Posts Tagged Medical treatment
[Conference Paper] HandMATE: Wearable Robotic Hand Exoskeleton and Integrated Android App for At Home Stroke Rehabilitation – Full Text
We have developed HandMATE (Hand Movement Assisting Therapy Exoskeleton); a wearable motorized hand exoskeleton for home-based movement therapy following stroke. Each finger and the thumb is powered by a linear actuator which provides flexion and extension assistance. Force sensitive resistors integrated into the design measure grasp and extension initiation force. An assistive therapy mode is based on an admittance control strategy. We evaluated our control system via subject and bench testing. Errors during a grip force tracking task while using the HandMATE were minimal (<1%) and comparable to unassisted healthy hand performance. We also outline a dedicated app we have developed for optimal use of HandMATE at home. The exoskeleton communicates wirelessly with an Android tablet which features guided exercises, therapeutic games and performance feedback. We surveyed 5 chronic stroke patients who used the HandMATE device to further evaluate our system, receiving positive feedback on the exoskeleton and integrated app.
Stroke is the leading cause of severe long-term disability in the US . The probability of regaining functional use of the impaired upper extremity is low . At 6 months post stroke, 62% of survivors failed to achieve some dexterity . Such impairments can inhibit the individual’s ability to perform activities of daily living (ADL). Subsequently, upper limb rehabilitation recovery to improve ADL is one of the main self-reported goals of stroke survivors .
Outpatient rehabilitation is recommended for survivors that have been discharged from inpatient rehabilitative services . However, outpatient rehabilitation in general is largely underutilized, with only 35.5% of stroke survivors using services . Factors inhibiting outpatient therapy include cost, lack of resources and transportation. Wearable robotics that enable home-based therapy have the potential to overcome these barriers. They provide assistive movement forces which enable task-specific training in real-life situations that patients are often unable to practice without a clinician. See  for wearable hand robots for rehabilitation review.
At home therapy is not without its limitations. The inability to motivate oneself and fatigue are the most common reported factors resulting in failure to adhere to home based exercise programs for stroke recovery . While wearable robotics can reduce fatigue during exercise, it does not directly address lack of motivation. Research has shown incorporating games into home therapy can encourage compliance . Zondervan et al. showed that use of an instrumented sensor glove, named the MusicGlove, improved self-reported use and quality of movement, greater than convention at home exercises . Other studies showed increased motivation to complete the therapeutic exercises and optimized movement when the user is given feedback of their performance via the Microsoft Kinect . Wearable robotic systems that offer feedback and gaming capability may optimize at home stroke therapy.
Such a system was presented by Nijenhuis et al. in which stroke survivors showed motor improvements after completing a 6 week self-administered training program comprised of a dynamic hand orthosis and gaming environment . However, the hand device was passive, assisting only with extension, which limits the range of stroke survivors who could utilize such a system. Research groups have proposed combining their powered take-home wearable hand devices with custom integrated gaming systems , or guided exercises ; however, they have yet to conduct clinical trials. Notably, Ghassemi et al., have developed an integrated multi-user VR system to use with their X-Glove actuated orthosis, which will allow for client-therapist sessions without the patient having to travel .
Tablets are relatively inexpensive, portable, and straight forward to use, with 47% of internet users globally already owning one . Furthermore, a recent study demonstrated the success of a tablet based at home exercise program in improving the recovery of stroke survivors . Notably, the study evaluated the accessibility of tablets, concluding every participant used the tablet successfully. Therefore a wearable powered hand robot with a dedicated tablet app which will provide functional games, task-specific guided exercises and feedback of movement, could optimize at home stroke therapy.
The goal of this project was to create a wearable robotic exoskeleton that enables repetitive practice of task-specific and goal orientated movements, which translates into improvements in ADL. Furthermore, for maximum use and successful integration into home-based rehabilitation, we aimed to create an Android application compatible with the robotic exoskeleton.
To meet these goals, the following design objectives were established: 1) Assistance with finger flex/extension. 2) Assistance with thumb carpometacarpal (CMC) add/abduction and thumb metacarpophalangeal (MCP) flex/extension. 3) Independent assistive control of each finger and thumb. 4) Portable for at home use, meaning the device has to be lightweight and wireless. 5) Relatively affordable. 6) Integrated with android tablet app. Specific design goals for the app included: 1) Easy to use. 2) Allow the user to control the exoskeletons assistance mode through the app. 3) Records the user’s data and prompts the user via notifications to complete the allocated daily or weekly recommended activity time.
In this paper we will evaluate if the proposed device and app goals have been achieved via bench and subject testing.
The HandMATE device (Fig. 1) builds upon the Hand Spring Operated Movement Enhancer (HandSOME) devices , , . The HandSOME devices are non-motorized wearable exoskeletons that assists stroke patients with finger and thumb extension movements. The HandSOME I device assists with gross whole hand opening movements, while the HandSOME II assists isolated extension movement of 15 finger and thumb degrees of freedom (DOF), allowing performance of various grip patterns used in ADL. While both devices have been shown to significantly increase range of motion (ROM) and functional ability in chronic stroke subjects ,, the HandSOME devices only assist with extension movements and require enough flexion activity to overcome the assistance of the extension springs. As many stroke patients also suffer finger and thumb flexion weakness, we decided to build upon the work of the high DOF HandSOME II and additionally utilize power actuation so we can assist with both flexion and extension movements.
[Abstract + References] Feasibility of Wearable Sensing for In-Home Finger Rehabilitation Early After Stroke
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[Abstract] A Therapist Helping Hand for Walker-Assisted Gait Rehabilitation: A Pre-Clinical Assessment – IEEE Conference Publication
[ARTICLE] Portable Motion-Analysis Device for Upper-Limb Research, Assessment, and Rehabilitation in Non-Laboratory Settings – Full Text
An integral part of clinical care for individuals with motor disorders is to assess motor function to guide and evaluate medical treatment, surgical intervention or physical therapy. One of the challenges for assessing motor function is to define sensitive and quantitative measures that can be readily obtained in clinical practice. The objective of this study was to develop a device that affords quantitative assessment of motor impairments in non-laboratory settings. The specific focus is on individuals with upper-limb movement disorders. One central goal was to ground the task in scientific research to relate clinical measures to research and capitalize on insights from fundamental research.
This paper first lays out the need for such a device particularly for children with motor disorders and post-stroke rehabilitation. We then motivate the specific motor task that was originally conceived for basic research on motor control. We then detail the design of the prototype with all hardware and software components so that it can be replicated. One design goal was to make the device low-cost, so that it can be used in many clinical environments including at home for therapeutic exercises. We conclude with first results from pilot experiments acquired both in a traditional laboratory setting and in an Epilepsy Monitoring Unit. These first data were obtained from children with dystonia. However, the device is not limited to this population and is currently further modified for the assessment of stroke patients.
A. Clinical Assessments of Motor Disorders
A motor disorder manifests as an impaired ability to execute a movement with the intended spatial and temporal pattern. This includes abnormal posturing, presence of unintended excessive movement, and normal movements occurring at unintended or inappropriate times . Patients with upper-limb impairments require special assistance to perform common motor tasks associated with self-care, such as feeding and dressing. Challenges in their movement control result in frustration, which leads to less engagement and practice, and thereby fewer opportunities to attenuate their motor disabilities and improve their movement control.
Motor disorder are observed also among children. Cerebral Palsy (CP) is a common cause of movement disorders among children, affecting 3 to 4 individuals per 1000 births in the US. The dyskinetic form of CP occurs in 15% of all cases . Due to inflexible postures, caused by muscle spasms and contractures together with involuntary jerky movements, children with dyskinetic CP are often prevented from participation in many daily activities. This also prevents them from acquiring age-appropriate motor skills during critical periods of skill development , . This is particularly aggravated when the condition affects the upper limbs.
For clinical motor assessments, the current standard tools are clinical scales. For cerebral palsy, typical tests are the gross motor function classification system (GMFCS) , the manual ability classification system (MACS) , the House Scale , the Melbourne Assessment , the Assisting Hand Assessment , the Hypertonia Assessment Tool (HAT) , the Barry-Albright Dystonia (BAD) scale , and the Shriners Hospital for Children Upper Extremity Evaluation . These outcome measures were devised to satisfy the typical criteria for effective outcome measures, including reliability, validity, specificity, and responsiveness . Although useful, these rating scales rely on subjective assessment and questionnaires that are vulnerable to inter-rater and test-retest reliability, nonlinearity, multi-dimensionality, and ceiling or floor effects . These shortcomings need to be overcome by more quantitative outcome measures to provide a better evaluation of the individual’s motor functions and abilities, and potentially utilize such measures to objectvely assess and titrate interventions.
B. Quantitative Assessment of Motor Function
Motion tracking technologies have provided quantitative means of recording movements through a variety of sensing technology that tracks and stores movement. Camera-based motion capture, such as Vicon (Vicon Motion Systems, Oxford, UK) and Optitrak (Northern Digital Inc, Ontario, CA) requires external markers or sensors placed on key anatomical landmarks to reconstruct the skeletal model of human body parts. These state-of-the-art technologies track motion to very high precision with high sampling rates and they have been used for pre- and post-treatment assessment of upper- or lower-extremity pathologies. However, such data acquisition is limited to traditional laboratory settings because the multi-camera systems are expensive and not portable.
On the other hand, there are low-cost inertial measurement units (IMUs) that directly measure acceleration, rotational change and magnetic orientation. While these sensors have the advantage that they are self-contained and wearable, drawbacks are degraded accuracy due to drift, calibration errors and noise inherent to inertial sensors and the need to frequently recharge batteries for real-time data streaming . Moreover, attaching sensors to body parts can be inconvenient or even impossible for certain clinical populations, and many children will not tolerate them.
In view of the above arguments, there is a strong need for less invasive devices that can provide quantitative measurements in tasks related to upper-extremeity motor function. Preferably, such a device should allow for portability and be low-cost to reach large populations.
C. Low-Cost Rehabilitation at Home
Rehabilitation follows standard practice and frequently requires one-on-one interaction with a therapist for extended periods of time. For these reasons, robotic devices have emerged to deliver higher-dosage and higher-intensity training for patients with movement disorders such as cerebral palsy and stroke –. However, while effective, robotic therapy is expensive and to date can only be used in clinical settings. To increase the volume in therapy, lower-cost devices that can be used at home are urgently needed.
Performance improvements with predominant home training are indeed possible. This was demonstrated by pediatric constraint-induced movement therapy (CIMT) for children with hemiparetic CP , . Further, it was shown that even children with severe dystonia can improve their performance if they use an interface or device that enables and facilitates their severely handicapped movements .
A portable low-cost device for home use that is able to provide reliable quantitative measurements would help address the above shortcomings. Measurements could also be streamed to careproviders on a secure cloud protocol, for diagnosis of interventions, analysis of therapeutic outcomes, and further follow up.
D. Theoretically-Grounded Rehabilitation
Motor tasks for home therapy should be engaging to avoid boredom and attrition and should also have functional relevance. With this goal in mind, we developed a motor task that was motivated by the daily self-feeding activity of leading a cup of coffee or a spoon filled with soup to the mouth. The core challenge of actions of this kind is that moving such an object with sloshing liquid presents complex interaction forces: any force applied to the cup also applies a force to the liquid that then acts back on the hand. When such internal dynamics is present, interaction forces become quite complex, and the human performing the task needs to predict and preempt the internal dynamics of the moving liquid. Clearly, better understanding task is like guiding a cup of coffee to one’s mouth or a spoonful of soup has high functional relevance. While many such functional tasks have been developed for rehabiltation (e.g., the box-and-block and the pegboard task), the quantitative assessment should allow for more than descriptive outcome measures such as error or success rate. Monitoring the ‘process’ continuously should provide more detailed insight into coordinative challenges. This is indeed possible in the task of guiding a cup of coffee as we explain next.
In previous research, we abstracted a relevant, yet simplified model task, inspired by guiding a cup of coffee –. To reduce the complexity and afford theoretical analyses, the “cup of coffee” was simplified to a rigid object with a rolling ball inside. The rolling ball represents the moving liquid; this is also similar to the children’s game of transporting an egg in a spoon . Fig.1A-C shows the transition from the real object to the simplified physical model. Importantly, the original task (Fig.1A) was reduced to a two-dimensional model, where the subject interacts with the object via a robotic manipulandum. The virtual model consists of a cart with a suspended pendulum, a well-known benchmark problem in control theory.
[Abstract + References] Complex network changes during a virtual reality rehabilitation protocol following stroke: a case study
[Abstract] Towards Bilateral Upper-Limb Rehabilitation after Stroke using Kinect Game – IEEE Conference Publication
In the modern world an extended life expectancy coupled with a sedentary lifestyle raises concerns over long term health in the population. This is highlighted by the increasing incidence of disability stemming from multiple sources, for example medical conditions such as cancer or stroke . While avoiding the lifestyle factors that have a high association with these diseases would be the preferred solutions of health services the world over, as populations get progressively older and more sedentary, this becomes increasingly more difficult , . The treatment of these conditions is often complex; in stroke for example, the initial incident is a constriction of blood flow in the brain which in turn damages the nervous system’s ability to communicate with the rest of the body. This damage will occur in one hemisphere of the body but can impact both the upper and lower limbs, as well as impairing functional processes such as speech and cognitive thinking.
[Abstract + References] Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication
Biomechanical analysis is an important feature during the evaluation and clinical diagnosis of motor deficits caused by traumas or neurological diseases. For that reason Motion capture (MoCap) systems are widely used in biomechanical studies, in order to collect position data from anatomical landmarks with high accuracy. Their results are used to estimate joint movements, positions, and muscle forces. These quantitative results improve the tracking of changes in motor functions over time, being more accurately than clinical ratings . For clinical applications, these results are usually transformed into clinically meaningful and interpretable parameters, such as gait speed, motion range of joints and body balance.