Posts Tagged Rehabilitation robotics

[Editorial] Rehabilitation and assistive robotics – Advances in Mechanical Engineering

It is estimated that in the European Union (EU) the proportion of the population aged over 65 years will rise from 17.1% in 2008 to 30% in 2060 and that the proportion of persons aged over 80 years will rise from 4.4% to 12.1% over the same period (EUROSTAT population projections). Neurological conditions, especially stroke, are a major cause of disability among older people. Incidence of a first stroke in Europe is about 1.1 million and prevalence about 6 million. Currently, about 75% of stroke sufferers survive 1 year after. This proportion will increase in the coming years due to steadily increasing quality in hyper-acute lifesaving practice, follow-up acute and sub-acute care, and lifelong management of these conditions. Despite these positive developments in stroke care, approximately 80% of stroke patients experience long-term reduced manual dexterity, a 72% of those affected by stroke suffer leg weakness, affecting walking, and half of all patients with neurological conditions are unable to perform everyday tasks. Rehabilitation and assistive robotics have the potential to change older people lives improving their recovery and/or supporting them to perform everyday tasks.

The purpose of this special collection is to provide an opportunity for researchers working in academy or industry to show their latest theoretical, technological, and experimental aspects of rehabilitation and assistive robotics. A total of eight articles have been accepted after a strict peer review process.

In the topic of rehabilitation robotics, Fraile et al. present an end-effector rehabilitation robot, a 2-degree-of-freedom planar robotic platform for upper limb rehabilitation in post-stroke patients. In addition, they describe the ergonomic mechanical design, the system control architecture, and the rehabilitation therapies that can be performed by the aforementioned rehabilitation robot. There are other two more papers included in this topic. In the first one, Diez et al. propose a novel multimodal robotic system for upper-limb neurorehabilitation therapies in physical environments, interacting with real objects. This system consists of an end-effector upper-limb rehabilitation robot, a hand exoskeleton, a gaze tracking system, an object tracking system, and electromyography measuring units. Their experimental results show that the proposed system is feasible and safe enough. Wrong detections in electromyography (EMG) are the main cause of failure; however, in the 97% of the trials, it still resulted in successful grasping and releasing. In the second one, Simonetti et al. present the design and development of a modular architecture for delivering upper limb robotic telerehabilitation with the CBM-Motus, a planar unilateral robotic machine. Their architecture allows a therapist to set a therapy session on his or her side and send it to the patient’s side with a standardized communication protocol; the user interacts with the robot that provides an adaptive assistance during the rehabilitation tasks. Moreover, the experimental results with seven healthy subjects show the reliability of the novel architecture and the capability to be easily tailored to the user’s needs with the chosen robotic device.

In the topic of robotic prosthetics, Barone et al. propose a multilevel control of an anthropomorphic robotic hand with prosthetic features. The novel approach is based on two distinct levels consisting of (1) a policy search learning algorithm combined with central pattern generators in the higher level and (2) a parallel force/position control managing slippage events in the lower level. Their experimental results demonstrate that the proposed control has the potential to adapt to changes in the environment and guarantees grasp stability, by avoiding object fall thanks to prompt slippage event detection. Moreover, Sekine et al. present the development of a shoulder prosthesis based on a hybrid actuation system composed of pneumatic elastic actuators (PEAs) and servo motors. Their results show that the joints with PEAs could absorb more impact force, which is very important for safe use, than with motors.

In this special collection, there are two papers in the field of wearable exoskeletons. In the first one, Ning et al. present the design and development of a power-assisted gait orthosis. The paper analysed the gait characteristics with crutches, designed the mechanical architecture, and optimized it using genetic algorithms. Moreover, the performance of the final design is verified under many external conditions, such as no-load, gait movement, long-term continuous movement, and load tests. In the second one, Zhang et al. propose a human–machine force interaction designing architecture for a load-carrying exoskeleton. Their experimental results show that the human–machine interaction force detection at the back and feet and the identification of different body modalities and movement intention are feasible. Moreover, the actual load on the human back is far less than the payload, which shows that their exoskeleton has good power-assisted effect.

The last paper included in this special collection is about a novel algorithm to estimate the instantaneous tremor parameters such as the time-varying dominant frequency in the case of nonsynchronous sampling and to distinguish the tremulous movement from the raw data. The experimental results reported by Wang et al. demonstrate that the proposed solution could detect the unknown dominant frequency and distinguish the tremor components with higher accuracy than the existing procedures.

Source: Rehabilitation and assistive roboticsAdvances in Mechanical Engineering – Nicolas Garcia-Aracil, Alicia Casals, Elena Garcia, 2017

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[ARTICLE] Modifying upper-limb inter-joint coordination in healthy subjects by training with a robotic exoskeleton – Full Text

Abstract

Background

The possibility to modify the usually pathological patterns of coordination of the upper-limb in stroke survivors remains a central issue and an open question for neurorehabilitation. Despite robot-led physical training could potentially improve the motor recovery of hemiparetic patients, most of the state-of-the-art studies addressing motor control learning, with artificial virtual force fields, only focused on the end-effector kinematic adaptation, by using planar devices. Clearly, an interesting aspect of studying 3D movements with a robotic exoskeleton, is the possibility to investigate the way the human central nervous system deals with the natural upper-limb redundancy for common activities like pointing or tracking tasks.

Methods

We asked twenty healthy participants to perform 3D pointing or tracking tasks under the effect of inter-joint velocity dependant perturbing force fields, applied directly at the joint level by a 4-DOF robotic arm exoskeleton. These fields perturbed the human natural inter-joint coordination but did not constrain directly the end-effector movements and thus subjects capability to perform the tasks. As a consequence, while the participants focused on the achievement of the task, we unexplicitly modified their natural upper-limb coordination strategy. We studied the force fields direct effect on pointing movements towards 8 targets placed in the 3D peripersonal space, and we also considered potential generalizations on 4 distinct other targets. Post-effects were studied after the removal of the force fields (wash-out and follow up). These effects were quantified by a kinematic analysis of the pointing movements at both end-point and joint levels, and by a measure of the final postures. At the same time, we analysed the natural inter-joint coordination through PCA.

Results

During the exposition to the perturbative fields, we observed modifications of the subjects movement kinematics at every level (joints, end-effector, and inter-joint coordination). Adaptation was evidenced by a partial decrease of the movement deviations due to the fields, during the repetitions, but it occurred only on 21% of the motions. Nonetheless post-effects were observed in 86% of cases during the wash-out and follow up periods (right after the removal of the perturbation by the fields and after 30 minutes of being detached from the exoskeleton). Important inter-individual differences were observed but with small variability within subjects. In particular, a group of subjects showed an over-shoot with respect to the original unexposed trajectories (in 30% of cases), but the most frequent consequence (in 55% of cases) was the partial persistence of the modified upper-limb coordination, adopted at the time of the perturbation. Temporal and spatial generalizations were also evidenced by the deviation of the movement trajectories, both at the end-effector and at the intermediate joints and the modification of the final pointing postures towards targets which were never exposed to any field.

Conclusions

Such results are the first quantified characterization of the effects of modification of the upper-limb coordination in healthy subjects, by imposing modification through viscous force fields distributed at the joint level, and could pave the way towards opportunities to rehabilitate pathological arm synergies with robots.[…]

Continue —> Modifying upper-limb inter-joint coordination in healthy subjects by training with a robotic exoskeleton | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 Example of goal-directed pointing task (GDM). The four pictures show the motion from the starting position to the WAM button, while performing GDM task. In this case the subjects were not asked to follow any specific endpoint trajectory

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[ARTICLE] User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke – Full Text

Abstract:

Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.

1 Introduction

Stroke is one of the dominant causes of acquired disability [1] and it is the second leading cause of death worldwide [2]. The high incidence of the disease and the current demographic developments are likely to increase the number of stroke patients in the future. Most of the survivors have physical, cognitive and functional limitations and require intensive rehabilitation in order to resume independent everyday life [3]. Therefore, the main goal of motor rehabilitation is relearning of voluntary movement capability, a process which takes at least several months, some improvement can occur even after years. In the rehabilitation clinic, patients usually receive a daily intensive therapy program. However, for further improvement of motor abilities, severely affected patients are required to continue their rehabilitation training outside the rehabilitation settings, after being discharged from the rehabilitation clinic. Langhammer and Stanghelle [4] found that a lack of follow-up rehabilitation treatment at home leads to deterioration of activities of daily living (ADL) and to motor functions in general. A possible solution is an individualized and motivating telerehabilitation system in the patient’s domestic environment. Some studies [5], [6] have confirmed the advantage of home rehabilitation after stroke and showed that telerehabilitation received high acceptance and satisfaction, both from patients, as well as from health professionals [7]. Most of the existing telesystems [7], [8] are based on audio-visual conferencing or on virtual environments and contain rather simple software for monitoring patients’ condition. However, in neurological rehabilitation the sensorimotor loop needs to be activated by provision of physiological haptic feedback (touch and proprioception) [3].

Robot-based rehabilitation is currently one of the most prevalent therapeutic approaches. It is often applied in hospitals alongside conventional therapy and is beneficial for motor recovery [9]. Rehabilitation training including a haptic-therapy device may therefore be even more promising for home environments than non-haptic telerehabilitation. Several telerehabilitation systems, which include not only audio and visual, but also haptic modality, already exist [10], [11] . Most of these solutions use low-cost commercial haptic devices (e.g. joysticks) for therapy training, with the goal of cost minimization and providing procurable technology. Nonetheless, devices specifically developed for stroke rehabilitation, which are already established in clinical settings, may have greater impact on motor relearning and could therefore also be more effective at home, compared with existing home rehabilitation devices.

In a previous paper [12], we presented a concept and design overview of a haptic robot-based telerehabilitation system for upper extremities which is currently under development. In the present work, we describe therapeutic requirements, user-centred development [13] and implementation of the patient’s station of the telesystem.

Continue —> User-centered design of a patient’s work station for haptic robot-based telerehabilitation after stroke : Current Directions in Biomedical Engineering

Figure 3 Implementation of the patient’s work station based on Reha-Slide (left) and Bi-Manu-Track (right).

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[ARTICLE] Compensating the effects of FES-induced muscle fatigue by rehabilitation robotics during arm weight support – Full Text

Abstract

Motor functions can be hindered in consequence to a stroke or a spinal cord injury. This often results in partial paralyses of the upper limb. The effectiveness of rehabilitation therapy can be improved by the use of rehabilitation robotics and Functional Electrical Stimulation (FES). We consider a hybrid arm weight support combining both.

In order to compensate the effect of FES-induced muscle fatigue, we introduce a method to substitute the decreasing level of FES support by cable-driven robotics. We evaluated the approach in a trial with one healthy subject performing repetitive arm lifting. The controller automatically adapted the support and thus no increase in user generated volitional effort was observed when FES induced muscle fatigue occured.

Continue —> Compensating the effects of FES-induced muscle fatigue by rehabilitation robotics during arm weight support : Current Directions in Biomedical Engineering

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[Abstract] A Fully Fabric-Based Bidirectional Soft Robotic Glove for Assistance and Rehabilitation of Hand Impaired Patients

Abstract:

This paper presents a fully fabric-based bidirectional soft robotic glove designed to assist hand impaired patients in rehabilitation exercises and performing activities of daily living. The glove provides both active finger flexion and extension for hand assistance and rehabilitative training, through its embedded fabric-based actuators that are fabricated by heat press and ultrasonic welding of flexible thermoplastic polyurethane-coated fabrics. Compared to previous developed elastomeric-based actuators, the actuators are able to achieve smaller bend radius and generate sufficient force and torque to assist in both finger flexion and extension at lower air pressure. In this work, experiments were conducted to characterize the performances of the glove in terms of its kinematic and grip strength assistances on five healthy participants. Additionally, we present a graphical user interface that allows user to choose the desired rehabilitation exercises and control modes, which include button-controlled assistive mode, cyclic movement training, intention-driven task-specific training, and bilateral rehabilitation training.

Source: A Fully Fabric-Based Bidirectional Soft Robotic Glove for Assistance and Rehabilitation of Hand Impaired Patients – IEEE Xplore Document

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[ARTICLE] The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View – Full Text

Abstract

To date, rehabilitation robotics has come a long way effectively aiding the rehabilitation process of the patients suffering from paraplegia or hemiplegia due to spinal cord injury (SCI) or stroke respectively, through partial or even full functional recovery of the affected limb. The increased therapeutic outcome primarily results from a combination of increased patient independence and as well as reduced physical burden on the therapist. Especially for the case of gait rehabilitation following SCI or stroke, the rehab robots have the potential to significantly increase the independence of the patient during the rehabilitation process without the patient’s safety being compromised. An intensive gait-oriented rehabilitation therapy is often effective irrespective of the type of rehabilitation paradigm. However, eventually overground gait training, in comparison with body-weight supported treadmill training (BWSTT), has the potential of higher therapeutic outcome due its associated biomechanics being very close to that of the natural gait. Recognizing the apparent superiority of the overground gait training paradigms, a through literature survey on all the major overground robotic gait rehabilitation approaches was carried out and is presented in this paper. The survey includes an in-depth comparative study amongst these robotic approaches in terms of gait rehabilitation efficacy.

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Source: The Efficacy of State of the Art Overground Gait Rehabilitation Robotics: A Bird’s Eye View

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[VIDEO] Robots help stroke victims regain use of arms – Euronews

http://www.euronews.com/embed/305482

Introduced two decades ago for patients with neurological disorders, rehabilitation robotics is now a relatively widespread recovery method for patients.

At the National Hospital for Neurology and Neurosurgery in London, robots are used to help stroke victims regain the use of their arms.

Exoskeletons are attached to computer games specially designed to exercise specific sets of upper body muscles. At least 500 repetitions of a movement are needed to make any lasting change.

“It adds variety to the rehabilitation that they’re receiving which adds interest, and patients need to focus on what they’re doing and they need to concentrate again in order to change to affect plasticity,” says Fran Brander, a clinical physiotherapist at the NHNN in London.

“But it’s not the be all and end all. We couldn’t just buy six robots and have no therapists, or nobody to do the hands-on stuff, because the robot won’t lengthen tight muscles, it won’t know which are the specifically weak muscles that need strengthening.”

Before starting the exercise, the patient’s ability to move his or her arm is fed into the computer. If they are unable to move their arm, the robot moves it for them. If they start to move, the robot provides adjustable levels of assistance to help out, helping the brain and arm to learn to work together again.

“You forget what the arm can do when it hasn’t been used for some time. So they teach you new skills and put you on this upper hand clinic (clinical device) to encourage you to be able to use the right arm again,” explains one patient.

While the introduction of such devices doesn’t mean traditional physiotherapy is no longer needed, it can leave the most repetitive exercises to machines, freeing up more time for other, more complex tasks by humans.

Source: Robots help stroke victims regain use of arms | Euronews

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[ARTICLE] A modular telerehabilitation architecture for upper limb robotic therapy – Full Text

Several factors may prevent post-stroke subjects from participating in rehabilitation protocols, for example, geographical location of rehabilitation centres, socioeconomic status, economic burden and lack of logistics surrounding transportation. Early supported discharge from hospitals with continued rehabilitation at home represents a well-defined regimen of post-stroke treatment. Information-based technologies coupled with robotics have promoted the development of new technologies for telerehabilitation. In this article, the design and development of a modular architecture for delivering upper limb robotic telerehabilitation with the CBM-Motus, a planar unilateral robotic machine that allows performing state-of-the-art rehabilitation tasks, have been presented. The proposed architecture allows a therapist to set a therapy session on his or her side and send it to the patient’s side with a standardized communication protocol; the user interacts with the robot that provides an adaptive assistance during the rehabilitation tasks. Patient’s performance is evaluated by means of performance indicators, which are also used to update robot behaviour during assistance. The implementation of the architecture is described and a set of validation tests on seven healthy subjects are presented. Results show the reliability of the novel architecture and the capability to be easily tailored to the user’s needs with the chosen robotic device.

Figure 10.
Subject 1 performing 80 repetitions of the clock-game in unassisted simulated post-stroke condition: Cartesian position (upper left side), Cartesian velocity (right upper side), x component of hand velocity over time during NW forward/backward movement (lower left side) and y component of hand velocity over time during NW forward/backward movement (lower right side).

Continue —> A modular telerehabilitation architecture for upper limb robotic therapy – Jan 01, 2017

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[ARTICLE] Multimodal adaptive interfaces for 3D robot-mediated upper limb neuro-rehabilitation: an overview of bio-cooperative systems – Full Text HTML

Highlights

  • Novel classification of bio-cooperative robotic systems.
  • A multimodal 3D robotic platform for upper limb rehabilitation of post stroke patients.
  • Mechatronic module for guaranteeing arm-weight support during therapy.

Abstract

Robot-mediated neuro-rehabilitation has been proved to be an effective therapeutic approach for upper limb motor recovery after stroke, though its actual potential when compared to other conventional approaches has still to be fully demonstrated. Most of the proposed solutions use a planar workspace. One key aspect for influencing motor recovery mechanisms, such as neuroplasticity and the level of motivation and involvement of the patient in the exercise, is the design of patient-tailored protocols and on-line adaptation of the assistance provided by the robotic agent to the patient performance. Also, when abilities for performing activities of daily living shall be targeted, exercises in 3D workspace are highly preferable. This paper wants to provide a complete overview on bio-cooperative systems on neuro-rehabilitation, with a special focus on 3D multimodal adaptive interfaces, by partly in-depth reviewing the literature and partly proposing an illustrative case of how to build such a bio-cooperative based on the authors’ current research. It consists of an operational robotic platform for 3D upper limb robot-aided rehabilitation, directly derived from the MAAT system previously developed by the same research group. The system features on-line adaptation of therapy characteristics to specific patient needs and to the measured level of performance, by including the patient in the control loop. The system is composed of a 7-DoF robot arm, an adaptive interaction control system, a motorized arm-weight support system and a module for on-line evaluation of patient performance. Such module records patient biomechanical data through an unobtrusive, wearable sensory system, evaluates patient biomechanical state and updates robot control parameters for modifying level of assistance and task complexity in the 3D workspace. In addition, a multimodal interface provides information needed to control the motorized arm-weight support by means of a dedicated cable-pulley system.

Continue —> Multimodal adaptive interfaces for 3D robot-mediated upper limb neuro-rehabilitation: an overview of bio-cooperative systems

Computational schema of the proposed bio-cooperative system for upper limb ...

 

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[TEDx Talk] Robotics for Stroke Rehabilitation | Karen J. Nolan | TEDxHerndon – YouTube

Published on Aug 2, 2016

Dr. Karen J. Nolan discusses current uses of robotics for stroke rehabilitation. She discusses how we can re-train the biomechanics of our body.

Karen J. Nolan, PhD is a Senior Research Scientist in the Human Performance and Engineering at Kessler Foundation, Associate Professor of PM&R at Rutgers NJMS, Clinical Research Scientist at Children’s Specialized Hospital, and Affiliated Faculty of Biomedical Engineering at the New Jersey Institute of Technology. Dr. Nolan has extensive experience leading the design and implementation of biomechanical research and strong expertise in balance, gait, movement analysis, neuromuscular physiology, rehabilitation robotics, and peripheral motor control. Dr. Nolan is recognized as a leader in the field of biomechanics and motor rehabilitation and has been invited to give presentations on these topics at national and international conferences.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

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