Posts Tagged Robotic

[ARTICLE] Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial – Full Text



This study examined the treatment efficacy of proximal-emphasized robotic rehabilitation by using the InMotion ARM (P-IMT) versus distal-emphasized robotic rehabilitation by using the InMotion WRIST (D-IMT) in patients with stroke. A total of 40 patients with stroke completed the study. They received P-IMT, D-IMT, or control treatment (CT) for 20 training sessions. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scale. Secondary outcomes were the Motor Activity Log (MAL) and wrist-worn accelerometers. The differences on the distal FMA, total MRC, distal MRC, and MAL quality of movement scores among the 3 groups were statistically significant (P = 0.02 to 0.05). Post hoc comparisons revealed that the D-IMT group significantly improved more than the P-IMT group on the total MRC and distal MRC. Furthermore, the distal FMA and distal MRC improved more in the D-IMT group than in the CT group. Our findings suggest that distal upper-limb robotic rehabilitation using the InMotion WRIST system had superior effects on distal muscle strength. Further research based on a larger sample is needed to confirm long-term treatment effects of proximal versus distal upper-limb robotic rehabilitation.


Most stroke survivors are burdened with significant physical dysfunction, and approximately 60% to 80% continue to have upper-limb (UL) motor deficits into the chronic phase of stroke that have a large effect on their daily life1,2. Developing effective rehabilitation interventions to maxmize UL motor recovery and functional independence of patients with stroke is therefore one of the top priorities in clinical practice and research3,4.

Robot-assisted therapy (RT) has emerged during the last decade as a novel rehabilitation approach to intensify UL motor function5,6,7,8. RT helps provide intensive, repetitive, and interactive training in a controlled environment to promote motor control and recovery of patients9,10,11,12,13,14. Although positive results of RT on motor outcomes have been noted13,14,15, there are disparate effects and heterogeneities between trials depending on the robotic types (eg, exoskeleton versus end-effector, or proximal versus distal approach), protocols, dosages, and problems of patients15,16.

Very few studies have directly compared the relative effects of different robotic devices. A recent systematic review15 investigated the effect of robotic types and reported a trend favoring end-effector rather than exoskeleton robotic devices on motor function. However, the superiority of treatment effect on the UL joints targeted by robotics remains unknown, especially for distal robotics15. Thus, comparative trials of different robotic types (eg, proximal versus distal robots) are warranted to tailor robot-aided UL rehabilitation to patient’s needs.

This study mainly compared the treatment effects of the InMotion ARM versus the InMotion WRIST robotic systems. The major difference between the 2 robotic devices is that the InMotion ARM focuses on training shoulder and elbow movements (ie, proximal UL), and the InMotion WRIST targets wrist and forearm movements (ie, distal UL). The proximal UL segments are critical for stability and transport of the arm, and the distal UL joints are mainly responsible for object manipulation and are important for performing daily activities17,18.

Motor control of the proximal UL and distal UL might be driven by different descending pathways19. The dorsolateral pathways (eg, corticospinal and rubrospinal tracts) are important for control of distal UL movements, and the ventromedial pathways (eg, reticulospinal, vestibulospinal, and tectospinal tracts) act more on the axial and proximal UL muscles and movements20,21. Although the neural bases act on proximal and distal UL segments and their functional roles appear to be different, direct comparisons of the clinical efficacy of proximal versus distal UL training in stroke patients are lacking.

Mazzeloni et al.22 used the same robotic systems to evaluate the treatment effects of proximal RT versus distal RT and proximal RT combined in 2 groups. However, the study goals of Mazzeloni et al. and this work are different. The effects of RT directly related to the UL segments specifically treated could not be drawn from the study findings of Mazzeloni et al. The 2 RT systems, InMotion ARM and InMotion WRIST, allow us to directly compare the outcomes affected by the proximal versus distal UL training.

In addition, recent reviews of RT have shown non-significant improvements or small effects on daily function after UL robotic rehabilitation in patients with stroke14,15,23. Major goals of stroke rehabilitation are to improve not only motor function but also functional performance on daily activities. Moreover, many patients were unable to translate the improvements of motor function and muscle strength to daily activity performance, which led to persistent functional dependence24. Therefore, this study provided functional task practice after RT to enhance the gains from proximal and distal UL robotic rehabilitation on motor function and muscle strength transfer into the patients’ daily functional performance.

The study purposes were to investigate the treatment effects of proximal-emphasized RT by using the InMotion ARM (P-IMT) versus distal-emphasized RT by using the InMotion WRIST (D-IMT) compared with a control treatment (CT) in patients with stroke. We designed a conventional rehabilitation program as the CT to provide a higher-level of clinical evidence, which decreased the influence of nondirective research environment and participant factors on treatment efficacy (eg, the Hawthorne effect), and to pose a more ethical approach instead of no treatment or placebo.[…]

Continue —>  Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial | Scientific Reports


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[ARTICLE] Design and Interaction Control of a New Bilateral Upper-Limb Rehabilitation Device – Full Text


This paper proposed a bilateral upper-limb rehabilitation device (BULReD) with two degrees of freedom (DOFs). The BULReD is portable for both hospital and home environment, easy to use for therapists and patients, and safer with respect to upper-limb robotic exoskeletons. It was implemented to be able to conduct both passive and interactive training, based on system kinematics and dynamics, as well as the identification of real-time movement intention of human users. Preliminary results demonstrate the potential of the BULReD for clinical applications, with satisfactory position and interaction force tracking performance. Future work will focus on the clinical evaluation of the BULReD on a large sample of poststroke patients.

1. Introduction

In the United States, more than 700,000 people suffer from stroke each year, and approximately two-thirds of these individuals survive and require rehabilitation [1]. In New Zealand (NZ), there are an estimated 60,000 stroke survivors, and many of them have mobility impairments [2]. Stroke is the third reason for health loss and takes the proportion of 3.9 percent, especially for the group starting on middle age, suffering the stroke as a nonfatal disease in NZ [3]. Professor Caplan who studies Neurology at Harvard Medical School describes stroke as a term which is a kind of brain impairment as a result of abnormal blood supply in a portion of the brain [4]. The brain injury is most likely leading to dysfunctions and disabilities. These survivors normally have difficulties in activities of daily living, such as walking, speaking, and understanding, and paralysis or numbness of the human limbs. The goals of rehabilitation are to help survivors become as independent as possible and to attain the best possible quality of life.

Physical therapy is conventionally delivered by the therapist. While this has been demonstrated as an effective way for motor rehabilitation [5], it is time-consuming and costly. Treatments manually provided by therapists require to take place in a specific environment (in a hospital or rehabilitation center) and may last several months for enhanced rehabilitation efficacy [6]. A study by Kleim et al. [7] has shown that physical therapy like regular exercises can improve plasticity of a nervous system and then benefits motor enrichment procedures in promoting rehabilitation of brain functional models. It is a truth that physical therapy should be a preferable way to take patients into regular exercises and guided by a physical therapist, but Chang et al. [8] showed that it is a money-consuming scheme. Robot-assisted rehabilitation solutions, as therapeutic adjuncts to facilitate clinical practice, have been actively researched in the past few decades and provide an overdue transformation of the rehabilitation center from labor-intensive operations to technology-assisted operations [9]. The robot could also provide a rich stream of data from built-in sensors to facilitate patient diagnosis, customization of the therapy, and maintenance of patient records. As a popular neurorehabilitation technique, Liao et al. [10] indicated that robot-assisted therapy presents market potential due to quantification and individuation in the therapy session. The quantification of robot-assisted therapy refers that a robot can provide consistent training pattern without fatigue with the given parameter. The characterization of individuation allows therapists to customize a specific training scheme for an individual.

Many robotic devices have been developed in recent years for stroke rehabilitation and show great potential for clinical applications [1112]. Typical upper-limb rehabilitation devices are MIME, MIT-Manus, ARM Guide, NeReBot, and ARMin [51321]. Relevant evidences demonstrated that these robots are effective for upper-limb rehabilitation but mostly for the one side of the human body. Further, upper-limb rehabilitation devices can be unilateral or bilateral [2224]. Despite the argument between these two design strategies, bilateral activities are more common than unilateral activities in daily living. Liu et al. [25] pointed that the central nervous system dominates the human movement with coordinating bilateral limb to act in one unit instead of independent unilateral actions. From this point, bilateral robots are expected to be more potential than unilateral devices. Robotic devices for upper-limb rehabilitation can be also divided into two categories in terms of structure: the exoskeleton and the end-effector device [26]. Two examples of upper-limb exoskeletons are the arm exoskeleton [27] and the RUPERT IV [28]. In addition, Lum et al. [13] incorporated a PUMA 560 robot (Staubli Unimation Inc., Duncan, South Carolina) to apply forces to the paretic limbs in the MIME system. This robotic device can be made for both unilateral and bilateral movements in a three-dimensional space. To summarize, existing robotic exoskeletons for upper-limb rehabilitation are mostly for unilateral training.

There are some devices that have been specially designed for bilateral upper-limb training for poststroke rehabilitation. van Delden et al. [29] conducted a systematic review to provide an overview and qualitative evaluation of the clinical applications of bilateral upper-limb training devices. A systematic search found a total of six mechanical devices and 14 robotic bilateral upper-limb training devices, with a comparative analysis in terms of mechanical and electromechanical characteristics, movement patterns, targeted part, and active involvement of the upper limb, training protocols, outcomes of clinical trials, and commercial availability. Obviously, these mechanical devices require the human limbs to actively move for training, while the robotic ones can be operated in both passive and active modes. However, few of these robotic bilateral upper-limb training devices have been commercially available with current technology. For example, the exoskeleton presented in [30] requires the development of higher power-to-weight motors and structural materials to make it mobile and more compact.

The University of Auckland developed an end-effector ReachHab device to assist bilateral upper-limb functional recovery [31]. However, this device suffered from some limitations, such as deformation of the frame leading to significant vibration, also hard to achieve satisfactory control performance. This paper presents the design and interaction control of an improved bilateral upper-limb rehabilitation device (BULReD). This device is portable for both hospital and home environment, easy to use for therapists and patients, and safer with respect to upper-limb robotic exoskeletons. This paper is organized as follows. Following Introduction, a detailed description of the BULReD is given, including mechanical design, electrical design, kinematics, and dynamics. Then, the control design is presented for both passive training and interactive training, as well as the fuzzy-based adaptive training. Experiments and Results is introduced next and the last is Conclusion.[…]

Continue —>  Design and Interaction Control of a New Bilateral Upper-Limb Rehabilitation Device

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[ARTICLE] On neuromechanical approaches for the study of biological and robotic grasp and manipulation – Full Text


Biological and robotic grasp and manipulation are undeniably similar at the level of mechanical task performance. However, their underlying fundamental biological vs. engineering mechanisms are, by definition, dramatically different and can even be antithetical. Even our approach to each is diametrically opposite: inductive science for the study of biological systems vs. engineering synthesis for the design and construction of robotic systems. The past 20 years have seen several conceptual advances in both fields and the quest to unify them. Chief among them is the reluctant recognition that their underlying fundamental mechanisms may actually share limited common ground, while exhibiting many fundamental differences. This recognition is particularly liberating because it allows us to resolve and move beyond multiple paradoxes and contradictions that arose from the initial reasonable assumption of a large common ground. Here, we begin by introducing the perspective of neuromechanics, which emphasizes that real-world behavior emerges from the intimate interactions among the physical structure of the system, the mechanical requirements of a task, the feasible neural control actions to produce it, and the ability of the neuromuscular system to adapt through interactions with the environment. This allows us to articulate a succinct overview of a few salient conceptual paradoxes and contradictions regarding under-determined vs. over-determined mechanics, under- vs. over-actuated control, prescribed vs. emergent function, learning vs. implementation vs. adaptation, prescriptive vs. descriptive synergies, and optimal vs. habitual performance. We conclude by presenting open questions and suggesting directions for future research. We hope this frank and open-minded assessment of the state-of-the-art will encourage and guide these communities to continue to interact and make progress in these important areas at the interface of neuromechanics, neuroscience, rehabilitation and robotics.


Grasp and manipulation have captivated the imagination and interest of thinkers of all stripes over the millennia; and with enough reverence to even attribute the intellectual evolution of humans to the capabilities of the hand [123]. Simply put, manipulation function is one of the key elements of our identity as a species (for an overview, see [4]). This is a natural response to the fact that much of our physical and cognitive ability and well-being is intimately tied to the use of our hands. Importantly, we have shaped our tools and environment to match its capabilities (straightforward examples include lever handles, frets in string instruments, and touch-screens). This co-evolution between hand-and-world reinforces the notion that our hands are truly amazing and robust manipulators, as well as rich sensory, perceptual and even social information.

It then comes as no surprise that engineers and physicians have long sought to replicate and restore this functionality in machines—both as appendages to robots and prostheses attached to humans with missing upper limbs [5]. Robotic hands and prostheses have a long and illustrious history, with records of sophisticated articulated hands as early as Gottfried ‘Götz’ von Berlichingen’s iron hand in 1504 [6]. Other efforts [7891011] were often fueled by the injuries of war [12131415] and the Industrial Revolution [16]. The higher survival rate in soldiers who lose upper limbs [1718] and the continual emergence of artificial intelligence [1920] are but the latest impetus. Thus, the past 20 years have seen an explosion in designs, fueled by large scale governmental funding (e.g., DARPA’s Revolutionizing Prosthetics and HAPTIX projects, EU’s INPUT and SOFTPRO projects) and private efforts such as DeepMind. A new player in this space is the potentially revolutionary social network of high-quality amateur scientists as exemplified by the FABLAB movement [21]. They are enabled by ubiquitously accessible and inexpensive 3D printing and additive manufacturing tools [22], collaborative design databases ( and others), and communities with formal journals ( and Grassroots communities have also emerged that can, for example, compare and contrast the functionality of prosthetic hands whose price differs by three orders of magnitude (

For all the progress that we have seen, however, (i) robotic platforms remain best at pre-sorted, pick-and-place assembly tasks [23]; and (ii) many prosthetic users still prefer simple designs like the revered whole- or split-hook designs originally developed centuries ago [2425].

Why have robotic and prosthetic hands not come of age? This short review provides a current attempt to tackle this long-standing question in response to the current technological boom in robotic and prosthetic limbs. Similar booms occurred in response to upper limb injuries [25] after the Napoleonic [26], First [12] and Second World Wars [8], and—with the advent of powerful inexpensive computers—in response to industrial and space exploration needs in the 1960’s, 1970’s and 1980’s [272829303132]. We argue that a truly bio-inspired approach suffers, by definition, from both gaps in our understanding of the biology, and technical challenges in mimicking (what we understand of) biological sensors, motors and controllers. Although biomimicry is often not the ultimate goal in robotics in general, it is relevant for humanoids and prostheses. Thus, our approach is to clarify when and why a better understanding of the biology of grasp and manipulation would benefit robotic grasping and manipulation.

Similarly, why is our understanding of the nature, function and rehabilitation of biological arms and hands incomplete? Jacob Benignus Winsløw Jacques-Bénigne Winslow, (1669—1760) noted in his Exposition anatomique de la structure du corps humain (1732) that ‘The coordination of the muscles of the live hand will never be understood’ [33]. Interestingly, he is still mostly correct. As commented in detail before [4], there has been much work devoted to inferring the anatomical, physiological, neural and cognitive processes that produce the upper limb function we so dearly appreciate and passionately work to restore following trauma or pathology. We argue, as Galileo Galilei did, that mathematics and engineering have much to contribute to the understanding of biological systems. Without such a ‘mathematical language’ we run the risk, as Galileo put it, of ‘wandering in vain through a dark labyrinth’ [34]. Thus, this short review also attempts to point out important mathematical and engineering developments and advances that have helped our understanding of our hands.

This review first contrasts the fundamental differences between engineering and neuroscience approaches to biological robotic systems. Whereas the former applies engineering principles, the latter relies on scientific inference. We then discuss how the physics of the world provides a common ground between them because both types of systems have similar functional goals, and must abide by the same physical laws. We go on to evaluate how biological and robotic systems implement the necessary sensory and motor functions using the dramatically different anatomy, morphology and mechanisms available to each. This inevitably raises questions about differences in their sensorimotor control strategies. Whereas engineering system can be designed and manufactured to optimize well-defined functional features, biological systems evolve without such strict tautology. Biological systems likely evolve by implementing ecologically and temporally good-enough, sub-optimal or habitual control strategies in response to the current multi-dimensional functional constraints and goals in the presence of competition, variability, uncertainty, and noise. We conclude by exploring the notion that the functional versatility of biological systems that roboticists admire is, in fact, enabled by the very nonlinearities and complexities in anatomy, sensorimotor physiology, and neural function that engineering approaches often seek to avoid. […]

Continue —> On neuromechanical approaches for the study of biological and robotic grasp and manipulation | Journal of NeuroEngineering and Rehabilitation | Full Text

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[Abstract] A soft robotic supernumerary finger and a wearable cutaneous finger interface to compensate the missing grasping capabilities in chronic stroke patients


Stroke survivors who experience severe hemipare-sis often cannot completely recover the use of their hand and arm. Many of the rehabilitation devices currently available are designed to increase the functional recovery right after the stroke when, in some cases, biological restoring and plastic reorganization of the central nervous system can take place. However, this is not always the case. Even after extensive therapeutic interventions, the probability of regaining functional use of the impaired hand is low. In this respect, we present a novel robotic system composed of a supernumerary robotic finger and a wearable cutaneous finger interface. The supernumerary finger is used to help grasping objects while the wearable interface provides information about the forces exerted by the robotic finger on the object being held. We carried out two experiments, enrolling 16 healthy subjects and 2 chronic stroke patients. Results showed that using the supernumerary finger greatly improved the grasping capabilities of the subjects. Moreover, providing cutaneous feedback significantly improved the performance of the considered task and was preferred by all subjects.

Source: A soft robotic supernumerary finger and a wearable cutaneous finger interface to compensate the missing grasping capabilities in chronic stroke patients – IEEE Xplore Document

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[Conference paper] ERRSE: Elbow Robotic Rehabilitation System with an EMG-Based Force Control – Abstract+References


Robotic devices for rehabilitation purposes have been increasingly studied in the past two decades and are becoming more and more diffused, due to their effective support to the traditional therapy. They allow to automate in a repeatable manner the rehabilitative exercises and to quantify outcomes, giving important feedback to the therapist. This paper deals with the design, development and preliminary characterization of a robotic system, with an exoskeleton device, for assisted upper-limb rehabilitation, in which surface EMG measurements are used to implement a force-based active and resistive control. A prototype of the system has been realized, measurements of important parameters of the motion permitted to optimize the design and preliminary tests on the control strategy were carried out. 


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Source: ERRSE: Elbow Robotic Rehabilitation System with an EMG-Based Force Control | SpringerLink

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[Conference paper] Hand Robotic Rehabilitation: From Hospital to Home – Abstract+References


Stroke patients are often affected by hemiparesis. In the rehabilitation of these patients the function of the hand is often neglected. Thus in this work we propose a robotic approach to the rehabilitation of the hand of a stroke patient in hospital and also at home. Some experimental results can be presented here especially for inpatients. Further experimental results on home-patients must be acquired through a telemedicine platform, designed for this application. 


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Source: Hand Robotic Rehabilitation: From Hospital to Home | SpringerLink

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[ARTICLE] A soft robotic exosuit improves walking in patients after stroke – Full Text

A softer recovery after stroke

Passive assistance devices such as canes and braces are often used by people after stroke, but mobility remains limited for some patients. Awad et al. studied the effects of active assistance (delivery of supportive force) during walking in nine patients in the chronic phase of stroke recovery. A soft robotic exosuit worn on the partially paralyzed lower limb reduced interlimb propulsion asymmetry, increased ankle dorsiflexion, and reduced the energy required to walk when powered on during treadmill and overground walking tests. The exosuit could be adjusted to deliver supportive force during the early or late phase of the gait cycle depending on the patient’s needs. Although long-term therapeutic studies are necessary, the immediate improvement in walking performance observed using the powered exosuit makes this a promising approach for neurorehabilitation.


Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite—and perhaps because of—their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.


Bipedal locomotion is a defining trait of the human lineage, with a key evolutionary advantage being a low energetic cost of transport (1). However, the economy of bipedal gait may be lost because of neurological injury with disabling consequences. Hemiparetic walking (27) is characterized by a slow and highly inefficient gait that is a major contributor to disability after stroke (8, 9), which is a leading cause of disability among Americans (10). Despite rehabilitation, the vast majority of stroke survivors retain neuromotor deficits that prevent walking at speeds suitable for normal, economical, and safe community ambulation (11). Impaired motor coordination (12), muscle weakness and spasticity (13), and reduced ankle dorsiflexion (DF; drop foot) and knee flexion during walking are examples of typical deficits after stroke that limit walking speed and contribute to gait compensations such as hip circumduction and hiking (1418), increase the risk of falls, and reduce fitness reserve and endurance (3, 4, 9, 12, 1921). Even those able to achieve near-normal walking speeds present with gait deficits (22, 23) that hinder community reintegration and limit participation to well below what is observed in even the most sedentary older adults (24, 25), ultimately contributing to reduced health and quality of life (10, 26, 27).

Walking independence is an important short-term goal for survivors of a stroke; however, independence can be achieved via compensatory mechanisms. The persistence of neuromotor deficits after rehabilitation often necessitates the prescription of passive assistive devices such as canes, walkers, and orthoses to enable walking at home and in the community (2830). Unfortunately, commonly prescribed devices compensate for poststroke neuromotor impairments in a manner that prevents normal gait function. For example, ankle-foot orthoses (AFOs) inhibit normal push-off during walking (31) and reduce gait adaptability (32). The stigma associated with the use of these devices is also important to consider, especially for the growing population of young adult survivors of stroke (33, 34). The major personal and societal costs of stroke-induced walking difficulty and the limitations of the existing intervention paradigm motivate the development of rehabilitation interventions and technologies that enable the rapid attainment of more normal walking behavior.

Recent years have seen the development of powered exoskeletal devices designed to enable walking in individuals who are unable to walk (35, 36). Central to this remarkable engineering achievement is a rigid structure that can support its own weight and provide high amounts of assistance; however, these powerful machines may not always be necessary to restore more normal gait function in individuals who retain the ability to walk after neurological injury, such as the majority of those after stroke. To address this opportunity, our team developed a lightweight, soft wearable robot (exosuit) that interfaces to the paretic limb of persons after stroke via garment-like, functional textile anchors. Exosuits produce gait-restorative joint torques by transmitting mechanical power from waist-mounted body-worn (37) or off-board (38, 39) actuators to the wearer through the interaction of the textile anchors and a cable-based transmission.

Several factors, such as the compliance of the exosuit-human system (40), prevent exosuits from providing the assistance necessary to enable nonambulatory individuals to walk again (41); however, for ambulatory individuals, the lightweight and nonrestrictive nature of this technology has the potential to facilitate a more natural interaction with the wearer and minimize disruption of the natural dynamics of walking (42). Our first efforts developing exosuits led to the creation of systems that could comfortably deliver assistive forces to healthy users during walking (39, 40, 4347). Recently, we demonstrated that assistive forces delivered through the exosuit interface produce marked reductions in the energy cost of healthy walking (37, 48). Thus, although exosuits can only augment, not replace, a wearer’s existing gait functions, we posit that they have the potential to work synergistically with the residual abilities of individuals with impaired gait to improve walking function.

The primary objective of this foundational study was to evaluate the potential of using the exosuit technology to restore healthy walking behavior in individuals after stroke. Toward this end, we evaluated the effects on hemiparetic gait of actively assisting the paretic limb during treadmill walking using a tethered, unilateral (worn on only one side of the body) exosuit designed to supplement the wearer’s generation of paretic ankle plantarflexion (PF) during stance phase and DF during swing phase. We posited that this targeted assistance of the paretic ankle’s gait functions would facilitate more symmetrical propulsive force generation by the paretic and nonparetic limbs and reduce the energetic burden associated with poststroke walking, which previous work has shown can be more than 60% more costly (49). Previous work on wearable assistive robots for persons after stroke has suggested that the timing of PF force delivery during walking could be an important contributor to positive outcomes in this heterogeneous population (50). Hence, we also evaluated different onset timings of PF force delivery for each individual, hypothesizing that this timing would need to be individualized to optimize outcomes.

Designed to be unobtrusive to the wearer when not powered, the exosuit’s mass of ~0.9 kg is distributed along the length of the paretic limb similar to a pair of pants. Nonetheless, to understand the net effect of walking with an exosuit powered and assisting the paretic limb, it is necessary to evaluate whether there are effects because of simply wearing the exosuit passively (worn but unpowered). A secondary objective was thus to evaluate the effects of walking with the passive exosuit relative to walking with the exosuit not worn. Moreover, because one of the compelling aspects of soft wearable robots, such as exosuits, is their potential to provide gait assistance and, potentially, rehabilitation benefit during community-based walking activities, in addition to treadmill-based biomechanical investigation into the effects of a tethered exosuit, our final objective was to evaluate the effects of exosuit assistance delivered from a first-generation, body-worn (untethered) exosuit during overground walking. Ultimately, by investigating how individuals with poststroke hemiparesis respond to exosuit-generated active assistance of ankle PF and DF during treadmill and overground walking, this study serves to define the technology’s potential for improving mobility and enabling more effective neurorehabilitation after stroke. […]

Continue —> A soft robotic exosuit improves walking in patients after stroke | Science Translational Medicine


Fig. 1. Overview of a soft wearable robot (exosuit) designed to augment paretic limb function during hemiparetic walking. Exosuits (A) use garment-like functional textile anchors worn around the waist and calf (B) and Bowden cable-based mechanical power transmissions to generate assistive joint torques as a function of the paretic gait cycle (C). Integrated sensors (load cells and gyroscopes) are used to detect gait events and in a cable position–based force controller that modulates force delivery. The contractile elements of the exosuit are the Bowden cables located posterior and anterior to the ankle joint. Exosuit-generated PF and DF forces are designed to restore the paretic limb’s contribution to forward propulsion (GRF) and ground clearance (ankle DF angle during swing phase)—subtasks of walking that are impaired after stroke. Poststroke deficits in these variables are demonstrated through a comparison of paretic (black) and nonparetic (gray) limbs. Means across participants are presented (n = 7).


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[ARTICLE] An Evaluation of the Design and Usability of a Novel Robotic Bilateral Arm Rehabilitation Device for Patients with Stroke – Full Text

Introduction: Robot-assisted therapy for upper limb rehabilitation is an emerging research topic and its design process must integrate engineering, neurological pathophysiology, and clinical needs.

Purpose of the study: This study developed/evaluated the usefulness of a novel rehabilitation device, the MirrorPath, designed for the upper limb rehabilitation of patients with hemiplegic stroke.

Methods: The process follows Tseng’s methodology for innovative product design and development, namely two stages, device development and usability assessment. During the development process, the design was guided by patients’ rehabilitation needs as defined by patients and their therapists. The design applied synchronic movement of the bilateral upper limbs, an approach that is compatible with the bilateral movement therapy and proprioceptive neuromuscular facilitation theories. MirrorPath consists of a robotic device that guides upper limb movement linked to a control module containing software controlling the robotic movement.

Results: Five healthy subjects were recruited in the pretest, and 4 patients, 4 caregivers, and 4 therapists were recruited in the formal test for usability. All recruited subjects were allocated to the test group, completed the evaluation, and their data were all analyzed. The total system usability scale score obtained from the patients, caregivers, and therapists was 71.8 ± 11.9, indicating a high level of usability and product acceptance.

Discussion and conclusion: Following a standard development process, we could yield a design that meets clinical needs. This low-cost device provides a feasible platform for carrying out robot-assisted bilateral movement therapy of patients with hemiplegic stroke.

Clinical Trial Registration: identifier NCT02698605.


The World Health Organization (WHO) has reported that stroke is the third leading cause of death in developed countries and involves approximately 15 million stoke events annually. One-third of stroke patients die and a further one-third of events results in permanent disability. Depending on the location of the brain insult, stroke can lead to a wide range of functional impairments (Mackay et al., 2004); these include language, cognition, sensation, and motor functions. Motor impairment impacts the patient’s ability to perform activities of daily living. For the majority of patients, recovery of motor function involving an upper limb is slower than that of lower limb (Feys et al., 1998). Indeed, most activities of daily living rely the functioning of the upper limb, thus emphasizing the need for effective upper limb rehabilitation.

With an attempt to enhance the effectiveness of upper limb rehabilitation among stroke patients, a series of rehabilitation techniques have been developed and refined in recent decades; these include task-oriented motor training, constraint-induced movement therapy, mirror therapy, and bilateral movement training. Each of these methods has a number of theoretical advocates and each has been shown to be effective clinically. For instance, bilateral movement therapy, which involves coordinated movement of the bilateral upper limbs, has been shown to enhance upper limb recovery and coordination between the hands. Stoykov et al. (2009) found that bilateral arm training is more effective than unilateral training when restoring proximal upper limb function because it seems to improve the functional linkages between the bilateral hemispheres.

Even after receiving a full course of conventional rehabilitation, 60% of stroke patients still have difficulties when using their affected upper limb (Kwakkel et al., 1999). As a result, it has become the upmost importance to develop novel rehabilitation strategies that are able to help patients reach a higher level of recovery. One such approach is robot-assisted rehabilitation, which incorporates robotic technologies into the rehabilitation processes. Several well-known robot-assisted movement therapies for the upper limb has been implemented clinically, including MIT-Manus (Krebs et al., 1998), Bi-Manu-Track (Hesse et al., 2003), BATRAC (Cauraugh et al., 2010), and MIME (Burgar et al., 2000), each of which follows different movement therapy theories. Regarding the body parts that are mainly involved in therapy, Bi-Manu-Track focuses on the bilateral forearms and wrists, while BATRAC and MIME focus on the shoulder and elbow of the affected limb. Regarding the movement dimension, BATRAC involves movement in one-dimension, while MIME allows three-dimensional movement. In fact, the higher the degrees of freedom adopted during the movement therapy, the more complex is the design of the robotic device. As a result, it has become important to come up with a feasible design that fulfills the patient’s rehabilitation needs while avoiding the high costs that can be associated with instrument acquirement and maintenance. Furthermore, the effectiveness of the system needs to be comparable to that provided by conventional therapies so that a motivation to pursue this therapeutic option can be established (Kwakkel et al., 2008; Lo et al., 2010).

As an approach to the development of mechanical rehabilitation devices for hemiplegic upper limbs, Timmermans et al. (2009) proposed that three design domains are required; these were the therapy techniques used, the motivation of the patient, and resulting performance rewards. An online survey of physical therapists, 233 in total, indicated that a preferred upper limb robotic device needs to accommodate different hand movements, to be able to be used while in a seated position, to be able to provide the user with feedback, to focus on the restoration of activities of daily living, to able to be used at home, to have adjustable resistance levels and to cost less than US$6,000 (Lu et al., 2011).

In terms of usability, the interaction between the user and the machine tends to be overlooked during the development stage. Although a variety of upper limb rehabilitation machines have been proposed, only a few have been commercialized. This low market acceptance can be attributed to the high cost of these devices, safety concerns, and poor usability (Lee et al., 2005). To this end, the aim of this study was to design a bilateral upper limb rehabilitation device called MirrorPath for the rehabilitation of stroke patients that follows the theories of bilateral movement therapy and proprioceptive neuromuscular facilitation (PNF). These two theories were initially developed by Knott and Kabat and have been shown to have a positive effect on the range of active and passive motions needed by stroke patients (Sharman et al., 2006). Our device will guide the patient’s upper limbs, each of which moves along a diagonal motion path on the horizontal plane. The position and velocity of motion of the bilateral limbs are perfectly mirrored across the midline on the table. Finally, usability testing was conducted on the completed prototype.

Continue —>  Frontiers | An Evaluation of the Design and Usability of a Novel Robotic Bilateral Arm Rehabilitation Device for Patients with Stroke | Frontiers in Neurorobotics

Figure 2. (A) A patient performed bilateral diagonal movements using the device; (B) due to weakness of right upper limb, the patient’s grip was assisted with an elastic bandage, and the patient’s elbow was support by a sling; (C) the application scenario.

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[Abstract+References] Toward wearable supernumerary robotic fingers to compensate missing grasping abilities in hemiparetic upper limb 

This paper presents the design, analysis, fabrication, experimental characterization, and evaluation of two prototypes of robotic extra fingers that can be used as grasp compensatory devices for a hemiparetic upper limb. The devices are the results of experimental sessions with chronic stroke patients and consultations with clinical experts. Both devices share a common principle of work, which consists in opposing the device to the paretic hand or wrist so to restrain the motion of an object. They can be used by chronic stroke patients to compensate for grasping in several activities of daily living (ADLs) with a particular focus on bimanual tasks. The robotic extra fingers are designed to be extremely portable and wearable. They can be wrapped as bracelets when not being used, to further reduce the encumbrance. Both devices are intrinsically compliant and driven by a single actuator through a tendon system. The motion of the robotic devices can be controlled using an electromyography-based interface embedded in a cap. The interface allows the user to control the device motion by contracting the frontalis muscle. The performance characteristics of the devices have been measured experimentally and the shape adaptability has been confirmed by grasping various objects with different shapes. We tested the devices through qualitative experiments based on ADLs involving five chronic stroke patients. The prototypes successfully enabled the patients to complete various bimanual tasks. Results show that the proposed robotic devices improve the autonomy of patients in ADLs and allow them to complete tasks that were previously impossible to perform.

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Source: Toward wearable supernumerary robotic fingers to compensate missing grasping abilities in hemiparetic upper limbThe International Journal of Robotics Research – Irfan Hussain, Giovanni Spagnoletti, Gionata Salvietti, Domenico Prattichizzo, 2017

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[WEB SITE] Integration of FES Into G-EO System Gait Trainer Receives FDA Nod

Reha Technology USA Inc announces it now offers FDA-approved integrated Functional Electronic Stimulation (FES) for its G-EO System Evolution robotic gait trainer.

“The FES in conjunction with the G-EO System will allow clinicians to generate contractions in paralyzed or weakened muscles in lower extremities at the appropriate time in the walking cycle to maximize patient outcomes,” says Matthew Brooks, clinical director of Reha Technology USA Inc, in a media release.

The G-EO System robotic gait trainer provides passive and active, assistive and resistive training and the simulation of stairs walking up and down.

“We look forward to add this integrated FES feature to all of our current and future customers and we are confident that this extended offering will create added value for their therapy environment,” adds executive VP Paul Abrams, in the release.

[Source(s): Reha Technology USA Inc, PR Newswire]

Source: Integration of FES Into G-EO System Gait Trainer Receives FDA Nod – Rehab Managment

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