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
Rehabilitation exercises are those exercises that help in
improving joint and muscle function, helping people stand,
balance, walked. But these exercises work if done regularly
and done as proposed by the therapist. Sometimes the patients
has problems like scheduling their daily tasks, their
commitment for doing those exercises, and some other
difficultiessimilar to this. Thus failing to do the
movements and get benefit from the exercises. This paper
proposes a system that provides an intuitive way for
rehabilitation. This system contains use of pervasive health
technologies for addressing the over difficulty. The system
would provide a graphical interfacethat would help the
physiotherapist to create exercises in 3Denvironment, wherein
he would be animating a humanoid to showhow the exercise
is to be done.This would show to be more intuitive to patients
rather thanon paper. The system would also let therapist to
monitor patient while he/she is exercising.
Physical therapy cures injuries and promotes movements of
injured body parts by examining the patient’s body, diagnosing
the patient and then treating the patient using mechanical
force and movements which is carried out by physical
therapists (also known as physiotherapist). Analysis aims to
extend, and restore maximum functional ability throughout
life action uses the patient history and the physical
examination to find out what really the patient needs to do, to
restore the mobility of the injured muscle. Physical therapy
has many types of specialities:
• Orthopaedic and
With the developing technology worldwide, people have
started using handheld devices to carry on their day-to-day
activities. With this advancement, the demand for pervasive
computing and 3D visualization of images and videos has
been raised. The area this paper focuses on is a tele-medicine
and tele-therapy system for helpingthe patient to get the help
of the doctors at their home. When a patient undergoes a
surgery, he may need a physiotherapy session to regain his/her
muscle functionality. For this purpose the patient may need to
take one-to-one session with the physiotherapist. The patient
requires to do these sessions again and again till he/she
regains the muscle functionality. Much man power, resources
and time is need to do all this.
In today’s life, it may be impossible for a patient to get
sometime from the busy schedule and go for these one-to-one
sessions.Also there are elderly people who get surgery but
aren’t able to goto the therapist for every day sessions, also
there are people that live inremote location and due to this
they are not able to get good healthcare services. To resolve
such problems we will be developing a telephysiotherapysystem,
which would help to cater patients at
theirdoorstep. The system would be developed in two stages.
In the firststage the doctor will be provided with an interface
where he/shecan animate a humanoid with the exercise the
patient needs to do.
This would be done using the mobile device the therapist
would behaving. After creating this animation, the therapist
would be ableto record the animation and send the animation
to the appropriatepatient. In the second stage we would be
using sensors and otherdevices to monitor the patient
exercises(If the first stage proves tobe successful).
As stated in the first stage, the therapist would be able to
create3D animations, for which we can use the 3D computer
graphicalrendering on mobile devices. This 3D visualization
would be moreintuitive than the printed paper counterpart.
Thus, it is hoped thatthis would help to improve the patient
health in less costly way.
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We developed a tele-rehabilitation system to improve community rehabilitation for patients who are discharged early from hospital. The developed tele-rehabilitation system consists of devices designed to reduce the physical and economic burden on users while promoting optimum user movement. A Backend-as-a-Service cloud computing service was used for the communication between terminals. A non-contact sensor, Kinect, was used to measure movement. In addition, we used a three-dimensional (3D) display to present 3D images using binocular parallax, to encourage smooth movement of patients. We used this system for stroke patients and found improvements in task-performance time, smoothness of movements, and range of motion in all patients. No major issues occurred during the tele-rehabilitation. These results demonstrated the high operability and efficacy of our cloud service-based 3D virtual reality tele-rehabilitation system.
Source: IEEE Xplore Document – Trial operation of a cloud service-based three-dimensional virtual reality tele-rehabilitation system for stroke patients
Fig. 1 The portable YouGrabber system. a A patient playing the Airplane game on the portable YouGrabber system. b The complete data glove with sensor-“box”, bending sensors, and vibrating units attached to the size fit neoprene glove. c The complete equipment packed for “take away”
Home-based, computer-enhanced therapy of hand and arm function can complement conventional interventions and increase the amount and intensity of training, without interfering too much with family routines. The objective of the present study was to investigate the feasibility and usability of the new portable version of the YouGrabber® system (YouRehab AG, Zurich, Switzerland) in the home setting.
Fifteen families of children (7 girls, mean age: 11.3y) with neuromotor disorders and affected upper limbs participated. They received instructions and took the system home to train for 2 weeks. After returning it, they answered questions about usability, motivation, and their general opinion of the system (Visual Analogue Scale; 0 indicating worst score, 100 indicating best score; ≤30 not satisfied, 31–69 average, ≥70 satisfied). Furthermore, total pure playtime and number of training sessions were quantified. To prove the usability of the system, number and sort of support requests were logged.
The usability of the system was considered average to satisfying (mean 60.1–93.1). The lowest score was given for the occurrence of technical errors. Parents had to motivate their children to start (mean 66.5) and continue (mean 68.5) with the training. But in general, parents estimated the therapeutic benefit as high (mean 73.1) and the whole system as very good (mean 87.4). Children played on average 7 times during the 2 weeks; total pure playtime was 185 ± 45 min. Especially at the beginning of the trial, systems were very error-prone. Fortunately, we, or the company, solved most problems before the patients took the systems home. Nevertheless, 10 of 15 families contacted us at least once because of technical problems.
Despite that the YouGrabber® is a promising and highly accepted training tool for home-use, currently, it is still error-prone, and the requested support exceeds the support that can be provided by clinical therapists. A technically more robust system, combined with additional attractive games, likely results in higher patient motivation and better compliance. This would reduce the need for parents to motivate their children extrinsically and allow for clinical trials to investigate the effectiveness of the system.
Data glove, Pediatrics ,Neurorehabilitation, Upper extremities ,YouGrabber, Tele-rehabilitation, Game-based, Cerebral palsy, Children and adolescents, Clinical utility, User satisfaction
Continue —> Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study | Journal of NeuroEngineering and Rehabilitation | Full Text
This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system’s components for patients’ biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.
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Background: Most acute stroke patients with disabilities do not receive recommended rehabilitation following discharge to the community. Functional and social barriers are common reasons for non-adherence to post-discharge rehabilitation. Home rehabilitation is an alternative to centre-based rehabilitation but is costlier. Tele-rehabilitation is a possible solution, allowing for remote supervision of rehabilitation and eliminating access barriers. The objective of the Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial is to determine if a novel tele-rehabilitation intervention for the first three months after stroke admission improves functional recovery compared to usual care.
Methods/design: This is a single blind (evaluator blinded), parallel, two-arm randomised controlled trial study design involving 100 recent stroke patients. The inclusion criteria are age ≥40 years, having caregiver support and recent stroke defined as stroke diagnosis within 4 weeks. Consenting participants will be randomized with varying block size of 4 or 6 assuming a 1:1 treatment allocation with the participating centre as the stratification factor. The baseline assessment will be done within 4 weeks of stroke onset, followed by follow-up assessments at 3 and 6 months. The tele-rehabilitation intervention lasts for 3 months and includes exercise 5-days-a-week using an iPad-based system that allows recording of daily exercise with video and sensor data and weekly video-conferencing with tele-therapists after data review. Those allocated to the control group will receive usual care. The primary outcome measure is improvement in life task’s social activity participation at three months as measured by the disability component of the Jette Late Life Functional and Disability Instrument (LLFDI). Secondary outcome variables consist of gait speed (Timed 5-Meter Walk Test) and endurance (Two-Minute Walk test), performance of basic activities of daily living (Shah-modified Barthel Index), balance confidence (Activities-Specific Balance Confidence Scale), patient self-reported health-related quality-of-life [Euro-QOL (EQ-5D)], health service utilization (Singapore Stroke Study Health Service Utilization Form) and caregiver reported stress (Zarit Caregiver Burden Inventory).
Discussion: The goal of this trial is to provide evidence on the potential benefit and cost-effectiveness of this novel tele-rehabilitation programme which will guide health care decision-making and potentially improve performance of post-stroke community-based rehabilitation.
Trial Registration: This trial protocol was registered under ClinicalTrials.gov on 18 July 2013 as study title “The Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) Study” (ID: The STARS Study, ClinicalTrials.gov Identifier: NCT01905917).
Source: Singapore Tele-technology Aided Rehabilitation in Stroke (STARS) trial: protocol of a randomized clinical trial on tele-rehabilitation for stroke patients | BMC Neurology | Full Text
Patients with the frozen shoulder condition that limits their arm movement should seek rehabilitation assistance from a medical facility. The normal process is for the patients to travel from their home to a hospital or a medical center to see a physiotherapist. Such potentially cumbersome effort may reduce their motivation and determination to seek proper treatment. Our approach is to use a single smartphone with accelerometer, magnetic field, and gyroscope sensors to provide the necessary monitoring measurements to enable effective tele-rehabilitation. This work proposes a framework for such a system and has successful developed prototype based on the Android platform. Also, there are many different smartphones in the market. Therefore, we evaluated performance of three different smartphones, which are Samsung Google Nexus S, Samsung Galaxy Note 1, and Sony Xperia Z Ultra. According to the experimentation, we have shown that smartphones with the appropriate sensors are suitable for tele-rehabilitation. Also, a newer generation model would provide more precise measurements, as expected.
Continue —> Full Text PDF
Rehabilitation is an important branch of health care that aims to restore some or all of the patient’s physical, sensory, and/or mental capabilities that were lost due to injury, illness, or disease.
With the increasing number of people with disabilities, more specialized rehabilitation staff and facilities are needed. However, evidence suggests that people with disabilities face barriers in accessing the health and rehabilitation services they need in many settings.
Therefore, Telerehabilitation has emerged as an evolutionary field of tele-medicine to overcome this availability problem by providing a wide range of consultative, preventative, diagnostic, and therapeutic services via the internet. Pairing these practices with game-based therapy has proved to increase their potential impact specially with pediatric populations. This paper gives a survey on some existing studies and suggests moving these telerehabilitation games into the cloud for the sake of convenience and flexibility.
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Integrating emerging technologies has shown to have the potential to improve access to rehabilitation services and the adherence for physical therapy when they are applied into telemedicine environments.
This systematic review aims to explore telerehabilitation systems that use motion capture and video games for upper-limb rehabilitation purposes. Motion capture was focused on the information fusion from inertial sensors and other technologies. The search was limited to 2010-2013, from which 667 papers were obtained; afterwards,
duplicate papers were removed, thus, reducing the sample to 57 papers with full text availability. Finally, only 3 of them were selected by approaching the subject of this study.
We conclude that the fusion information from inertial sensors and other motion capture technologies appears to be a new tendency in remote monitoring of motor rehabilitation process. However, the combination of them with active video games in physiotherapy programs is only an emerging research area with promising results.
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Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness.
hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND.
Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes.
The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.
via JNER | Abstract | Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercises after stroke: results of a feasibility study in home setting.