Posts Tagged robot

[ARTICLE] Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients – Full Text


Objective: To determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients.


Methods: Subjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment.


Results: The RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups.


Conclusion: RT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity.


Spasticity is defined as a velocity-dependent increase in tonic stretch reflex, resulting from over-excitation of the stretch reflex due to upper motor neuron lesions [1]. It occurs frequently in patients with post-stroke hemiplegia. Excessive spasticity reduces patients’ range of motion (ROM) to the extent that it obstructs daily living activities and functional improvement, thereby adversely affecting successful rehabilitation.

Various treatment methods are used to control spasticity, such as exercise, drug therapy, electrostimulation, surgery, and local nerve block using botulinum toxin [2, 3, 4, 5]. Conventional rehabilitation therapy for spasticity administered by therapists includes passive stretching and ROM exercise treatment. The amount and effects of repetitive exercise manually induced by therapists may differ according to the therapists’ levels of experience [6].

In recent decades, rehabilitation treatment using a robot has been developed to reproduce accurate motions repeatedly with less input of physical effort and time by therapists. Upper extremity rehabilitation treatment using robots has been available since the 1990s and the clinical effects on upper extremity function recovery are reported.

Studies on robotic assisted rehabilitation therapy in stroke patients have shown significant improvement in motor abilities of the exercised limb and enhanced functional outcomes [7, 8, 9, 10, 11]. However, some studies indicated that when the duration and intensity of conventional treatment is matched with robotic treatment, motor recovery, activities of daily living, strength, and motor control show no group-wise differences [7]. Nevertheless, additional sessions of robotic treatment promote better motor recovery in patients with stroke, as compared with additional conventional treatment [12].

Previously, studies indicated variable treatment effects of robot-assisted rehabilitation treatment on upper extremity spasticity. Fazekas et al. [13] reported significant change in Modified Ashworth Score (MAS) of shoulder adductors and elbow flexor only in the robotic treatment group. However, it reportedly has a small, non-significant effect on muscle tone based on MAS in other studies [10, 11, 14].

The aim of the present study was to evaluate the effect of upper extremity rehabilitation robots on spasticity in stroke patients. We conducted a randomized controlled trial to evaluate upper extremity spasticity, motor power and functions in response to therapy.


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[Abstract] Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey


Recent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training.

This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI).

Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed.

A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.

Source: Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey : International Journal on Disability and Human Development

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[Abstract] Design of ELISE robot for the paretic upper limb of stroke survivors.


To characterize the ELISE project, a concept robot applicable in the neuro-rehabilitation of the entire paretic upper limb. The project has been designed and implemented based on comprehensive rehabilitation of the shoulder, forearm and hand. ELISE is a concept robotic system prepared for individualized approach in rehabilitation of stroke patients including diagnostics, passive and/or active exercises and reports. The ELISE system includes dual biofeedback solutions: rehabilitation exercises in virtual reality (VR) and the virtual assistant of therapist. The biomechanical, ergonomics, electrical/electronics, hardware/software aspects of the design are described in detail here. This paper suggests a new approach to rehabilitation robots for the spastic upper limb of stroke survivors. Rehabilitation with ELISE robot was based on movement exercises, which incorporate biofeedback in VR. The patient realizes common tasks from ordinary life. This innovative rehabilitation connects practical/social aspect of rehabilitation with movement exercises. With the aid of these stimulations, the ELISE robot is intended to speed up the process of recovery from damaged neuron connections in brain. Robot was designed for flexible assembly and can be tailored to individual needs and unique expectations of each therapist and patient. This is possible thanks to the modular design of the robot arm and software. The ELISE robot will be sold in different configurations (e.g. without an expander or a set of virtual games or a virtual assistant of therapist).

Source: EBSCOhost | 118462975 | Design of ELISE robot for the paretic upper limb of stroke survivors.

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[Abstract] E2Rebot: A robotic platform for upper limb rehabilitation in patients with neuromotor disability.


The use of robotic platforms for neuro-rehabilitation may boost the neural plasticity process and improve motor recovery in patients with upper limb mobility impairment as a consequence of an acquired brain injury.

A robotic platform for this aim must provide ergonomic and friendly design, human safety, intensive task-oriented therapy, and assistive forces. Its implementation is a complex process that involves new developments in the mechanical, electronics, and control fields.

This article presents the end-effector rehabilitation robot, a 2-degree-of-freedom planar robotic platform for upper limb rehabilitation in patients with neuromotor disability after a stroke. We describe the ergonomic mechanical design, the system control architecture, and the rehabilitation therapies that can be performed. The impedance-based haptic controller implemented in end-effector rehabilitation robot uses the information provided by a JR3 force sensor to achieve an efficient and friendly patient–robot interaction. Two task-oriented therapy modes have been implemented based on the “assist as needed” paradigm. As a result, the amount of support provided by the robot adapts to the patient’s requirements, maintaining the therapy as intensive as possible without compromising the patient’s health and safety and promoting engagement.


Source: E2Rebot: A robotic platform for upper limb rehabilitation in patients with neuromotor disability

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[Abstract] Trends in rehabilitation robots and their translational research in National Rehabilitation Center, Korea – SpringerLink


Robots are expected to play an important role in rehabilitation as rehabilitation robots can provide frequent and repetitive doses during treatment or provide seamless support in daily living activities. However, the research and development results of rehabilitation robots indicate that they are not suitable for clinical applications because of several requirements such as safety, effectiveness, long-term investment, and other barriers between bench and bedside.

This paper reviews the current trends in rehabilitation robots and then shares the experience of a translational research for rehabilitation robots in the National Rehabilitation Center (NRC) of Korea during the last three years.

The NRC translational research for rehabilitation robots consists of three parts: extramural projects of universities, research institutes, and companies for clinical applications, intramural projects within NRC, and operation of an NRC Robot Gym, i.e., a sharing space between clinicians and engineers.

This translational research provides infrastructures for clinicians and engineers conducting studies on rehabilitation robots. NRC is trying to connect robotic technology with clinical application through this translational research. In addition, a novel direction for the next three years is presented. This research will contribute visible results such as boosting the rehabilitation robot industry and improving the quality of life of people with disabilities and senior citizens.

Source: Trends in rehabilitation robots and their translational research in National Rehabilitation Center, Korea | SpringerLink

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[ARTICLE] Feasibility of using Lokomat combined with functional electrical stimulation for the rehabilitation of foot drop. – Full Text PDF


This study investigated the clinical feasibility of combining the electromechanical gait trainer Lokomat with functional electrical therapy (LokoFET), stimulating the common peroneal nerve during the swing phase of the gait cycle to correct foot drop as an integrated part of gait therapy.

Five patients with different acquired brain injuries trained with LokoFET 2-3 times a week for 3-4 weeks. Pre- and post-intervention evaluations were performed to quantify neurophysiological changes related to the patients’ foot drop impairment during the swing phase of the gait cycle. A semi-structured interview was used to investigate the therapists’ acceptance of LokoFET in clinical practice. The patients showed a significant increase in the level of activation of the tibialis anterior muscle and the maximal dorsiflexion during the swing phase, when comparing the pre- and post-intervention evaluations.

This showed an improvement of function related to the foot drop impairment. The interview revealed that the therapists perceived the combined system as a useful tool in the rehabilitation of gait. However, lack of muscle selectivity relating to the FES element of LokoFET was assessed to be critical for acceptance in clinical practice.

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[WEB SITE] Unique walking robot moves into rehabilitation clinic.


The LOPES II rehabilitation robot has been taken into use by the Roessingh rehabilitation centre in Enschede and the Sint Maartenskliniek in Nijmegen. In the coming weeks, the first patients in the Netherlands with, for example, a CVA or spinal cord injury, will practice with this unique rehabilitation robot in order to learn to walk better again. The novelty of the LOPES II is that the robot only supports the patient when needed during the walking practice. LOPES II was developed by a consortium consisting of the University of Twente and the mechatronic companies Moog and Demcon. Roessingh and Sint Maartenskliniek provided clinical input for the development process.

LOPES II is the redesigned successor to the LOPES I, which was developed by the University of Twente (Department of Biomedical Engineering, Herman van der Kooij). The has been used for research since 2007. In recent years, the consortium has worked hard to make the move to the clinic. With the installation of two systems, this has now been achieved.

Support only when needed

The robot supports the walking movement of people who are partially paralyzed following a stroke or spinal cord injury. LOPES holds the patient firmly around the pelvis, lower leg and foot. The device continuously measures how the patient walks and provides support when the patient’s walking movement is performed incorrectly. During a training programme, this support is adjusted to the patient’s walking ability by the physiotherapist. ‘Support only when needed’ is the starting point for the LOPES II. This encourages the patient to actively contribute to the walking, thereby promoting the recovery.

Enthusiastic responses

The therapists are enthusiastic about the possibilities offered by LOPES II. Hans Rietman, part-time professor of rehabilitation medicine and technology at the University of Twente and director of Roessingh Research and Development (RRD) in Enschede, says: “The robotic walking trainer, developed by means of intensive collaboration between clinic and technology, can, with a real human touch, help patients to walk independently step by step. It is a great asset for rehabilitation.”

Unique walking robot moves into rehabilitation clinic

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[ARTICLE] Exoskeleton Robots for Rehabilitation of the Upper Limb – Full Text PDF


The number of cerebrovascular and neuromuscular diseases are increasing in parallel with the rising avarage age of world’s population.

Usage of the rehabilitation robots for physiotherapy of patiens who have lost their limb motor functions, gains importance. The usage of these robots provides treatment for more patients, shortens the time period of treatment and provides doing the excersises accurately and repeatable.

Disuse of the upper limbs adversely affect the human life because this upper limbs are commonly used in daily life. Exoskeletal robot manipulators are one of the important application area of BIOMECHATRONICS.

In this study exoskeleton robots for upper limb rehabilitation available in the literature were examined and compared.

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[ARTICLE] Long-term Effectiveness of Intensive Therapy in Chronic Stroke


Background. While recent clinical trials involving robot-assisted therapy have failed to show clinically significant improvement versus conventional therapy, it is possible that a broader strategy of intensive therapy—to include robot-assisted rehabilitation—may yield clinically meaningful outcomes.

Objective. To test the immediate and sustained effects of intensive therapy (robot-assisted therapy plus intensive conventional therapy) on outcomes in a chronic stroke population.

Methods. A multivariate mixed-effects model adjusted for important covariates was established to measure the effect of intensive therapy versus usual care. A total of 127 chronic stroke patients from 4 Veterans Affairs medical centers were randomized to either robot-assisted therapy (n = 49), intensive comparison therapy (n = 50), or usual care (n = 28), in the VA-ROBOTICS randomized clinical trial. Patients were at least 6 months poststroke, of moderate-to-severe upper limb impairment. The primary outcome measure was the Fugl-Meyer Assessment at 12 and 36 weeks.

Results. There was significant benefit of intensive therapy over usual care on the Fugl-Meyer Assessment at 12 weeks with a mean difference of 4.0 points (95% CI = 1.3-6.7); P = .005; however, by 36 weeks, the benefit was attenuated (mean difference 3.4; 95% CI = −0.02 to 6.9; P = .05). Subgroup analyses showed significant interactions between treatment and age, treatment and time since stroke.

Conclusions. Motor benefits from intensive therapy compared with usual care were observed at 12 and 36 weeks posttherapy; however, this difference was attenuated at 36 weeks. Subgroups analysis showed that younger age, and a shorter time since stroke were associated with greater immediate and long-term improvement of motor function.

Source: Long-term Effectiveness of Intensive Therapy in Chronic Stroke

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[ARTICLE] Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke


Background: Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke.

Objective: To compare the rehabilitation effectiveness achieved by NMES robot–assisted wrist training and that by robot-assisted training.

Methods: This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training.

Results: The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot–assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05).

Conclusions: The NMES robot–assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.

Source: Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke

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