Posts Tagged robot

[REVIEW] Is robot-assisted therapy effective in upper extremity recovery in early stage stroke? —a systematic literature review

Abstract

[Purpose] The aim of this study was to systematically investigate the effects of robot-assisted therapy on the upper extremity in acute and subacute stroke patients.

[Subjects and Methods] The papers retrieved were evaluated based on the following inclusion criteria: 1) design: randomized controlled trials; 2) population: stroke patients 3) intervention: robot-assisted therapy; and 4) year of publication: May 2012 to April 2016. Databased searched were: EMBASE, PubMed and COCHRAN databases. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. [Results] Of the 637 articles searched, six studies were included in this systematic review. The PEDro scores range from 7 to 9 points.

[Conclusion] This review confirmed that the robot-assisted therapy with three-dimensional movement and a high degree of freedom had positive effects on the recovery of upper extremity motor function in patients with early-stage stroke. We think that the robot-assisted therapy could be used to improve upper extremity function for early stage stroke patients in
clinical setting.
 

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[ARTICLE] A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke – Full Text

Abstract

Background

It is a challenge to reduce the muscular discoordination in the paretic upper limb after stroke in the traditional rehabilitation programs.

Method

In this study, a neuromuscular electrical stimulation (NMES) and robot hybrid system was developed for multi-joint coordinated upper limb physical training. The system could assist the elbow, wrist and fingers to conduct arm reaching out, hand opening/grasping and arm withdrawing by tracking an indicative moving cursor on the screen of a computer, with the support from the joint motors and electrical stimulations on target muscles, under the voluntary intention control by electromyography (EMG). Subjects with chronic stroke (n = 11) were recruited for the investigation on the assistive capability of the NMES-robot and the evaluation of the rehabilitation effectiveness through a 20-session device assisted upper limb training.

Results

In the evaluation, the movement accuracy measured by the root mean squared error (RMSE) during the tracking was significantly improved with the support from both the robot and NMES, in comparison with those without the assistance from the system (P < 0.05). The intra-joint and inter-joint muscular co-contractions measured by EMG were significantly released when the NMES was applied to the agonist muscles in the different phases of the limb motion (P < 0.05). After the physical training, significant improvements (P < 0.05) were captured by the clinical scores, i.e., Modified Ashworth Score (MAS, the elbow and the wrist), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT).

Conclusions

The EMG-driven NMES-robotic system could improve the muscular coordination at the elbow, wrist and fingers.

Background

Stroke is a main cause of long-term disability in adults [1]. Approximately 70 to 80% stroke survivors experienced impairments in their upper extremity, which greatly affects the independency of their daily living [23]. In the upper limb rehabilitation, it also has been found that the recovery of the proximal joints, e.g., the shoulder and the elbow, is much better than the distal, e.g., the wrist and fingers [45]. The main possible reasons are: 1) The spontaneous motor recovery in early stage after stroke is from the proximal to the distal; and 2) the proximal joints experienced more effective physical practices than the distal joints throughout the whole rehabilitation process, since the proximal joints are easier to be handled by a human therapist and are more voluntarily controllable by most of stroke survivors [2]. However, improved proximal functions in the upper limb without the synchronized recovery at the distal makes it hard to apply the improvements into meaningful daily activities, such as reaching out and grasping objects, which requires the coordination among the joints of the upper limb, including the hand. More effective rehabilitation methods which may benefit the functional restoration at both the proximal and the distal are desired for post-stroke upper limb rehabilitation.

Besides the weakness and spasticity of muscles in the paretic upper limb, discoordination among muscles is also one of the major impairments after stroke, mainly reflected as abnormal muscular co-activating patterns and loss of independent joint control [26]. Stereotyped movements of the entire limb with compensation from the proximal joints are commonly observed in most of persons with chronic stroke who have passed six months after the onset of the stroke, during which abnormal motor synergies were gradually developed. Neuromuscular electrical stimulation (NMES) is a technique that can generate limb movements by applying electrical current on the paretic muscles [7]. Post-stroke rehabilitation assisted with NMES has been found to effectively prevent muscle atrophy and improve muscle strength [7], and the stimulation also evokes sensory feedback to the brain during muscle contraction to facilitate motor relearning [8]. It has been found that NMES can improve muscular coordination in a paralysed limb by limiting ‘learned disuse’ that stroke survivors are gradually accustomed to managing their daily activities without using certain muscles, which has been considered as a significant barrier to maximizing the recovery of post-stroke motor function [9]. However, difficulties have been found in NMES alone to precisely activate groups of muscles for dynamic and coordinated limb movements with desired accuracy in kinematics, for example, speeds and trajectories. It is because most of the NMES systems adopted transcutaneous stimulation with surface electrodes only recruiting muscles located closely to the skin surface with limited stimulation channels [8]. Therefore, the muscular force evoked may not be enough to achieve the precise limb motions. However, limb motions with repeated and close-to-normal kinematic experiences are necessary to enhance the sensorimotor pathways in rehabilitation, which has been found to contribute to the motor recovery after stroke [10]. Furthermore, faster muscular fatigue would be experienced when using NMES with intensive stimuli, in comparison with the muscle contraction by biological neural stimulation [11].

The use of rehabilitation robots is one of the solutions to the shortage of affordable professional manpower in the industry of physical therapy, to cope with the long-term and labour-demanding physical practices [10]. In comparison with the NMES, robots can well control the limb movements with electrical motors. Various robots have been proposed for upper limb training after stroke [1213]. Among them, the robots with the involvement of voluntary efforts from persons after stroke demonstrated better rehabilitation effects than those with passive limb motions, i.e., the limb movements are totally dominated by the robots [10]. Physical training with passive motions only contributed to the temporary release of muscle spasticity; whereas, voluntary practices could improve the motor functions of the limb with longer sustainability [1014]. In our previous studies, we designed a series of voluntary intention-driven rehabilitation robotics for physical training at the elbow, the wrist and fingers [1415161718]. Residual electromyography (EMG) from the paretic muscles was used to control the robots to provide assistive torques to the limb for desired motions. The results of applying these robots in post-stroke physical training showed that the target joint could obtain motor improvements after the training; however, more significant improvements usually appeared at its neighbouring proximal joint mainly due to the compensatory exercises from the proximal muscles [1517]. In order to improve the muscle coordination during robot-assisted training, we integrated NMES into the EMG-driven robot as an intact system for wrist rehabilitation [1619]. It has been found that the combined assistance with both robot and NMES could reduce the excessive muscular activities at the elbow and improve the muscle activation levels related to the wrist, which was absent in the pure robot assisted training [16]. More recently, combined treatment with robot and NMES for the wrist by other research group also demonstrated more promising rehabilitation effectiveness in the upper limb functions than pure robot training [20]. However, most of the proposed devices are for single joint treatment, and cannot be used for multi-joint coordinated upper limb training. Furthermore, the training tasks provided by these devices are not easy to be directly translated into daily activities. We hypothesized that multi-joint coordinated upper limb training assisted by both NMES and robot could improve the muscular coordination in the whole upper limb and promote the synchronized recovery at both the proximal and distal joints. In this work, we designed a multi-joint robot and NMES hybrid system for the coordinated upper limb physical practice at the elbow, wrist and fingers. Then, the rehabilitation effectiveness with the assistance of the device was evaluated by a pilot single-group trial. EMG signals from target muscles were used for voluntary intention control for both the robot and NMES parts.

Methods

The NMES-robot system

The system developed is a wearable device as shown in Fig. 1. It can support a stroke subject to perform sequencing limb movements, i.e., 1) elbow extension, 2) wrist extension associated with hand open, 3) wrist flexion and 4) elbow flexion, with the purpose of simulating the coordination of the joints in arm reaching out, hand open for grasping, and withdrawing in daily activities. The starting position of the motion cycle was set at the elbow joint extended at 180° and the wrist extended at 45°, which is also the end point for a motion cycle. In each phase of the motion, visual guidance on a computer screen was provided to a subject by following a moving cursor on the computer screen with a constant angular velocity at 10°/s for the movement of the wrist and the elbow. The subject was asked to minimize the target and actual joint positions during the tracking. In the limb tasks, assistances would be provided from the mechanical motors and NMES at the same time related to the wrist and elbow flexion/extension. NMES alone was applied for finger extension, and there was no assistance from the system for finger flexion (hand grasp). It is because that the main impairment in the hand for persons with chronic stroke is hand open, and the hand grasp can be achieved passively due to spasticity in finger flexors, and one channel NMES has demonstrated the capacity to achieve the gross open of the hand with finger extensions in clinical practices [2]. With the attempt to reduce the overall weight of the system, especially at the distal joints, for the coordinated multi-joint training of the whole upper limb, finger motions were only supported by the NMES in this work. The robot and NMES combined effects on individual finger motions in chronic stroke have been investigated in our previous work [21]. A hanging system was used to lift up the testing limb to a horizontal level (Fig. 1), to compensate the limb gravity and the weight of the wearable part of the system (totally 895 g).

Fig. 1 a The schematic diagram of the experimental setup, b a photo of a subject who is conducting the tracking task with the NMES-robot, c a photo of a subject wearing the mechanical parts of the system, d the configuration of the NMES electrodes and EMG electrodes on a driving muscle. The driving muscles in the study are BIC, TRI, FCR and the muscle union of ECU-ED

Continue —> A Neuromuscular Electrical Stimulation (NMES) and robot hybrid system for multi-joint coordinated upper limb rehabilitation after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

 

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

ABSTRACT

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.

INTRODUCTION

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.

 

Continue —> KoreaMed Synapse

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

Abstract

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.

Abstract:

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.

Abstract

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

Abstract

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 http://partner.googleadservices.com/gpt/pubads_impl_94.js

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

Abstract

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, Prof.dr.ir. 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

For more visit —> Unique walking robot moves into rehabilitation clinic

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

Abstract

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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