Posts Tagged robotics

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


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

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


  • 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.



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.


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


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.


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).


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 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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[ARTICLE] Transcutaneous Vagus Nerve Stimulation Combined with Robotic Rehabilitation Improves Upper Limb Function after Stroke – Full Text


The efficacy of standard rehabilitative therapy for improving upper limb functions after stroke is limited; thus, alternative strategies are needed. Vagus nerve stimulation (VNS) paired with rehabilitation is a promising approach, but the invasiveness of this technique limits its clinical application. Recently, a noninvasive method to stimulate vagus nerve has been developed. The aim of the present study was to explore whether noninvasive VNS combined with robotic rehabilitation can enhance upper limb functionality in chronic stroke. Safety and efficacy of this combination have been assessed within a proof-of-principle, double-blind, semirandomized, sham-controlled trial. Fourteen patients with either ischemic or haemorrhagic chronic stroke were randomized to robot-assisted therapy associated with real or sham VNS, delivered for 10 working days. Efficacy was evaluated by change in upper extremity Fugl–Meyer score. After intervention, there were no adverse events and Fugl–Meyer scores were significantly better in the real group compared to the sham group. Our pilot study confirms that VNS is feasible in stroke patients and can produce a slight clinical improvement in association to robotic rehabilitation. Compared to traditional stimulation, noninvasive VNS seems to be safer and more tolerable. Further studies are needed to confirm the efficacy of this innovative approach.

1. Introduction

Upper limb impairment is a common consequence of stroke with a deep impact on patient’s quality of life. Since the efficacy of standard rehabilitative therapy is limited, alternative strategies are needed. Robot-assisted rehabilitation can be useful in stroke patients because it allows an intensive as well as task-specific training characterized by high repetition of movements in a strongly motivating environment [13]. Several studies have explored the possibility to potentiate the effect of robotic therapy by the association with noninvasive human brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), that can induce neuroplasticity via long-term potentiation-/depression- (LTP-/LTD-) like phenomena [4]. Although intriguing, the evidence in support of this strategy remains low [56]. Indeed, the literature analysis of the published data seems to demonstrate that the association of rTMS with robotic training has the same clinical gain derived from robotic therapy alone. Moreover, rTMS is contraindicated in patients who suffered from haemorrhagic stroke for the risk of inducing seizures [7]. For these reasons, there is great interest in the development of alternative techniques of neuromodulation that can foster the effect of robotic therapy.

Vagus nerve stimulation (VNS) is approved as adjunctive treatment for refractory epilepsy and depression but is currently under investigation for a wide range of neurological diseases [8]. In particular, recent studies have demonstrated that VNS paired with rehabilitation significantly improves forelimb strength and movement speed in rat models of ischemic [9] and haemorrhagic stroke [10]. VNS is believed to enhance the benefits of rehabilitation by promoting neuroplasticity [11]. Preliminary data [12] have showed that such approach is also feasible in patients; however, the diffusion of this technique is limited by its invasiveness. Indeed, VNS requires the surgical implantation of a stimulator of the cervical branch of the vagus nerve. Recently, it has been proposed a noninvasive technique that consists of transcutaneous stimulation of the vagus nerve (tVNS) in external auditory channel at the inner side of the tragus. Both neuroimaging [13] and neurophysiological [14] studies have demonstrated that the effect of tVNS on brain activity is quite similar to the effect induced by traditional, invasive VNS.

The aim of the present study was to explore whether tVNS can enhance the benefit induced by robotic rehabilitation on motor function of the upper limb in chronic stroke. Safety and efficacy of this combination have been assessed within a proof-of-principle, double-blind, semirandomized, sham-controlled trial. […]

Continue —> Transcutaneous Vagus Nerve Stimulation Combined with Robotic Rehabilitation Improves Upper Limb Function after Stroke

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[Review] Technical Developments for Rehabilitation of Mobility – Full Text


Technically assisted rehabilitation of mobility after stroke has been well established for several years. There is good evidence for the use of end-effector devices, exoskeletons and treadmill training with and without body weight support. New developments provide the possibility for functional training during mobilization, even in intensive care units. Mobile exoskeleton devices have been developed, but their clinical effects need still to be evaluated. All devices should not only focus on increasing the number of repetitions, but also include motivational aspects such as virtual reality environments. Hygienic aspects impose a special challenge. All devices should be integrated into a rational and clearly-defined therapy concept.


Technicallyassisted rehabilitation of mobility after stroke has been well established for several years [1]. The premise “if you want to learn to walk, you have to walk” is of primary importance. In 1995, the working group led by Stefan Hesse showed that repetitive training of walking movements using a treadmill leads to greater improvement of walking ability in stroke patients compared to conventional physiotherapy [2].

Since using a treadmill for severely affected patients is not an optimal approach, alternative solutions have been sought [3]. Almost simultaneously two technical solutions were developed. By developing the electromechanical Gangtrainer GT1®, the Berlin group created a so-called end-effector device in which the trajectory of the gait cycle is predefined and the body’s center of gravity is controlled by a belt system in the vertical and horizontal direction. An alternative technical solution, the Lokomat®, was developed by a Zürich working group as an exoskeleton which uses motors to control the knee and hip joints, so that the patient can perform gait exercises even in the case of complete paraplegia.

These approaches can now be classified as clearly evidence-based. Within the framework of the guideline initiative of the German Society for Neurorehabilitation, the guideline “Rehabilitation of Motor Function after Stroke” (ReMos) was published in 2015. Based on a systematic literature search, a total of 188 randomized clinical trials and 11 systematic reviews were identified that met stipulated quality criteria [4]. This literature was grouped not only according to interventions, but also according to the target criteria and thus the severity of the patients’ disability. Based on available evidence, different recommendations were made for gaining and improving mobility, improving walking speed, walking distance and balance [5].

However, during the last few years the rehabilitation landscape in Germany has been particularly characterized by earlier admissions of patients who are still quite disabled when leaving the primary care hospitals. This is demonstrated by massive increases in early rehabilitation treatment capacity, including those with possibilities of mechanical ventilation [6]. For patients, this development offers the advantage of being transferred early in structured rehabilitative environments where new solutions are being developed. The current state of the art as well as new developments will be discussed below. […]

Continue —> Thieme E-Journals – Neurology International Open / Full Text

Fig. 1 Verticalization in conjunction with initiation of walking movements (Erigo®, image rights: Hocoma, Zürich, Switzerland).

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[Review] Robot-Assisted and Device-Based Rehabilitation of the Upper Extremity – Full Text


Neurorehabilitation of patients with upper limb motor dysfunction due to central nervous system damage still lacks adequate standardization. During the last decade, robot- and device-assisted rehabilitation has become more feasible for the treatment of functional disorders of the upper limb after stroke. Here we present an overview of technological aspects and differential use of devices for upper limb rehabilitation as well as a review of relevant clinical studies. We also discuss the potential for standardized evaluation in the context of limited health care resources. The effectiveness of device-assisted therapy, in comparison to conventional approaches, remains a matter of debate, largely due to the heterogeneous design of the available clinical studies. However, we believe that a better understanding of the timing, intensity, and quality of upper limb rehabilitation, as well as technological progress, will lead to the establishment of a central role for robot- and device-assisted rehabilitation in the next decade.


Improvement of the functionality of the upper limb after an injury to the central nervous system (CNS) is one of the most important tasks of neurorehabilitation. Stroke is the leading cause of upper limb disability, with a range of complex functional upper limb impairments occurring in approximately 50 to 70 percent of cases [1]. In addition, these patients commonly exhibit sensory-motor deficits of the lower extremity, speech impairment, visual defects, and cognitive deficits during the acute phase. Even limited dysfunction of the upper extremity can result in significant limitations of daily activities and quality of life [2]. The probability of regaining sufficient hand function, i. e., grasping adequate for performance of everyday activities, in the presence of a pronounced functional disorder due to a distal paresis or hand paralysis, is at most 20 percent [3]. Effective therapy of the upper limb is therefore a crucial component of neurorehabilitation.

In recent years, neurorehabilitative therapy for motor deficits has focused on task-specific training, comprising repetitive, context-specific exercises. In addition, introduction of “shaping” exercises at the individual patient’s limits of motion, as well as active or passive repetitive activities to reinforce motor learning, should be considered essential foundations of rehabilitative therapy.

A uniform standard of therapy for upper extremity sensorimotor deficits is not currently in place, and individual variation in deficits renders such a standardization unlikely. Based on 109 publications, the guidelines of the German Society for Neurorehabilitation (Deutsche Gesellschaft für Neurorehabilitation), “Rehabilitative Therapy of Arm Paresis after Stroke” published in 2009 [4] provide recommendations regarding the timing, duration, and intensity of therapy. The highest levels (A and B) of recommended therapy contain subgroups of repetitive exercises for gripping and releasing to treat paresis of the hand with partially retained proximal motor function. These include damage-oriented training for arm capacity, basic arm trainingconstraint-induced movement therapymirror therapy, and mental training, as well as neuromuscular electrostimulation (NMES)Robotics-supported upper limb therapy provides a potential adjunct, particularly for those unable to perform the therapeutic motions independently, and is classified as recommendation level B (therapy that should be carried out), i. e., offering average efficacy with a medium to high degree of supporting evidence, based on studies of device-supported therapy focusing on stereotypical movements, without specific task-oriented exercises.

Despite considerable growth in recent years in the number of studies investigating the efficacy of robot-assisted interventions in improving arm function and daily activity performance, the methodological heterogeneity of the studies has led to the conclusion in recent Cochrane meta-analyses that the evidence remains limited [5] [6]. Nonetheless, a systematic review and meta-analysis this year suggested there may be improvement in motor control and muscle strength [7].

In the next sections, we provide an overview of the current state of technological developments as well as clinical applications. […]

Continue —-> Thieme E-Journals – Neurology International Open / Full Text


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[ARTICLE] A composite robotic-based measure of upper limb proprioception – Full Text



Proprioception is the sense of the position and movement of our limbs, and is vital for executing coordinated movements. Proprioceptive disorders are common following stroke, but clinical tests for measuring impairments in proprioception are simple ordinal scales that are unreliable and relatively crude. We developed and validated specific kinematic parameters to quantify proprioception and compared two common metrics, Euclidean and Mahalanobis distances, to combine these parameters into an overall summary score of proprioception.


We used the KINARM robotic exoskeleton to assess proprioception of the upper limb in subjects with stroke (N = 285. Mean days post-stroke = 12 ± 15). Two aspects of proprioception (position sense and kinesthetic sense) were tested using two mirror-matching tasks without vision. The tasks produced 12 parameters to quantify position sense and eight to quantify kinesthesia. The Euclidean and Mahalanobis distances of the z-scores for these parameters were computed each for position sense, kinesthetic sense, and overall proprioceptive function (average score of position and kinesthetic sense).


A high proportion of stroke subjects were impaired on position matching (57%), kinesthetic matching (65%), and overall proprioception (62%). Robotic tasks were significantly correlated with clinical measures of upper extremity proprioception, motor impairment, and overall functional independence. Composite scores derived from the Euclidean distance and Mahalanobis distance showed strong content validity as they were highly correlated (r = 0.97–0.99).


We have outlined a composite measure of upper extremity proprioception to provide a single continuous outcome measure of proprioceptive function for use in clinical trials of rehabilitation. Multiple aspects of proprioception including sense of position, direction, speed, and amplitude of movement were incorporated into this measure. Despite similarities in the scores obtained with these two distance metrics, the Mahalanobis distance was preferred.


Stroke is heterogeneous, affecting sensory, motor, and cognitive functions that are required for daily activities. While there are well validated tools to assess motor and speech functions (eg. Fugl-Meyer Assessment (FMA) [1], the National Institute of Health Stroke Scale (NIHSS) [2], Chedoke-McMaster Stroke Assessment Impairment Inventory (CMSA) [3]) the use of high quality, validated assessment tools for measuring sensory function post-stroke (proprioception in particular) is limited [4], and there is still a lack of a gold standard assessment. While the FMA and NIHSS have sensory components to the assessment, they are seldom used as a sole measure of sensory impairment in research studies focused on sensation as they are based on relatively coarse scales. Yet, sensory and proprioceptive impairments have a significant negative impact on functional recovery following stroke [56789]. Individuals with sensory and motor impairments, compared to those with just motor impairments, have longer lengths of hospitalization and fewer discharges home [101112]. Furthermore, it has recently been shown that motor and proprioceptive impairments can occur independently after stroke [13].

Some commonly used clinical assessments of proprioception post-stroke include: 1) simple passive limb movement detection test [14] in which an examiner moves a subject’s limb segment with their eyes closed, and subjects are asked to say which direction the limb was moved; 2) the Revised Nottingham Sensory Assessment [1516] in which the subject is asked to mirror match the movement of a passively moved limb by a therapist; and 3) the Thumb Localizing Test [17] which involves passive movement of a subject’s arm and hand to a random position overhead, and is followed by subjects reaching to grasp their thumb with the opposite (less affected) hand. These assessments are scored crudely as normal, slightly impaired, or absent, and lack the sensitivity to detect smaller changes in proprioceptive function in part due to poor inter- and intrarater reliability [1819]. Therefore, establishing an objective and reproducible method to assess proprioceptive impairments post-stroke is vital to evaluating the efficacy of different treatments.

Other more advanced methods to assess proprioception have been developed [20212223], with many using robotic technology to measure the kinematics of an individual’s movements. Assessment devices can now measure position sense and kinesthetic impairments after stroke using arm contralateral matching [13242526], in which a subject’s affected arm is passively moved by the robot to a position, and the subject mirror-matches the movement/position with their less affected limb. Another paradigm involves passive movement of a subject’s limb to a specified position, returning the limb to the starting position, and then having subjects actively move the same arm to this remembered position [2126]. This method has an advantage in that it does not require interhemispheric transfer of information, but has limited value in assessing people with concurrent motor deficits, or in assessing kinematic aspects of proprioception, such movement speed and amplitude perception. Further, results can be confounded by problems with spatial working memory. Threshold for detection of passive movement paradigms have also been used to assess proprioception [2728]. This paradigm eliminates confounds due to motor impairment and interhemispheric transfer of information but again, little information about the kinematics of movement perception (e.g. speed or direction) are gained from this task, and it typically takes much longer to complete than position/movement matching. Lastly, Carey et al. [20] have developed and validated a wrist position sense test, where a subject’s wrist is moved to a position (wrist flexion or extension) and without vision of the wrist the subject has to use their other arm to move a cursor to the direction the wrist is pointing. This method minimizes confounds due to interhemispheric information transfer and motor deficits, but again does not provide information about kinesthetic impairments.

Many of these assessments are reliable, reproducible, objective, and provide quantitative measures of proprioceptive function in the upper limbs. Dukelow et al. [1324], used a KINARM robot (BKIN Technologies, Kingston, ON), and detailed a contralateral position-matching task for the upper extremities that can measure various aspects of an individual’s position sense including: absolute error, variability in matching positions, systematic shifts in perceived workspace, and perceived contraction or expansion of the workspace. Similarly, Semrau et al. [25] recently detailed a kinesthetic matching task using the KINARM robot that can measure an individual’s ability to mirror-match the speed, direction, and amplitude of a robotically moved limb [825]. These tasks are reliable [24], and provide numerous parameters that describe an individual’s position or kinesthetic sense impairments and can be used to guide a rehabilitation program tailored to the individual. Furthermore, these studies have shown a strong relationship between proprioceptive impairments and functional independence post-stroke, yet proprioceptive impairments are often not addressed in day-to-day therapy. Reliable and quantitative assessment tools are therefore critical for testing the efficacy of rehabilitation treatments, as in clinical rehabilitation trials.

While multiple kinematic parameters can provide a level of exactness around the nature of an individual’s proprioceptive impairments and are helpful for rehabilitation planning, a summary measure is needed for clinical therapeutic trials in rehabilitation. Thus, a single continuous metric of upper limb proprioceptive function that combines all parameters from the position and kinesthetic matching robotic tasks was developed using two common measures of distance, Euclidean distance (EDist) and Mahalanobis distance (MDist) [29]. The EDist was chosen as it is an easily interpretable calculation and considers each parameter independently. It is the square root of the sum of squared distances between data points (i.e. the straight-line distance between two points in three-dimensional space). The MDist is the next measure we used to compare with the EDist. It was chosen because the calculation accounts for correlations between parameters (by using the inverse of the variance-covariance matrix of the data set of interest), therefore preventing the overweighting of correlated parameters in the calculation. It is the distance between a point and the center of a distribution, measured along the major axes of variation (i.e. the standard deviation of an object in more than one dimension) [3031].. Because the kinematic parameters derived from the robotic tasks may demonstrate some degree of correlation with one another [13], the MDist can account for this auto-correlation. Theoretically, it should perform better at identifying stroke subjects who perform abnormally on the tasks and those who have atypical patterns of behavior relative to controls. The MDist is generally preferred over the EDist for multivariable data since it can cope with different structures of data [31].

MDist (or variants of it) has recently been used in other studies when examining reaching movements after stroke [32].. Our primary aim was to examine differences and similarities between two summary scores (EDist and MDist) in their ability to differentiate proprioceptive impairment in individuals with stroke from controls in a large patient sample. We hypothesized that using a composite proprioception score calculated from the Mahalanobis distance would more accurately identify impaired proprioception in individuals with stroke compared to a proprioception score calculated from the Euclidean distance.[…]


Continue —>  A composite robotic-based measure of upper limb proprioception | Journal of NeuroEngineering and Rehabilitation | Full Text


Fig. 1a KINARM robotic exoskeleton (BKIN Technologies, Kingston, ON, Canda). Subjects are seated in the wheelchair base with arms supported by the arm troughs. b Top-down view of the position matching task. The stroke affected arm was positioned by the robot (black targets, green lines) and subjects were required to mirror-match the target positions with their opposite hand (open targets, blue lines). Nine targets were matched to six times each for a total of 54 trials, presented in pseudorandom order. c Top-down view of an exemplar subject performing one trial of the kinesthetic matching task. The stroke affected arm was moved by the robot between two targets (green lines) and subjects were required to mirror match the speed, direction, and amplitude of movement as soon as they felt the robot move their arm (blue lines). The speed versus time profile represents the temporal aspects of the task, by measuring the response latency (time to initiation of the active arm movement) and peak speed ratio (difference between peak speeds of the passive (green) and active (blue) hands)

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[ARTICLE] How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers – Full Text


Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.


Disabilities cause complex problems in society often unique to each person. A physical disability can limit a person’s ability to access buildings and other facilities, drive, use public transportation, or obtain the health benefits of regular exercise. Blindness can limit a person’s ability to interpret images or navigate the environment. Disabilities in speaking or writing ability may limit the effectiveness of communication. Cognitive disabilities can alter a person’s employment opportunities. In total, a substantial fraction of the world’s population – at least 1 in 6 people – face these individualized problems that combine to create major societal impacts, including limited participation. Further, the average person in the United States can expect to live 20% of his or her life with disability, with the rate of disability increasing seven-fold by age 65 [1].

In light of these complex, pervasive issues, the field of rehabilitation engineering asks, “How can technology help?” Answering this question is also complex, as it often requires the convergence of multiple engineering and design fields (mechanical, electrical, materials, and civil engineering, architecture and industrial design, information and computer science) with clinical fields (rehabilitation medicine, orthopedic surgery, neurology, prosthetics and orthotics, physical, occupational, and speech therapy, rehabilitation psychology) and scientific fields (neuroscience, neuropsychology, biomechanics, motor control, physiology, biology). Shaping of policy, generation of new standards, and education of consumers play important roles as well.

In the US, a unique research center structure was developed to try to facilitate this convergence of fields. In the 1970’s the conceptual model of a Rehabilitation Engineering Center (REC), focusing engineering and clinical expertise on particular problems associated with disability, was first tested. The first objective of the nascent REC’s, defined at a meeting held by the Committee on Prosthetic Research and Development of the National Academy of Sciences, was “to improve the quality of life of the physically handicapped through a total approach to rehabilitation, combining medicine, engineering, and related science” [2]. This objective became a working definition of Rehabilitation Engineering [2].

The first five centers focused on topics including functional electrical stimulation, powered orthoses, neuromuscular control, the effects of pressure on tissue, prosthetics, sensory feedback, quantification of human performance, total joint replacement, and control systems for powered wheelchairs and the environment [2]. The first two RECs were funded by the Department of Health, Education, and Welfare in 1971 at Rancho Los Amigos Medical Center in Downey, CA, and Moss Rehabilitation Hospital in Philadelphia. Three more were added the following year at the Texas Institute for Rehabilitation and Research in Houston, Northwestern University/the Rehabilitation Institute of Chicago, and the Children’s Hospital Center in Boston, involving researchers from Harvard and the Massachusetts Institute of Technology [3]. The Rehabilitation Act of 1973 formally defined REC’s and mandated that 25 percent of research funding under the Act go to them [2]. The establishment of these centers was stimulated by “the polio epidemic, thalidomide tragedy and the Vietnam War, as well as the disability movement of the early 70s with its demands for independence, integration and employment opportunities” [3].

After the initial establishment of these RECs, the governmental funding agency evolved into the National Institute on Disability and Rehabilitation Research (NIDRR, a part of the U.S. Department of Education), and now is the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR, a part of the U.S. Department of Health and Human Services. Today, as we describe below, the RERC’s study a diverse set of technologies and their use by people with a disability, including human-computer interaction, mobile computing, wearable sensors and actuators, robotics, computer gaming, motion capture, wheeled mobility, exoskeletons, lightweight materials, building and transportation technology, biomechanical modeling, and implantable technologies. For this review, we invited all RERCs that were actively reporting to NIDILRR at the onset of this review project in 2015, and had not begun in the last two years, to participate. These were centers that were funded (new or renewal) in the period 2008-2013, except the RERC Wheelchair Transportation Safety, which was funded from 2001-2011. Two of the RERCs did not respond (see Table 1). For each center, we asked it to describe the user needs it targets, summarize key advances that it had made, and identify emerging innovations and opportunities. By reviewing the scope of rehabilitation engineering research through the lens of the RERCs, our goal was to better understand the evolving nature and demands of rehabilitation technology development, as well as the influence of a multidisciplinary structure, like the RERCs, in shaping the producing of such technology. We also performed an analysis of how multidisciplinary the current RERCs actually are (see Table 3), and asked the directors to critique and suggest future directions for the RERC program.[…]

Continue —>  How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 14 Some MARS RERC projects. a) The KineAssist MX® Gait and Balance Device b) The Armeo Spring® reaching assistance device c) The March Hare virtual reality therapy game d) The Lokomat® gait assistance robot e) Robotic Error Augmentation between the therapist and patient f) lever drive wheelchair g) Ekso® exoskeleton h) Body-machine interface for device control

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