Robotic and sensor-based neurologic rehabilitation for the upper limb is an established concept for motor learning and is recommended in many national guidelines. The complexity of the human hands and arms and the different activities of daily living are leading to an approach in which robotic and sensor-based devices are used in combination to fulfill the multiple requirements of this intervention. A multidisciplinary team of the Fondazione Don Carlo Gnocchi (FDG), an Italian nonprofit foundation, which spans across the entire Italian territory with 28 rehabilitation centers, developed a strategy for the implementation of robotic rehabilitation within the FDG centers. Using an ad hoc form developed by the team, 4 robotic and sensor-based devices were identified among the robotic therapy devices commercially available to treat the upper limb in a more comprehensive way (from the shoulder to the hand). Encouraging results from a pilot study, which compared this robotic approach with a conventional treatment, led to the deployment of the same set of robotic devices in 8 other FDG centers to start a multicenter randomized controlled trial. Efficiency and economic factors are just as important as clinical outcome. The comparison showed that robotic group therapy costs less than half per session in Germany than standard individual arm therapy with equivalent outcomes. To ensure access to high-quality therapy to the largest possible patient group and lower health care costs, robot-assisted group training is a likely option.
Posts Tagged Robotic
BIONIK Laboratories Corp launches its newest generation InMotion ARM/HAND robotic system for clinical rehabilitation of stroke survivors and those with mobility impairments due to neurological conditions.
The new technology, which made its official debut recently at the American Physical Therapy Association Combined Sections Meeting (APTA CSM) in Washington, DC, includes the following new features, according to the Toronto-based company:
- Enhanced hand-rehabilitation technology: provides therapy focused on hand opening and grasping for patients ready to retrain reach and grasp functional tasks.
- InMotion EVAL: assesses hand movements precisely and objectively, allowing clinicians to better measure and quantify patient progress.
- Improved, comprehensive reporting: improved documentation of patient outcomes, easier use and enhanced interpretation of evaluation results, allowing clearer progress indications over the complete rehabilitation journey, all on one screen.
“The goal of our new generation InMotion ARM/HAND is to enable rehabilitation facilities to enhance their treatment programs for patients recovering from stroke or other neurological injury who are ready to retrain reach and grasp functionality. Along with the improved reporting capabilities, we believe our innovative technology will enable clinicians to improve the patient rehabilitation process and achieve greater recovery for stroke survivors,” says Dr Eric Dusseux, CEO, BIONIK Laboratories, in a media release.
“We’re pleased to unveil the new generation InMotion ARM/HAND at APTA CSM and to showcase its functionality to some of the leading minds in physical therapy,” he adds.
[Source(s): BIONIK Laboratories Corp, Business Wire]
[Abstract] Combining Transcutaneous Vagus Nerve Stimulation and Upper-Limb Robotic Rehabilitation in Chronic Stroke Patients
Introduction And Aims: Vagus nerve stimulation (VNS) is a promising approach for enhancing rehabilitation effects in stroke patients, but the invasiveness of this technique reduces its clinical application. Recently, a non-invasive technique for stimulating vagus nerve has been developed. We evaluated safety, feasibility, and efficacy of noninvasive VNS combined with robotic rehabilitation for improving upper limb functionality in chronic stroke.
via Combining Transcutaneous Vagus Nerve Stimulation and Upper-Limb Robotic Rehabilitation in Chronic Stroke Patients – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation
[BOOK Chapter] Application of a Robotic Rehabilitation Training System for Recovery of Severe Plegie Hand Motor Function after a Stroke – Full Text PDF
We have developed a rehabilitation training system (UR-System-PARKO: Useful
and Ultimate Rehabilitation System-PARKO) for patients after a stroke to promote
recovery of motor function of the severe plegic hand with hemiplegia. A clinical
test with six patients for the therapeutic effect of the UR-System-PARKO for severe
plegic hand was performed. For all patients, the active ranges of motion (total
active motion) of finger extension improved after training with the UR-SystemPARKO. Moreover, the modified Ashworth scale (MAS) scores of finger extension
increased. Thus, the training reduced the spastic paralysis. These results suggest the
effectiveness of training with the UR-System-PARKO for recovery of motor function as defined by finger extension in the severe plegic hand.
Stroke is the leading cause of disability in Japan, with more than 1 million people
in Japan living with a disability as a result of stroke. Therefore, interventions that
address the sensorimotor impairments resulting from stroke are important. Motor
function may be restored more than 6 months after a stroke [1, 2], but these studies
included patients with only moderate poststroke hemiplegia, whereas most stroke
survivors have a severely plegic hand with difficulty extending the fingers . This
suggests that a method is needed for treatment of these severely affected cases.
However, although a few studies on rehabilitation therapy for severe plegic hands
have been reported, no marked recovery of ability in extension of the fingers of
the plegic hands was achieved in any study [4, 5]. Proprioceptive neuromuscular
facilitation (PNF) is a therapeutic method that was reported to increase the muscle
strength of the plegic extremities in patients with stroke-induced hemiplegia .
However, since PNF is indicated for patients with a certain level of joint motion,
this method has not been used for severe plegic hands where the fingers cannot
extend. Thus, the first author developed a method to build up the extensor digitorum muscle strength using PNF [7, 8] for stroke patients with severe hemiplegia.
With this therapy, he has performed repeated facilitation training using his hands
on stroke patients with a severe plegic hand to help them recover their motor function, and a good treatment outcome was achieved [9, 10] (Figure 1).
Facilitation training uses extension of the elbow joint with resistance applied to
the tips of the fully extended hemiplegic fingers to increase the force of the extensor digitorum muscle. However, this approach is time-consuming for the therapist.
Therefore, development of a training system is required instead of repeated
facilitation training by a therapist. The objectives of this study were to develop
a training system to increase the output of the extensor digitorum muscle force
and to verify the effect of training with the developed system on a severe plegic
hand. The training system is called the UR-System-PARKO (a useful and ultimate
rehabilitation support system for PARKO). The UR-System-PARKO was developed
by remodeling the simplified training system, which developed previously for
resistance training of hemiplegic upper limbs . A brace for securing the plegic
hand to the UR-System-PARKO was developed on the basis of repeated facilitation
training by a therapist.[…]
A research team at Hong Kong Polytechnic University (PolyU) has developed a robotic arm to facilitate self-help and upper-limb mobile rehabilitation for stroke patients after discharge from hospital.
Referred to as a mobile exo-neuro-musculo-skeleton, the robotic arm enables intensive and effective self-help rehabilitation exercise.
The lightweight device is said to be the first of its kind to combine exo-skeleton, soft robot and exo-nerve stimulation technologies. It is intended to cater to the increasing need for outpatient rehabilitation service for stroke patients.
PolyU Department of Biomedical Engineering researcher Hu Xiaoling said: “We are confident that with our mobile exo-neuro-musculo-skeleton, stroke patients can conduct rehabilitation training anytime and anywhere, turning the training into part of their daily activities.
“We hope such flexible self-help training can well supplement traditional outpatient rehabilitation services, helping stroke patients achieve a much better rehabilitation progress.”
Designed to be flexible and easy-to-use, the robotic arm is compact in size, has fast responses and requires a minimal power supply.
It comprises different components for the wrist/hand, elbow, and fingers that can be worn separately or together for various functional training needs. The device can also be connected to a mobile application, where users can manage their training.
The exo-skeleton and soft robot components of the device offer external mechanical forces guided by voluntary muscle signals in order to facilitate the desired joint movement for the patients.
PolyU improved the rehabilitation by adding its Neuro-muscular Electrical Stimulation (NMES) technology, which allows the robotic arm to contract user’s muscles when electromyography signals are detected.
When tested in a clinical trial involving ten stroke patients, the robotic arm is reported to have led to better muscle coordination, wrist and finger functions, and lower muscle spasticity following 20 two-hour training sessions.
The researchers plan to collaborate with hospitals and clinics for conducting additional trials.
[WEB SITE] HOMEREHAB – Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – The European Coordination Hub for Open Robotics Development
Rehabilitation can help hemiparetic patients to learn new ways of using and moving their weak arms and legs. With immediate therapy it is also possible that people who suffer from hemiparesis may eventually regain movement. However, reductions in healthcare reimbursement place constant demands on rehabilitation specialists to reduce the cost of care and improve productivity. Service providers have responded by shortening the length of patient hospitalisation.
The HOMEREHAB project will develop a new tele-rehabilitation robotic system for delivering therapy to stroke patients at home. It will research on the complex trade-off between robotic design requirements for in home systems and the performance required for optimal rehabilitation therapies, which current commercial systems designed for laboratories and hospitals do not take into account. Additionally, the new home scenario also demands for the smart monitoring of the patient’s physiological state, and the adaptation of the rehabilitation therapy for an optimal service.
[Abstract + References] Evaluation of an Upper-Limb Rehabilitation Robotic Device for Home Use from Patient Perspective
This paper presents a user study to evaluate the system’s performance by measuring objective indicators and subjective perception between the two versions of a planar rehabilitation robotic device: (i) PupArm system, called RoboTherapist 2D system for commercial purpose, designed and developed for clinical settings; and (ii) Homerehab system, developed for home use. Homerehab system is a home rehabilitation robotic platform developed inside the EU HOMEREHAB-Echord++ project framework. Nine patients with different neurological disorders participate in the study. Based on the analysis of subjective assessments of usability and the data acquired objectively by the robotic devices, we can conclude that the performance and user experience with both systems are very similar. This finding will be the base of more extensively studies to demonstrate that home-therapy with HomeRehab could be as efficient as therapy in clinical settings assisted by PupArm robot.
This work has been supported by the European Commission through the project HOMEREHAB: “Development of Robotic Technology for Post-Stroke Home Tele-Rehabilitation – Echord++” (Grant agreement: 601116); by the AURORA project (DPI2015-70415-C2-2-R), which is funded by the Spanish Ministry of Economy and Competitiveness and by the European Union through the European Regional Development Fund (ERDF), “A way to build Europe” and by Conselleria d’Educació, Cultura i Esport of Generalitat Valenciana through the grant APOTIP/2017/001.
Go, A.S., Mozaffarian, D., Roger, V.L.: Heart disease and stroke statistics–2014 update: a report from the American Heart Association. Circulation 129, e28–e292 (2014)
Langhorne, P., Coupar, F., Pollock, A.: Motor recovery after stroke: a systematic review. Lancet Neurol. 8(8), 741–754 (2009)
Richards, L., Hanson, C., Wellborn, M., Sethi, A.: Driving motor recovery after stroke. Top. Stroke Rehabil. 15(5), 397–411 (2008)
Linder, S.M., Rosenfeldt, A.B., Reiss, A., Buchanan, S., Sahu, K., Bay, C.R., Wolf, S.L., Alberts, J.L.: The home stroke rehabilitation and monitoring system trial: a randomized con-trolled trial. Int. J. Stroke 8(1), 1747–4949 (2013)
Diaz, I., Catalan, J.M., Badesa, F.J., Justo, X., Lledo, L.D., Ugartemendia, A., Gil, J.J., Díez, J., Garca-Aracil, N.: Development of a robotic device for post-stroke home tele-rehabilitation. Adv. Mech. Eng
Badesa, F.J., Llinares, A., Morales, R., Garcia-Aracil, N., Sabater, J.M., Perez-Vidal, C.: Pneumatic planar rehabilitation robot for post-stroke patients. Biomed. Eng. Appl. Basis Commun. 26(2), 1450025 (2014)
Brooke, J.: SUS: a quick and dirty usability scale. In: Jordan, P.W., Thomas, B., Weerdmeester, B.A., McClealland, I.L. (eds.) Usability Evaluation in Industry, pp. 189–194. Taylor and Francis, London (1996)
LLinares, A., Badesa, F.J., Morales, R., Garcia-Aracil, N., Sabater, J., Fernandez, E.: Robotic assessment of the influence of age on upper-limb sensorimotor function. Clin. Interv. Aging 8, 879 (2013). https://doi.org/10.2147/CIA.S45900
Robotic and sensor-based neurologic rehabilitation for the upper limb is an established concept for motor learning and is recommended in many national guidelines. The complexity of the human hands and arms and the different activities of daily living are leading to an approach in which robotic and sensor-based devices are used in combination to fulfill the multiple requirements of this intervention.
A multidisciplinary team of the Fondazione Don Carlo Gnocchi (FDG), an Italian nonprofit foundation, which spans across the entire Italian territory with 28 rehabilitation centers, developed a strategy for the implementation of robotic rehabilitation within the FDG centers. Using an ad hoc form developed by the team, 4 robotic and sensor-based devices were identified among the robotic therapy devices commercially available to treat the upper limb in a more comprehensive way (from the shoulder to the hand). Encouraging results from a pilot study, which compared this robotic approach with a conventional treatment, led to the deployment of the same set of robotic devices in 8 other FDG centers to start a multicenter randomized controlled trial. Efficiency and economic factors are just as important as clinical outcome.
The comparison showed that robotic group therapy costs less than half per session in Germany than standard individual arm therapy with equivalent outcomes. To ensure access to high-quality therapy to the largest possible patient group and lower health care costs, robot-assisted group training is a likely option.
- Lo, A.C., Guarino, P.D., Richards, L.G. et al, Robot-assisted therapy for long-term upper-limb impairment after stroke. N Engl J Med. 2011;365:1749.
- Hesse, S., Heß, A., Werner, C.C., Kabbert, N., Buschfort, R. Effect on arm function and cost of robot assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: A randomized controlled trial. Clin Rehabil. 2014;28:637–647.
Smith BM, Albus JS, Barbera AJ. A Glossary of Terms for Robotics. Prepared for U.S. Air Force Materials Laboratory Integrated Computer Aided Manufacturing Program. U.S. Department of Commerce. National Bureau of Standards. 1981. Available at: https://www.gpo.gov/fdsys/pkg/GOVPUB-C13-7a9025561f229e1f7fb504ace852d602/pdf/GOVPUB-C13-7a9025561f229e1f7fb504ace852d602.pdf. Accessed September 5, 2018..
- Feigin, V.L., Forouzanfar, M.H., Krishnamurthi, R. et al, Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–255.
- Mehrholz, J., Pohl, M., Platz, T., Kugler, J., Elsner, B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.Cochrane Database Syst Rev. 2015;11:CD006876.
- Kolominsky-Rabas, P.L., Heuschmann, P.U., Marschall, D. et al, Lifetime cost of ischemic stroke in Germany: Results and national projections from a population-based stroke registry. The Erlangen Stroke Project. Stroke. 2006;37:1179–1183.
- Ringelstein, E.B., Nabavi, D.G. Der ischämische Schlaganfall: Eine praxisorientierte Darstellung von Pathophysiologie, Diagnostik und Therapie. 1st ed. Kohlhammer, Germany; 2007.
Deutscher Verband für Physiotherapie. Aktuelle Arbeitsmarktdaten veröffentlicht—Fachkräftemangel in der Physiotherapie mehr als deutlich. Available at: https://www.physio-deutschland.de/fachkreise/news-bundesweit/einzelansicht/artikel/Aktuelle-Arbeitsmarktdaten-veroeffentlicht-Fachkraeftemangel-in-der-Physiotherapie-mehr-als-deutlich.html. Published March 2017. Accessed April 5, 2018..
- Wright, D.L., Shea, C.H. Cognition and motor skill acquisition: Contextual dependencies. in: C.R. Reynolds (Ed.) Cognitive assessment: A multidisciplinary perspective. Springer Verlag US, Boston, MA; 1994:89–106.
- Masiero, S., Armani, M., Rosati, G. Upper-limb robot-assisted therapy in rehabilitation of acute stroke patients: Focused review and results of new randomized controlled trial. J Rehabil Res Dev. 2011;48:355–366.
- Mehrholz, J., Hädrich, A., Platz, T., Kugler, J., Pohl, M. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012;6:CD006876.
- Norouzi-Gheidari, N., Archambault, P.S., Fung, J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: Systematic review and meta-analysis of the literature. J Rehabil Res Dev. 2012;49:479–496.
- Masiero, S., Carraro, E., Ferraro, C., Gallina, P., Rossi, A., Rosati, G. Upper limb rehabilitation robotics after stroke: A perspective from the University of Padua, Italy. J Rehabil Med. 2009;41:981–985.
- Wagner, T.H., Lo, A.C., Peduzzi, P. et al, An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke. Stroke. 2011;42:2630–2632.
- Masiero, S., Poli, P., Armani, M., Ferlini, G., Rizzello, R., Rosati, G. Robotic upper limb rehabilitation after acute stroke by NeReBot: Evaluation of treatment costs. Biomed Res Int. 2014;2014:265634.
- De Wit, L., Putman, K., Dejaeger, E. et al, Use of time by stroke patients: A comparison of four European rehabilitation centers. Stroke. 2005;36:1977–1983.
- Lee, K.B., Lim, S.H., Kim, K.H. et al, Six-month functional recovery of stroke patients: A multi-time-point study. Int J Rehabil Res. 2015;38:173–180.
- Veerbeek, J.M., van Wegen, E., van Peppen, R. et al, What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014;9 (e87987).
[Abstract] EEG predicts upper limb motor improvement after robotic rehabilitation in chronic stroke patients
Robotic rehabilitation is known to be at least as effective as conventional training for upper limb motor recovery after stroke; nevertheless, which patients could benefit from this treatment is unknown and finding markers that could predict rehabilitation outcome is a challenge.
We aimed at understanding the neural mechanisms of motor function recovery after upper limb robotic rehabilitation in chronic stroke patients using neurophysiological markers obtained by electroencephalography recording (EEG).
Material and method
Fourteen chronic stroke patients (M/F: 11/3; 59.5 ± 13 yrs) with mild to moderate upper limb paresis were subjected to 10 sessions of upper limb rehabilitation with a planar mobile robotic device (MOTORE, Humanware). Fugl–Meyer Assessment Scale (FMAS) and Wolf Motor Function Test (WMFT) were administered before (t0), at the end (t1) and at 1 month follow-up (t2); at the same timing 64-channals EEG was recorded.
We analyzed power spectrum density in different frequency bands of the affected and unaffected hemispheres with 64-ch EEG and their correlation with motor impairment as measured by clinical scales. Correlation analyses were performed to identify the indicators of good rehabilitative outcome.
Clinical assessment indicated a significant functional improvement in upper limb motor function at the end of rehabilitation as assessed with FMAS and WMFT score that is maintained at follow-up. We found a positive correlation between global Alpha activity at t0 and WMFT score variation (t0–t1) and between global Beta activity at t0 and WMFT time variation (t0–t1) and a positive correlation between Beta activity at t0 in the unaffected hemisphere and FMAS variation (t0–t1 and t0–t2).
Robotic rehabilitation improves upper limb motor performance in stroke patients even in the chronic phase. The amount of Alpha and Beta band power at t0 is suggestive of rehabilitation-related motor outcome. Our results suggest that EEG recording preliminarily to robotic rehabilitation could help identifying good responders to treatment thus optimizing results.
Flexo-glove is a 3D printed soft exoskeleton robotic glove with compact and streamlined design for assistance in activities of daily livings and rehabilitation purposes of patients with hand function impairment.
- Overall weight of 330g including battery
- Providing 22N pinch force, 48N power grasp force and object grasp size of up to 81mm in diameter
- Two control modes: intention-sensing via wireless surface EMG for assistive mode and externally-directed via an accompanying smartphone
Project Details: —> Visit site
- Initiated the project with the idea of using soft 3D printed materials in design of the Flexo-glove inspired by X-Limb
- Performed feasibility study for using cable-driven mechanism in actuation of rehabilitation glove
- Leading a group of four mechatronics engineering students to fabricate the prototype and characterise the grip forces
- Received Dyason fellowship, $5000 travel fellowship awarded by Melbourne Robotic Lab. to visit Harvard BioRobotics Lab
Flexo-glove: A 3D Printed Soft Exoskeleton Robotic Glove for Impaired Hand Rehabilitation and Assistance
40th International Engineering in Medicine and Biology Conference (EMBC), 2018.
Full Text PDF