed with the Repeated Measures Analysis of Variance and the Friedman test, under a 5% significance.


Both interventions provided benefits to chronic stroke patients. Exercise program with action observation presented better results on motor recovery (p < 0.001) and functional use of the affected limb (p < 0.001) when compared with conventional therapy. Both treatments improved the manual dexterity of the participants (p = 0.002), but in a similar way (p = 0.461).


A six-month exercise program with action observation provided benefits on functional recovery and functional use of an affected upper limb in chronic stroke patients. Exercises with action observation demonstrated the potential for improving affected upper limb in chronic stroke patients.



Recovery of the affected upper limb is one of the great challenges in the rehabilitation of stroke patients. Approximately 60% of severely affected individuals do not present manual dexterity six months after the stroke1. The functional deficits of the upper limb affect the ability for self-care, contribute to low perceived quality of life and higher healthcare services costs2,3.

Exercise programs should start early, be intensive and developed with the active participation of patients to promote motor learning and minimize functional deficits4. Action observation training (AO) is an alternative treatment in which the individual observes an action and then imitates the task5.

AO stimulates the mirror neuron system, a special type of neurons activated by the execution and observation of action6. Initially studied in monkeys, the mirror neuron system is associated with the premotor cortex, supplementary motor area, primary somatosensory cortex, and inferior parietal cortex. By its connections with neurocognitive processing, exercises programs that stimulate the mirror neuron system may promote important benefits to stroke patients6,7.

During AO there is an activation of several cortical areas. An internal representation of the action can potentiate motor learning and functional recovery8,9. AO uses movements guided by external stimuli in which visual attention recruits the cerebellar-thalamic-cortical circuit10. This circuit is involved in neural integration during the initial stages of motor learning. In this matter, Wright and collegues11 showed that directed attention facilitates corticospinal excitability of the brain.

Previous studies using AO showed positive results in the recovery of the affected upper limb in stroke12 13 14 15 1617. There were improvements in functionality, on the ability to perform activities of daily living and on manual dexterity. Nevertheless, there are still few studies comparing the effects of AO versus conventional therapy (exercise without AO) aiming to see how effective AO is in relation to exercise programs already consecrated.

Thus, in the present study, we investigated the benefits of AO in comparison to conventional physical therapy on upper limb functional recovery, manual dexterity and everyday use of the affected upper limb in individuals with stroke. We hypothesized that AO would present better outcomes to patients with stroke than a conventional exercise program.[…]

Continue —-> Exercises with action observation contribute to upper limb recovery in chronic stroke patients: a controlled clinical trial

Figure 2 Example of action observation training for participants of the experimental group. 


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[ARTICLE] Effect of Vojta Therapy on Balance and Walking of Community Dwelling Chronic Stroke Patients – Full Text PDF


Objectives: To evaluate effect of Vojta Therapy on balance and
walking of community dwelling chronic stroke patients.
Study design: Single group clinical trial with pre and post test.
Setting: VojtaTherapy clinic, Division of Physical Therapy,
Department of Rehabilitation Medicine, Trang Hospital.
Subjects: Community dwelling chronic stroke patients with
abnormal gait referred to the VojtaTherapy clinic.
Methods: Every participant did a timed up and go test (TUGT)
immediately before and after the VojtaTherapy. Techniques were
chosen according to response of patients with 30 minutes per
session. Treatment and assessment were repeated once a week
for three weeks.
Results: Twenty chronic stroke patients with average age of
63.1 (SD = 13.23) years and average duration after stroke of
58.35 (SD = 52.83) months were enrolled into the study. The
median TUGT scores of the first, second and third pre-treatment
were 28, 22 and 19.5 respectively. Friedman test demonstrated a
significant difference (p < 0.001). Median TUGT Score of the first,
second, and third post treatment TUGT score were 22.5, 18 and
18.5 respectively. Wilcoxon test showed significant difference of
pre versus post treatments in everysessions (p < 0.0001).
Conclusion: Once a week of VojtaTherapy for three weeks can
improve walking in community dwelling chronic stroke patients.
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[Abstract] Upper Limb Three-Dimensional Reachable Workspace Analysis Using the Kinect Sensor in Hemiplegic Stroke Patients



reachable workspace evaluation using the Kinect sensor was previously introduced as a novel upper limb outcome measure in neuromuscular and musculoskeletal conditions. This study investigated its usefulness in hemiplegic stroke patients.


Forty-one patients with hemiplegic stroke were included. Kinect-based reachable workspace analysis was performed on both paretic and nonparetic sides. Upper limb impairment was measured using the Fugl-Meyer Assessment and the Motricity Index on the paretic side. Disability was assessed using the shortened Disabilities of the Arm, Shoulder, and Hand questionnaire. Correlations between the relative surface areas, impairment scores, and disability were analyzed.


Quadrants 1, 3, and 4 as well as the total relative surface area of the paretic side were significantly reduced compared with the nonparetic side. The total relative surface area of the paretic side correlated with the Fugl-Meyer Assessment scores, the Motricity Index for Upper Extremity, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Furthermore, quadrant 3 was the most important determinant of upper limb impairment and disability.


reachable workspace (a sensor-based measure that can be obtained relatively quickly and unobtrusively) could be a useful and alternative outcome measure for upper limb in hemiplegic stroke patients.

via Upper Limb Three-Dimensional Reachable Workspace Analysis Us… : American Journal of Physical Medicine & Rehabilitation

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[Abstract] The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis

Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) to reduce lower limb spasticity in adult stroke survivors.

Data Sources: A systematic review of Medline/Pubmed, CENTRAL, CINAHL, PEDro database, REHABDATA, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos from 1980 to December 2018 was carried out.

Review Methods: The bibliography was screened to identify clinical trials (controlled and before-after) that used ESWT to reduce spasticity in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed risk of bias by PEDro scale. The primary outcome was spasticity.

Results: A total of 12 studies (278 participants) were included (5 randomized controlled trials, 1 controlled trial, and 6 before-after studies). A meta-analysis was performed by randomized controlled trials. A beneficial effect on spasticity was found. The mean difference (MD) was 0.58; 95% confidence interval (CI) 0.30 to 0.86 and also in subgroup analysis (short, medium, and long term). The MD for range of motion was 1.81; CI −0.20 to 3.82 and for lower limb function the standard mean difference (SMD) was 0.34; 95% CI −0.09 to 0.77. Sensitivity analysis demonstrated a better beneficial effect for myotendinous junction. MD was 1.5; 95% CI −2.44 to 5.44 at long-term (9 weeks).

Conclusion: The ESWT (radial/focused) would be a good non-invasive rehabilitation strategy in chronic stroke survivors to reduce lower limb spasticity, increase ankle range of motion, and improve lower limb function. It does not show any adverse events and it is a safe and effective method.

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[ARTICLE] Design and Analysis of a Wearable Upper Limb Rehabilitation Robot with Characteristics of Tension Mechanism – Full Text HTML


Nowadays, patients with mild and moderate upper limb paralysis caused by cerebral apoplexy are uncomfortable with autonomous rehabilitation. In this paper, according to the “rope + toothed belt” generalized rope drive design scheme, we design a utility model for a wearable upper limb rehabilitation robot with a tension mechanism. Owing to study of the human upper extremity anatomy, movement mechanisms, and the ranges of motion, it can determine the range of motion angles of the human arm joints, and design the shoulder joint, elbow joint, and wrist joint separately under the principle of ensuring the minimum driving torque. Then, the kinematics, workspace and dynamics analysis of each structure are performed. Finally, the control system of the rehabilitation robot is designed. The experimental results show that the structure is convenient to wear on the human body, and the robot’s freedom of movement matches well with the freedom of movement of the human body. It can effectively support and traction the front and rear arms of the affected limb, and accurately transmit the applied traction force to the upper limb of the joints. The rationality of the wearable upper limb rehabilitation robot design is verified, which can help patients achieve rehabilitation training and provide an effective rehabilitation equipment for patients with hemiplegia caused by stroke.

1. Introduction

The number of young patients with functional impairment of the upper limbs caused by stroke has increased rapidly, as influenced by accelerated pace of life, poor lifestyles and environmental factors [1,2]. Limb movement disorder, which is caused by hemiplegia after stroke, not only reduces the quality of life of patients, but also brings great pain to their physiology and psychology. Effective rehabilitation training can improve the defect of patients’ nerve function and maintain the degree of joint activity; it also prevents joint spasms and enhances the final rehabilitation degree of patients’ motor functions significantly [3]. The traditional rehabilitation training is one-to-one auxiliary exercise for patients by therapists. This method is difficult to develop an effective treatment plan, and it is tough to control accurately [4]. With the development of rehabilitation robot technology and rehabilitation medicine, the rehabilitation robot has become a novel motor nerve rehabilitation treatment technology. It is of great significance to take advantage of rehabilitation robot technology for rehabilitation training to the recovery of limb function of stroke patients [5]. The traditional methods of treatment, which are based on the therapist’s clinical experience, have the problems of large staff consumption, long rehabilitation cycles, limited rehabilitation effects, and so on. The research and application of rehabilitation robot system is expected to alleviate the contradiction between supply and demand of rehabilitation medical resources effectively, and improve the quality of life of stroke patients [6,7].[…]

Continue —-> Applied Sciences | Free Full-Text | Design and Analysis of a Wearable Upper Limb Rehabilitation Robot with Characteristics of Tension Mechanism | HTML

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Figure 1. Shoulder joint freedom of motion. (a) Flexion/extension; (b) abduction/adduction; (c) internal rotation/external rotation.

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