[VIDEO] gloreha Sinfonia – YouTube

Fits like a Glove

Doctors, phisiotherapists and caregivers have a mutual key goal: enhancing Patient Quality of Life. Professional experience and robotic technology are the ideal means to a successful rehabilitation.
Gloreha is a robotic glove which permits customizable, task-oriented, and adjustable therapies. An involving and motivating therapy is given by the sum of upper limb motor recovery, proprioceptive stimulation and interaction with real objects.
Gloreha Sinfonia is a device for upper limb rehabilitation that supports patients during all the phases of recovery.

A comfortable and lightweight glove
The key feature of Gloreha Sinfonia is a rehabilitation glove which supports fingers joint motion, while detecting voluntary active motion.
Patients are totally involved during motor exercises, thanks to multisensory stimulation and 3D animation on the screen.
According to necessity, motion can be triggered by the robotic glove (passive mobilization), or by the patients themselves (active games). The device will support patients’ effort, intervening only when necessary (active-assisted mobilization).

Task-oriented functional exercises for rehabilitation
The aim of every rehabilitation program is the recovery of the Activities of Daily Living (ADL). Gloreha Sinfonia helps patients perform grasping, reaching, picking exercises, and interacting with real objects.
Gloreha Sinfonia is an ideal workstation designed to recover functional movements. It also provides a wide variety of motivational and challenging exercises with different difficulty levels.

Weight compensation
Gloreha Sinfonia includes two dynamic supports. Their function is to relieve upper limb weight, fostering the completion of functional exercises:
Patients’ arms can completely move and float freely.

[WEB SITE] The future of stroke rehabilitation: upper limb recovery | ACNR | Online Neurology Journal

The future of stroke rehabilitation: upper limb recovery

The impact of stroke-related impairment around the world remains high.1 In particular, residual upper limb dysfunction after stroke is a major clinical, economic and societal problem. In the UK alone, the economic burden of stroke is estimated at over £5 billion a year and so improving outcomes after stroke is an important clinical and scientific goal. Nearly three-quarters of stroke survivors experience upper limb symptoms after acute stroke and in the first six months only 20% or so achieve some functional recovery.2,3 Management of the upper limb after stroke can be complex, requiring approaches that avoid complications, promote recovery and provide compensatory strategies in varying combinations depending on severity and time post-stroke.1

The wrong dose of rehabilitation?

There is concern that the dose and intensity of upper limb rehabilitation after stroke is too low. During early inpatient rehabilitation, the time spent engaged in activities, especially functional upper limb movements, is surprisingly low.4,5 Several studies have examined whether increasing the time spent on upper limb therapy makes a difference. For example, an additional two to three hours of arm training a day for six weeks reduced impairment and improved function by clinically meaningful amounts when started one to two months after stroke,6 but anything less than this does not appear to provide much benefit on average.7,8 It seems likely that when it comes to upper limb therapy, more is better.

However, the intensity (amount of activity), as well as the overall dose (time spent in therapy) is important. Data from work in rodent models of stroke suggest that changes in synaptic density (a marker of the neuroplastic reorganisation that is the substrate for recovery) in the primary motor cortex occur after hundreds but not tens of repetition.9 In human stroke patients, the typical number of repetitions in a therapy session can be much lower.4 It may be the case that there is a threshold of activity below which the neuroplastic reorganisation of surviving motor networks supporting recovery is unlikely to occur.10

How to increase the dose of rehabilitation?

One way of increasing dose is to implement a treatment programme that patients can administer themselves. The self-administered ‘graded repetitive arm supplementary program’(GRASP) has the advantage of being flexible enough to use in patients with a range of impairments. When started early after stroke in an in-patient setting, four weeks of GRASP led to improvements in upper limb function compared to patients undergoing an education programme. These gains were maintained at five months post-stroke. GRASP is easy to administer, cost-effective and feasible to implement in a number of health care settings on a large scale.12

Constraint-induced movement therapy (CIMT) also increases the dose of functionally relevant training. Patients are required to wear a sling or mitten restricting use of the unaffected upper limb resulting in increased use of the affected hand/arm in functional tasks. CIMT led to improvements in the performance of functional tasks compared to standard (less intense) treatment.13 Despite its apparent simplicity, it is not always tolerated well if worn for six hours per day (standard protocol) and so modified protocols have been used, although less well studied.

The use of  in guiding highly specific training regimes might also allow a sufficient number of repetitions to be delivered in a motivating environment. Some devices allow weight support of the arm, so that skilled movements can be practiced even in the presence of significant shoulder weakness. Most clinical trials have been small and have involved chronic stroke patients. Two relatively large studies of upper limb robotic training in chronic stroke patients have recently been carried out.14,15 Both achieved high numbers of repetitions but only improved impairment by a few points compared to usual (less intense) therapy, and results were not greatly different to standard therapy matched for dose. It is likely that robotics and other technology such as virtual-reality based rehabilitation will find use as adjunctive therapy, rather than replacement for hands-on therapy. In other words, technological solutions provide a way of providing massed practice, but hands-on therapy is crucial for turning benefits into functional gains. Advances in devices that can be used and monitored in a patient’s own home will also be required before technological approaches to neurorehabilitation have a substantial impact.

Continue —> The future of stroke rehabilitation: upper limb recovery | ACNR | Online Neurology Journal

[ARTICLE] Robotics in the Rehabilitation of Neurological Conditions – Full Text PDF

Introduction

The research of robotics for the rehabilitation of neurological conditions has increased in the last decade. The technological advances of the 21st century are bringing robotics to all domains of our society (Morone et al., 2014).

Our research site has been focusing upon the application of robotic technology for neurological conditions. Our current robotic research is on the upper and lower motor function in patients with stroke (CVA), spinal cord injury (SCI), and brain injury (BI). The research of robotics in the rehabilitation of neurological conditions has been constrained by cost and lack of insurance coverage. In the United States the use of robotics in health care has the potential to deliver highly intensive activity-based therapy (Scott and Dukelow, 2011). Loss of motor function is a result and consequence of neurological disorders (Moreno et al., 2011). The stroke prevalence is estimated at 2.9%, or a new stroke occurs every 40 seconds. While spinal cord injury has an incidence rate of traumatic SCI from 12.1 to 57.8 per million (Moreno et al., 2011). Additionally, other neurological diseases such as, Parkinson’s, cerebral palsy…

Continue —> Robotics in the Rehabilitation of Neurological Conditions (PDF Download Available).

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[Proceedings] What should we consider when designing rehabilitation robots for the upper limb of the neurologically impaired? – Full Text PDF

Abstract

Rehabilitation robotics has the potential to significantly increase access to useful therapeutic upper limb exercise for those suffering from neurological impairment. In order to maximise the potential of such technology to promote motor learning/relearning clearly we must consider carefully how it is designed, and who should be engaged in its development. In this paper we present our perspective on some important design considerations and highlight relevant literature. Our findings have implications for the development and optimisation of rehabilitation robotic technology for improving upper limb function in the neurologically impaired.

1 Introduction

Neurological impairment including stroke, the commonest form of adult disability in the USA, and cerebral palsy (CP), the commonest form of severe childhood disability in Europe (Hagberg and Hagberg, 1993), are a significant burden on healthcare providers with both conditions often affecting the volitional control of one or both upper limbs. Restorative technologies, such as rehabilitation robotics, aim to accelerate skill acquisition to increase the functional abilities of the neurologically impaired without device assistance. A benefit of rehabilitation robotics to healthcare providers is increased patient access to rehabilitation treatment as existing rehabilitation treatment is predominately delivered by therapy staff and as such is resource limited. Improved access to therapy maximises the potential of recovery and as a consequence a better quality of life whilst resulting in a more cost efficient healthcare provider. The paradigm of upper limb rehabilitation robotics is a motivating computer environment, which promotes therapeutic movements of the impaired limb with a powered interface implementing a control algorithm to promote recovery.

Rehabilitation robotic therapy for the upper limb has demonstrated statistically significant benefits, with improvements in kinematic parameters including movement time, path and smoothness of reach observed (Fasoli, et al., 2008, Huang and Krakauer, 2009, Fluet, et al., 2010, Weightman, et al., 2011, NorouziGheidari, et al., 2012, Chen and Howard, 2014). Rehabilitation robotics have demonstrated potential benefits and large scale trials to further evaluate their efficacy are on-going, for example in the United Kingdom (UK) The Northumbria Healthcare National Health Service (NHS) trust is undertaking a 5 year trial with stroke patients using the MIT-MANUS to evaluate improvement in upper limb function. In such a multidisciplinary area of research there is the potential to develop rehabilitation robots, which have not drawn upon the research previously conducted in this area or related disciplines. This can lead to sub-optimal systems, which do not maximise the quality of therapeutic exercise or worse still are not utilised because of poor design. Furthermore, as a community are we confident that rehabilitation robotic technology is suitably mature to conduct large scale efficacy trials? The danger in evaluating technology before suitable maturity is that it is set up to fail and as such starved of investment and development stifled. Clearly we need to consider carefully the design requirements for upper limb rehabilitation robotic technology drawing on our current knowledge.

In this paper we aim to highlight some important design considerations for upper limb rehabilitation robots and highlight relevant literature with the objective of stimulating discussion with the community and providing a resource for those interested in developing such technology. We do not intend on providing an exhaustive list of design considerations but instead present our opinion of important design factors and highlight where we believe our focus should be.

Continue –> Full Text PDF