Posts Tagged robotics

[ARTICLE] Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges – Full Text

Abstract

A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.

1. Introduction

Significant advances have been made in the management of stroke (including prevention, acute management, and rehabilitation); however cerebrovascular diseases remain the third most common cause of death and the first cause of disability worldwide [16]. Stroke causes brain damage, leading to loss of motor function. Upper limb (UL) function is particularly reduced, resulting in disability. Many rehabilitation techniques have been developed over the last decades to facilitate motor recovery of the UL in order to improve functional ability and quality of life [710]. They are commonly based on principles of motor skill learning to promote plasticity of motor neural networks. These principles include intensive, repetitive, task-oriented movement-based training [1119]. A better understanding of the neural substrates of motor relearning has led to the development of innovative strategies and tools to deliver exercise that meets these requirements. Treatments mostly target the neurological impairment (paresis, spasticity, etc.) through the activation of neural circuits or by acting on peripheral effectors. Robotic devices provide exercises that incorporate key elements of motor learning. Advanced robotic systems can offer highly repetitive, reproducible, interactive forms of training for the paretic limb, which are quantifiable. Robotic devices also enable easy and objective assessment of motor performance in standardized conditions by the recording of biomechanical data (i.e., speed, forces) [2022]. This data can be used to analyze and assess motor recovery in stroke patients [2326]. Since the 1990s, many other technology-based approaches and innovative pharmaceutical treatments have also been developed for rehabilitation, including virtual reality- (VR-) based systems, botulinum neurotoxin (BoNT) injections, and noninvasive brain stimulation (NIBS) (Direct Current Stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS)). There is currently no high-quality evidence to support any of these innovative interventions, despite the fact that some are used in routine practice [27]. By their respective mechanisms of action, each of these treatments could potentiate the effects of robotic therapy, leading to greater improvements in motor capacity. The aim of this paper is to review studies of combined treatments based on robotic rehabilitation and to analyze the rationale behind such approaches.[…]

 

Continue —> Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges

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[Abstract] Early robot-assisted gait retraining in non-ambulatory patients with stroke: a single blind randomized controlled trial

BACKGROUND: Restoration of walking function is a primary concern of neurorehabilitation with respect to the aspired social and vocational reintegration. To date, the best practice for improving gait early after stroke is still object of debate. On one hand, repetitive task-specific approaches with higher intensities of walking have been observed to result in greater improvements of gait after stroke. Conversely there is some evidence that conventional gait training would be more effective for facilitating walking ability after stroke.
AIM: To compare the effects of an early treatment protocol of add-on robot-assisted gait training with add-on conventional overground physiotherapy for improving locomotion in non-ambulatory adult stroke patients.
DESIGN: Single-blind randomized controlled trial.
SETTING: Neurorehabilitation hospital.
POPULATION: Seventy-four subacute patients with first-ever ischemic stroke.
METHODS: The patients were randomized into two groups. The training program consisted of forty, 2-hour sessions (including 45 minutes basic training, 45 minutes add-on training plus rest periods), five days a week, for eight consecutive weeks. Patients allocated to the add-on robot-assisted gait training were treated by means of the Lokomat. Patients allocated to the add-on conventional overground gait training aimed at improving postural control during gait, body weight transfer, stability during the stance phase, free swing phase, adequate heel contact and gait pattern. Primary outcome was the modified Emory Functional Ambulation Profile. Secondary outcomes were the Rivermead Motor Index, the Mobility Milestones and the Hochzirl Walking Aids Profile.
RESULTS: No significant difference was observed between groups with regards to age (P=0.661), time from stroke onset (P=0.413) and the primary outcome (P=0.854) at baseline evaluation. As to the primary outcome, no significant differences were found between groups at the end of the study. As During the 8-week training, within-group comparisons showed significant improvements of mean modified Emory Functional Ambulation Profile in both groups (P<0.001).
CONCLUSIONS: Our results support the hypothesis that an early treatment protocol of robot-assisted gait retraining is not superior to add-on conventional gait training intervention for improving locomotion in non- ambulatory stroke patients.
CLINICAL REHABILITATION IMPACT: This study might help to better understand the role of robot-assisted gait training in early phase stroke rehabilitation.

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via Early robot-assisted gait retraining in non-ambulatory patients with stroke: a single blind randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2018 Mar 29 – Minerva Medica – Journals

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[Poster] Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

Highlights

  • Participants improved on motor outcomes after engaging in high-repetition robotics arm training.
  • There were no differences between external focus or internal focus of attention on retention of motor skills after 4 weeks of arm training.
  • Individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus during motor training found in healthy individuals.
  • Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment.

Abstract

Objective

To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training.

Design

Randomized, repeated-measures, mixed analysis of variance.

Setting

Outpatient clinic.

Participants

Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3).

Interventions

Four-week arm training protocol on a robotic device (12 sessions).

Main Outcome Measures

Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up.

Results

There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35).

Conclusions

There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

 

via Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke – ScienceDirect

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[Abstract] Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.

Abstract

PURPOSE:

The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated.

METHODS:

This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation.

RESULTS:

Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing.

CONCLUSION:

This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.

 

via Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: … – PubMed – NCBI

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[Abstract] Validity of Robot-Based Assessments of Upper Extremity Function

Abstract

Objective

To examine the validity of 5 robot-based assessments of arm motor function poststroke.

Design

Cross-sectional study.

Setting

Outpatient clinical research center.

Participants

Volunteer sample of participants (N=40; age, >18y; 3–6mo poststroke) with arm motor deficits that had reached a stable plateau.

Interventions

Not applicable.

Main Outcome Measures

Clinical standards included the arm motor domain of the Fugl-Meyer Assessment (FMA) and 5 secondary motor outcomes: hand/wrist subsection of the arm motor domain of the FMA, Action Research Arm Test, Box and Block test (BBT), hand motor subscale of the Stroke Impact Scale Version 2.0, and Barthel Index. Robot-based assessments included wrist targeting, finger targeting, finger movement speed, reaction time, and a robotic version of the BBT. Anatomical measures included percent injury to the corticospinal tract (CST) and extent of injury of the hand region of the primary motor cortex obtained from magnetic resonance imaging.

Results

Participants had moderate to severe impairment (arm motor domain of the FMA scores, 35.6±14.4; range, 13.5–60). Performance on the robot-based tests, including speed (r=.82; P<.0001), wrist targeting (r=.72; P<.0001), and finger targeting (r=.67; P<.0001), correlated significantly with the arm motor domain of the FMA scores. Wrist targeting (r=.57–.82) and finger targeting (r=.49–.68) correlated significantly with all 5 secondary motor outcomes and with percent CST injury. The robotic version of the BBT correlated significantly with the clinical BBT but was less prone to floor effects. Robot-based assessments were comparable to the arm motor domain of the FMA score in relation to percent CST injury and superior in relation to extent of injury to the hand region of the primary motor cortex.

Conclusions

The present findings support using a battery of robot-based methods for assessing the upper extremity motor function in participants with chronic stroke.

via Validity of Robot-Based Assessments of Upper Extremity Function – Archives of Physical Medicine and Rehabilitation

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[Abstract] Interventions for Improving Upper Limb Function after Stroke – Cochrane Database Syst Rev.

Abstract

Impairment of the upper limbs is quite frequent after stroke, making rehabilitation an essential step towards clinical recovery and patient empowerment. This review aimed to synthetize existing evidence regarding interventions for upper limb function improvement after Stroke and to assess which would bring some benefit. The Cochrane Database of Systematic Reviews, the Database of Reviews of Effects and PROSPERO databases were searched until June 2013 and 40 reviews have been included, covering 503 studies, 18 078 participants and 18 interventions, as well asdifferent doses and settings of interventions. The main results were:

  1. Information currently available is insufficient to assess effectiveness of each intervention and to enable comparison of interventions;
  2. Transcranial direct current stimulation brings no benefit for outcomes of activities of daily living;
  3. Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy, mental practice, mirror therapy, interventions for sensory impairment, virtual reality and repetitive task practice;
  4. Unilateral arm training may be more effective than bilateral arm training;
  5. Moderate-quality evidence showed a beneficial effect of robotics on measures of impairment and ADLs;
  6. There is no evidence of benefit or harm for technics such as repetitive transcranial magnetic stimulation, music therapy, pharmacological interventions, electrical stimulation and other therapies.

Currently available evidence is insufficient and of low quality, not supporting clear clinical decisions. High-quality studies are still needed.

 

via [Analysis of the Cochrane Review: Interventions for Improving Upper Limb Function after Stroke. Cochrane Database Syst Rev. 2014,11:CD010820]. – PubMed – NCBI

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[BOOK] Emerging Therapies in Neurorehabilitation II – Βιβλία Google

Εξώφυλλο
José L. PonsRafael RayaJosé González
Springer30 Οκτ 2015 – 318 σελίδες

This book reports on the latest technological and clinical advances in the field of neurorehabilitation. It is, however, much more than a conventional survey of the state-of-the-art in neurorehabilitation technologies and therapies. It was written on the basis of a week of lively discussions between PhD students and leading research experts during the Summer School on Neurorehabilitation (SSNR2014), held September 15-19 in Baiona, Spain. Its unconventional format makes it a perfect guide for all PhD students, researchers and professionals interested in gaining a multidisciplinary perspective on current and future neurorehabilitation scenarios. The book addresses various aspects of neurorehabilitation research and practice, including a selection of common impairments affecting CNS function, such as stroke and spinal cord injury, as well as cutting-edge rehabilitation and diagnostics technologies, including robotics, neuroprosthetics, brain-machine interfaces and neuromodulation.

via Emerging Therapies in Neurorehabilitation II – Βιβλία Google

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[Abstract] Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study

Objective: To evaluate the feasibility and safety of home rehabilitation of the hand using a robotic glove, and, in addition, its effectiveness, in hemiplegic patients after stroke.

Methods: In this non-randomized pilot study, 21 hemiplegic stroke patients (Ashworth spasticity index ≤ 3) were prescribed, after in-hospital rehabilitation, a 2-month home-program of intensive hand training using the Gloreha Lite glove that provides computer-controlled passive mobilization of the fingers. Feasibility was measured by: number of patients who completed the home-program, minutes of exercise and number of sessions/patient performed. Safety was assessed by: hand pain with a visual analog scale (VAS), Ashworth spasticity index for finger flexors, opponents of the thumb and wrist flexors, and hand edema (circumference of forearm, wrist and fingers), measured at start (T0) and end (T1) of rehabilitation. Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip test) were also measured at T0 and T1.

Results: Patients performed, over a mean period 56 (49–63) days, a total of 1699 (1353–2045) min/patient of exercise with Gloreha Lite, 5.1 (4.3–5.8) days/week. Seventeen patients (81%) completed the full program. The mean VAS score of hand pain, Ashworth spasticity index and hand edema did not change significantly at T1 compared to T0. The MI, NHPT and Grip test improved significantly (p = 0.0020, 0.0156 and 0.0024, respectively) compared to baseline.

Conclusion: Gloreha Lite is feasible and safe for use in home rehabilitation. The efficacy data show a therapeutic effect which need to be confirmed by a randomized controlled study.

 

via Home-based hand rehabilitation with a robotic glove in hemiplegic patients after stroke: a pilot feasibility study: Topics in Stroke Rehabilitation: Vol 0, No 0

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[Abstract] What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis

Highlights

  • Recovery of walking function is one of the main goals of patients after stroke.
  • RAGT may be considered a valuable tool in improving gait abnormalities.
  • The earlier the gait training starts, the better the motor recovery.

Abstract

Background

Studies about electromechanical-assisted devices proved the validity and effectiveness of these tools in gait rehabilitation, especially if used in association with conventional physiotherapy in stroke patients.

Objective

The aim of this study was to compare the effects of different robotic devices in improving post-stroke gait abnormalities.

Methods

A computerized literature research of articles was conducted in the databases MEDLINE, PEDro, COCHRANE, besides a search for the same items in the Library System of the University of Parma (Italy). We selected 13 randomized controlled trials, and the results were divided into sub-acute stroke patients and chronic stroke patients. We selected studies including at least one of the following test: 10-Meter Walking Test, 6-Minute Walk Test, Timed-Up-and-Go, 5-Meter Walk Test, and Functional Ambulation Categories.

Results

Stroke patients who received physiotherapy treatment in combination with robotic devices, such as Lokomat or Gait Trainer, were more likely to reach better results, compared to patients who receive conventional gait training alone. Moreover, electromechanical-assisted gait training in association with Functional Electrical Stimulations produced more benefits than the only robotic treatment (−0.80 [−1.14; −0.46], p > .05).

Conclusions

The evaluation of the results confirm that the use of robotics can positively affect the outcome of a gait rehabilitation in patients with stroke. The effects of different devices seems to be similar on the most commonly outcome evaluated by this review.

 

via What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis – Journal of Clinical Neuroscience

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[ARTICLE] Development of a robotic device for post-stroke home tele-rehabilitation – Full Text

This work deals with the complex mechanical design task of converting a large pneumatic rehabilitation robot into an electric and compact system for in-home post-stroke therapies without losing performance. It presents the new HomeRehab robot that supports rehabilitation therapies in three dimensions with an adaptive controller that optimizes patient recovery. A preliminary usability test is also conducted to show that its performance resembles that found in RoboTherapist 2D commercial system designed for hospitals. The mechanical design of a novel and smart two-dimensional force sensor at the end-effector is also described.

According to the World Health Organization, by 2050, the number of persons over 65 years old will increase by 73% in the industrialized countries and by 207% worldwide.1 This segment of population is particularly prone to suffer a cerebrovascular accident or stroke, since the relative incidence of stroke doubles every decade after age 55. Stroke survivors immediately experience hemiparesis, resulting in impairment of extremities associated with diminished health-related quality of life.2 Rehabilitation can help hemiparetic patients to learn new ways of using and moving their weak arms and legs. It is also possible with immediate therapy 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.3 Service providers have responded by shortening the length of patient hospitalization.4,5 Additionally, early home supported discharge of subacute stroke patients has been proved to have a significant impact on motor recovery after stroke although it requires some level of innovation of methods and tools for service delivery to really become a sustainable solution for the healthcare system.6,7 All these reasons support the necessity of in-home rehabilitation systems as the one proposed in this work.

Socially, chronic stroke patients can highly benefit from innovative approaches based on home rehabilitation therapy.8 Technological and scientifically, only a few commercial systems are currently available for in-home use (e.g. HandMentor™,9 ReJoyce,10 and ArmeoBoom from Hocoma), and their performances are not comparable to in-person therapies.11 Key challenges not addressed properly for home systems include features such as affordability, autonomy, and high performance. Only if all requirements are satisfied, it will be possible to encourage national health systems, insurance companies, and patients to apply such platforms.

This work is part of an ongoing project called HomeRehab that will develop a new tele-rehabilitation robotic system for delivering therapy to stroke patients at home. Instead, Technologies has a robotic system called RoboTherapist 2D (Figure 1) developed to provide rehabilitation to patients who suffer from stroke and/or other neurological disorders.12 Currently, the system, as the majority of commercial devices, is only designed to be used in hospitals and medical centers in collaboration with nurses and medical staff.13

figure

Figure 1. RoboTherapist 2D system from Instead Technologies.

HomeRehab aims to modify and adapt the system so it can be used at home by patients easily and supporting the premise of tele-rehabilitation.14 This article describes in detail the mechanical design of the new HomeRehab system that adapts the RoboTherapist 2D for in-home use by making it smaller, lighter, and cheaper, but maintaining its high performance. Additionally, the system includes a third degree-of-freedom (DOF) plus a novel low-cost force sensor that were not considered for the original platform, but they are very interesting features for a complete in-home solution. Another key feature of the whole system is that it integrates patient monitoring techniques using wearable devices to monitor the physiological state of the patient and modify exercises based on that information.

The following section briefly summarizes the main requirements considered to develop a successful device, and afterward in section “Mechanical design,” the mechanical design of the new system is described in detail. Section “Robot controller” presents the controller of the robot as well as the adaptive controller implemented for the rehabilitation therapies. Section “Usability pilot study” carries out a validation phase by conducting several tests and surveys to compare the usability of RoboTherapist 2D with HomeRehab, and last section gathers main conclusions. […]

 

Continue —>   Development of a robotic device for post-stroke home tele-rehabilitationAdvances in Mechanical Engineering – Iñaki Díaz, José María Catalan, Francisco Javier Badesa, Xabier Justo, Luis Daniel Lledo, Axier Ugartemendia, Jorge Juan Gil, Jorge Díez, Nicolás García-Aracil, 2018

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