Posts Tagged robot

[Abstract] Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients

Purpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis.

Material and methods: Twenty-two patients with stroke-induced hemiparesis participated in a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, nineteen (86%) participated in this long-term follow-up study. Assessments two, five and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (RMS error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness measures represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or < 17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months.

Results: Fugl-Meyer scores were stable from five to 54 months (+1[-2;4], median[1st;3rd quartiles], ns). Kinematic changes in the three directions pooled were: distance covered, -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p<0.05). Group 2 showed decline vs Group 1 (p<0.001) in FM (Group 1, +3[1;5], p<0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p<0.001). At 54 months, FM and MFS were highly correlated (Pearson’s rho = 0.89; p<0.001).

Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, kinematic performance deteriorated in spite of community-based therapy, especially in patients with more severe impairment.


via Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients: International Journal of Neuroscience: Vol 0, No ja


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[WEB SITE] Wearable Robot Provides Artificial Muscle Power – Rehab Managment

(a) Overview of wearing set-up of the assist wear. (b) Structure of the multilayered PVC gel actuator with two types of anode mesh electrodes. The red layer with small holes is comprised of slide electrodes to minimize the friction with the slide shafts. (c) Contraction and expansion movement of the stretching type actuator with the DC field turned on and off. (d) FlexiForce sensor-based motion detection (position estimator). (e) Power and controller. (Photo courtesy of Hashimoto laboratory)

(a) Overview of wearing set-up of the assist wear. (b) Structure of the multilayered PVC gel actuator with two types of anode mesh electrodes. The red layer with small holes is comprised of slide electrodes to minimize the friction with the slide shafts. (c) Contraction and expansion movement of the stretching type actuator with the DC field turned on and off. (d) FlexiForce sensor-based motion detection (position estimator). (e) Power and controller. (Photo courtesy of Hashimoto laboratory)

A collaborative research team from Shinshu University in Japan has designed a wearable robot to support a person’s hip joint while walking. Details of their prototype are published in Smart Materials and Structures.

“With a rapidly aging society, an increasing number of elderly people require care after suffering from stroke, and other-age related disabilities. Various technologies, devices, and robots are emerging to aid caretakers,” writes team leader Minoru Hashimoto, a professor of textile science and technology at Shinshu University, noting that several technologies meant to assist a person with walking are often cumbersome to the user.

“[In our] current study, [we] sought to develop a lightweight, soft, wearable assist wear for supporting activities of daily life for older people with weakened muscles and those with mobility issues,” he adds, in a media release from Shinshu University.

The wearable system consists of plasticized polyvinyl chloride (PVC) gel, mesh electrodes, and applied voltage. The mesh electrodes sandwich the gel, and when voltage is applied, the gel flexes and contracts, like a muscle. It’s a wearable actuator, the mechanism that causes movement.

“We thought that the electrical mechanical properties of the PVC gel could be used for robotic artificial muscles, so we started researching the PVC gel,” Hashimoto notes. “The ability to add voltage to PVC gel is especially attractive for high speed movement, and the gel moves with high speed with just a few hundred volts.”

In a preliminary evaluation, a stroke patient with some paralysis on one side of his body walked with and without the wearable system.

“We found that the assist wear enabled natural movement, increasing step length and decreasing muscular activity during straight line walking,” Hashimoto states. The researchers also found that adjusting the charge could change the level of assistance the actuator provides.

The robotic system earned first place in demonstrations with their multilayer PVC gel artificial muscle at the, “24th International Symposium on Smart Structures and Materials & Nondestructive Evaluation and Health Monitoring” for SPIE the international society for optics and photonics.

Next, the researchers plan to create a string actuator using the PVC gel, which could potentially lead to the development of fabric capable of providing more manageable external muscular support with ease, the release continues.

[Source(s): Shinshu University, Science Daily]

via Wearable Robot Provides Artificial Muscle Power – Rehab Managment

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[ARTICLE] Combined treatment of botulinumtoxin and robot-assisted rehabilitation therapy on poststroke, upper limb spasticity: A case report – Full Text


Rationale: Spasticity is a major complication after stroke, and botulinumtoxin A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve voluntary motor control or activities of daily living function of paretic upper limbs. This study investigated whether BoNT-A injection combined with robot-assisted upper limb therapy improves voluntary motor control or functions of upper limbs after stroke.

Patient concerns: Two subacute stroke patients were transferred to the Department of Rehabilitation.

Diagnoses: Patients demonstrated spasticity in the upper extremity on the affected side.

Interventions: BoNT-A was injected into the paretic muscles of the shoulder, arm, and forearm of the 2 patients at the subacute stage. Conventional rehabilitation therapy and robot-assisted upper limb training were performed during the rehabilitation period.

Outcomes: Manual dexterity, grip strength, muscle tone, and activities of daily living function were improved after multidisciplinary rehabilitation treatment.

Lessons: BoNT-A injection in combination with multidisciplinary rehabilitation treatment, including robot-assisted arm training, should be recommended for subacute spastic stroke patients to enhance appropriate motor recovery.

1 Introduction

Upper limb spasticity is a common complication following stroke, occurring in 20% to 40% of stroke survivors.[1] As upper limb spasticity, joint contractures, and pain limit the voluntary motor control of the arm and hand, the functions of which are essential for the activity of daily living (ADL), ADL dependencies, including hygiene, dressing, and positioning, can be exacerbated.[2]

Injection of botulinumtoxin A (BoNT-A), which is commonly used in the management of focal spasticity in the chronic phase of stroke, reduces muscle tone and passive range of motion. However, it is unclear whether BoNT-A can improve voluntary motor control or ADL functions of upper limbs.[3]

Recently, task-specific high-intensity training with a multidisciplinary team approach has become an important concept in stroke rehabilitation therapy, and robot-assisted arm training (RAT) has been shown to allow well tolerated and intensive task-specific repetitive training of the paretic arm.[4] However, multidisciplinary rehabilitation therapies using RAT in combination with BoNT-A injection have rarely been applied to subacute poststroke spasticity. Thus, we report on 2 cases showing the beneficial effects of RAT in combination with BoNT-A injection on upper limb spasticity in the subacute phase of stroke. […]

Continue —> Combined treatment of botulinumtoxin and robot-assisted reha… : Medicine

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[Abstract] Hybrid impedance control of a robot manipulator for wrist and forearm rehabilitation: Performance analysis and clinical results


Therapeutic exercises play an important role in the physical therapy and the rehabilitation. The exercises that can be assisted by a physiotherapist are increasingly being performed by the rehabilitation robots partially or fully due to their various merits. This study aims to develop a complete rehabilitation system, which consists of a rehabilitation robot, an HMI and a hybrid impedance controller that can model all the therapeutic exercises for an upper limb rehabilitation. The 3-DOF upper limb rehabilitation robot is able to perform the movements of flexion–extension and ulnar–radial deviation for the wrist, and the movement of pronation–supination for the forearm. The experimental studies were conducted with healthy subjects and patients. First, the experiments were done with the healthy subjects to prove the control performance of the robotic system. The results showed that the hybrid impedance controlled robot can perform the therapeutic exercises very successfully. Then, the experimental studies were carried out with the real patients in a clinical environment. At the end of the treatment process, remarkable improvements were observed in terms of the limb force in all of the patients.


via Hybrid impedance control of a robot manipulator for wrist and forearm rehabilitation: Performance analysis and clinical results

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[ARTICLE] Development of the Wrist Rehabilitation Therapy (WRist-T) Device based on Automatic Control for Traumatic Brain Injury Patient – iMEDiTEC 2017 – Full Text

In Malaysia, there are not many physiotherapists (PT) as well as rehabilitation centers. Limb rehabilitation is common in rehabilitation centers which include upper limbs and lower limbs. Generally, for upper limb, wrist, hand and fingers rehabilitation is frequently conducted in the centers by PT. The current scenario in Malaysia for wrist rehabilitation is the PT use conventional method to carry out the rehabilitation
procedures. The problem with this procedures, it is time-consuming as the PT need to attend every patient for about 20-30 minutes. This could also lead to exhaustion both to PT and patients. The session can only be done with the assistance on PT, however, there are many patients could not commit to the therapy session due to logistic and domestic problems. This problem can be greatly solved with rehabilitation robot but the
current product in the market is expensive and not affordable especially for low-income earners family. In this paper, a novel automatic control of wrist rehabilitation therapy; called WRist-T device has been developed. The novelty of the device is three modes of exercises that can be carried out which is the flexion and extension, radial and ulnar deviation and pronation and supination. By using this device, the patient can easily receive physiotherapy session with minor supervision from the physiotherapist at the hospital or rehabilitation center and also can be conducted at patient home.[…]

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via Restoring collagen in menopausal women – HEALTH & SCIENCE – Jerusalem Post



 NOVEMBER 25, 2017 23:29

Jerusalem’s Alyn Hospital recently discussed at its annual conference a variety of modern ways to improve the quality of life of disabled young people.


THE MOST modern wheelchairs are available for children who can even maneuver them with eye movements or joysticks, but robots and virtual reality have joined them.. (photo credit:JUDY SIEGEL-ITZKOVICH)

Rehabilitation of disabled children and teens no longer involves just training in the use of wheelchairs and providing prostheses to replace missing limbs. Ever-advancing technology has added robots, virtual reality, video screens and other assisting devices and ways to improve the youngsters’ quality of life and family cohesion. There are even (highly expensive) drugs that significantly ameliorate diseases that used to be considered hopeless. One powerhouse behind this revolution is Jerusalem’s ALYN Hospital, a national and comprehensive rehabilitation center for physically challenged and disabled children, adolescents and young adults.

The nonprofit facility, which treats all young patients, regardless of religious belief, nationality or ethnic background, was founded in 1932 by American orthopedist Dr. Henry Keller, who dedicated his life to such children. Working out of an old re-purposed monastery in the capital’s Katamon neighborhood, the medical staff cared for children disabled in the polio epidemic that spread through Israel and the rest of the world in the 1940s and 1950s. ALYN served as a treatment center, residence and school for 200 young patients.

In 1971, the voluntary organization was able to build the impressive Woldenberg Family Hospital complex in Jerusalem’s Kiryat Hayovel neighborhood to serve inpatients and outpatients.

Today, it is one of the world’s leading hospitals specializing in the active and intensive rehabilitation of children who have a broad range of physical disabilities caused not only by various congenital and progressive muscle, nerve and bone diseases, but also feeding disorders, severe respiratory problems, road and home accidents, terrorist attacks and severe burns. Patients who underwent orthopedic operations and neurosurgery also recover and are rehabilitated at ALYN.

The center includes a pre-school daycare center for children aged six months to three years, kindergartens, an after-school integration program and school classes. It provides services including occupational therapy, physiotherapy, hydrotherapy, speech therapy and psychological counseling in addition to support by medical specialists and social workers.

Its director-general since 2011, Dr. Maurit Beeri recently opened ALYN’s Third Annual Conference on Rehabilitation at the capital’s Crowne Plaza Hotel. An accompanying exhibition displayed a large variety of equipment available for disabled youngsters from wheelchairs to electronic devices.

Beeri, who graduated from the Hebrew University Medical Faculty and trained as a pediatrician at the Hadassah University Medical Center in Jerusalem, had never heard about ALYN until, as a medical resident, she was sent to work there for a few months. She saw there that children in wheelchairs could be taught to walk.

“I went and felt in love with it. It was a big discovery for me. If you want to create a real change in the life of a child, this is the place you should be.”

Health, she said at the conference attended by some 200 doctors, nurses, physiotherapists, occupational therapists and other, “is not just the absence of disease. It is to grow and develop, to enjoy well-being. Over a billion people in the world – one in seven – suffer from some type of disability. They have three times the risk of the non-disabled to be hurt in the health system, and half lack accessibility to a decent health system.”

While 250 million people around the globe need eyeglasses and don’t have them and many disabled people lack wheelchairs and other basic equipment, humanity is still much better off today than 200 years ago, said Beeri. Medical technology is developing at a rapid pace – faster than the health system does, so not all get the rehabilitation they need.

Over 17% of Israelis have some kind of physical disability, but today’s Israeli medical students “don’t hear the word ‘rehabilitation.’ They aren’t exposed to it in their studies.

They are not told what physiotherapists, occupational therapists, speech pathologists and audiologists do.” Child rehabilitation here is nevertheless more advanced than in many countries, she added, but even so, many significant things are lacking.”

Only recently did the Health Ministry open a rehabilitation division (headed by Dr. Tsaki Ziv-Ner) to coordinate such functions. “The future is very promising. There is more awareness of the rights of disabled; the problem is in the details. Everyone has the right to live with honor and as much independence as they can.”

DR. KEREN Politi, a pediatric neurologist at ALYN, told the participants that only a few decades ago, there was little to do to help children. “But thanks to genetics, we can give treatments, prevent problems and improve their quality of life – even with spinal muscular atrophy (SMA, which affects about 80 Israeli children) and Duchenne muscular dystrophy.

“We can influence gene regulation. We can give treatment with medical cannabis or with blood from the umbilical cord,” she said. “We can insert healthy genes into sick cells using exon skipping [a form of RNA splicing used to cause cells to “skip” over faulty or misaligned sections of genetic code, creating a shorter but still functional protein].”

A new drug approved by the US Food and Drug Administration named Spinraza that costs NIS 2 million a year per patient can help SMA kids hold up their head better, roll over, crawl and even stand. If the child is treated within 13 weeks of diagnosis, said Politi, they do much better. But covering the bill for all SMA children would gobble up a third of the annual increase to the basket of health services. “There are a lot of things we don’t know, such as how early to start. Maybe it could be given to the fetus, but there is a risk that this might cause leukemia.

Another drug, in an earlier stage of development, would be in pill form and threaten the sales of Spinraza if it proves just as effective, but there is as yet no evidence of longterm benefits.”

Medical cannabis for children is controversial.

“There are three types, and they have 60 different chemicals. Cannabis was used even in the 1850s for headaches and seizures, but its medical use declined as drug companies [falsely] claimed it was addictive and caused violence and psychosis. In the last 20 years, however, it has been brought back and used for numerous medical purposes in all ages.”

Every large Israeli pediatrics department tries cannabis oil on some children. “At ALYN,” said Politi, many parents want it for painful spasms and other things, but I dispense it carefully, not for children with normal cognition.”

Umbilical cord blood is being used experimentally to turn regular cells from the bone marrow into stem cells that can produce growth factors and have an anti-inflammatory effect. There is a group at Duke University in North Carolina that is looking at use of umbilical cord blood on cerebral palsy, but it has not brought about a big change.”

One of her young patients who suffered damage due to separation of her mother’s placenta got umbilical cord blood, but it didn’t help with the seizures. But medical cannabis was tried and he was able to sleep at night for the first time without crying.

PROF. TAMAR Weiss, a University of Haifa expert in the use of technology for rehabilitation, noted that there “is huge and accelerating growth in use of technologies. Almost every day there is something new. It took 50 years for half of public to get a telephone, and much less for smartphone. In rehabilitation, we have not yet reached this speed. We have to use ‘disruptive technologies’ – innovation that creates a new market and eventually disrupts an existing market, displacing established firms and products. But not all paradigm shifts mean an improvement in treatment,” she said. More than half of all rehabilitation technologies that came to the market in the last decade are not used today or they are underused because people didn’t know how to use it. Children from Gaza, for example, were given many devices for their disability but when they went home, they were just put in the closet.

A successful item for rehabilitation is video on a screen so disabled children can move. There are relatively cheap virtual reality devices that can benefit them and are easy to use. A company named SenSerum offers a virtual playground that children with autism can use to jump as if they were on a real trampoline.

“There is a need to find a way for robots to copy human movements, and the technology should be inexpensive, small in size and light in weight. They should be adaptable to the intelligence and abilities of each child and be able to document changes and improvements.”

Robots are very good for disabled kids because “they repeat and are consistent. They can provide exact, continuous quantitative feedback through sensors,” Weiss said. Obviously, robots alone are not enough. They must be complemented by human therapists.

ALYN PHYSIOTHERAPIST Orit Bartov presented the benefits of “intelligent wheelchairs” with built-in sensors to prevent collisions and “eye-drivers” that enable steering with one’s eyes. Children can visit the zoo along with the family using a respirator that’s the size of a laptop. There are cheap children’s plastic and metal wheelchairs for the developing countries.”

While physiotherapy in the 1990s was aimed at strengthening one joint at a time, said Bartov, today it involves rehabilitating the whole body, creating balance, control of movement and coordination.

“Muscle tone is not an aim but a means. There is cognitive rehabilitation, not just medical but also biological, psychological and social. We have to learn about the longterm effects of operations on muscle and use new knowledge in engineering, neuroscience and rehabilitation to create new interventions.”

It takes about a decade for knowledge to be translated from development of technology into a product used in the field.

“We used to try to change the patient, but it’s more important to change the patient’s environment to suit him,” she explained.

The physiotherapist’s take-home message is that the disabled patient should always be the focus; we are not technicians but evidence-based clinicians; there is no alternative to using your hands; and don’t be afraid to try something new.”

ALYN RECENTLY set up a program called PELE (Child Solutions) to create individualized products for helping children with special needs identified by therapists or family members. Professionals and volunteers in engineering and other fields donate their time to design what they need, said Dana Hochstein Mann, the director of ALYNnovation to match the innovative products with manufacturers around the world who want, through cooperation, to bring it to the world market.

Mann noted that zippers developed by Under Armor for the disabled to close with one hand have expanded their use to the wider public. “A child asked Nike to make a shoe with a zipper in the back to make it easy to put on. Now they are being made as a fashionable item for the general public. Companies such as ReWalk and OrCam, are talking about accessibility for the disabled all the time.”

Israel became the “Startup Nation,” said Mann, for good reasons.

“We are not satisfied with situations that need improvement. We don’t like failure, but it is acceptable, as it’s better for an entrepreneur to try something than having never tried; one learns from failure. Due to the lack of funds in Israel, creative solutions result.

It’s a minuscule market without neighboring countries where we can sell products, so one can start small and then grow and think global.” In the rehabilitation field, all these conditions are beneficial, she concluded.

PERHAPS THE most inspiring speaker was a young man who reached the stage on his wheelchair via a ramp. Shahar Botzer, who was born with paralyzed legs but whose arms are functional, heads 2B Community, a venture capital group that invests in young, small-to-medium businesses with potential for significant growth and a turnover of over NIS 1 million a year.

It aims not only at making money but also has a social goal and strict standards that examine the business’s ethical conduct in a wide variety of parameters, including fair employment, environmental protection and contribution to the community.

Married and with a family, Botzer clearly exemplifies what ALYN would want all its “graduates” to strive for.

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[Abstract] Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation


The paper suggests a therapeutic device for hemiparesis that combines robot-assisted rehabilitation and mirror therapy. The robot, which consists of a motor, a position sensor, and a torque sensor, is provided not only to the paralyzed wrist, but also to the unaffected wrist to induce a symmetric movement between the joints. As a user rotates his healthy wrist to the direction of either flexion or extension, the motor on the damaged side rotates and reflects the motion of the normal side to the symmetric angular position. To verify performance of the device, five stroke patients joined a clinical experiment to practice a 10-minute mirroring exercise. Subjects on Brunnstrom stage 3 had shown relatively high repulsive torques due to severe spasticity toward their neutral wrist positions with a maximum magnitude of 0.300kgfm, which was reduced to 0.161kgfm after the exercise. Subjects on stage 5 practiced active bilateral exercises using both wrists with a small repulsive torque of 0.052kgfm only at the extreme extensional angle. The range of motion of affected wrist increased as a result of decrease in spasticity. The therapeutic device not only guided a voluntary exercise to loose spasticity and increase ROM of affected wrist, but also helped distinguish patients with different Brunnstrom stages according to the size of repulsive torque and phase difference between the torque and the wrist position.

Source: Robot-assisted mirroring exercise as a physical therapy for hemiparesis rehabilitation – IEEE Conference Publication

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[Editorial] Robotics in Biomedical and Healthcare Engineering – Journal of Healthcare Engineering

The rapid progress of robotic technique provides new opportunities
for the biomedical and healthcare engineering. For
instance, a micro-nano robot allows us to study the fundamental
problems at cellular scale owing to its precise
positioning and manipulation ability; the medical robot
paves a new way for the low invasive and high efficient clinical
operation; and rehabilitation robot is able to improve the
rehabilitative efficacy of patients. This special issue aims at
exhibiting the latest research achievements, findings, and
ideas in the field of robotics in biomedical and healthcare
engineering, especially focusing on the upper/lower limb
rehabilitation, walking assistive robot, telerobotic surgery,
and radiosurgery.

Currently, there is an increasing population of patients
suffering from limb motor dysfunction, which can be caused
by nerve injuries associated with stroke, traumatic brain
injury, or multiple sclerosis. Past studies have demonstrated
that highly repetitive movement training can result in
improved recovery. The robotic-assisted technique is a novel
and rapidly expanding technology in upper/lower limb rehabilitation
that can enhance the recovery process and facilitate
the restoration of physical function by delivering high-dose
and high-intensity training. This special issue covers several
interesting papers addressing these challenges. X. Tu and
coworkers introduced an upper limb rehabilitation robot
powered by pneumatic artificial muscles which cooperates
with functional electrical stimulation arrays to realize active
reach-to-grasp training for stroke patients. The dynamic
models of a pneumatic muscle and functional electrical
stimulation-induced muscle are built for reaching training.
By using surface electromyography, the subject’s active intent
can be identified. Finally, grasping and releasing behaviors
can be realized by functional electrical stimulation array electrodes.
C. Guo and coworkers proposed an impedance-based
iterative learning control method to analyze the squatting
training of stroke patients in the iterative domain and time
domain. Patient’s training trajectory can be corrected by integrating
the iterative learning control scheme with the value of
impedance. In addition, the method can gradually improve
the performance of trajectory tracking by learning the past
trajectory tracking information and obtain specific training
condition of different individuals. The paper demonstrated
an effective control methodology in dealing with repeated
tracking control problems or periodic disturbance rejection
problems. Apart from these works, J. Li and coworkers
designed an open-structured treadmill gait trainer for lower
limb rehabilitation; T. Sun and coworkers proposed a
method for detecting the motion of human lower limbs
including all degrees of freedoms via the inertial sensors,
which permits analyzing the motion ability according to the
rehabilitation needs.

Other biomedical and healthcare robots included in this
special issue cover a range of interesting topics, such as walking
assistive robot, telerobotic surgery, and radiosurgery. To improve the walking ability of the elderly, the walker-type
rehabilitation robot has become a popular research topic over
the last decade. C. Tao and coworkers proposed a hierarchical
shared control method of the walking-aid robot for both
human motion intention recognition and the obstacle
emergency-avoidance method based on the artificial potential
field. In the implementation, the human motion intention
is obtained from the interaction force measurements of
the sensory system composed of force sensing registers and
a torque sensor. Meanwhile, a laser-range finder forward is
applied to detect the obstacles and try to guide the operator
based on the repulsion force calculated by artificial potential
field. The robot realizes obstacle avoidance while keeping
partially the operators’ original walking intention. X. Li and
coworkers demonstrated a general framework for robotassisted
surgical simulators for a more robust and resilient
robotic surgery. They created a hardware-in-the-loop simulator
platform and integrated the simulator with a physics
engine and a state-of-the-art path planning algorithm to help
surgeons acquire an optimal sense of manipulating the robot
instrumental arm. Eventually, they achieved autonomous
motion of the surgical robot. For coping with the workspace
issue during the application of Linac system during radiosurgery,
a specialized robotic system was presented by Y. Noh
et al. The design and implementation of the robotic system
were elaborated. All of these works showed comparative
advantages versus classical approaches and will hold great
potential for providing insights on the practical and systematic
design of robots that serve for broad applications in
biomedical and healthcare engineering.

The objectives of the special issue were reached in terms
of advancing the state of the art of robotic techniques and
addresing the challenging problems in biomedical and
healthcare engineering. Several critical problems in these
areas were addressed, and most of the proposed contributions
showed very promising results that outperform existing
studies. Some of the proposed approaches were also validated
from patients’ perspectives, which show the applicability of
these techniques in realistic environments.

We would like to express our thanks to all the authors who
submitted their work to this special issue and to all the
reviewers who helped us ensure the quality.

Chengzhi Hu
Qing Shi
Lianqing Liu
Uche Wejinya
Yasuhisa Hasegawa
Yajing Shen

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[ARTICLE] Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke – Full Text

Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice, robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function, but have yet to reinstate function to pre-stroke levels— which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved, and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality rehabilitation training (RAVR), and a program of repetitive task practice training (RTP).
Ten chronic stroke subjects participated in eight, three-hour sessions of RAVR therapy. Another group of 9 stroke subjects participated in eight sessions of matched RTP therapy. Functional Magnetic Resonance Imagining (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex (cMC), ipsilesional primary somatosensory cortex (iS1), ventral premotor area (iPMv), and supplementary motor area (iSMA). Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement.
Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple regions of interest was reduced and re-lateralized to the ipsilesional side. Second, these changes correlated with improvement in JTHFT scores. Our findings suggest that RAVR training may lead to different neurophysiological changes when compared to traditional therapy. This effect may be attributed to the influence that augmented visual and haptic feedback during RAVR training exerts over higher-order somatosensory and visuomotor areas.


Recovery of hand function is challenging after stroke. Empirical data suggest that treatment can be beneficial if it includes many repetitions of challenging and meaningful tasks (13). Several approaches to delivering high volume, intense, and salient rehabilitation activities have emerged over the last two decades. These treatments, which include repetitive task practice (RTP), robotically assisted rehabilitation, and virtual rehabilitation activities, produce improvements in hand function that exceed the standard of care in the US (45).

Although a strong case has been made that virtual reality (VR) and robotics can be useful technologies for delivering challenging, meaningful, and mass practice, outcome studies investigating the true benefits of VR/robotics as compared to dose-matched RTP remain mixed (67). For example, we have shown significant group-level improvement in hand and arm function of chronic stroke survivors in response to RTP and robot-assisted VR (RAVR) training to be similar for both groups (8), a finding that agrees with group-level effects in other clinical studies (910). However, whether the underlying neural patterns of reorganization that are induced by the different training regimes are also similar remains unknown. This becomes important to understand because it may inform researchers and clinicians whether RAVR versus RTP may preferentially facilitate distinct neural patterns of reorganization. If so, then perhaps the therapy choice can be tailored more appropriately to individuals to elicit optimal benefits.

The goal of this study was to compare the effect of RAVR- and RTP-based interventions on neural pattern reorganization. Because neural reorganization likely reflects complex processes that include the formation of new connections and/or re-weighting of existing connections, the patterns that emerge are unlikely to be reliably captured using one proxy of activation. For example, while numerous studies have shown training-induced changes in the extent of brain activity, the results of those studies conflict in terms of whether the changes reflect an increase or a decrease in brain activity (1115). Second, there seems to be a relationship between the pattern of reorganization (increase or decrease in ipsilesional somatosensory activation) and intactness of the hand knob area of M1 and its descending motor fibers (16), and a dependence on whether the lesion is cortical or subcortical (17). Connectivity measures may be a complementary way to understand neural reorganization patterns underlying stroke recovery (18) by providing additional information about dynamic network-level changes above and beyond what can be inferred from extent and laterality of activation (1920).

In this study, we therefore characterize the pattern of neural reorganization using multiple measures that included the magnitude of change in brain activation, the extent of activation, the re-lateralization of brain activation in a set of homologous interhemispheric regions of interest, and interactions between multiple regions of interest based on measures of functional and effective connectivity. To our knowledge, this is the first study to characterize brain reorganization at the ROI and network interaction level with multiple functional magnetic resonance imaging (fMRI) measures before and after RAVR and RTP training. In order to delineate the relevance of brain reorganization after training, we also correlated the brain activation outcomes with clinical outcome measures.

We hypothesized that both treatments might have similar effects on the magnitude and laterality of activation in a given region of interest. However, because RAVR training provides a training environment that is enriched and augmented with visual and haptic feedback, we expected that the functional and effective connectivity between motor/premotor cortices and visuomotor areas like the superior parietal lobule may show stronger effects in the RAVR group, as compared to the RTP-based training group (2125). We propose that identifying the neurophysiologic correlates of behavioral motor function improvement might allow strategic refinement of existing training approaches and the development of individually tailored interventions. […]


Continue —>  Frontiers | Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke | Neurology

Figure 1(A,B) The robotic arm, a data glove and force-reflecting hand system used in the robot-assisted virtual reality therapy. (C) Virtual reality feedback during the fMRI movement task. For each hand, one arrow points to the starting position of the hand (open) and another arrow defines the magnitude of finger flexion during the task.

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[Abstract] Design factors and opportunities of rehabilitation robots in upper-limb training after stroke


The occurrence of strokes has been progressively increasing. Upper limb recovery after stroke is more difficult than lower limb. One of the rapidly expanding technologies in post-stroke rehabilitation is robot-aided therapy. The advantage of robots is that they are able to deliver highly repetitive therapeutic tasks with minimal supervision of a therapist. However, from the literature, the focus of robotic design in stroke rehabilitation has been technology-driven. Clinical and therapeutic requirements were not seriously considered in the design of rehabilitation robots. The purpose of this study was twofold: (1) demonstrate the missing elements of current robot-aided therapy; (2) identify design factors and opportunities of rehabilitation robots (in upper-limb training after stroke). In this study, we performed a literature review on articles relevant to rehabilitation robots in upper-limb training after stroke. We identified the design foci of current rehabilitation robots for upper limb stroke recovery. Using the therapeutic framework for stroke rehabilitation in occupational therapy, we highlighted design factors and opportunities of rehabilitation robots. The outcomes of this study benefit the robotics design community in the design of rehabilitation robots.

1. Introduction

A robot is defined as a machine programmable to perform and modify tasks in response to changes in the environment [1]. The benefits of robots are noticeable in productivity, safety, and in saving time and money. The advancement of robot technologies in the past decade caused the wide adoption of robots in our lives and in the society. For instance, in education, robots were implemented in undergraduate courses to teach core artificial intelligence concepts, e.g., algorithms for searching tree data structures [2]. In agriculture, robotic milking systems (being able to reduce labor/operational costs) were installed to replace conventional milking that gave cows the freedom to be milked throughout the day [3]. In healthcare, service robots were implemented to provide functional assistance for the elderly in home environments, e.g., bringing medication for the emergency and picking up heavy objects low on the ground [4].

Source: Design factors and opportunities of rehabilitation robots in upper-limb training after stroke – IEEE Xplore Document

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