Posts Tagged prosthetics

[BLOG POST] Rehabilitation Medicine is Changing: Use Tech to Keep Up – Hocoma

Rehabilitation Medicine is Changing: Use Tech to Keep Up

The needs of patients are continually evolving just as the aging population continues to grow. Advancements in neurological rehabilitation help top facilities keep the best talent and optimize outcomes in the face of increasing stroke events.

A delicate balance

For neurorehabilitation therapy, there is a delicate balance between available resources and their ever-increasing demand. As demographics change and the global population ages, the healthcare system faces an even heavier economic burden. Experts estimate that stroke rates in Europe will increase by 30% by the year 20501. Improved acute care translates to a growing need for rehab. Limited time with a therapist and a shrinking work force translates to a significant gap in rehabilitation needs versus the availability of care.


A growing senior population

It is a well-known fact that in the coming years, the majority of the world’s population will be advanced in age.2 Many aging individuals will experience health complications such as neurological or cardiovascular diseases that require rehabilitative care.3 As acute medical care and survival rates improve, so does the urgent need for rehabilitation. If current rehabilitation practices do not change, hospitals and other medical facilities will likely struggle to accommodate their patients.

Limited Therapist Time

Reports show that even in top European rehab facilities, only a few hours a day are devoted to hands-on care.4 While intensity and repetition have been shown to produce the best clinical outcomes in neurological or physical rehab programs, the majority of a patient’s time in the hospital is spent idle. To maximize therapy time, a change in how rehabilitation is administered would likely benefit patients and providers tremendously. One such change includes technology-assisted training.

Emerging Trends in Biotech

Robotic rehabilitation has been shown to be as effective, if not more effective than conventional care5,6. In addition to facilitating more intense and thorough rehab for patients, this technology confers benefits such as:

  • Empowerment – by giving real-time feedback and promoting autonomy, technology helps patients heal themselves. The internet has also led to increased patient knowledge — a significant boon when handled appropriately by health care professionals.
  • Telemedicine – patients can connect to the best doctors through remote care, allowing them to heal from home. National healthcare systems have successfully reduced the length of inpatient rehabilitation via alternatives like telerehabilitation so that patients can continue their training after discharge.
  • Gamification – increases patient engagement in rehab practice through play. Not only for pediatric patients, games and virtual reality can help older patients remain motivated to complete rehab programs.
  • Body sensors – provide real-time, accurate and digital measurements for feedback and optimal care. Incorporating body sensors, virtual reality and gamification can provide an immersive therapy experience with digital precision.
  • Exoskeletons and prosthetics – enable movement assistance that stabilizes patients and helps them to walk and to complete daily life activities when they would never have been able to achieve this before.

As rehabilitation facilities incorporate new technologies, patient care will become more efficient. Technology enables hospitals to better meet the needs of a growing senior population while preventing therapist burnout in therapists — ultimately making world-class care a reality.



1 Norrving B, Barrick J, Davalos A, et al. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J. 2018;3(4):309–336. doi:10.1177/2396987318808719
2 Beard JR, Officer A, de Carvalho IA, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–2154. doi:10.1016/S0140-6736(15)00516-4
3 Béjot Y, Bailly H, Graber M, Garnier L, Laville A, Dubourget L, Mielle N, Chevalier C, Durier J, Giroud M. Impact of the Ageing Population on the Burden of Stroke: The Dijon Stroke Registry. Neuroepidemiology. 2019;52(1-2):78-85. doi: 10.1159/000492820. Epub 2019 Jan 2. PubMed PMID: 30602168.
4 De Wit L, Putman K, Dejaeger E, Baert I, Berman P, Bogaerts K, Brinkmann N, Connell L, Feys H, Jenni W, Kaske C, Lesaffre E, Leys M, Lincoln N, Louckx F, Schuback B, Schupp W, Smith B, De Weerdt W. Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke. 2005 Sep;36(9):1977-83. doi: 10.1161/01.STR.0000177871.59003.e3. Epub 2005 Aug 4. PubMed PMID: 16081860.
5 Mehrholz, J., S. Thomas, C. Werner, J. Kugler, M. Pohl and B. Elsner (2017). “Electromechanical-Assisted Training for Walking after Stroke (Update).” Cochrane Database Syst Rev 5: Cd006185.
6 Mehrholz, J., M. Pohl, T. Platz, J. Kugler and B. Elsner (2018). “Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.” Cochrane Database Syst Rev 9: CD006876.


Want to know more? For the full story of the changing landscape of rehabilitation medicine for an aging population, download our pdf: 5 Reasons Technology is the Future of Rehab Medicine

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[VIDEO] Third Thumb Changes The Prosthetics Game – YouTube

London-based product designer, Dani Clode designed a third thumb to change the way people think about prosthetics. Clode believes that prosthetics extent a wearer’s ability. They shouldn’t be regarded as a replacement to part of the human body. The third thumb is made from a series of interconnected parts: a hand piece, an attachment, cables, motors, and two Bluetooth controllers.

See more from Dani Clode:

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[Abstract + References] Upper Limb Rehabilitation Therapies Based in Videogames Technology Review


Worldwide, stroke is the third cause of physical disability, rehabilitation therapy is a main topic of focus for the recovery of life quality. Rehabilitation of these patients presents great challenges since many of them do not find the motivation to perform the necessary exercises, or do not have the economic resources or the adequate support to receive physiotherapy. For several years now, an alternative that has been in development is game-based rehabilitation, since this could be used in a hospital environment and eventually at patients home. The aim of this review is to present the advances in videogames technology to be used for rehabilitation and training purposes- in preparation for prosthetics fitting or Neuroprosthesis control training–, as well as the devices that are being used to make this alternative more tangible. Videogames technology rehabilitation still has several challenges to work on, more research and development of platforms to have a larger variety of games to engage with different age-range patients is still necessary.
1. Y. X. Hung , P. C. Huang , K. T. Chen , and W. C. Chu , “ What do stroke patients look for in game-based rehabilitation: A survey study ,” Med. (United States) , vol. 95 , no. 11 , pp. 1 – 10 , 2016 .

2. E. Vogiatzaki , Y. Gravezas , N. Dalezios , D. Biswas , A. Cranny , and S. Ortmann , “ Telemedicine System for Game-Based Rehabilitation of Stroke Patients in the FP7- ‘ StrokeBack ’ Project ,” 2014 .

3. W. Johnson , O. Onuma , and S. Sachdev , “ Stroke: a global response is needed ,” Bull. World Heal. Organ ., vol. 94 p. 634 – 634A , 2016 .

4. A. Tabor , S. Bateman , E. Scheme , D. R. Flatla , and K. Gerling , “ Designing Game-Based Myoelectric Prosthesis Training ,” in Proceedings of the 2017 CHI Conference on Human Factors in Computing Systems – CHI ’17 , 2017 , pp. 1352 – 1363 .

5. B. Lange et al. , “ Interactive game-based rehabilitation using the Microsoft Kinect ,” Proc. – IEEE Virtual Real ., no. November 2016 , pp. 171 – 172 , 2012 .

6. C. Prahm , I. Vujaklija , F. Kayali , P. Purgathofer , and O. C. Aszmann , “ Game-Based Rehabilitation for Myoelectric Prosthesis Control ,” JMIR Serious Games , vol. 5 , no. 1 , pp. 1 – 13 , 2017 .

7. B. D. Winslow , M. Ruble , and Z. Huber , “ Mobile, Game-Based Training for Myoelectric Prosthesis Control ,” Front. Bioeng. Biotechnol .,vol. 6 , no. July , pp. 1 – 8 , 2018 .

8. “ The SENIAM Project ,” 2019 . [Online]. Available: . [Accessed: 21-Jan-2019 ].

9. M. B. I. Reaz , M. S. Hussain , and F. Mohd-Yasin , “ Techniques of EMG signal analysis: Detection, processing, classification and applications ,” Biol. Proced. Online , vol. 8 , no. 1 , pp. 11 – 35 , 2006 .

10. R. S. Armiger and R. J. Vogelstein , “ Air-Guitar Hero: A real-time video game interface for training and evaluation of dexterous upper-extremity neuroprosthetic control algorithms ,” Circuits Syst. Conf. BIOCAS 2008 , pp. 121 – 124 , 2008 .

11. H. Oppenheim , R. S. Armiger , and R. J. Vogelstein , “ WiiEMG: A real-time environment for control of the Wii with surface electromyography ,” in Proceedings of 2010 IEEE International Symposium on Circuits and Systems , 2010 , pp. 957 – 960 .

12. G. I. Yatar and S. A. Yildirim , “ Wii Fit balance training or progressive balance training in patients with chronic stroke: a randomised controlled trial ,” J. Phys. Ther. Sci ., vol. 27 , no. 4 , pp. 1145 – 1151 , 2015 .

13. N. Norouzi-Gheidari , M. F. Levin , J. Fung , and P. Archambault , “ Interactive virtual reality game-based rehabilitation for stroke patients ,” in 2013 International Conference on Virtual Rehabilitation, ICVR 2013 2013 .

14. B. Lange , C. Chang , E. Suma , B. Newman , A. S. Rizzo , and M. Bolas , “ Development and Evaluation of Low Cost Game-Based Balance Rehabilitation Tool Using the Microsoft Kinect Sensor ,” 2011 , pp. 1831 – 1834 .

15. Y. Chen et al. , “ Game Analysis, Validation, and Potential Application of EyeToy Play and Play 2 to Upper-Extremity Rehabilitation ,” no. December , 2014 .

16. P. Visconti , F. Gaetani , G. A. Zappatore , and P. Primiceri , “ Technical features and functionalities of Myo armband: An overview on related literature and advanced applications of myoelectric armbands mainly focused on arm prostheses ,” Int. J Smart Sens. Intell. Syst ., vol. 11 , no. 1 , pp. 1 – 25 , 2018 .

17. S. S. Esfahlani and G. Wilson , “ Development of Rehabilitation System (ReHabgame) through Monte-Carlo Tree Search Algorithm ,” 2018 , pp. 1 – 8 .

18. “ Welcome to Myo Support ,” 2019 . [Online]. Available: [Accessed: 19-Jan-2019 ].

19. “ PAULA 1.2 | Myo Software | Myo Hands and Components |Upper Limb Prosthetics | Prosthetics | Ottobock US Healthcare .”[Online]. Available: [Accessed: 21-Jan-2019 ].

20. J. Lewis , P. Merritt , M. Bowler , and D. Brown , “ Evaluation of the suitability of games based stroke rehabilitation using the Novint Falcon ,” 2018 , no. August .

21. G. Ghazaei , A. Alameer , P. Degenaar , G. Morgan , and K. Nazarpour , “ Deep learning-based artificial vision for grasp classification in myoelectric hands ,” J. Neural Eng ., vol. 14 , no. 3 , 2017 .

22. B. Terlaak , H. Bouwsema , C. K. V. D. Sluis , and R. M. Bongers , “ Virtual training of the myosignal ,” PLoS One , vol. 10 , no. 9 , 2015 .

23. J. W. Burke , M. D. J. McNeill , D. K. Charles , P. J. Morrow , J. H. Crosbie , and S. M. McDonough , “ Designing Engaging, Playable Games for Rehabilitation ,” in 8th International Conference on Disability, Virtual Reality and Associated Technologies (ICDVRAT) , 2010 , pp. 195 – 201 .


via Upper Limb Rehabilitation Therapies Based in Videogames Technology Review – IEEE Conference Publication

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[VIDEO] Third Thumb Changes the Prosthetics Game – YouTube


London-based product designer, Dani Clode designed a third thumb to change the way people think about prosthetics. Clode believes that prosthetics extent a wearer’s ability. They shouldn’t be regarded as a replacement to part of the human body. The third thumb is made from a series of interconnected parts: a hand piece, an attachment, cables, motors, and two Bluetooth controllers. See more from Dani Clode:

via Third Thumb Changes the Prosthetics Game – YouTube

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[WEB SITE] O&P’s Virtual Present and Future.


Virtual reality is a potentially important tool in patient rehabilitation and training, as well as prosthetic design.

O&P News, December 2017

Despite technological advances in prosthetics, a major problem within the O&P profession remains that a large percentage of amputees still abandon or reject their prosthesis due to lack or training or knowledge of their device, according to Ashley D. Knight, PhD.

A biomedical engineer research associate at the Center for Assistive, Rehabilitation and Robotics Technologies at the University of South Florida, Knight told O&P Newsthat untrained amputees will adjust their bodies in awkward or compensatory motions rather than reposition a joint position while performing a task with a prosthetic device. This causes misuse and improper function, which has been shown to lead to significant injuries.


However, according to Knight, one possible way to address this is by incorporating virtual reality into rehabilitation and prosthesis training.

“A successful training and rehabilitation program would allow amputees to improve their ability to perform with optimal motion and use all prosthetic control capabilities,” Knight said. “Using virtual reality for training and rehabilitation could allow for a successful controlled, individualized, progressive regime, while providing expertise care to patients both in a clinic and at home.”

Jeff Erenstone, CPO, founder and CEO of Create O&P, uses modification software in virtual reality to make digital plaster models.

Jeff Erenstone, CPO, founder and CEO of Create O&P, uses modification software in virtual reality to make digital plaster models.
Source: Gary Ziele/Create O&P.

Advanced stick figures

According to Knight, whose dissertation, “The Development of a Platform Interface with the Use of Virtual Reality to Enhance,” investigated the use of virtual reality in prosthetic training, the advantage of using virtual reality in O&P is that it allows for instant visual feedback, expertise training and motivational, immersive applications.

Knight’s dissertation, which was published in 2017 by ProQuest LLC, described the development of a “stick figure” model of the user’s motion in real-time and a character avatar animating certain motions that the patient can follow while performing rehabilitative and training tasks. Among the five participants who were unilateral transradial amputees using their own prosthetic devices, all showed improved positing, movement symmetry, joint range of motion, motivation and overall improved performance after using the virtual reality program.

“Virtual reality could allow patients to be immersed into a virtual environment while provided real-time visual feedback of their instantaneous motion, alongside an individualized predictive optimal goal motion to follow,” Knight said.

Virtually ‘endless’ advantages

Michael Wininger, PhD

Michael Wininger

According to Michael Wininger, PhD, an assistant professor of prosthetics and orthotics at the University of Hartford department of rehabilitation sciences, the potential advantages of virtual reality are endless.

“In virtual reality, you can create any setting, any environment and customize it to the patient,” he told O&P News. “You can have it be really sensitive to their specific needs, and the program can run anytime, day or night. You don’t have to feed it, and you don’t have to pay it. It’s always ready to be turned on, and it doesn’t have bad days.

Virtual reality, as well as augmented reality, has become more popular in teaching and clinical settings in the last 15 years, Wininger said. He added that researchers have found that rehabilitation and training with virtual reality can result in improved outcomes for patients compared to the current training and rehabilitation paradigm.

This has been recognized in the past with regard to stroke rehabilitation. However, it has more recently been implemented in O&P settings, he said.


“If you have someone who has a stroke and they can’t use their affected limb well and you present them with a conventional clinical test, it’s up to the clinician to get as much as they can from the patient,” he said. “However, with virtual reality, the clinician can encourage the patient to engage with the virtual environment — they want to grab a ball or score a point, and it becomes more satisfying. People are inherently interested in playing games and getting the high score.”

An amputee performs a rehabilitative training task on the Computer Assisted Rehabilitation Environment system at the Center for Assistive Rehabilitation and Robotics Technology Lab at the University of South Florida, with the optimal model shown on the right as the character avatar and the real-time model shown on the left as the white stick figure.
Source: Ashley D. Knight/Center for Assistive Rehabilitation and Robotics Technology Lab, University of South Florida.


Using virtual reality, patients can see themselves in a brand-new space, with the room transformed around them into something exotic or engaging, Wininger said. Such immersive environments can in turn help the patient become more interested in training. According to Wininger, if clinicians can convince patients to complete a task when they are inside the clinic or when they are in a virtual training environment, they are more likely to be able to accomplish that same task once they have left the clinic or that training environment.

“The old adage is, ‘If you don’t use it, you lose it,’” Wininger said. “It’s about developing skills in a setting that they can translate into actual activities in their daily living. If they don’t practice it, then they are never going to use it in the real world.”


Virtual reality can also make rehabilitation more accessible for patients.

As an example, Wininger pointed to the Nintendo video game Pokémon Go, which uses augmented reality to allow players to “catch” monsters that appear to populate the real world. According to Wininger, the game shows that children, teens and young adults are open to such virtual or augmented experiences, and could be more willing to use similar technologies in rehabilitation and prosthetic training.

“Kids know this stuff and they want this stuff,” he said. “It also makes it more accessible because they can just bring it home. You don’t have to schlep all this equipment to the clinic on a snowy day. You can just turn on your virtual reality system and do it at home — and they should, because research shows that regular exposure to your training program improves your outcomes. Doing it multiple times a week is not effective, but multiple times a day will improve outcomes.”

Clinicians and their young patients stand to gain tremendously if they can find a way to incorporate virtual gaming into their prosthetic rehabilitation program, Wininger added, as it could boost participation.


“Suddenly you have people who could not play games, playing games,” he said. “It could make an inroad for them.”

Virtual design, digital fabrication

In June 2017, 3-D printer supplier Create O&P, announced the development of a new software platform that uses virtual reality and 3-D printing to allow clinicians to design, print and test fit a prosthesis in less than 3 hours.

Clinicians who use the system are able to scan a patient and upload the image to a smartphone. Then, using a virtual reality headset, they can modify a digital mold by hand in the virtual world, the company said. The clinician can design a test socket around the digital mold and send it to a 3-D printer for fabrication.

Jeff Erenstone

According to Jeff Erenstone, CPO, founder and CEO of Create O&P, the company uses the Google Daydream, a virtual reality headset that interfaces with the user’s smartphone. The headset can cost as little as $60. Unlike other virtual reality systems that require large amounts of computing power, the Daydream uses a smartphone, which has the additional benefit of increasing mobility, Erenstone said.

“It’s used for the modifications on the amputee’s limb, making digital plaster models,” he said. “Usually in O&P, you would take a cast, make a plaster model from that, modify the shape to get the right clinical set to make the socket and get the right prosthetic leg or arms. In our office, we are doing, from start to finish, check sockets in 3 hours consistently, and that involves 15 minutes on a computer, the printer prints it in about 2.5 hours, and then there is 10 minutes of post processing. Aside from that 15 minutes on the computer, it’s a completely hands-free process, so no technician is running around to get that done.”

According to Erenstone, that represents a huge gain in man-power efficiency, both in terms of the practitioner and the technician. The technician can then focus on more complex things “instead of just pouring plaster,” he added.

However, even with its advantages, the transition to virtual reality can be awkward for technicians who are used to working with solid objects. For that reason, Erenstone, who is also the owner and head clinician of Mountain Orthotics and Prosthetics, said his companies use touch screens along with the virtual reality technology, to simulate a certain degree of “pushback.”


“It’s weird — you don’t get the haptic feedback,” he said. “That’s why we’ve been using the touch screen technology, so you can feel your fingers pushing back on something. Meanwhile, with virtual reality, you are sort of just waving your hands in the air. Adding haptic feedback would be huge, so you could actually push back against something.”

According to Erenstone, the hardest part of convincing clinicians and technicians to use the software is the idea of no longer working with one’s hands and performing the physical manipulation of a plaster model.

“So, we’ve been working on intuitive ways to transfer the skillset they already have and have them be able to, without a big paradigm shift, use this digital technology,” he added.

Current limits

Despite its promise, virtual reality, as the technology currently stands, is not without drawbacks.

According to Erenstone, the lack of a haptic response is one of them.

“There is still kind of a software lag, where it’s not as efficient as we need to be yet, but that is just the virtual reality aspect of it,” Erenstone said. “However, in 6 months that issue may be resolved, based on the way technology moves. In the past, you would need an $800 virtual reality system and need to plug it into something with serious computing power to access these systems. Now, it can be cellphone based, and browser based and now they are writing programs that can build on that.”

According to Knight, there is limited knowledge of virtual reality currently in O&P, which could result in insufficient training.

“There are a limited number of specialists and expertise in the field, especially when considering upperextremity prostheses, resulting in amputees not having sufficient training with their device,” Knight said.

Another issue with the current state of virtual reality technology is that it is not known exactly how to design and interface with the program with the highest efficiency. According to Wininger, the best virtual reality systems available today still require supervision by humans, even as it adapts to the patient’s needs.

“The problem is that the intelligence for these software packages is not where we need it to be yet, so it still requires a lot of management,” Wininger said. “And if you present something to a patient that is suboptimal, they may get discouraged and throw it away and decide not to use it. That way, you have lost on your investment, and virtual reality is currently not cheap.”

According to Wininger, the most significant issue with virtual reality is that developers still do not yet know exactly how to design or harness virtual reality for maximum efficacy.


“Therefore, there are less opportunities to improve our game there,” he said. “I would say that, in 10 years, the statisticians will have caught up to software designers to address this issue, but we’re not there yet.”

Future, fun and games

According to Wininger, the true driver of virtual reality technology is currently the gaming market, due to its deep pockets and active development scene. However, he foresees O&P “catching up to gaming” in the coming years.

“In the short-term, we will eventually see a situation in which innovations in virtual reality that come out in the gaming world will soon after become available for use in O&P,” Wininger said. “After that, anything that the gaming folks come up with, we in O&P can then use, and then we can work in lockstep with them. We’re almost there now.”

In rare instances, Wininger said O&P could develop technologies that could eventually be appropriated by the gaming industry.

“Prosthetics is all about controlling one thing with something else,” he said. “I can see some applications where gamers may be interested in taking prosthetic systems and even using them in a game.”

According to Knight, the future of virtual reality in O&P should include small-scale, adaptable options for rehabilitation practitioners. She added that widespread at-home use could successfully provide effective training and rehabilitative care to patients.

Virtual reality technology also has the potential to affect the future of the developing world, according to Erenstone. The continued development of mobile-based virtual reality will help residents and researchers in developing countries to more easily take advantage of the technology, he added.

“In the United States, we can buy a laptop with a touchscreen, but in the developing world, that is a specialty device and another piece of hardware they have to buy,” he said. “Meanwhile, everyone has a cellphone. I’ve been to Haiti, Nepal and India, and everyone has a cellphone, partly because they don’t have the infrastructure for landlines. We would be using the technology that they already have.” – by Jason Laday

Disclosures: Erenstone reports employment with Create O&P and Mountain Orthotics and Prosthetics. Knight and Wininger report no relevant financial disclosures

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[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text


Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.


Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 [1].

In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.

In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” [2]. This objective became a working definition of Rehabilitation Engineering [2].

The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment [2]. The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology [3]. The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them [2]. The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” [3].

After the initial establishment of these RECs, the governmental funding agency evolved into the National Institute on Disability and Rehabilitation Research (NIDRR, a part of the U.S. Department of Education), and now is the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, a part of the U.S. Department of Health and Human Services. Today, as we describe below, the RERC’s study a diverse set of technologies and their use by people with a disability, including human-computer interaction, mobile computing, wearable sensors and actuators, robotics, computer gaming, motion capture, wheeled mobility, exoskeletons, lightweight materials, building and transportation technology, biomechanical modeling, and implantable technologies. For this review, we invited all RERCs that were actively reporting to NIDILRR at the onset of this review project in 2015, and had not begun in the last two years, to participate. These were centers that were funded (new or renewal) in the period 2008-2013, except the RERC Wheelchair Transportation Safety, which was funded from 2001-2011. Two of the RERCs did not respond (see Table 1). For each center, we asked it to describe the user needs it targets, summarize key advances that it had made, and identify emerging innovations and opportunities. By reviewing the scope of rehabilitation engineering research through the lens of the RERCs, our goal was to better understand the evolving nature and demands of rehabilitation technology development, as well as the influence of a multidisciplinary structure, like the RERCs, in shaping the producing of such technology. We also performed an analysis of how multidisciplinary the current RERCs actually are (see Table 3), and asked the directors to critique and suggest future directions for the RERC program.[…]

Continue —>  How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 14 Some MARS RERC projects. a) The KineAssist MX® Gait and Balance Device b) The Armeo Spring® reaching assistance device c) The March Hare virtual reality therapy game d) The Lokomat® gait assistance robot e) Robotic Error Augmentation between the therapist and patient f) lever drive wheelchair g) Ekso® exoskeleton h) Body-machine interface for device control

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[ARTICLE] On neuromechanical approaches for the study of biological and robotic grasp and manipulation – Full Text


Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition, dramatically different and can even be antithetical. Even our approach to each is diametrically opposite: inductive science for the study of biological systems vs. engineering synthesis for the design and construction of robotic systems. The past 20 years have seen several conceptual advances in both fields and the quest to unify them. Chief among them is the reluctant recognition that their underlying fundamental mechanisms may actually share limited common ground, while exhibiting many fundamental differences. This recognition is particularly liberating because it allows us to resolve and move beyond multiple paradoxes and contradictions that arose from the initial reasonable assumption of a large common ground. Here, we begin by introducing the perspective of neuromechanics, which emphasizes that real-world behavior emerges from the intimate interactions among the physical structure of the system, the mechanical requirements of a task, the feasible neural control actions to produce it, and the ability of the neuromuscular system to adapt through interactions with the environment. This allows us to articulate a succinct overview of a few salient conceptual paradoxes and contradictions regarding under-determined vs. over-determined mechanics, under- vs. over-actuated control, prescribed vs. emergent function, learning vs. implementation vs. adaptation, prescriptive vs. descriptive synergies, and optimal vs. habitual performance. We conclude by presenting open questions and suggesting directions for future research. We hope this frank and open-minded assessment of the state-of-the-art will encourage and guide these communities to continue to interact and make progress in these important areas at the interface of neuromechanics, neuroscience, rehabilitation and robotics.


Grasp and manipulation have captivated the imagination and interest of thinkers of all stripes over the millennia; and with enough reverence to even attribute the intellectual evolution of humans to the capabilities of the hand [123]. Simply put, manipulation function is one of the key elements of our identity as a species (for an overview, see [4]). This is a natural response to the fact that much of our physical and cognitive ability and well-being is intimately tied to the use of our hands. Importantly, we have shaped our tools and environment to match its capabilities (straightforward examples include lever handles, frets in string instruments, and touch-screens). This co-evolution between hand-and-world reinforces the notion that our hands are truly amazing and robust manipulators, as well as rich sensory, perceptual and even social information.

It then comes as no surprise that engineers and physicians have long sought to replicate and restore this functionality in machines—both as appendages to robots and prostheses attached to humans with missing upper limbs [5]. Robotic hands and prostheses have a long and illustrious history, with records of sophisticated articulated hands as early as Gottfried ‘Götz’ von Berlichingen’s iron hand in 1504 [6]. Other efforts [7891011] were often fueled by the injuries of war [12131415] and the Industrial Revolution [16]. The higher survival rate in soldiers who lose upper limbs [1718] and the continual emergence of artificial intelligence [1920] are but the latest impetus. Thus, the past 20 years have seen an explosion in designs, fueled by large scale governmental funding (e.g., DARPA’s Revolutionizing Prosthetics and HAPTIX projects, EU’s INPUT and SOFTPRO projects) and private efforts such as DeepMind. A new player in this space is the potentially revolutionary social network of high-quality amateur scientists as exemplified by the FABLAB movement [21]. They are enabled by ubiquitously accessible and inexpensive 3D printing and additive manufacturing tools [22], collaborative design databases ( and others), and communities with formal journals ( and Grassroots communities have also emerged that can, for example, compare and contrast the functionality of prosthetic hands whose price differs by three orders of magnitude (

For all the progress that we have seen, however, (i) robotic platforms remain best at pre-sorted, pick-and-place assembly tasks [23]; and (ii) many prosthetic users still prefer simple designs like the revered whole- or split-hook designs originally developed centuries ago [2425].

Why have robotic and prosthetic hands not come of age? This short review provides a current attempt to tackle this long-standing question in response to the current technological boom in robotic and prosthetic limbs. Similar booms occurred in response to upper limb injuries [25] after the Napoleonic [26], First [12] and Second World Wars [8], and—with the advent of powerful inexpensive computers—in response to industrial and space exploration needs in the 1960’s, 1970’s and 1980’s [272829303132]. We argue that a truly bio-inspired approach suffers, by definition, from both gaps in our understanding of the biology, and technical challenges in mimicking (what we understand of) biological sensors, motors and controllers. Although biomimicry is often not the ultimate goal in robotics in general, it is relevant for humanoids and prostheses. Thus, our approach is to clarify when and why a better understanding of the biology of grasp and manipulation would benefit robotic grasping and manipulation.

Similarly, why is our understanding of the nature, function and rehabilitation of biological arms and hands incomplete? Jacob Benignus Winsløw Jacques-Bénigne Winslow, (1669—1760) noted in his Exposition anatomique de la structure du corps humain (1732) that ‘The coordination of the muscles of the live hand will never be understood’ [33]. Interestingly, he is still mostly correct. As commented in detail before [4], there has been much work devoted to inferring the anatomical, physiological, neural and cognitive processes that produce the upper limb function we so dearly appreciate and passionately work to restore following trauma or pathology. We argue, as Galileo Galilei did, that mathematics and engineering have much to contribute to the understanding of biological systems. Without such a ‘mathematical language’ we run the risk, as Galileo put it, of ‘wandering in vain through a dark labyrinth’ [34]. Thus, this short review also attempts to point out important mathematical and engineering developments and advances that have helped our understanding of our hands.

This review first contrasts the fundamental differences between engineering and neuroscience approaches to biological robotic systems. Whereas the former applies engineering principles, the latter relies on scientific inference. We then discuss how the physics of the world provides a common ground between them because both types of systems have similar functional goals, and must abide by the same physical laws. We go on to evaluate how biological and robotic systems implement the necessary sensory and motor functions using the dramatically different anatomy, morphology and mechanisms available to each. This inevitably raises questions about differences in their sensorimotor control strategies. Whereas engineering system can be designed and manufactured to optimize well-defined functional features, biological systems evolve without such strict tautology. Biological systems likely evolve by implementing ecologically and temporally good-enough, sub-optimal or habitual control strategies in response to the current multi-dimensional functional constraints and goals in the presence of competition, variability, uncertainty, and noise. We conclude by exploring the notion that the functional versatility of biological systems that roboticists admire is, in fact, enabled by the very nonlinearities and complexities in anatomy, sensorimotor physiology, and neural function that engineering approaches often seek to avoid. […]

Continue —> On neuromechanical approaches for the study of biological and robotic grasp and manipulation | Journal of NeuroEngineering and Rehabilitation | Full Text

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[Abstract] Robotic Devices to Enhance Human Movement Performance.


Robotic exoskeletons and bionic prostheses have moved from science fiction to science reality in the last decade. These robotic devices for assisting human movement are now technically feasible given recent advancements in robotic actuators, sensors, and computer processors. However, despite the ability to build robotic hardware that is wearable by humans, we still do not have optimal controllers to allow humans to move with coordination and grace in synergy with the robotic devices. We consider the history of robotic exoskeletons and bionic limb prostheses to provide a better assessment of the roadblocks that have been overcome and to gauge the roadblocks that still remain. There is a strong need for kinesiologists to work with engineers to better assess the performance of robotic movement assistance devices. In addition, the identification of new performance metrics that can objectively assess multiple dimensions of human performance with robotic exoskeletons and bionic prostheses would aid in moving the field forward. We discuss potential control approaches for these robotic devices, with a preference for incorporating feedforward neural signals from human users to provide a wider repertoire of discrete and adaptive rhythmic movements.

Source: Robotic Devices to Enhance Human Movement Performance: Kinesiology Review: Vol 6, No 1

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[BOOK] Progress in Motor Control: Theories and Translations – Google Books

ΕξώφυλλοThis single volume brings together both theoretical developments in the field of motor control and their translation into such fields as movement disorders, motor rehabilitation, robotics, prosthetics, brain-machine interface, and skill learning. Motor control has established itself as an area of scientific research characterized by a multi-disciplinary approach. Its goal is to promote cooperation and mutual understanding among researchers addressing different aspects of the complex phenomenon of motor coordination. Topics covered include recent theoretical advances from various fields, the neurophysiology of complex natural movements, the equilibrium-point hypothesis, motor learning of skilled behaviors, the effects of age, brain injury, or systemic disorders such as Parkinson’s Disease, and brain-computer interfaces.

Source: Progress in Motor Control: Theories and Translations – Google Books

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[WEB SITE] The brain can rewire itself after an injury

Illustration by CRISTINA BYVIK

Living things can repair themselves. Damaged skin and fractured bones heal, and a damaged liver can regenerate itself.

Only recently have scientists begun to understand this is also true of the brain.

Perpetually responding to its environment, the brain possesses a remarkable ability to rewire itself, to actually reroute sensory impulses and change its physical structure.

Brain injuries, whether internally caused by a stroke or externally by some type of trauma, represent the supreme test of this regenerative ability.

Stroke is the third-leading cause of death in the United States, killing nearly 130,000 Americans annually, according to the U.S. Centers for Disease Control and Prevention. A total of 795,000 people have a stroke annually. Most of these strokes are ischemic — that is, caused by an interruption in oxygen supply to a part of the brain. Blood clots commonly cause ischemic strokes.


Meanwhile, brain trauma caused more than 50,000 deaths in the U.S. in 2010, according to the CDC. And traumatic brain injury was diagnosed in more than 280,000 hospitalization cases.

In children, falls caused 55 percent of such injuries. The rate soars to 81 percent in adults older than 65. Among all ages, motor vehicle crashes caused 14 percent of cases. And with the wars in Iraq and Afghanistan, thousands of American troops have endured such injuries.

Whether caused by stroke or external trauma, these brain injuries present much of the same challenges in rehabilitation, said Dr. Michael Lobatz, a neurologist with the La Jolla-based Scripps Health network. Undamaged parts of the brain need to learn how to take over functions normally performed by the portions that have been harmed.

Continue —>  The brain can rewire itself after an injury |

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