Posts Tagged Muscles

[Abstract + References] Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions


Functional electrical stimulation (FES) is capable of activating muscles that are under-recruited in neurological diseases, such as stroke. Therefore, FES provides a promising technology for assisting upper-limb motor functions in rehabilitation following stroke. However, the full benefits of FES may be limited due to lack of a systematic approach to formulate the pattern of stimulation. Our preliminary work demonstrated that it is feasible to use muscle synergy to guide the generation of FES patterns.In this paper, we present a methodology of formulating FES patterns based on muscle synergies of a normal subject using a programmable multi-channel FES device. The effectiveness of the synergy-based FES was tested in two sets of experiments. In experiment one, the instantaneous effects of FES to improve movement kinematics were tested in three patients post ischemic stroke. Patients performed frontal reaching and lateral reaching tasks, which involved coordinated movements in the elbow and shoulder joints. The FES pattern was adjusted in amplitude and time profile for each subject in each task. In experiment two, a 5-day session of intervention using synergy-based FES was delivered to another three patients, in which patients performed task-oriented training in the same reaching movements in one-hour-per-day dose. The outcome of the short-term intervention was measured by changes in Fugl–Meyer scores and movement kinematics. Results on instantaneous effects showed that FES assistance was effective to increase the peak hand velocity in both or one of the tasks. In short-term intervention, evaluations prior to and post intervention showed improvements in both Fugl–Meyer scores and movement kinematics. The muscle synergy of patients also tended to evolve towards that of the normal subject. These results provide promising evidence of benefits using synergy-based FES for upper-limb rehabilitation following stroke. This is the first step towards a clinical protocol of applying FES as therapeutic intervention in stroke rehabilitation.

I. Introduction

Muscle activation during movement is commonly disrupted due to neural injuries from stroke. A major challenge for stroke rehabilitation is to re-establish the normal ways of muscle activation through a general restoration of motor control, otherwise impairments may be compensated by the motor system through a substitution strategy of task control [1]. In post-stroke intervention, new technologies such as neuromuscular electrical stimulation (NMES) or functional electrical stimulation (FES) offer advantages for non-invasively targeting specific groups of muscles [2]–[4] to restore the pattern of muscle activation. Nevertheless, their effectiveness is limited by lack of a systematic methodology to optimize the stimulation pattern, to implement the optimal strategy in clinical settings, and to design a protocol of training towards the goal of restoring motor functions. This pioneer study addresses these issues in clinical application with a non-invasive FES technology.

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1. M. F. Levin, J. A. Kleim, and S. L. Wolf, “What do motor ‘recovery’ and ‘compensation’ mean in patients following stroke?” Neurorehabilitation Neural Repair, vol. 23, no. 4, pp. 313–319, 2008.

2. G. Alon, A. F. Levitt, and P. A. McCarthy, “Functional electrical stimulation (FES) may modify the poor prognosis of stroke survivors with severe motor loss of the upper extremity: A preliminary study,” Amer. J. Phys. Med. Rehabil., vol. 87, no. 8, pp. 627–636, 2008.

3. W. Rong, “A neuromuscular electrical stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke,” J. Neuroeng. Rehabil., vol. 14, no. 1, p. 34, Dec. 2017.

4. J. J. Daly, “Recovery of coordinated gait: Randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training,” Neurorehabilitation Neural Repair, vol. 25, no. 7, pp. 588–596, Sep. 2011.

5. R. Nataraj, M. L. Audu, R. F. Kirsch, and R. J. Triolo, “Comprehensive joint feedback control for standing by functional neuromuscular stimulation—A simulation study,” IEEE Trans. Neural Syst. Rehabil. Eng., vol. 18, no. 6, pp. 646–657, Dec. 2010.

6. R. Nataraj, M. L. Audu, and R. J. Triolo, “Restoring standing capabilities with feedback control of functional neuromuscular stimulation following spinal cord injury,” Med. Eng. Phys., vol. 42, pp. 13–25, Apr. 2017.

7. H. Rouhani, M. Same, K. Masani, Y. Q. Li, and M. R. Popovic, “PID controller design for FES applied to ankle muscles in neuroprosthesis for standing balance,” Frontiers Neurosci., vol. 11, p. 347, Jun. 2017.

8. V. K. Mushahwar, P. L. Jacobs, R. A. Normann, R. J. Triolo, and N. Kleitman, “New functional electrical stimulation approaches to standing and walking,” J. Neural Eng., vol. 4, no. 3, pp. S181–S197, Sep. 2007.

9. B. J. Holinski, “Intraspinal microstimulation produces over-ground walking in anesthetized cats,” J. Neural Eng., vol. 13, no. 5, p. 056016, Oct. 2016.

10. M. B. Popovic, D. B. Popovic, T. Sinkjær, A. Stefanovic, and L. Schwirtlich, “Restitution of reaching and grasping promoted by functional electrical therapy,” Artif. Organs, vol. 26, no. 3, pp. 271–275, Mar. 2002.

11. A. B. Ajiboye, “Restoration of reaching and grasping movements through brain-controlled muscle stimulation in a person with tetraplegia: A proof-of-concept demonstration,” Lancet Lond. Engl., vol. 389, no. 10081, pp. 1821–1830, May 2017.

12. J. H. Grill and P. H. Peckham, “Functional neuromuscular stimulation for combined control of elbow extension and hand grasp in C5 and C6 quadriplegics,” IEEE Trans. Rehabil. Eng., vol. 6, no. 2, pp. 190–199, Jun. 1998.

13. M. R. Popovic, T. A. Thrasher, M. E. Adams, V. Takes, V. Zivanovic, and M. I. Tonack, “Functional electrical therapy: Retraining grasping in spinal cord injury,” Spinal Cord, vol. 44, no. 3, pp. 143–151, Mar. 2006.

14. C. Ethier, E. R. Oby, M. J. Bauman, and L. E. Miller, “Restoration of grasp following paralysis through brain-controlled stimulation of muscles,” Nature, vol. 485, no. 7398, pp. 368–371, May 2012.

15. G. Alon, “Use of neuromuscular electrical stimulation in neureorehabilitation: A challenge to all,” J. Rehabil. Res. Develop., vol. 40, no. 6, pp. 9–12, Dec. 2003.

16. G. Alon, A. F. Levitt, and P. A. McCarthy, “Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: A pilot study,” Neurorehabilitation Neural Repair, vol. 21, no. 3, pp. 207–215, Jun. 2007.

17. C. Church, C. Price, A. D. Pandyan, S. Huntley, R. Curless, and H. Rodgers, “Randomized controlled trial to evaluate the effect of surface neuromuscular electrical stimulation to the shoulder after acute stroke,” Stroke, vol. 37, no. 12, pp. 2995–3001, Dec. 2006.

18. J. H. Cauraugh and S. B. Kim, “Chronic stroke motor recovery: Duration of active neuromuscular stimulation,” J. Neurolog. Sci., vol. 215, nos. 1–2, pp. 13–19, Nov. 2003.

19. S. Ferrante, T. Schauer, G. Ferrigno, J. Raisch, and F. Molteni, “The effect of using variable frequency trains during functional electrical stimulation cycling,” Neuromodulation, Technol. Neural Interface, vol. 11, no. 3, pp. 216–226, Jul. 2008.

20. R. W. Fields, “Electromyographically triggered electric muscle stimulation for chronic hemiplegia,” Arch. Phys. Med. Rehabil., vol. 68, no. 7, pp. 407–414, Jul. 1987.

21. G. H. Kraft, S. S. Fitts, and M. C. Hammond, “Techniques to improve function of the arm and hand in chronic hemiplegia,” Arch. Phys. Med. Rehabil., vol. 73, no. 3, pp. 220–227, Mar. 1992.

22. G. van Overeem Hansen, “EMG-controlled functional electrical stimulation of the paretic hand,” Scand. J. Rehabil. Med., vol. 11, no. 4, pp. 189–193, 1979.

23. J. H. Cauraugh, S. B. Kim, and A. Duley, “Coupled bilateral movements and active neuromuscular stimulation: Intralimb transfer evidence during bimanual aiming,” Neurosci. Lett., vol. 382, nos. 1–2, pp. 39–44, Jul. 2005.

24. J. S. Knutson, D. D. Gunzler, R. D. Wilson, and J. Chae, “Contralaterally controlled functional electrical stimulation improves hand dexterity in chronic hemiparesis: A randomized trial,” Stroke, vol. 47, no. 10, pp. 2596–2602, Oct. 2016.

25. D. A. E. Bolton, J. H. Cauraugh, and H. A. Hausenblas, “Electromyogram-triggered neuromuscular stimulation and stroke motor recovery of arm/hand functions: A meta-analysis,” J. Neurol. Sci., vol. 223, no. 2, pp. 121–127, Aug. 2004.

26. M. K.-L. Chan, R. K.-Y. Tong, and K. Y.-W. Chung, “Bilateral upper limb training with functional electric stimulation in patients with chronic stroke,” Neurorehabilitation Neural Repair, vol. 23, no. 4, pp. 357–365, May 2009.

27. J. B. Manigandan, G. S. Ganesh, M. Pattnaik, and P. Mohanty, “Effect of electrical stimulation to long head of biceps in reducing gleno humeral subluxation after stroke,” Neuro Rehabil., vol. 34, no. 2, pp. 245–252, 2014.

28. S. Li, C. Zhuang, C. M. Niu, Y. Bao, Q. Xie, and N. Lan, “Evaluation of functional correlation of task-specific muscle synergies with motor performance in patients poststroke,” Frontiers Neurol., vol. 8, p. 337, Jul. 2017.

29. A. d’Avella, P. Saltiel, and E. Bizzi, “Combinations of muscle synergies in the construction of a natural motor behavior,” Nature Neurosci., vol. 6, no. 3, pp. 300–308, Mar. 2003.

30. V. C. K. Cheung, “Muscle synergy patterns as physiological markers of motor cortical damage,” Proc. Nat. Acad. Sci. USA, vol. 109, no. 36, pp. 14652–14656, Sep. 2012.

31. D. J. Clark, L. H. Ting, F. E. Zajac, R. R. Neptune, and S. A. Kautz, “Merging of healthy motor modules predicts reduced locomotor performance and muscle coordination complexity post-stroke,” J. Neurophysiol., vol. 103, no. 2, pp. 844–857, Feb. 2010.

32. E. Ambrosini, “Neuro-mechanics of recumbent leg cycling in post-acute stroke patients,” Ann. Biomed. Eng., vol. 44, pp. 3238–3251, Jun. 2016.

33. C. Zhuang, J. C. Marquez, H. E. Qu, X. He, and N. Lan, “A neuromuscular electrical stimulation strategy based on muscle synergy for stroke rehabilitation,” in Proc. IEEE 7th Int./EMBS Conf. Neural Eng. (NER), vol. 15, Apr. 2015, pp. 816–819.

34. R. S. Razavian, B. Ghannadi, N. Mehrabi, M. Charlet, and J. McPhee, “Feedback control of functional electrical stimulation for 2-D arm reaching movements,” IEEE Trans. Neural Syst. Rehabil. Eng., vol. 26, no. 10, pp. 2033–2043, Oct. 2018.

35. C. M. Niu, C. Zhuang, Y. Bao, S. Li, N. Lan, and Q. Xie, “Synergy-based NMES intervention accelerated rehabilitation of post-stroke hemiparesis,” in Proc. Assoc. Acad. Physiatrists Annu. Conf., Las Vegas, NV, USA, 2017.

36. H. Qu, “Development of network-based multichannel neuromuscular electrical stimulation system for stroke rehabilitation,” J. Rehabil. Res. Develop., vol. 52, no. 3, pp. 263–278, 2016.

37. C. M. Niu, “Effectiveness of short-term training with a synergy-based FES paradigm on motor function recovery post stroke,” in Proc. 12th Int. Soc. Phys. Rehabil. Med. World Congr., Paris, France, 2018.

38. T. Wang, “Customization of synergy-based FES for post-stroke rehabilitation of upper-limb motor functions,” in Proc. IEEE 40th Annu. Int. Conf. Eng. Med. Biol. Soc. (EMBS), Jul. 2018, 3541–3544.

39. L. L. Baker, D. R. McNeal, L. A. Benton, B. R. Bowman, and R. L. Waters, Ed., Neuromuscular Electrical Stimulation a Practical Guide, 4th ed. Downey, CA, USA: Los Amigos Research & Education Institute, 2000.

40. A. d’Avella, A. Portone, L. Fernandez, and F. Lacquaniti, “Control of fast-reaching movements by muscle synergy combinations.,” J. Neurosci., vol. 26, no. 30, pp. 7791–7810, Jul. 2006.

41. R. D. Wilson, “Upper-limb recovery after stroke: A randomized controlled trial comparing EMG-triggered, cyclic, and sensory electrical stimulation,” Neurorehabilitation Neural Repair, vol. 30, no. 10, pp. 978–987, Nov. 2016.

42. A. J. Levine, “Identification of a cellular node for motor control pathways,” Nature Neurosci., vol. 17, no. 4, pp. 586–593, Apr. 2014.

43. S. B. Frost, S. Barbay, K. M. Friel, E. J. Plautz, and R. J. Nudo, “Reorganization of remote cortical regions after ischemic brain injury: A potential substrate for stroke recovery,” J. Neurophysiol., vol. 89, no. 6, pp. 3205–3214, Jun. 2003.

44. P. Langhorne, J. Bernhardt, and G. Kwakkel, “Stroke rehabilitation,” Lancet, vol. 377, no. 9778, pp. 1693–1702, May 2011.

45. M. D. Ellis, B. G. Holubar, A. M. Acosta, R. F. Beer, and J. P. A. Dewald, “Modifiability of abnormal isometric elbow and shoulder joint torque coupling after stroke,” Muscle Nerve, vol. 32, pp. 170–178, Aug. 2005.

46. J. P. A. Dewald, P. S. Pope, J. D. Given, T. S. Buchanan, and W. Z. Rymer, “Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects,” Brain, vol. 118, no. 2, pp. 495–510, 1995.

47. D. G. Kamper, A. N. McKenna-Cole, L. E. Kahn, and D. J. Reinkensmeyer, “Alterations in reaching after stroke and their relation to movement direction and impairment severity,” Arch. Phys. Med. Rehabil., vol. 83, no. 5, pp. 702–707, May 2002.

48. C. L. Massie, S. Fritz, and M. P. Malcolm, “Elbow extension predicts motor impairment and performance after stroke,” Rehabil. Res. Pract., vol. 2011, pp. 1–7, 2011.

49. V. C. K. Cheung, L. Piron, M. Agostini, S. Silvoni, A. Turolla, and E. Bizzi, “Stability of muscle synergies for voluntary actions after cortical stroke in humans,” Proc. Nat. Acad. Sci. USA, vol. 106, no. 46, pp. 19563–19568, Nov. 2009.

50. J. Roh, W. Z. Rymer, and R. F. Beer, “Robustness of muscle synergies underlying three-dimensional force generation at the hand in healthy humans,” J. Neurophysiol., vol. 107, no. 8, pp. 2123–2142, Apr. 2012.

51. J. Roh, W. Z. Rymer, and R. F. Beer, “Evidence for altered upper extremity muscle synergies in chronic stroke survivors with mild and moderate impairment,” Frontiers Hum. Neurosci., vol. 9, p. 6, Feb. 2015.

52. J. Roh, W. Z. Rymer, E. J. Perreault, S. B. Yoo, and R. F. Beer, “Alterations in upper limb muscle synergy structure in chronic stroke survivors,” J. Neurophysiol., vol. 109, no. 3, pp. 768–781, Feb. 2013.

53. W. H. Backes, W. H. Mess, V. van Kranen-Mastenbroek, and J. P. H. Reulen, “Somatosensory cortex responses to median nerve stimulation: fMRI effects of current amplitude and selective attention,” Clin. Neurophysiol., vol. 111, no. 10, pp. 1738–1744, Oct. 2000.

54. G. Francisco, “Electromyogram-triggered neuromuscular stimulation for improving the arm function of acute stroke survivors: A randomized pilot study,” Arch. Phys. Med. Rehabil., vol. 79, no. 5, pp. 570–575, May 1998.

55. S. K. Sabut, C. Sikdar, R. Kumar, and M. Mahadevappa, “Functional electrical stimulation of dorsiflexor muscle: Effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients,” Neurorehabilitation, vol. 29, no. 4, pp. 393–400, 2011.

56. Y.-H. Wang, F. Meng, Y. Zhang, M.-Y. Xu, and S.-W. Yue, “Full-movement neuromuscular electrical stimulation improves plantar flexor spasticity and ankle active dorsiflexion in stroke patients: A randomized controlled study,” Clin. Rehabil., vol. 30, no. 6, pp. 577–586, Jun. 2016.

57. W. H. Chang and Y.-H. Kim, “Robot-assisted therapy in stroke rehabilitation,” J. Stroke, vol. 15, no. 3, p. 174, 2013.

58. H. G. Wu, Y. R. Miyamoto, L. N. G. Castro, B. P. Ölveczky, and M. A. Smith, “Temporal structure of motor variability is dynamically regulated and predicts motor learning ability,” Nature Neurosci., vol. 17, no. 2, pp. 312–321, Jan. 2014.

59. J. Frère and F. Hug, “Between-subject variability of muscle synergies during a complex motor skill,” Frontiers Comput. Neurosci., vol. 6, p. 99, Dec. 2012.

60. S. Muceli, A. T. Boye, A. d’Avella, and D. Farina, “Identifying representative synergy matrices for describing muscular activation patterns during multidirectional reaching in the horizontal plane,” J. Neurophysiol., vol. 103, no. 3, pp. 1532–1542, Mar. 2010.

61. J. F. Soechting and F. Lacquaniti, “Invariant characteristics of a pointing movement in man,” J. Neurosci., vol. 1, no. 7, pp. 710–720, Jul. 1981.

62. B. Cesqui, A. d’Avella, A. Portone, and F. Lacquaniti, “Catching a ball at the right time and place: Individual factors matter,” PLoS ONE, vol. 7, no. 2, p. e31770, Feb. 2012.


via Synergy-Based FES for Post-Stroke Rehabilitation of Upper-Limb Motor Functions – IEEE Journals & Magazine

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[BLOG POST] Antidepressants help us understand why we get fatigued during exercise

In general, the term ‘fatigue’ is used to describe any exercise-induced decline in the ability of a muscle to generate force. To identify the causes of fatigue, it is common to examine two divisions of the body that might be affected during exercise. The central component of fatigue includes the many nerves that travel throughout the brain to the spinal cord. The peripheral component predominantly reflects elements in the muscle itself. If there is a problem with either of these components, the ability to contract a muscle might be compromised. For many years, there has been suggestion that central fatigue is heavily influenced by neurotransmitters that get released in the central nervous system (such as dopamine and serotonin). However, little research has been performed in this area.

Serotonin is a chemical that can improve mood, and increasing the amount of serotonin that circulates in the brain is a common therapy for depression. However, serotonin also plays a vital role in activating neurons in the spinal cord which tell the muscle to contract. With the correct amount of serotonin release, a muscle will activate efficiently. However, if too much serotonin is released, there is a possibility that the muscle will rapidly fatigue. Recent animal studies indicate that moderate amounts of serotonin release, which are common during exercise, can promote muscle contractions (Cotel et al. 2013). However, massive serotonin release, which may occur with very large bouts of exercise, could further exacerbate the already fatigued muscle (Perrier et al. 2018).

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. These medications keep serotonin levels high in the central nervous system by stopping the chemical from being reabsorbed by nerves (reuptake inhibition). Instead of using SSRIs to relieve symptoms of depression, we used them in our recent study (Kavanagh et al. 2019) to elevate serotonin in the central nervous system, and then determine if characteristics of fatigue are enhanced when serotonin is elevated. We performed three experiments that used maximal voluntary contractions of the biceps muscle to cause fatigue in healthy young individuals. Our main goal was to determine if excessive serotonin limits the amount of exercise that can be performed, and then determine which central or peripheral component was compromised by excessive serotonin.


Given that SSRIs influence neurotransmitters in the central nervous system, it was not surprising that peripheral fatigue was unaltered by the medication. However, central fatigue was influenced with enhanced serotonin. The time that a maximum voluntary contraction could be held was reduced with enhanced serotonin, whereby the ability of the central nervous system to drive the muscle was compromised by 2-5%. We further explored the location of dysfunction and found that the neurons in the spinal cord that activate the muscle were 4-18% less excitable when fatiguing contractions were performed in the presence of enhanced serotonin.


The central nervous system is diverse, and the fatigue that is experienced during exercise is not just restricted to the brain. Instead, the spinal cord plays an integral role in activating muscles, and mechanisms of fatigue also occur in these lower, often overlooked, neural circuits. This is the first study to provide evidence that serotonin released onto the motoneurones contributes to central fatigue in humans.


Kavanagh JJ, McFarland AJ, Taylor JL. Enhanced availability of serotonin increases activation of unfatigued muscle but exacerbates central fatigue during prolonged sustained contractions. J Physiol. 597:319-332, 2019.

If you cannot access the paper, please click here to request a copy.


Cotel F, Exley R, Cragg SJ, Perrier JF. Serotonin spillover onto the axon initial segment of motoneurons induces central fatigue by inhibiting action potential initiation. Proc Natl Acad Sci U S A. 110:4774-4779, 2013.

Perrier JF, Rasmussen HB, Jørgensen LK, Berg RW. Intense activity of the raphe spinal pathway depresses motor activity via a serotonin dependent mechanism. Front Neural Circuits. 11:111, 2018.


Associate Professor Justin Kavanagh is a researcher and lecturer at Griffith University. His team explores how the central nervous system controls voluntary and involuntary movement, and he has particular interests in understanding how medications can be used to study mechanisms of human movement.

via Antidepressants help us understand why we get fatigued during exercise – Motor Impairment


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[Abstract] EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation


Rehabilitation is important treatment for post stroke patient to regain their muscle strength and motor coordination as well as to retrain their nervous system. Electromyography (EMG) has been used by researcher to enhance conventional rehabilitation method as a tool to monitor muscle electrical activity however EMG signal is very stochastic in nature and contains some noise. Special technique is yet to be researched in processing EMG signal to make it useful and effective both to researcher and to patient in general. Feature extraction is among the signal processing technique involved and the best method for specific EMG study needs to be applied. In this works, nine feature extractions techniques are applied to EMG signals recorder from subjects performing upper limb rehabilitation activity based on suggested movement sequence pattern. Three healthy subjects perform the experiment with three trials each and EMG data were recorded from their bicep and deltoid muscle. The applied features for every trials of each subject were analyzed statistically using student T-Test their significant of p-value. The results were then totaled up and compared between the nine features applied and Auto Regressive coefficient (AR) present the best result and consistent with each subjects’ data. This feature will be used later in our future research work of Upper-limb Virtual Reality Rehabilitation.

via EMG Feature Extractions for Upper-Limb Functional Movement During Rehabilitation – IEEE Conference Publication

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[Abstract + References] A Tendon-driven Upper-limb Rehabilitation Robot – IEEE Conference Publication


Rehabilitation robots are playing an increasingly important role in daily rehabilitation of patients. In recent years, exoskeleton rehabilitation robots have become a research hotspot. However, the existing exoskeleton rehabilitation robots are mainly rigid exoskeletons. During rehabilitation training using such exoskeletons, the patient’s joint rotation center is fixed, which cannot adapt to the actual joint movements, resulting in secondary damage to the patients. Therefore, in this paper, a tendon-driven flexible upper-limb rehabilitation robot is proposed; the structure and connectors of the rehabilitation robot are designed considering the physiological structure of human upper limbs; we also built the prototype and performed experiments to validate the designed robot. The experimental results show that the proposed upper-limb rehabilitation robot can assist the human subject to conduct upper-limb rehabilitation training.

I. Introduction

Central nervous system diseases, such as stroke, spinal cord injury and traumatic brain injury, tend to cause movement disorder [1]. Clinical studies have shown that intensive rehabilitation training after cerebral injury help patients recover motoric functions because of the brain plasticity [1], [2]. Traditional movement therapy is highly dependent on physiotherapists and the efficacy is limited by professional knowledge and skill levels of physiotherapists [3]. Upper-limbs recover more slowly than lower limbs because of the complex function of neurons. Meanwhile, the rehabilitation therapies are unaffordable for most patients. Robotic rehabilitation opened another way of rehabilitation training and its efficacy has been validated in clinical trials [3], [4]. Many upper-limb robot devices have been developed for rehabilitation or assistance in various forms. One of the famous devices was MIT-MANUS developed by MIT. This kind of devices are stationary external system where the patient inserts their hand or arm and is robotically assisted or resisted in completing predetermined tasks [3], [5]. Other examples of this type of devices include Lum et al.^{\prime}s MIME [6], Kahn et al.’s ARM Guide [7] and a 2-DOF upper-limb rehabilitation robot developed by Tsinghua



1. M. Hallett, “Plasticity of the human motor cortex and recovery from stroke”, Brain Research Reviews, vol. 36, pp. 169-174, 2001.

2. J. D. Schaechter, “Motor rehabilitation and brain plasticity after hemiparetic stroke”, Progress in Neurobiology, vol. 73, pp. 61-72, 2004.

3. Q. Yang, D. Cao, J. Zhao, “Analysis on State of the Art of upper-limb Rehabilitation Robots”, Jiqiren/robot, vol. 35, pp. 630, 2013.

4. P. Maciejasz, J. Eschweiler, K. Gerlach-Hahn, A. Jansen-Troy, S. Leonhardt, “A survey on robotic devices for upper-limb rehabilitation”, Journal of Neuroengineering & Rehabilitation, vol. 11, pp. 3, 2014.

5. C. J. Nycz, M. A. Delph, G. S. Fischer, “Modeling and design of a tendon actuated flexible robotic exoskeleton for hemiparetic upper-limb rehabilitation”, International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 3889-3892, 2015.

6. P. S. Lum, C. G. Burgar, P. C. Shor, “Use of the MIME robotic system to retrain multijoint reaching in post-stroke hemiparesis: why some movement patterns work better than others”, Engineering in Medicine and Biology Society 2003. Proceedings of the International Conference of the IEEE, vol. 2, pp. 1475-1478, 2003.

7. D. J. Reinkensmeyer, L. E. Kahn, M. Averbuch, A. Mckenna-Cole, B. D. Schmit, W. Z. Rymer, “Understanding and treating arm movement impairment after chronic brain injury: progress with the ARM guide”, Journal of Rehabilitation Research & Development, vol. 37, pp. 653-662.

8. Y. Zhang, Z. Wang, L. Ji, S. Bi, “The clinical application of the upper extremity compound movements rehabilitation training robot”, International Conference on Rehabilitation Robotics, pp. 91-94, 2005.

9. H. Fukushima, “Health and wellbeing in the 21st century (No. 4): Early rehabilitation and conditions for which it is appropriate [J]” in Social-human environmentology, pp. 6, 2004.

10. T. G. Sugar, J. He, E. J. Koeneman, J. B. Koeneman, R. Herman, H. Huang et al., “Design and control of RUPERT: a device for robotic upper extremity repetitive therapy”, IEEE Transactions on Neural Systems & Rehabilitation Engineering a Publication of the IEEE Engineering in Medicine & Biology Society, vol. 15, no. 3, pp. 336-46, 2007.

11. J. C Perry, J. Rosen, S. Burns, “Upper-Limb Powered Exoskeleton Design”, Mechatronics IEEE/ASME Transactions on, vol. 12, pp. 408-417, 2007.

12. A. U. Pehlivan, O. Celik, M. K. O’Malley, “Mechanical design of a distal arm exoskeleton for stroke and spinal cord injury rehabilitation”, IEEE International Conference on Rehabilitation Robotics IEEE Int Conf Rehabil Robot, pp. 5975428, 2011.

13. S Koo, T. P. Andriacchi, “The Knee Joint Center of Rotation is Predominantly on the Lateral Side during Normal Walking[J]”, Journal of Biomechanics, vol. 41, no. 6, pp. 1269, 2008.

14. Y. Mao, S. K. Agrawal, “Transition from mechanical arm to human arm with CAREX: A cable driven ARm EXoskeleton (CAREX) for neural rehabilitation”, Proc. IEEE Int. Conf. Robot. Autom., pp. 2457-2462, 2012.

15. Y. Mao, X. Jin, G. G. Dutta, J. P. Scholz, S. K. Agrawal, “Human movement training with a cable driven ARm EXoskeleton (CAREX)”, IEEE Trans. Neural Syst. Rehabil. Eng., vol. 23, no. 1, pp. 84-92, Jan. 2015.

16. DJ Reinkensmeyer, JL Emken, SC. Cramer, “Robotics motor learning and neurologic recovery”, Annual Review of Biomedical Engineering, vol. 6, no. 1, pp. 497-525, 2004.

17. QZ Yang, CF Cao, JH. Zhao, “Analysis of the status of the research of the upper-limb rehabilitative robot”, Robot, vol. 35, no. 5, pp. 630-640, 2013.

18. XZ Jiang, XH Huang, CH Xiong et al., “Position Control of a Rehabilitation Robotic Joint Based on Neuron Proportion-Integral and Feedforward Control”, Journal of Computational & Nonlinear Dynamics, vol. 7, no. 2, pp. 024502, 2012.

19. ZC Chen, Z. Huang, “Motor relearning in the application of the rehabilitation therapy for stroke”, Chinese Journal of Rehabilitation Medicine, vol. 22, no. 11, pp. 1053-1056, 2007.

20. JC Perry, J Rosen, S. Burns, “Upper-Limb Powered Exoskeleton Design[J]”, IEEE/ASME Transactions on Mechatronics, vol. 12, no. 4, pp. 408-417, 2007.

21. C LV, Research on rehabilitation robot for upper-limb hemiplegia, Shanghai China:, 2011.

22. Y K Woo, G H Cho, E Y. Yoo, Effect of PNF Applied to the Unaffected Side on Muscle Tone of Affected Side in Patients with Hemiplegia[J], vol. 9, no. 2, 2002.

23. JH Liang, JP Tong, X. Li, “Observation of the curative effect of continuous passive movement of joints in the treatment of lower limb spasticity”, Theory and practice of rehabilitation in China, vol. 14, no. 11, pp. 1067-1067, 2008.


via A Tendon-driven Upper-limb Rehabilitation Robot – IEEE Conference Publication

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[Abstract] Electromyography Based Orthotic Arm and Finger Rehabilitation System


Electromyography (EMG), a technique used to analyze and record electric current produced by skeletal muscles, has been used to control replacement limbs, and diagnose muscle irregularities. In this work, an EMG based system comprising of an orthotic arm and finger device to aid in muscle rehabilitation, is presented. As the user attempts to contract their bicep or forearm muscles, the system senses the change in the EMG signals and in turn triggers the motors to assist with flexion and extension of the arm and fingers. As brain is a major factor for muscle growth, mental training using motor imagery was incorporated into the system. Subjects underwent mental training to show the capability of muscle growth. The measured data reveals that the subjects were able to compensate for the loss of muscle growth, due to shorter physical training sessions, with mental training. Subjects were then tested using the orthotic arm and finger rehabilitation device with motor imagery. The findings also showed a positive increase in muscle growth using the rehabilitation system. Based on the experimental results, the EMG rehabilitation system presented in this paper has the potential to increase muscle strength and improve the recovery rate for muscle injuries, partial paralysis, or muscle irregularities.

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[Abstract] Design and Evaluation of a Soft and Wearable Robotic Glove for Hand Rehabilitation


In the modern world, due to an increased aging population, hand disability is becoming increasingly common. The prevalence of conditions such as stroke is placing an ever-growing burden on the limited fiscal resources of health care providers and the capacity of their physical therapy staff. As a solution, this paper presents a novel design for a wearable and adaptive glove for patients so that they can practice rehabilitative activities at home, reducing the workload for therapists and increasing the patient’s independence. As an initial evaluation of the design’s feasibility the prototype was subjected to motion analysis to compare its performance with the hand in an assessment of grasping patterns of a selection of blocks and spheres. The outcomes of this paper suggest that the theory of design has validity and may lead to a system that could be successful in the treatment of stroke patients to guide them through finger flexion and extension, which could enable them to gain more control and confidence in interacting with the world around them.

I. Introduction

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 [1]. 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 [1], [2]. 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.


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[Abstract] A soft robotic glove for hand motion assistance


Soft robotic devices have the potential to be widely used in daily lives for their inherent compliance and adaptability, which result in high safety under unexpected situations. System complexity and requirements are much lower, comparing with conventional rigid-bodied robotic devices, which also result in significantly lower costs. This paper presents a robotic glove by utilizing soft artificial muscles providing redundant degrees of freedom (DOFs) to generate both flexion and extension hand motions for daily grasping and manipulation tasks. Different with the existing devices, to minimize the weight applied to the user’s hands, pneumatic soft actuators were located on the fore arm and drive each finger via cable-transmission mechanisms. This actuation mechanism brings extra adaptability, motion smoothness, and user safety to the system. This design makes wearable robotic gloves more light-weight and user-friendly. Both theoretical and experimental analyses were conducted to explore the mechanical properties of pneumatic soft actuators. In addition, the fingertip trajectories were analyzed using Finite Element Methods, and a series of experiments were conducted evaluating both the technical and practical performances of the proposed glove.


I. Introduction

Glove-type wearable robotic devices are developed to assist people with impaired hand functions both in their activities of daily living (ADLs) and in rehabilitation [1]–[12]. Most of such wearable robotic devices generate hand movements with linkage systems actuated by electrical motors which usually are heavy and inconvenient for using. Moreover, because of the human hand variation, most wearable robotic devices require customization in order to fulfill the geometrical fitting requirements between the exoskeleton device and the human hand joints. Approximating the high dexterity of human hands usually requires high complexity in both the mechanical and controller structures of the robotic systems, and hence also results in high costs for most users.

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[Abstract] MIT-Skywalker: On the use of a markerless system


This paper describes our efforts to employ the Microsoft Kinect as a low cost vision control system for the MIT-Skywalker, a robotic gait rehabilitation device. The Kinect enables an alternative markerless solution to control the MIT-Skywalker and allows a more user-friendly set-up. A study involving eight healthy subjects and two stroke survivors using the MIT-Skywalker device demonstrates the advantages and challenges of this new proposed approach.

Source: MIT-Skywalker: On the use of a markerless system – IEEE Xplore Document

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[Abstract] Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation


Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.

Source: Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation – IEEE Xplore Document

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[Abstract] Design factors and opportunities of rehabilitation robots in upper-limb training after stroke


The occurrence of strokes has been progressively increasing. Upper limb recovery after stroke is more difficult than lower limb. One of the rapidly expanding technologies in post-stroke rehabilitation is robot-aided therapy. The advantage of robots is that they are able to deliver highly repetitive therapeutic tasks with minimal supervision of a therapist. However, from the literature, the focus of robotic design in stroke rehabilitation has been technology-driven. Clinical and therapeutic requirements were not seriously considered in the design of rehabilitation robots. The purpose of this study was twofold: (1) demonstrate the missing elements of current robot-aided therapy; (2) identify design factors and opportunities of rehabilitation robots (in upper-limb training after stroke). In this study, we performed a literature review on articles relevant to rehabilitation robots in upper-limb training after stroke. We identified the design foci of current rehabilitation robots for upper limb stroke recovery. Using the therapeutic framework for stroke rehabilitation in occupational therapy, we highlighted design factors and opportunities of rehabilitation robots. The outcomes of this study benefit the robotics design community in the design of rehabilitation robots.

1. Introduction

A robot is defined as a machine programmable to perform and modify tasks in response to changes in the environment [1]. The benefits of robots are noticeable in productivity, safety, and in saving time and money. The advancement of robot technologies in the past decade caused the wide adoption of robots in our lives and in the society. For instance, in education, robots were implemented in undergraduate courses to teach core artificial intelligence concepts, e.g., algorithms for searching tree data structures [2]. In agriculture, robotic milking systems (being able to reduce labor/operational costs) were installed to replace conventional milking that gave cows the freedom to be milked throughout the day [3]. In healthcare, service robots were implemented to provide functional assistance for the elderly in home environments, e.g., bringing medication for the emergency and picking up heavy objects low on the ground [4].

Source: Design factors and opportunities of rehabilitation robots in upper-limb training after stroke – IEEE Xplore Document

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