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Posts Tagged Robotic
[ARTICLE] Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System – Full Text
Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.
Insufficient motor control compromises the ability of Stroke Patients (SP) to perform activities of daily living and will likely have a negative impact on the quality of life. Improving Upper Limb (UL) function is an important part of post-stroke rehabilitation in order to reduce disability . Recovery in the context of motor ability may refer to the return of pre-stroke muscle activation patterns or to compensation involving the appearance of alternative muscle activation patterns that attempt to compensate for the motor function deficit . The past decades have seen rapid development of a wide variety of assistive technologies that can be used in UL rehabilitation. These include electromyographic biofeedback, virtual reality, electromechanical and robotic devices, electrical stimulation, transcranial magnetic stimulation, direct current stimulation, and orthoses . Currently, two effective technologies that provide external feedback to SP during training, improve the retention of learned skills, and may be able to enhance the motor recovery are discussed .
Virtual Reality (VR): The Microsoft TM Kinect-based system provides feedback on movement execution and/or goal attainment . Incorporating therapy exercises into virtual games can make therapy more enjoyable and more realistic, such that task-based exercises have increased applicability in the clinical environment [6,7], increasing motivation and therefore adherence, which are useful for navigating this virtual environment; this has been identified as the most feasible for future implementation .
Electromechanical and robotic devices can move passive UL along more secure movement trajectories and provide either assistance or resistance to movement of a single joint or control of inter-segmental coordination. Recent technological advances have the ability to control multiple joints accurately at the same time, enabling them to produce more realistic task-based exercises for SP . Compared to manual therapy, robots have the potential to provide intensive rehabilitation consistently for a longer duration . Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires physiological limb muscle activation, which can be achieved through functional UL movement exercises and activation of the appropriate peripheral receptors . The Armeo Spring robot-assisted trainer device may improve UL motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability . Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy [12,13]. There is evidence that robot training for the hand is superior; during post-stroke rehabilitation, hand training is likely to be the most useful [8,13].
Previous studies have shown that the use of systems based on VR environments, motion sensors, and robotics can improve motor function. Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions [14,15,16].
The objectives of the study are to clarify in which area of functional UL recovery these new technologies are more suitable and effective and how much these interventions affect functional state and cognitive functions.
We raise the hypothesis that a robot-assisted device and virtual reality both have a positive effect on functional independence recovery in stroke-affected patients; however, having a different influence on UL motor function and cognitive changes. We assume that the robot-assisted device is more efficient and more accurately allows selecting tasks for developing specific motor function (range of motion, strength or dexterity of the affected arm), while Kinect-based games provide more free movements that are less suitable for specific motor function development and may be more targeted for cognitive functions.
An adaptive robotic system has been developed to be used for hand rehabilitation. Previously developed exoskeletons are either very complex in terms of mechanism, hardware and software, or simple but have limited functionality only for a specific rehabilitation task. Some of these studies use simple position controllers considering only to improve the trajectory tracking performance of the exoskeleton which is inadequate in terms of safety and health of the patient. Some of them focus only on either passive or active rehabilitation, but not both together. Some others use EMG signals to assist the patient, but this time active rehabilitation is impossible unless different designs and control strategies are not developed. The proposed mechanical structure is extremely simple. The middle and the proximal phalanxes are used as a link of consecutively connected two 4-bar mechanisms, respectively. The PIP and MCP joints are actuated by a single electro mechanical cylinder to produce complex flexion and extension movements. It is simpler than similar ones from aspect with the mechanical structure and the biodynamic fit of the hand, making it practicable in terms of production and personal usage. Simple design lets to implement adaptive compliance controller for all active and passive rehabilitation tasks, instead of developing complex and different strategies for different rehabilitation tasks. Furthermore, using the Luenberger observer for unmeasured velocity state variable, an on-line estimation method is used to estimate the dynamic parameters of the system. This makes possible to estimate the force exerted by the patient as well, without a force sensor.
[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.
The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.
50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.
The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).
These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.
These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.
This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.
Motus Nova is expanding its list of partner hospitals and clinics using its FDA-approved robotic stroke therapy system. It also plans to introduce its system to the consumer market for home use in Q3 2019.
Twenty-five hospitals in the Atlanta area within Emory Healthcare, the Grady Health System, and the Wellstar Health System are now using the Motus Nova rehabilitation therapy system, which is designed to use Artificial Intelligence (AI) to accelerate recovery from neurological injuries such as strokes.
The system features a Hand Mentor and Foot Mentor, which are sleeve-like robots that fit over a stroke survivor’s impaired hand or foot. Equipped with an active-assist air muscle and a suite of sensors and accelerometers, they provide clinically appropriate assistance and resistance while individual’s perform the needed therapeutic exercises.
A touchscreen console provides goal-directed biofeedback through interactive games—which Motus Nova calls “theratainment”—that make the tedious process of neuro rehab engaging and fun.
“It’s a system that has proven to be a valuable partner to stroke therapy professionals, where it complements skilled clinical care by augmenting the repetitive rehabilitation requirements of stroke recovery and freeing the clinician to do more nuanced care and assessment,” says Nick Housley, director of clinical research for Atlanta-based Motus Nova, in a media release.
“And while we continue to fill orders for the system to support therapy in the clinic and hospital, we also are looking to use our system to fill the gap patients often experience in receiving the needed therapy once they go home.”
Clinical studies show that neuroplasticity begins after approximately many 10’s to 100’s of hours of active guided rehab. The healing process can take months or years, and sometimes the individuals might never fully recover. Yet the typical regimen for stroke survivors is only two to three hours of outpatient therapy per week for a period of three to four months.
“These constraints were instituted by the Centers for Medicare & Medicaid Services (CMS) in determining Medicare reimbursement without a full understanding of the appropriate dosing required for stroke recovery, and many private insurers have adopted the policy, as well,” states David Wu, Motus Nova’s CEO.
Motus Nova plans to offer a more practical model, the release continues.
“By making the system available for home use at a reasonable weekly rate as long as the patient needs it, the individual can perform therapy anytime,” Wu adds. “A higher dosage of therapy can be achieved without the inconvenience of scheduling appointments with therapists or traveling to and from a clinic, and without the high cost of going to an outpatient center every time the individual wants to do therapy.”
While the system gathers data about individual performance, AI tailors the regimen to maximize user gains, discover new approaches, minimize side effects and help the stroke survivor realize his or her full potential more quickly.
“By optimizing factors such as frequency, intensity, difficulty, encouragement, and motivation, the AI system builds a personalized medicine plan uniquely tailored to each individual user of the system,” Housley comments.
“Our system is durable, too, proven in clinical trials to deliver an engaging physical therapy experience over thousands of repetitions. We look forward to making it available on a much wider scale in the coming months.”
[Source(s): Motus Nova, PR Newswire]
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.