Posts Tagged Robotic
[ARTICLE] Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke – Full Text
Background: We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. Methods: A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale (MAS), Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). Results: A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. Conclusions: In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.
Stroke (or cerebrovascular accident) is a sudden ischemic or hemorrhagic episode which causes a disturbed generation and integration of neural commands from the sensorimotor31 areas of the cortex. As a consequence, the ability to selectively activate muscle tissues for performing movement is reduced.26 Sixty percent of those individuals who survive a stroke exhibit a sensorimotor deficit of one or both hands and may benefit from rehabilitation to maximize recovery of the upper extremity.23,25 Restoration of arm and hand motility is essential for the independent performance of daily activities.23,26 A prompt and effective rehabilitation approach is essential28 to obtain recovery of an impaired limb to prevent tendon shortening, spasticity, and pain.2
Recent technologies have facilitated the use of robots as tools to assist patients in the rehabilitation process, thus maximizing patient outcomes.4 Several groups have developed robotic tools for upper limb rehabilitation of the shoulder and elbow.27 These robotic tools assist the patient with carrying out exercise protocols and may help restore upper limb mobility.22,26 The complexity of wrist and finger articulations had delayed the development of dedicated rehabilitation robots until 2003 when the first tool based on continuous passive motion (CPM) was presented followed by several other solutions, with various levels of complexity and functionality.3
A recent review on the mechanisms for motor relearning reported factors such as attention and stimuli (reinforcement) are crucial during learning which indicates that motor relearning can take place with patients with neurological disorders even when only the sensorial passive stimulation is applied.30 In addition, another review reported the benefits of CPM for stretching and upper limb passive mobilization for patients with stroke but that CPM treatment requires further research.40
Among robotic devices, Gloreha (Figure 1),5,10 with its compliant mechanical transmission, may represent an easily applied innovative solution to rehabilitation, because the hand can perform grasp and release activities wearing the device by mean of a flexible and light orthosis. Our objective of this study was to determine the efficacy of robot-assisted motion in addition to traditional physiotherapy (PT) and occupational therapy (OT) compared with additional time spent in PT and OT on stroke patients with hand paralysis on function, motor strength, spasticity, and pain.
[Abstract] Robotic and Mechanotherapeutic Technology to Restore the Functions of the Upper Limbs: Prospects for Development (Review).
We have analyzed the advantages and disadvantages of the robotic and mechanotherapeutic technologies used for rehabilitation of the upper limbs. Robotic and mechanotherapeutic devices started as simple controllers and upper limb weight support systems in kinesitherapy, but have subsequently shown their potential as systems for providing task oriented movement training, by efforts to maximize the correspondence between the features of anatomical and biomechanical arms. Integration of functional neuromuscular electrostimulation with robotic and mechanotherapeutic technology considerably widens the possibilities of using robots for rehabilitation and for providing mechanical assistance, while the appearance of portable and fixed exoskeletons is leading to completely new devices based on both rehabilitation and assistive technologies. Currently prototypes of robotic assistive and rehabilitation devices controlled by brain-computer interfaces are being developed.
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[ARTICLE] Effectiveness of robotic-assisted gait training in stroke rehabilitation: A retrospective matched control study – Full Text HTML
This study aimed to evaluate the effectiveness of robotic-assisted gait training (RAGT) in improving functional outcomes among stroke patients.
This was a retrospective matched control study.
This study was conducted in an extended inpatient rehabilitation centre.
Patients and intervention
There were 14 patients with subacute stroke (4–31 days after stroke) in the RAGT group. Apart from traditional physiotherapy, the RAGT group received RAGT. The number of sessions for RAGT ranged from five to 33, and the frequency was three to five sessions per week, with each session lasting for 15–30 minutes. In the control group, there were 27 subacute stroke patients who were matched with the RAGT group in terms of age, days since stroke, premorbid ambulatory level, functional outcomes at admission, length of training, and number of physiotherapy sessions received. The control group received traditional physiotherapy but not RAGT.
Modified Functional Ambulation Category (MFAC), Modified Rivermead Mobility Index (MRMI), Berg’s Balance Scale (BBS), and Modified Barthel Index (MBI) to measure ambulation, mobility, balance, and activities of daily living, respectively.
Both RAGT and control groups had significant within-group improvement in MFAC, MRMI, BBS, and MBI. However, the RAGT group had higher gain in MFAC, MRMI, BBS, and MBI than the control group. In addition, there were significant between-group differences in MFAC, MRMI, and BBS gains (p = 0.026, p = 0.010, and p = 0.042, respectively). There was no significant between-group difference (p = 0.597) in MBI gain (p = 0.597).
The results suggested that RAGT can provide stroke patients extra benefits in terms of ambulation, mobility, and balance. However, in the aspect of basic activities of daily living, the effect of RAGT on stroke patients is similar to that of traditional physiotherapy.
Stroke, also known as cerebrovascular accident, is an acute disturbance of focal or global cerebral function, with signs and symptoms lasting more than 24 hours or leading to death, presumably of vascular origin . In Hong Kong, around 25,000 stroke patients are admitted to public hospitals under the Hong Kong Hospital Authority annually . Although mortality and morbidity among stroke patients have declined due to medical advances, impacts on stroke survivors and community remain significant. The most widely recognized impairment caused by stroke is motor impairment, which restricts muscle movement or mobility function . Many stroke patients experience difficulties in walking, and improving walking is one of the main goals of rehabilitation . Since it was shown that the process of spontaneous recovery is almost completed within 6–10 weeks , early rehabilitation is essential to maximize the function of patients after stroke. Recent evidence suggests that high-intensity repetitive task-specific practice might be the most effective principle when trying to promote motor recovery after stroke . Robotic-assisted gait training (RAGT) is a new global physiotherapy technology that applies the high-intensity repetitive principle to improve mobility of patients with stroke or other neurological disorders. The advantage of RAGT may be the reduction of the effort required by therapists compared with treadmill training with partial bodyweight support, as they no longer need to set the paretic limbs or assist in trunk movements . People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices . More specifically, people in the first 3 months after stroke and those who are not able to walk seem to benefit most from this type of intervention . Evidence also shows that the use of RAGT in stroke patients has positive effects on their balance .
Randomized controlled trials and systemic reviews have demonstrated the effectiveness of RAGT for stroke patients in terms of functional outcomes such as walking ability ,  and  and balance  and . However, limited published evidence is available on the effectiveness of RAGT in improving other functioning activities such as basic activities of daily living (ADL)  and . If RAGT can improve walking ability and balance of stroke patient, can RAGT also improve basic ADL of stroke patients? The hierarchical pattern of progression in basic ADL is in the following order: bathing, dressing, transferring, toileting, controlling continence, and feeding, with bathing being the most complex task and feeding the least ; however, walking ability and balance contribute to parts of basic ADL. Moreover, factors that make the greatest contribution to ADL after stroke were found to be balance, upper extremity function, and perceptual and cognitive functions . If RAGT can improve ADL of stroke patients, which of the above factors is/are enhanced by RAGT? Can RAGT also enhance perceptual and cognitive functions of stroke patients? Hence, controlled studies are necessary to address these research questions. A retrospective study conducted by Dundar et al  investigated the effect of robotic training in functional independence measure and other functional outcomes of patients with subacute and chronic stroke. However, the study concluded that combining robotic training with conventional physiotherapy produced better improvement than conventional physiotherapy in terms of functional independence measure, but not walking status or balance. The result was opposite to the specificity of training principle  that gait training should produce more positive effect for walking and balance than ADL. Hence, this study intends to investigate the effectiveness of RAGT in improving functional mobility and basic ADL for stroke patients, and hopefully can lead to further randomized controlled studies to investigate the impact of RAGT on basic ADL.
[Abstract] Comparison of exercise training effect with different robotic devices for upper limb rehabilitation: a retrospective study
BACKGROUND: Several robotic devices have been proposed for upper limb rehabilitation, but they differ in terms of application fields and the technical solutions implemented.
AIM: To compare the effectiveness of three different robotic devices for shoulder-elbow rehabilitation in reducing motor impairment and improving motor performance in post-stroke patients.
DESIGN: Retrospective multi-center study.
SETTING: Inpatient rehabilitation hospital.
POPULATION: Eighty-seven chronic and subacute post-stroke patients, aged 48-85 years.
METHODS: Data were obtained through a retrospective analysis of patients who underwent a 3- week rehabilitation program including robot-assisted therapy of the upper limb and conventional physical therapy. Patients were divided into three groups according to the robot device used for exercise training: ‘Braccio di Ferro” (BdF), InMotion2 (IMT), and MEchatronic system for MOtor recovery after Stroke (MEMOS). They were evaluated at the beginning and end of treatment using the Fugl-Meyer (FM) and Modified Ashworth (MAS) clinical scales and by a set of robot measured kinematic parameters.
RESULTS: The three groups were homogeneous for age, level of impairment, time since the acute event, and spasticity level. A significant effect of time (p<0.001) was evident on FM and kinematic parameters across all groups. The average change in the FM score was 9.5, 7.3 and 7.1 points, respectively, for BdF, IMT and MEMOS. No significant between-group differences were observed at the MAS pre- vs. post-treatment. A significant interaction between time and groups resulted for the mean velocity (MV, p<0.005) and movement smoothness parameters (nPK, p<0.001 and SM, p<0.02). The effect size (ES) was large for the FM score and MV parameter, independently of the type of robot device used. Further, the ES ranged from moderate to large ￼for the remaining kinematic parameters except for the movement accuracy (mean distance, MD), which exhibited a small ES in the BdF and MEMOS groups.
CONCLUSIONS: The motor function gains obtained during robot-assisted therapy of stroke patients seem to be independent of the type of robot device used for the training program. All devices tested in this study were effective in improving the level of impairment and motor performance.
CLINICAL REHABILITATION IMPACT: This study could help rehabilitation professionals to set-up comparative studies involving rehabilitation technologies.
Source: Comparison of exercise training effect with different robotic devices for upper limb rehabilitation: a retrospective study – European Journal of Physical and Rehabilitation Medicine 2016 Sep 27 – Minerva Medica – Journals
[Abstract] A Low-Profile Soft Robotic Sixth-Finger for Grasp Compensation in Hand-Impaired Patients – Journal of Medical Devices – ASME DC
[THESIS] AUGMENTED REALITY SYSTEM FOR REHABILITATION: NEW APPROACH BASED ON HUMAN INTERACTION AND BIOFEEDBACK – Full Text PDF
Rehabilitation is the process of training for someone in order to recover or improve their lost functions caused by neurological deficits. The upper limb rehabilitation system provides relearning of motor skills that are lost due to any neurological injuries via motor rehabilitation training. The process of motor rehabilitation is a form of motor learning via practice or experience. It requires thorough understanding and examination of neural processes involved in producing movement and learning as well as the medical aspects that may affect the central nervous system (CNS) or peripheral nervous system (PNS) in order to develop an effective treatment system. Although there are numerous rehabilitation systems which have been proposed in literatures, a low cost upper limb rehabilitation system that maximizes the functional recovery by stimulating the neural plasticity is not widely available. This is due to lack of motivation during rehabilitation training, lack of real time biofeedback information with complete database, the requirement of one to one attention between physiotherapist and patient, the technique to stimulate human neural plasticity.
Therefore, the main objective of this thesis is to develop a novel low cost rehabilitation system that helps recovery not only from loss of physical functions, but also from loss of cognitive functions to fulfill the aforementioned gaps via multimodal technologies such as augmented reality (AR), computer vision and signal processing. In order to fulfill such ambitious objectives, the following contributions have been implemented.
Firstly, since improvements in physical functions are targeted, the Rehabilitation system with Biofeedback simulation (RehaBio) is developed. The system enhances user’s motivation via game based therapeutic exercises and biofeedback. For this, AR based therapeutic games are developed to provide eye-hand coordination with inspiration in motivation via immediate audio and visual feedback. All the exercises in RehaBio are developed in a safe training environment for paralyzed patients. In addition to that, realtime biofeedback simulation is developed and integrated to serve in two ways: (1) from the patient’s point of view, the biofeedback simulation motivates the user to execute the movements since it will animate the different muscles in different colors, and (2) from the therapist’s point of view, the muscle simulations and EMG threshold level can be evaluated as patient’s muscle performance throughout the rehabilitation process.
Secondly, a new technique that stimulates the human neural plasticity is proposed. This is a virtual human arm (VHA) model that driven by proposed continuous joint angle prediction in real time based on human biological signal, Electromyogram (EMG). The VHA model simulation aims to create the illusion environment in Augmented Realitybased Illusion System (ARIS).
Finally, a complete novel upper limb rehabilitation system, Augmented Reality-based Illusion System (ARIS) is developed. The system incorporates some of the developments in RehaBio and real time VHA model to develop the illusion environment. By conducting the rehabilitation training with ARIS, user’s neural plasticity will be stimulated to reestablish the neural pathways and synapses that are able to control mobility. This is achieved via an illusion concept where an illusion scene is created in AR environment to remove the impaired real arm virtually and replace it with VHA model to be perceived as part of the user’s own body. The job of the VHA model in ARIS is when the real arm cannot perform the required task, it will take over the job of the real one and will let the user perceive the sense that the user is still able to perform the reaching movement by their own effort to the destination point. Integration with AR based therapeutic exercises and motivated immediate intrinsic and extrinsic feedback in ARIS leads to serve as a novel upper limb rehabilitation system in a clinical setting.
The usability tests and verification process of the proposed systems are conducted and provided with very encouraging results. Furthermore, the developments have been demonstrated to the clinical experts in the rehabilitation field at Port Kembla Hospital. The feedback from the professionals is very positive for both the RehaBio and ARIS systems and they have been recommended to be used in the clinical setting for paralyzed patients.
[ARTICLE] A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol – Full Text PDF
Background. In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted.
Objectives. To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke.
Methods. Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient’s tolerance to robotic therapy.
Results. After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p < 0.00001), Motricity Index scale (p < 0.004) and Functional Independence Measure (p < 0.001). A lesser degree of improvement was achieved using conventional rehabilitation, the Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p < 0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p < 0.023).
Conclusions. Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.
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The AMADEO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for fingers and hands. The new design and the specially developed tyroS software make the AMADEO more flexible and offer an expanded spectrum of therapy options.
Nearly 50 years ago, “Grandpa Ray,” who had diabetic peripheral neuropathy, had three options for controlling his foot drop: a high-steppage gaitpattern, double metal upright ankle-foot orthotics (AFOs) attached to what he affectionately referred to as his “Herman Munster shoes,” or what he ultimately resorted to—cowboy boots. Today, there is a great variety of options to address the foot drop symptom that occurs with many different disorders and diseases. The difficulty now is being knowledgeable about the plethora of products available to find the best options for each patient.
Identifying the extent and cause of foot drop is the first step in determining the best treatment options. Symptoms can vary in severity, from a patient having a heel strike but then abruptly plantarflexing (PF) into a foot slap pattern to dragging of the toes during swing phase. Foot drop sufferers may also present with high steppage or hip circumduction compensatory gait patterns. Upper motor neuron (UMN) injury etiologies include stroke, brain injury, spinal cord injury, or multiple sclerosis. Lower motor neuron (LMN) injury causes include trauma, surgery, drug toxicity, or metabolic disease. Muscular-level etiologies of foot drop include muscular dystrophy, Charcot-Marie-Tooth disease, and post-polio syndrome.
Musculoskeletal deficits may be addressed by physical therapy treatment, and home program instruction to improve flexibility and strength into dorsiflexing (DF). Strength and range of motion training tools common to most physical therapy clinics include cuff weights such as those provided by Bolingbrook, Ill-based Advantage Medical, TheraBand resistance bands, available through The Hygenic Corporation/Performance Health, Akron, Ohio, and the BAPS board, marketed by AliMed, Dedham, Mass.
For more significant PF contractures, serial casting and static and dynamic day and nighttime splints can provide a low load prolonged stretch. Many types of these devices are manufactured. For example, on the AliMed Inc website there are 24 products in this category. The products differ in sizing, adaptability, materials used, weight-bearing capabilities (including ability to off-load areas of the foot where there may be wounds or wound susceptibility), and ability to control other rotational moments. Dynasplint Systems, Severna Park, Md, and Össur, Reykjavik, Iceland, also manufacture these types of orthoses. It can be overwhelming to sort out the products in this category, so reliance on a trusted certified orthotist to help match patient needs with products can be invaluable.
Neuromuscular electrical stimulation (NMES) devices such as the Empi Continuum by Empi, a DJO Global company, Vista, Calif, or the Zynex Nexwave from Zynex Medical, Lone Tree, Colo, can be used in cases where a muscle can be stimulated to contract. Clinicians can use these handheld units in the clinic, as well as set them up for patient home use. These AC current devices, of course, will not work in a LMN injury unless substantial neural recovery has occurred. NMES can help retard atrophy and assist patients in relearning to contract the anterior tibialis muscle.
Retraining patients to contract the anterior tibialis can be enhanced with the use of surface EMG biofeedback (BFB) units that provide audio and visual feedback correlating with the degree of volitional activation. The NeuroEDUCATOR 4 system available through Therapeutic Alliance Inc, in Fairborn, Ohio, has four channels available to monitor unilateral, bilateral, agonist, and/or antagonist muscles for obtaining maximal volitional signal in a coordinated manner. The addition of monitoring motor activation while choosing home program exercises provides assurance to both patient and physical therapist that the chosen activities are indeed producing effective motor activation even when there is lack of visual motion. There are also combination NMES and BFB systems such as the MyoTrac from Thought Technology Ltd, Montreal West, Quebec, Canada, with which patients can initiate NMES to heighten contraction of the muscle after they reach a target volitional contraction guided by the BFB visual and audio display.
Whether or not recovery of motor function is in the picture, patients will typically benefit from some type of AFO intervention in the interim of recovery or as a permanent solution when recovery is not likely. The first goal of the brace is to hold up the toe so the patient does not trip during swing phase of the gait cycle. Secondly, using devices that have some flex via the property of the materials used or adding a hinge to the brace can help achieve rollover for a more fluid gait cycle and reduce energy expenditure. Alternatively, providing rigidity at the ankle can help to correct problems up the chain, such as a DF stop to reduce knee buckling or a PF stop to help reduce knee hyperextension. Adding in other kinetic chain corrections such as medial or lateral posts…..