Posts Tagged robotics

[Abstract] A Method for Self-Service Rehabilitation Training of Human Lower Limbs – IEEE Conference Publication

Abstract

Recently, rehabilitation robot technologies have been paid more attention by the researchers in the fields of rehabilitation medicine engineering and robotics. To assist active rehabilitation of patients with unilateral lower extremity injury, we propose a new self-service rehabilitation training method in which the injured lower limbs are controlled by using the contralateral healthy upper ones. First, the movement data of upper and lower limbs of a healthy person in normal walk are acquired by gait measurement experiments. Second, the eigenvectors of upper and lower limb movements in a cycle are extracted in turn. Third, the linear relationship between the movement of upper and lower limbs is identified using the least squares method. Finally, the results of simulation experiments show that the established linear mapping can achieve good accuracy and adaptability, and the self-service rehabilitation training method is effective.

via A Method for Self-Service Rehabilitation Training of Human Lower Limbs – IEEE Conference Publication

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[Abstract] The effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial

Abstract

Objective

To compare the effects of unilateral, proximal arm robot-assisted therapy combined with hand functional electrical stimulation to intensive conventional therapy for restoring arm function in subacute stroke survivors.

Design

This was a single blinded, randomized controlled trial.

Setting

Inpatient Rehabilitation University Hospital.

Participants

Forty patients diagnosed with ischemic stroke (time since stroke <8 weeks) and upper limb impairment were enrolled.

Interventions

Participants randomized to the experimental group received 30 sessions (5 sessions/week) of robot-assisted arm therapy and hand functional electrical stimulation (RAT + FES). Participants randomized to the control group received a time-matched intensive conventional therapy (ICT).

Main outcome measures

The primary outcome was arm motor recovery measured with the Fugl-Meyer Motor Assessment. Secondary outcomes included motor function, arm spasticity and activities of daily living. Measurements were performed at baseline, after 3 weeks, at the end of treatment and at 6-month follow-up. Presence of motor evoked potentials (MEPs) was also measured at baseline.

Results

Both groups significantly improved all outcome measures except for spasticity without differences between groups. Patients with moderate impairment and presence of MEPs who underwent early rehabilitation (<30 days post stroke) demonstrated the greatest clinical improvements.

Conclusions

A robot-assisted arm training plus hand functional electrical stimulation was no more effective than intensive conventional arm training. However, at the same level of arm impairment and corticospinal tract integrity, it induced a higher level of arm recovery.

 

via The effects of a robot-assisted arm training plus hand functional electrical stimulation on recovery after stroke: a randomized clinical trial – ScienceDirect

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[WEB SITE] Neurorehabilitation: Fighting strokes with robotics

Having a stroke can be a scary experience, but the long road to recovery might be getting shorter, thanks to research out of ECU.

Imagine suddenly losing control of a limb or your ability to communicate.

And while this happens, excruciating pain spreads across your head.

This was Joanna’s experience when she had a  at the age of 44.

“I was sick three days up to having my stroke,” Joanna explains. “I had vomiting, headaches and was not making much sense when talking.”

“Three days later, I was sitting down and then it felt like my head was being squeezed between two vices. Excruciating pain.”

Risk factor

In Australia, strokes affect around 55,000 people a year and are the third most common cause of death and a leading cause of disability.

There’s a range of factors that increase the risk of strokes, including diet, exercise and .

But one of the most telling  is, simply, age.

From the age of 45, the risk of a stroke in men is one in four, and for women, it’s one in five.

Fortunately, our knowledge of strokes and how to combat them has improved a lot in the past few decades.

A big part of the solution is getting help quickly, according to Edith Cowan University (ECU) Professor Dylan Edwards.

“If it’s the blockage of a blood vessel, it can be treated very well by anti-coagulant therapy that will break up the blood clot and restore the blood flow to the brain,” Dylan says.

“Typically, you notice somebody is having a stroke by them having issues with their speech or they have a weakness or funny sensation in one side of their body.”

But surviving a stroke is only part of the journey, and with 65% of stroke survivors suffering from some form of disability, restoring motor skills is a critical part of rehabilitation.

Road to recovery

Recovery from stroke can be a long and frustrating road for even the smallest paralysation.

For stroke survivor Joanna, the frustration she felt not being able to move normally made the recovery process even more challenging.

“The emotional side of having the stroke has affected me more than anything else,” Joanna says.

“You slowly get used to the fact that you can’t move your left side, and you know that you’ll get therapy. But when I had people come visit, when they left, I was in tears [out of frustration].”

Joanna eventually started to get some feeling back in her left side, just to her thumb at first.

“It was still a shock that I had lost all of that, so just a little bit of movement was enough to keep me going and stay motivated.”

Fighting back with technology

At ECU’s Lab for NeuroRehabilitation and Robotics, Dylan and his team have been researching how to help people recover their motor control after a brain or spinal cord injury.

Part of their research focuses on understanding the recovery of stroke survivors, using a robotic sensory platform called the Kinarm Exoskeleton Lab.

“The Kinarm looks like a fancy piece of gym equipment,” Dylan explains. “You sit inside the device and position your arms on top of movable handles, and you’re wheeled into this virtual reality environment.”

For the user in the chair, it feels like you’re playing a series of games, moving the chair’s arms to get a response on the screen—such as bouncing balls off paddles.

But the real work is happening behind the scenes.

“All of this information is acquired by these high-powered computers and analysed for how the person is performing,” Dylan says. “This [helps] identify the precise proprioceptive issue with an individual stroke survivor so we can prescribe therapy more effectively.”

In simplest terms, the Kinarm helps identify issues where the user is telling their arm to move but the resulting movement is not what they were trying to do.

This could be an arm not extending the full distance or slower reaction times.

With strokes usually affecting one side of the body more than the other, the unaffected side can provide a good baseline for what their normal reactions should be.

But what if both sides of the body have been affected? The Kinarm can pick up on that too, detecting deficits in what would be considered the unaffected side and showing this in the test results.

R&R—Robotics and Recovery

For Joanna, using the Kinarm has been a challenging experience, even three years after her stroke.

“It actually made you concentrate more in the game to hit the balls coming down,” she explains.

“I think that made you use the brain to try and keep up with your eye, which it didn’t, but I gave it my best shot. I also noticed my peripheral vision has gone.”

“It highlighted for me the improvements I have got since my stroke, which is nice for me three years on to see how it was then to what I could actually achieve on the Kinarm now.”

The data collected helps doctors prescribe the most beneficial treatment for their patients, based on the results of the tests.

Whether it’s heading towards recovering the function in a limb or something as simple as the mobility of a single joint, Dylan believes even small changes are worth pursuing.

“Some degree of independence—even though it might be apparent to an onlooker or a carer—can be very meaningful for a patient.”

“Small changes that we have made in the past through prescribing therapies effectively are things like being able to stabilise yourself on the train and send a text message.”

Recovering movement and lives

While full recovery from a stroke is not guaranteed, any improvement to quality of life can mean everything for survivors. Restoring simple movements can help patients build up their self-confidence to return to their everyday lives.

“Often stroke patients are in the older age bracket, and many of them are working,” Dylan says. “It’s very depressing to be disengaged from a functional work life, and going back to work might just be having the confidence of turning over a page of paper at your desk.”

As we learn more about how the body and brain recover after these , there’s hope we can find ways to better support those who have experienced extensive motor damage.

While there’s medication and training regimes to follow, at its core, it comes down to the drive to actively engage in recovering.

And even if it’s just through small victories, a spark from ECU’s Lab for NeuroRehabilitation and Robotics could help light the fire of determination in .


Explore further

Regulating blood supply to limbs improves stroke recovery

 

via Neurorehabilitation: Fighting strokes with robotics

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[Abstract] A game changer: the use of digital technologies in the management of upper limb rehabilitation – BOOK

Abstract

Hemiparesis is a symptom of residual weakness in half of the body, including the upper extremity, which affects the majority of post stroke survivors. Upper limb function is essential for daily life and reduction in movements can lead to tremendous decline in quality of life and independence. Current treatments, such as physiotherapy, aim to improve motor functions, however due to increasing NHS pressure, growing recognition on mental health, and close scrutiny on disease spending there is an urgent need for new approaches to be developed rapidly and sufficient resources devoted to stroke disease. Fortunately, a range of digital technologies has led to revived rehabilitation techniques in captivating and stimulating environments. To gain further insight, a meta-analysis literature search was carried out using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Articles were categorized and pooled into the following groups; pro/anti/neutral for the use of digital technology. Additionally, most literature is rationalised by quantitative and qualitative findings. Findings displayed, the majority of the inclusive literature is supportive of the use of digital technologies in the rehabilitation of upper extremity following stroke. Overall, the review highlights a wide understanding and promise directed into introducing devices into a clinical setting. Analysis of all four categories; (1) Digital Technology, (2) Virtual Reality, (3) Robotics and (4) Leap Motion displayed varying qualities both—pro and negative across each device. Prevailing developments on use of these technologies highlights an evolutionary and revolutionary step into utilizing digital technologies for rehabilitation purposes due to the vast functional gains and engagement levels experienced by patients. The influx of more commercialised and accessible devices could alter stroke recovery further with initial recommendations for combination therapy utilizing conventional and digital resources.

via A game changer: the use of digital technologies in the management of upper limb rehabilitation – Enlighten: Publications

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[Abstract] Cognitive Reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke. A multicenter study of the Fondazione Don Carlo Gnocchi

Abstract

Introduction

Rehabilitation plays a central role in stroke recovery. Besides conventional therapy, technological treatments have become available. About technological rehabilitation, its effectiveness and appropriateness are not yet well defined, hence researches focused on different variables impacting the recovery are needed. Results from literature identified the Cognitive Reserve (CR) as a variable impacting on the cognitive outcome. In this paper we aim to evaluate whether the CR influences the motor outcome in patients after stroke treated with conventional or robotic therapy and if it may address towards one treatment rather than another.

Methods/Patients

Seventy‐five stroke patients were enrolled in five Italian neurological rehabilitation centres. Patients were assigned either to a Robotic Group, rehabilitation by means of robotic devices, or to a Conventional Group, where a traditional approach was used. Patients were evaluated at baseline and after rehabilitation treatment of 6 weeks through Action Research Arm Test (ARAT), Motricity Index (MI) and Barthel Index (BI). CR was assessed at baseline using the Cognitive Reserve Index (CRI) questionnaire.

Results

Considering all patients, a weak correlation was found between the CRI related to leisure time and MI evolution (r:0.276; p=0.02). Among the patients who performed a robotic rehabilitation a moderate correlation emerged between the CRI related to working activities and the MI evolution (r:0.422; p=0.02).

Conclusions

Our results suggest that CR may influence the motor outcome. For each patient, the CR and its subcategories should be considered in the choice between conventional and robotic treatment.

 

via Cognitive Reserve as a useful variable to address robotic or conventional upper limb rehabilitation treatment after stroke. A multicenter study of the Fondazione Don Carlo Gnocchi – Padua – – European Journal of Neurology – Wiley Online Library

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[Abstract] Robotic Techniques Used for Increasing Improvement Rate In The Rehabilitation Process Of Upper Limb Stroke Patients – Full Text PDF

Abstract

The rate of stroke patients in Pakistan is increasing, resulting in the decrease mobility of the patients. The movement of upper limb stoke patient is decreased due to the weakness and loss of joint control in his upper body. To improve the coordination of movement of the upper limb stroke patients, many methods e.g. passive and active modes for improving the disrupted mobility are introduced. The objectives of this paper are to first review the studies on upper limb stroke patients and the techniques used for increasing the improvement rate through physical therapy by exoskeleton and evaluation of the performance of the patient using methods such as quantification and graphical representations so that it can be shown to the patient for his motivation to improve further. The paper introduces a mechanical design of exoskeleton with 1 degree of freedom for elbow and 2 degrees of freedom for shoulder movement for rehabilitation of joints of stoke patients. It also mentions the safety that will be taken in the process so that the exoskeleton is safe to use when it is in contact with human. The model of the exoskeleton has the characteristic of being modular and easily operable and use admittance control strategy. Control strategy of the exoskeleton is discussed to maintain the position and orientation of the device and also is able to cater the gravitational attraction which plays an important part in the movement of the actuators. The mathematical model of motion attained due to the degrees of freedom of the exoskeleton is then evaluated and the lastly areas where the future work of exoskeleton can be done are discussed.

Full Text PDF

via Robotic Techniques Used for Increasing Improvement Rate In The Rehabilitation Process Of Upper Limb Stroke Patients | Sukkur IBA Journal of Computing and Mathematical Sciences

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[WEB PAGE] An expert opinion: upper limb rehabilitation after stroke

Key take home messages

  1. Clinically meaningful improvements are possible in chronic stroke patients
  2. The dose of rehabilitation treatment needs to be larger than currently delivered
  3. Rehabilitation is a complex intervention that cannot be reduced to a single element

Somewhere between 50-80% of stroke survivors have upper limb symptoms after acute stroke1 and persistent difficulty in using the upper limb is a major contributor to ongoing physical disability.2 A commonly held view is that most recovery from stroke occurs over the first three to six months after which little improvement is possible, especially at the level of impairment.3-6 We argue that this may be a self-fulfilling prophecy resulting in lack of provision of potentially helpful rehabilitation.

What is the best way to promote upper limb recovery after stroke? Most studies of behavioural interventions have investigated forms of constraint induced movement therapy (CIMT),7,8 repetitive task training (RTT)9 or robotics,10 each of which focuses on increasing the activity of the affected limb. Kwakkel et al8suggested that motor function, arm-hand activities and self-reported arm-hand functioning in daily life, improved immediately after CIMT and at long-term follow-up, but the comparison was often with usual care. It is worth noting that CIMT approaches were said to be more likely to be successful in promoting long term benefits if the protocol included shaping, massed practice and a behavioural transfer package, whereas simple forced use therapy was ineffective.8 RTT also has some evidence to support benefits over what is described as usual care, but the evidence for benefits over ‘matched therapy’ is less strong.9 The use of robotics can increase the number of movement repetitions, but has failed to produce clinically meaningful effects.10 Indeed, the recent RATULS study showed that compared with usual care, approximately 23 hours of robot-assisted training and matched dose ‘upper limb therapy’ did not improve upper limb function.11Overall, it would appear that asking patients to make simple repetitions of movement, however meaningful the task, is relatively ineffective without some way of actively translating any improvements into activities of daily living. Simply increasing the number of repetitions does not appear to be effective,12 and this in itself should give us pause for thought.

A few studies have tested more complex therapies incorporating a number of different elements. The ICARE study13 of upper limb treatment after stroke went beyond simple repetitions, using a structured, task-oriented motor training programme that was impairment focused, task specific, intense, engaging, collaborative, self-directed, and patient centred, starting about six weeks post-stroke. Outcomes were not improved by this approach, but on reflection it is likely that, as with many of the studies, the dose of 30 hours over ten weeks was too low (the usual care group received 11.2 hours over ten weeks). Despite scepticism that stroke patients would be able to ‘tolerate’ much higher doses,12 one study managed to deliver 300 hours of upper limb therapy to chronic stroke patients over twelve weeks and reported changes in measures of both impairment and activity that were far greater than those in lower dose studies,14 and in fact the findings of this study have recently been replicated by the same group.15 We recently reported the findings of the Queen Square Upper Limb (QSUL) Neurorehabilitation programme,16 a single centre clinical service that provides 90 hours of treatment focusing on the post-stroke upper limb. Most patients entering the programme were in the chronic stage (> 6 months post-stroke), but were able to complete the 90 hours of the programme, even though they exhibited a wide range of impairments and fatigue levels. Despite the time since stroke (median = 18 months) we observed (i) large clinically meaningful improvements in upper limb impairment and activity (of a magnitude similar to those reported by McCabe et al.), and importantly (ii) that these changes were maintained, or even improved upon, six months after treatment.

The first lesson to take from these studies is that post-stroke rehabilitation programmes and clinical trials are almost certainly under dosing patients. In future, clinical trials must investigate the effects of much higher doses than are currently being used. The second question to be raised is what are the key ‘active ingredients’ of an upper limb rehabilitation treatment? Whilst it is not clear what the optimal behavioural approach for promoting upper limb recovery should be, it is clear that simple protocol driven approaches have not led to large or sustained effects,17 both of which are necessary to produce a step change in stroke recovery. Successful post-stroke neurorehabilitation is likely to require a combination of complimentary approaches. If we accept this premise, then we are unlikely to determine the optimal combination of active ingredients simply by studying each approach in isolation, because the interactions between these elements will also have to be considered.

So how do we work out what the ‘active ingredients’ of upper limb rehabilitation are? A more sensible way forward is to look at interventions that have already demonstrated a high level of efficacy and then begin to work out their key components. Here, it is important to say that we need to start with treatments that have a high chance of achieving minimum clinically important differences (MCID) rather than small changes that might be statistically significant. Both McCabe et al14 and Daly et al,15 as well as the QSUL programme,16 produced large improvements on both impairment and activity limitation and both involved more complex treatment approaches, not restricted to one element. It is worth considering these in more detail.

  • Analysis of movement and performance in activities of daily living. The initial assessment is crucial. The question, ‘why does this person’s hand and arm not work’ should never be answered with ‘because they have had a stroke’. There needs to be an appreciation of the range of potential contributory impairments (patterns of weakness, spasticity, loss of joint range, shoulder restriction and pain, sensory loss, apraxia, cognitive deficits, depression, apathy, fatigue etc.) because each of these becomes a therapeutic target. Our view is that without informed clinical reasoning based on the presence or absence of specific impairments, the correct treatment approach is unlikely to be selected.
  • Identify and treat barriers. Avoid complications that will prevent participation in an active rehabilitation programme. We commonly see loss of passive joint range preventing people accessing finger or thumb movement, due to either spasticity or non-neural shortening. This can happen at most joints, but particularly in the hand. As well as increased finger flexion, be alert to loss of flexion at MCP joints which makes it difficult to shape the hand properly. Treatment involves splinting and optimal spasticity management. We also see pain and restriction of range in the shoulder. Restriction of external rotation in particular should raise the possibility of adhesive capsulitis. Despite the lack of a clear evidence base for treating post-stroke adhesive capsulitis, anecdotally we have had success with capsular hydrodilatation followed by physiotherapy.
  • Preparation. Manual techniques are used to optimise and improve baseline at an impairment level, for example mobilising joints to improve range, lengthening and strengthening muscles to ensure they are at a biomechanical advantage to generate force, training sensory discrimination and improving postural control and balance.
  • Reduction of impairment and re-education of quality and control of movement within activities of daily living. Individualised meaningful tasks are practiced repeatedly in order to facilitate task mastery with a focus on quality of movement. This is achieved through (i) adaptation of the task, e.g. decomposing tasks into individual components to be practiced; (ii) adaptation of the environment, e.g. fabrication of functional splints and adaptation of tools such as cutlery or screwdrivers, to enable integration of the affected hand in meaningful activities; (iii) assistance, e.g. de-weighting the arm to allow strengthening and training of movement quality and control through increased range.
  • Coaching (involving instruction, supervision, reinforcement) was considered a key component of the QSUL programme, used throughout to embed new skills and knowledge into individual daily routines. Consequently, individuals increase participation and confidence in their desired goals, enhancing self-efficacy and motivation to sustain behavioural change beyond the end of the active treatment period.
  • Sustaining change. Our view is that the approach described, delivered at a high dose is most likely to achieve clinically meaningful improvement together with improved self-efficacy and behaviour change that results in retention of gains or further improvement (something not routinely seen with many upper limb interventions that have been investigated).

Rehabilitation is often criticised for not following standardised approaches that lend themselves to investigation through clinical trials. However, when single elements are then studied in isolation the results are often not clinically meaningful and are not sustained.18,19 Looking at the difference between these approaches and those taken by McCabe et al14, Daly et al15 and QSUL16 should be informative, with a view to formally describing the key elements of a successful treatment. Whilst approaches at the activity and participation level will vary as they are tailored to an individual’s specific meaningful goals, the overall therapeutic approach taken towards specific impairments should be the same across all patients. Ideally, it should be possible to describe the principles of an optimal intervention using a format such as the TIDIER guidelines.18,19

There is a way to go before we can really say we understand both the treatment itself and the effects of the treatment on individuals. This will require careful assessment of both the ‘input’ (the nature of the behavioural intervention) and of the ‘output’ (the resulting behavioural change) at a level of fine-grained detail that is not currently achieved on a regular basis, for example using kinematic20 or neurophysiological21 assessment. In addition, this input-output relationship will be modulated by a number of patient characteristics, which could relate to behavioural characteristics (e.g. severity, presence of multiple impairments) or to biological characteristics (e.g. the nature and extent of brain damage, time since stroke, age, medication).

Overall, our experience suggests that much higher doses and intensity of upper limb neurorehabilitation can be delivered with beneficial effects. We have highlighted the need to consider the dose and the nature of the intervention as well as appropriate patient stratification in informing future clinical trial design.

Figure 1. Outcome scores for all patients on the Queen Square Upper Limb Rehabilitation programme. Each data point represents a single patient. Top row shows individual scores at admission, discharge, six weeks and six months after discharge. Bottom row shows the individual difference scores for admission to discharge, admission to six weeks post-discharge, and admission to six months post-discharge. Scores are shown for modified Fugl-Meyer (upper limb), Action Research Arm Test and Chedoke Arm and Hand Activity Inventory (CAHAI). Median (solid line) and upper and lower quartiles (dotted lines) are shown. (Reproduced with permission from Ward et al, J Neurol Neurosurg Psychiatry. 2019 May;90(5):498-506).


References

  1. Lawrence ES et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32:1279–1284.
  2. Broeks JG, Lankhorst GJ, Rumping K, Prevo AJ. The long-term outcome of arm function after stroke: results of a follow-up study. Disabil Rehabil. 1999;21:357–364.
  3. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJH. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:2181–2186.
  4. Nakayama H, Jørgensen HS, Raaschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75:394–398.
  5. Sunderland A et al. Enhanced physical therapy for arm function after stroke: a one year follow up study. J. Neurol. Neurosurg. Psychiatr. 1994;57:856–858.
  6. Wade DT, Langton-Hewer R, Wood VA, Skilbeck CE, Ismail HM. The hemiplegic arm after stroke: measurement and recovery. J. Neurol. Neurosurg. Psychiatr. 1983;46:521–524 .
  7. Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev CD004433 (2015). doi:10.1002/14651858.CD004433.pub3
  8. Kwakkel G, Veerbeek J, van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol. 2015;14:224–234.
  9. French B et al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2016;11:CD006073.
  10. Veerbeek JM, Langbroek-Amersfoort AC, van Wegen, EEH, Meskers CGM, Kwakkel G. Effects of Robot-Assisted Therapy for the Upper Limb After Stroke. Neurorehabil Neural Repair. 2017;31: 107–121.
  11. Rodgers H et al. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial. Lancet (2019). doi:10.1016/S0140-6736(19)31055-4.
  12. Lang CE et al. Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial. Ann. Neurol. 2016;80:342–354.
  13. Winstein CJ et al. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. JAMA. 2016;315:571–581.
  14. McCabe J, Monkiewicz M, Holcomb J, Pundik S, Daly JJ. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015; 96:981–990.
  15. Daly JJ et al. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair. 1545968319846120 (2019). doi:10.1177/1545968319846120.
  16. Ward NS, Brander F, Kelly K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry jnnp-2018-319954 (2019). doi:10.1136/jnnp-2018-319954
  17. Pollock A et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. CD010820 (2014). doi:10.1002/14651858.CD010820.pub2
  18. Hoffmann TC et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348;g1687.
  19. Walker MF et al. Improving the Development, Monitoring and Reporting of Stroke Rehabilitation Research: Consensus-Based Core Recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 2017;31:877–884.
  20. Balasubramanian S, Colombo R, Sterpi I, Sanguineti V, Burdet E. Robotic assessment of upper limb motor function after stroke. Am J Phys Med Rehabil. 2012;91:S255-269.
  21. Cheung VCK et al. Muscle synergy patterns as physiological markers of motor cortical damage. Proc. Natl. Acad. Sci. U.S.A. 2012;109:14652–14656.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Correspondence to: Nick Ward, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG.
Conflict of interest statement: None declared.
Provenance and peer review: Submitted and externally reviewed.
Date first submitted: 15/4/19
Date resubmitted after peer review: 10/6/19
Acceptance date: 11/6/19
To cite: Ward NS, Kelly K, Brander F. ACNR 2019;18(4):20-22
Published online: 1/8/19

via An expert opinion: upper limb rehabilitation after stroke | ACNR | Online Neurology Journal

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[Abstract] Pre-therapeutic Device for Post-stroke Hemiplegic Patients’ Wrist and Finger Rehabilitation

Abstract

Background/Objectives

This paper suggests a pre-therapeutic device for post-stroke hemiplegic patients’ wrist and finger rehabilitation both to decrease and analyze their muscle tones before the main physical or occupational therapy.

Method/Statistical Analysis

We designed a robot which consists of a BLDC motor, a torque sensor, linear motion guides and bearings. Mechanical structure of the robot induces flexion and extension of wrist and finger (MCP) joints simultaneously with the single motor. The frames of the robot were 3D printed. During the flexion/extension exercise, angular position and repulsive torque of the joints are measured and displayed in real time.

Findings

A prototype was 3D printed to conduct preliminary experiment on normal subject. From the neutral joint position (midway between extension and flexion), the robot rotated 120 degrees to extension direction and 30 degrees to flexion direction. First, the subject used the machine with the usual wrist and finger characteristics without any tones. Second, the same subject intentionally gave strength to the joints in order to imitate affected upper limb of a hemiplegic patient. During extension exercise, maximum repulsive torque of the normal hand was 2 Nm whereas that of the firm hand was almost 5 Nm. The result revealed that the device was capable enough to not only rotate rigid wrist and fingers with the novel robotic structure, but also present quantitative data such as the repulsive torque according to the joint orientation as an index of joint spasticity level.

Improvements/Applications

We are planning to improve the system by applying torque control and arranging experiments at hospitals to obtain patients’ data and feedbacks to meet actual needs in the field.

via Indian Journals

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[VIDEO] Indego Therapy – Alice’s Story — Anatomical Concepts (UK)

MEET ALICE

After her brain injury, there seemed little hope for recovery. With the right therapy, tools and attitude she has defied all odds.
Her stepfather, Bob, and therapists at More Rehab tell us her story, her rehabilitation journey so far, and the particular benefits of walking therapy with the Indego exoskeleton.

We’re sure you agree that she is an extraordinary woman!
We also hope that you can see that it is a combination of great therapy, excellent technology, incredible support and hard work that creates results. Here at Anatomical Concepts we focus on the Technology, and we partner with great therapists (just like More Rehab) who we know will give a high standard of support, training and encouragement.

You can learn a lot more about Indego here or complete the form below and we’ll be in touch!

via Indego Therapy – Alice’s Story — Anatomical Concepts (UK)

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[ARTICLE] Hand Rehabilitation Robotics on Poststroke Motor Recovery – Full Text

Abstract

The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers’ view or on the training paradigms on the clinicians’ view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.

1. Background

Stroke, caused by death of brain cells as a result of blockage of a blood vessel supplying the brain (ischemic stroke) or bleeding into or around the brain (hemorrhagic stroke), is a serious medical emergency []. Stroke can result in death or substantial neural damage and is a principal contributor to long-term disabilities []. According to the World Health Organization estimates, 15 million people suffer stroke worldwide each year []. Although technology advances in health care, the incidence of stroke is expected to rise over the next decades []. The expense on both caring and rehabilitation is enormous which reaches $34 billion per year in the US []. More than half of stroke survivors experience some level of lasting hemiparesis or hemiplegia resulting from the damage to neural tissues. These patients are not able to perform daily activities independently and thus have to rely on human assistance for basic activities of daily living (ADL) like feeding, self-care, and mobility [].

The human hands are very complex and versatile. Researches show that the relationship between the distal upper limb (i.e., hand) function and the ability to perform ADL is stronger than the other limbs []. The deficit in hand function would seriously impact the quality of patients’ life, which means more demand is needed on the hand motor recovery. However, although most patients get reasonable motor recovery of proximal upper extremity according to relevant research findings, recovery at distal upper extremity has been limited due to low effectivity []. There are two main reasons for challenges facing the recovery of the hand. First, in movement, the hand has more than 20 degree of freedom (DOF) which makes it flexible, thus being difficult for therapist or training devices to meet the needs of satiety and varied movements []. Second, in function, the area of cortex in correspondence with the hand is much larger than the other motor cortex, which means a considerable amount of flexibility in generating a variety of hand postures and in the control of the individual joints of the hand. However, to date, most researches have focused on the contrary, lacking of individuation in finger movements []. Better rehabilitation therapies are desperately needed.

Robot-assisted therapy for poststroke rehabilitation is a new kind of physical therapy, through which patients practice their paretic limb by resorting to or resisting the force offered by the robots []. For example, the MIT-Manus robot uses the massed training approach by practicing reaching movements to train the upper limbs []; the Mirror Image Movement Enabler (MIME) uses the bilateral training approach to train the paretic limb while reducing abnormal synergies []. Robot-assisted therapy has been greatly developed over the past three decades with the advances in robotic technology such as the exoskeleton and bioengineering, which has become a significant supplement to traditional physical therapy []. For example, compared with the therapist exhausted in training patients with manual labor, the hand exoskeleton designed by Wege et al. can move the fingers of patients dexterously and repeatedly []. Besides, some robots can also be controlled by a patient’s own intention extracted from biosignals such as electromyography (EMG) and electroencephalograph (EEG) signals []. These make it possible to form a closed-loop rehabilitation system with the robotic technology, which cannot be achieved by any conventional rehabilitation therapy [].

Existing reviews of hand rehabilitation robotics on poststroke motor recovery are insufficient, for most studies research on the application of robot-assisted therapy on other limbs instead of the hand []. Furthermore, current reviews focus on either the hardware design of the robots or the application of specific training paradigms [], while both of them are indispensable to an efficient hand rehabilitation robot. The hardware system makes the foundation of the robots’ function, while the training paradigm serves as the real functional parts in the motor recovery that decides the effect of rehabilitation training. These two parts are closely related to each other.

This paper focuses on the application of robot-assisted therapy on hand rehabilitation, giving an overview of hand rehabilitation robotics from the hardware systems to the training paradigms in current designs, for a comprehensive understanding is pretty meaningful to the development of an effective rehabilitation robotic system. The second section provides a general view of the robots in the entire rehabilitation robotic system. Then, the third section sums up and classifies hardware systems and the training paradigms in several crucial aspects on the author’s view. Last, the state of the art hand rehabilitation robotics is discussed and possible direction of future robotics in hand rehabilitation is predicted.[…]

Continue —-> Hand Rehabilitation Robotics on Poststroke Motor Recovery

 

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Figure 3
Examples of different kinds of robots [].

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