Posts Tagged Rehabilitation Engineering

[WEB SITE] A glove to treat symptoms of stroke

A glove to treat symptoms of stroke

Enter a captionA new glove being developed by Georgia Tech and Stanford researchers aims to treat symptoms of stroke through vibration. Credit: Courtesy Caitlyn Seim

The most obvious sign someone has survived a stroke is usually some trouble speaking or walking. But another challenge may have an even greater impact on someone’s daily life: Often, stroke survivors lose sensation and muscle control in one arm and hand, making it difficult to dress and feed themselves or handle everyday objects such as a toothbrush or door handle.

Now, doctors and engineers at Stanford and Georgia Tech are working on a novel therapy that could help more  survivors regain the ability to control their arms and hands – a vibrating glove that gently stimulates the wearer’s hand for several hours a day.

Caitlyn Seim, a  at Georgia Tech, started the project in the hope that the glove’s stimulation could have some of the same impact as more traditional exercise programs. After developing a prototype, she approached Stanford colleagues Maarten Lansberg, an associate professor of neurology, and Allison Okamura, a professor of mechanical engineering, in order to expand her efforts. With help from a Wu Tsai Neurosciences Institute Neuroscience seed grant, the trio are working to improve on their prototype glove and bring the device closer to clinical testing.

“The concept behind it is that users wear the glove for a few hours each day during normal  – going to the supermarket or reading a book at home,” said Seim. “We are hoping that we can discover something that really helps stroke survivors.”

Reaching for new stroke treatments

Seim, Lansberg and Okamura’s goal is a tall order. Despite some individual success stories, the reality is that most stroke struggle to regain the ability to speak, move around and take good care of themselves.

“Stroke can affect patients in many ways, including causing problems with , gait, vision, speech and cognition,” Lansberg said, yet despite decades of research, “there are essentially no treatments that have been proven to help stroke patients recover these functions.”

It was in that context that all three researchers independently started thinking about what they could do to improve the lives of people who’ve survived strokes. As the  in the bunch, Lansberg had already been treating stroke patients for years and has helped lead the Stanford Stroke Collaborative Action Network, or SCAN, another project of the Wu Tsai Neurosciences Institute. Okamura, meanwhile, has focused much of her research on haptic or touch-based devices, and in the last few years her lab has spent more and more time thinking about how to use those devices to help stroke survivors.

“Rehabilitation engineering provides a unique opportunity for me to work directly with the patients who are affected by our research,” Okamura said. “The potential to translate the kind of technology relatively quickly to a commercial product that can reach a large number of  in need of therapy is also very exciting.”

For her part, Seim’s interest in stroke stems from an interest in wearable computing devices – but rather than build more virtual reality goggles and smartwatches, Seim said she wants to apply wearable computing to the areas of health and accessibility, “areas which have some of the most compelling problems to me,” she said.

Growing a new idea

With that ambition in mind, Seim built a prototype vibrating glove that she hoped would stimulate nerves and improve both sensation and function in stroke survivors’ hands and arms. After collecting some promising initial data, Seim reached out to the Stanford team.

“Stanford has SCAN and StrokeNet, along with a community of interdisciplinary engineering and computing research, so I reached out to Maarten, and he was very supportive,” Seim said.

Now, Seim, Lansberg and Okamura are revising the glove’s design to improve its function and to add elements for comfort and accessibility. Then, they’ll begin a new round of clinical tests at Stanford.

Long term, the hope is to build something that helps  recover some of the functions they have lost in their hands and arms. And if initial tests work out, Lansberg said, it’s possible the same basic idea could be applied to treat other complications associated with stroke.

“The glove is an innovative idea that has shown some promise in pilot studies,” Lansberg said. “If proven beneficial for patients with impaired arm function, it is conceivable that variations of this type of therapy could be developed to treat, for example, patients with impaired gait.”


Explore further

Clot removal beyond normal treatment time, still improved quality of life after stroke


Provided by Stanford University

 

via A glove to treat symptoms of stroke

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[Abstract] Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

Abstract

Rehabilitation is an important process to restore muscle strength and joint’s range of motion. This paper proposes a biomechatronic design of a robotic arm that is able to mimic the natural movement of the human shoulder, elbow and wrist joint. In a preliminary experiment, a subject was asked to perform four different arm movements using the developed robotic arm for a period of two weeks. The experimental results were recorded and can be plotted into graphical results using Matlab. Based on the results, the robotic arm shows encouraging effect by increasing the performance of rehabilitation process. This is proven when the result in degree value are accurate when being compared with the flexion of both shoulder and elbow joints. This project can give advantages on research if the input parameter needed in the flexion of elbow and wrist.

I. Introduction

According to the United Nations (UN), by 2030 the number of people over 60 years will increase by 56 per cent, from 901 million to more than 1.4 billion worldwide [1]. As the number of older persons is expected to grow, it is imperative that government and private health care providers prepare adequate and modern facilities that can provide quality services for the needs of older persons especially in rehabilitation centers. Implementation of robotic technology in rehabilitation process is a modern method and definitely can contribute in this policy and capable in promoting early recovery and motor learning [2]. Furthermore, systematic application of robotic technology can produce significant clinical results in motor recovery of post-traumatic central nervous system injury by assisting in physical exercise based on voluntary movement in rehabilitation [3].

via Biomechatronics design of a robotic arm for rehabilitation – IEEE Conference Publication

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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

Abstract

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.

Background

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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[Abstract] The Present and Future of Robotic Technology in Rehabilitation – SpringerLink

Abstract

Robotic technology designed to assist rehabilitation can potentially increase the efficiency of, and accessibility to, therapy by assisting therapists to provide consistent training for extended periods of time, and collecting data to assess progress. Automatization of therapy may enable many patients to be treated simultaneously and possibly even remotely, in the comfort of their own homes, through telerehabilitation. The data collected can be used to objectively assess performance and document compliance as well as progress. All of these characteristics can make therapists more efficient in treating larger numbers of patients. Most importantly for the patient, it can increase access to therapy which is often in high demand and rationed severely in today’s fiscal climate. In recent years, many consumer-grade low-cost and off-the-shelf devices have been adopted for use in therapy sessions and methods for increasing motivation and engagement have been integrated with them. This review paper outlines the effort devoted to the development and integration of robotic technology for rehabilitation.

Source: The Present and Future of Robotic Technology in Rehabilitation | SpringerLink

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[WEB SITE] A New Assistive Glove Can Help People Regain Hand Function After a Stroke – NARIC

About 800,000 Americans have a stroke each year, according to the Centers for Disease Control and Prevention. A stroke occurs when a blood vessel in the brain becomes blocked or bursts, causing brain damage. Sometimes, stroke can lead to long-lasting difficulties with moving one hand or arm due to both muscle weakness and spasms. Therapies are available to help people regain hand mobility after a stroke, but these therapies may not work for people with severely limited hand movement. Research shows that, even with therapy, some people can stall in their recovery (plateau) around three months after experiencing a stroke. A recent NIDILRR-funded study tested a new portable assistive glove to see if it could help people move beyond that plateau and regain hand strength and mobility after a stroke.

Researchers from the Rehabilitation Research and Training Center on Enhancing the Functional and Employment Outcomes of Individuals Who Experience a Stroke tested a new therapy device called the X-Glove. The X-Glove is a modified sports glove with cables running through the back of the glove along the fingers. The cables apply an external source to aid or resist finger movements through a battery-powered system. The glove can be set to one of two modes: passive stretching mode and active training mode. In the passive stretching mode, the glove bends and straightens the user’s finger joints in a repeating cycle. This passive movement provides finger stretching that helps loosen the muscles and reduce spasms. In the active training mode, the glove provides individualized constant tension that maintains the finger joints toward a straight position. The user then bends his or her finger against the tension to build finger strength.

The researchers tested the glove with 13 stroke survivors who were receiving rehabilitation services in a day program, including physical, speech, and occupational therapy. The participants were at least 40 years old and had a stroke in the past 2-6 months. Most had severe limitations in their hand function. The participants completed an additional 15 occupational therapy sessions, 3 per week for 5 weeks, using the X-Glove.

An occupational therapist assists a patient with therapy exercises using the X-glove. The patient is wearing the glove on his right hand and grasping a telephone handset.

Photo: A therapy session with the X-glove.

At the beginning of each session, the participants completed 30 minutes of passive finger stretching with the glove set in the passive stretching mode to help loosen the muscles and reduce spasms. Then they practiced using their hand to complete meaningful tasks for 60 minutes with the glove set in the active training mode to help build strength and skills, while the glove provided resistance. For example, participants practiced grasping, holding, and lifting small objects in their affected hand while pushing against the tension applied by the glove. To find out if the task practice with the X-Glove improved hand function, the researchers first measured participants’ hand mobility and strength three times, once per week over 3 weeks, before the participants started working with the glove. The researchers then took measurements after the participants’ ninth occupational therapy session with the glove, at the end of the fifteenth session, and again one month after the sessions ended.

Although the participants showed little or no improvement in hand strength or function over the course of 3 weeks before working with the glove, they did improve significantly with the help of the X-Glove. For example, the researchers found that participants’ grip was strengthened by about 35% and maintained the strength one month after the treatment ended. The participants also did better on functional tests, such as moving blocks or pouring water from glass to glass. According to the authors, participants showed improvement within the first half of the treatment, and continued to improve throughout the treatment sessions. They suggested that participants could have improved more with more time using the X-Glove.

According to the authors, these findings indicated that with devices like the X-glove, improvements in hand function are possible even for people with severe hand impairment after a stroke. Incorporating both passive stretching of and active practice with the hand during occupational therapy using a device like the X-Glove may help push past the therapy plateau if implemented soon after a stroke. For future research, the authors recommended randomized controlled trials to test the X-Glove with stroke patients in inpatient and outpatient rehabilitation settings, as well as studies with longer treatment and follow-up periods.

To Learn More

The prototype X-Glove and other hand rehabilitation technology are under development at the Rehabilitation Institute of Chicago’s Hand Rehabilitation Laboratory:http://smpp.northwestern.edu/research/hand/research.html

To see the X-Glove and other hand rehabilitation technology in action, check out this Prezi from the Hand Rehabilitation Laboratory https://prezi.com/8jmdkbz3gm2h/new-developments-in-the-hand-rehabilitation-lab-at-ric/

Flint Rehabilitation developed the Music Glove, another hand rehabilitation device that was tested under a NIDILRR grant and shown to improve hand function post-stroke:https://www.flintrehab.com/musicglove/

The American Stroke Association and the National Stroke Association both offer resources for stroke recovery:

http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/
RegainingIndependence/PhysicalChallenges/Post-Stroke-Rehabilitation_UCM_310447_Article.jsp#.V5IeuvmANBc

http://www.stroke.org/we-can-help/survivors/stroke-recovery

To Learn More About This Study

Fischer, H.C., Triandafilou, K.M., Thielbar, K.O., Ochoa, J.M., Lazzaro, E.D.C., Pacholski, K.A., & Kamper, D.G. (2016) Use of a portable assistive glove to facilitate rehabilitation in stroke survivors with severe hand impairment. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 24(3), 344-351. This article is available from the NARIC collection under Accession Number J73926

Date published:

2016-08-17

Source: National Rehabilitation Information Center | Information for Independence

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[BOOK CHAPTER] Toward an Upper-Limb Neurorehabilitation Platform Based on FES-Assisted Bilateral Movement: Decoding User’s Intentionality

Abstract

In the last years there has been a noticeable progress in motor learning, neuroplasticity and functional recovery after the occurrence of brain lesion. Rehabilitation of motor function has been associated to motor learning that occurs during repetitive, frequent and intensive training. Neuro-rehabilitation is based on the assumption that motor learning principles can be applied to motor recovery after injury, and that training can lead to permanent improvements of motor functions in patients with muscle deficits. The emergent research field of Rehabilitation Engineering may provide promise technologies for neuro-rehabilitation therapies, exploiting the motor learning and neural plasticity concepts. Among those technologies, the FES-assisted systems could provide repetitive training-based therapies and have been developed to aid or control the upper and lower limbs movements in response to user’s intentionality. Surface electromyography (SEMG) reflects directly the human motion intention, so it can be used as input information to control an active FES-assisted system. The present work describes a neurorehabilitation platform at the upper-limb level, based on bilateral coordination training (i.e. mirror movements with the unaffected arm) using a close-loop active FES system controlled by user. In this way, this work presents a novel myoelectric controller for decoding movements of user to be employed in a neurorehabilitation platform. It was carried out a set of experiments to validate the myoelectric controller in classification of seven human upper-limb movements, obtaining an average classification error of 4.3%. The results suggest that the proposed myoelectric pattern recognition method may be applied to control close-loop FES system.

more —>  Toward an Upper-Limb Neurorehabilitation Platform Based on FES-Assisted Bilateral Movement: Decoding User’s Intentionality – Springer.

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