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[Abstract + References] A Novel Exoskeleton with Fractional Sliding Mode Control for Upper Limb Rehabilitation


The robotic intervention has great potential in the rehabilitation of post-stroke patients to regain their lost mobility. In this paper, firstly, we present a design of a novel, 7 degree-of-freedom (DOF) upper limb robotic exoskeleton (u-Rob) that features shoulder scapulohumeral rhythm with a wide range of motions (ROM) compared to other existing exoskeletons. An ergonomic shoulder mechanism with two passive DOF was included in the proposed exoskeleton to provide scapulohumeral motion with corresponding full ROM. Also, the joints of u-Rob have more range of motions compared to its existing counterparts. Secondly, we propose a fractional sliding mode control (FSMC) to control u-Rob. Applying the Lyapunov theory to the proposed control algorithm, we showed the stability of it. To control u-Rob, FSMC has shown effectiveness to handle unmodeled dynamics (e.g. friction, disturbance, etc.) in terms of better tracking and chatter compared to traditional SMC.


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[ARTICLE] Portable Motion-Analysis Device for Upper-Limb Research, Assessment, and Rehabilitation in Non-Laboratory Settings – Full Text


This study presents the design and feasibility testing of an interactive portable motion-analysis device for the assessment of upper-limb motor functions in clinical and home settings. The device engages subjects to perform tasks that imitate activities of daily living, e.g. drinking from a cup and moving other complex objects. Sitting at a magnetic table subjects hold a 3D printed cup with an adjustable magnet and move this cup on the table to targets that can be drawn on the table surface. A ball rolling inside the cup can enhance the task challenge by introducing additional dynamics. A single video camera with a portable computer tracks real-time kinematics of the cup and the rolling ball using a custom-developed, color-based computer-vision algorithm. Preliminary verification with marker-based 3D-motion capture demonstrated that the device produces accurate kinematic measurements. Based on the real-time 2D cup coordinates, audio-visual feedback about performance can be delivered to increase motivation. The feasibility of using this device in clinical diagnostics is demonstrated on 2 neurotypical children and also 3 children with upper-extremity impairments in the hospital, where conventional motion-analysis systems are difficult to use. The device meets key needs for clinical practice: 1) a portable solution for quantitative motor assessment for upper-limb movement disorders at non-laboratory clinical settings, 2) a low-cost rehabilitation device that can increase the volume of in-home physical therapy, and 3) the device affords testing and training a variety of motor tasks inspired by daily challenges to enhance self-confidence to participate in day-to-day activities.



An integral part of clinical care for individuals with motor disorders is to assess motor function to guide and evaluate medical treatment, surgical intervention or physical therapy. One of the challenges for assessing motor function is to define sensitive and quantitative measures that can be readily obtained in clinical practice. The objective of this study was to develop a device that affords quantitative assessment of motor impairments in non-laboratory settings. The specific focus is on individuals with upper-limb movement disorders. One central goal was to ground the task in scientific research to relate clinical measures to research and capitalize on insights from fundamental research.

This paper first lays out the need for such a device particularly for children with motor disorders and post-stroke rehabilitation. We then motivate the specific motor task that was originally conceived for basic research on motor control. We then detail the design of the prototype with all hardware and software components so that it can be replicated. One design goal was to make the device low-cost, so that it can be used in many clinical environments including at home for therapeutic exercises. We conclude with first results from pilot experiments acquired both in a traditional laboratory setting and in an Epilepsy Monitoring Unit. These first data were obtained from children with dystonia. However, the device is not limited to this population and is currently further modified for the assessment of stroke patients.

A. Clinical Assessments of Motor Disorders

A motor disorder manifests as an impaired ability to execute a movement with the intended spatial and temporal pattern. This includes abnormal posturing, presence of unintended excessive movement, and normal movements occurring at unintended or inappropriate times [1]. Patients with upper-limb impairments require special assistance to perform common motor tasks associated with self-care, such as feeding and dressing. Challenges in their movement control result in frustration, which leads to less engagement and practice, and thereby fewer opportunities to attenuate their motor disabilities and improve their movement control.

Motor disorder are observed also among children. Cerebral Palsy (CP) is a common cause of movement disorders among children, affecting 3 to 4 individuals per 1000 births in the US. The dyskinetic form of CP occurs in 15% of all cases [2]. Due to inflexible postures, caused by muscle spasms and contractures together with involuntary jerky movements, children with dyskinetic CP are often prevented from participation in many daily activities. This also prevents them from acquiring age-appropriate motor skills during critical periods of skill development [3], [4]. This is particularly aggravated when the condition affects the upper limbs.

For clinical motor assessments, the current standard tools are clinical scales. For cerebral palsy, typical tests are the gross motor function classification system (GMFCS) [5], the manual ability classification system (MACS) [6], the House Scale [7], the Melbourne Assessment [8], the Assisting Hand Assessment [9], the Hypertonia Assessment Tool (HAT) [10], the Barry-Albright Dystonia (BAD) scale [11], and the Shriners Hospital for Children Upper Extremity Evaluation [12]. These outcome measures were devised to satisfy the typical criteria for effective outcome measures, including reliability, validity, specificity, and responsiveness [13]. Although useful, these rating scales rely on subjective assessment and questionnaires that are vulnerable to inter-rater and test-retest reliability, nonlinearity, multi-dimensionality, and ceiling or floor effects [14]. These shortcomings need to be overcome by more quantitative outcome measures to provide a better evaluation of the individual’s motor functions and abilities, and potentially utilize such measures to objectvely assess and titrate interventions.

B. Quantitative Assessment of Motor Function

Motion tracking technologies have provided quantitative means of recording movements through a variety of sensing technology that tracks and stores movement. Camera-based motion capture, such as Vicon (Vicon Motion Systems, Oxford, UK) and Optitrak (Northern Digital Inc, Ontario, CA) requires external markers or sensors placed on key anatomical landmarks to reconstruct the skeletal model of human body parts. These state-of-the-art technologies track motion to very high precision with high sampling rates and they have been used for pre- and post-treatment assessment of upper- or lower-extremity pathologies. However, such data acquisition is limited to traditional laboratory settings because the multi-camera systems are expensive and not portable.

On the other hand, there are low-cost inertial measurement units (IMUs) that directly measure acceleration, rotational change and magnetic orientation. While these sensors have the advantage that they are self-contained and wearable, drawbacks are degraded accuracy due to drift, calibration errors and noise inherent to inertial sensors and the need to frequently recharge batteries for real-time data streaming [15]. Moreover, attaching sensors to body parts can be inconvenient or even impossible for certain clinical populations, and many children will not tolerate them.

In view of the above arguments, there is a strong need for less invasive devices that can provide quantitative measurements in tasks related to upper-extremeity motor function. Preferably, such a device should allow for portability and be low-cost to reach large populations.

C. Low-Cost Rehabilitation at Home

Rehabilitation follows standard practice and frequently requires one-on-one interaction with a therapist for extended periods of time. For these reasons, robotic devices have emerged to deliver higher-dosage and higher-intensity training for patients with movement disorders such as cerebral palsy and stroke [16]–[17][18][19]. However, while effective, robotic therapy is expensive and to date can only be used in clinical settings. To increase the volume in therapy, lower-cost devices that can be used at home are urgently needed.

Performance improvements with predominant home training are indeed possible. This was demonstrated by pediatric constraint-induced movement therapy (CIMT) for children with hemiparetic CP [20], [21]. Further, it was shown that even children with severe dystonia can improve their performance if they use an interface or device that enables and facilitates their severely handicapped movements [22].

A portable low-cost device for home use that is able to provide reliable quantitative measurements would help address the above shortcomings. Measurements could also be streamed to careproviders on a secure cloud protocol, for diagnosis of interventions, analysis of therapeutic outcomes, and further follow up.

D. Theoretically-Grounded Rehabilitation

Motor tasks for home therapy should be engaging to avoid boredom and attrition and should also have functional relevance. With this goal in mind, we developed a motor task that was motivated by the daily self-feeding activity of leading a cup of coffee or a spoon filled with soup to the mouth. The core challenge of actions of this kind is that moving such an object with sloshing liquid presents complex interaction forces: any force applied to the cup also applies a force to the liquid that then acts back on the hand. When such internal dynamics is present, interaction forces become quite complex, and the human performing the task needs to predict and preempt the internal dynamics of the moving liquid. Clearly, better understanding task is like guiding a cup of coffee to one’s mouth or a spoonful of soup has high functional relevance. While many such functional tasks have been developed for rehabiltation (e.g., the box-and-block and the pegboard task), the quantitative assessment should allow for more than descriptive outcome measures such as error or success rate. Monitoring the ‘process’ continuously should provide more detailed insight into coordinative challenges. This is indeed possible in the task of guiding a cup of coffee as we explain next.

In previous research, we abstracted a relevant, yet simplified model task, inspired by guiding a cup of coffee [23]–[24][25][26]. To reduce the complexity and afford theoretical analyses, the “cup of coffee” was simplified to a rigid object with a rolling ball inside. The rolling ball represents the moving liquid; this is also similar to the children’s game of transporting an egg in a spoon [27]. Fig.1A-C shows the transition from the real object to the simplified physical model. Importantly, the original task (Fig.1A) was reduced to a two-dimensional model, where the subject interacts with the object via a robotic manipulandum. The virtual model consists of a cart with a suspended pendulum, a well-known benchmark problem in control theory.

FIGURE 1.Model for the task of carrying a cup of coffee. A: The real object. B: The simplified physical model. C: The equivalent cart-and pendulum model implemented in the virtual task.


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[Abstract] Hand Rehabilitation via Gesture Recognition Using Leap Motion Controller – Conference Paper

I. Introduction

Nowadays, a stroke is the fourth leading cause of death in the United States. In fact, every 40 seconds, someone in the US is having a stroke. Moreover, around 50% of stroke survivors suffer damage to the upper extremity [1]–[3]. Many actions of treating and recovering from a stroke have been developed over the years, but recent studies show that combining the recovery process with the existing rehabilitation plan provides better results and a raise in the patients quality of life [4]–[6]. Part of the stroke recovery process is a rehabilitation plan [7]. The process can be difficult, intensive and long depending on how adverse the stroke and which parts of the brain were damaged. These processes usually involve working with a team of health care providers in a full extensive rehabilitation plan, which includes hospital care and home exercises.


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13. K. R. Anderson, M. L. Woodbury, K. Phillips, L. V. Gauthier, “Virtual reality video games to promote movement recovery in stroke rehabilitation: a guide for clinicians”, Archives of physical medicine and rehabilitation, vol. 96, no. 5, pp. 973-976, 2015.

14. A. Estepa, S. S. Piriz, E. Albornoz, C. Martínez, “Development of a kinect-based exergaming system for motor rehabilitation in neurological disorders”, Journal of Physics: Conference Series, vol. 705, pp. 012060, 2016.

15. E. Chang, X. Zhao, S. C. Cramer et al., “Home-based hand rehabilitation after chronic stroke: Randomized controlled single-blind trial comparing the musicglove with a conventional exercise program”, Journal of rehabilitation research and development, vol. 53, no. 4, pp. 457, 2016.

16. L. Ebert, P. Flach, M. Thali, S. Ross, “Out of touch-a plugin for controlling osirix with gestures using the leap controller”, Journal of Forensic Radiology and Imaging, vol. 2, no. 3, pp. 126-128, 2014.

17. W.-J. Li, C.-Y. Hsieh, L.-F. Lin, W.-C. Chu, “Hand gesture recognition for post-stroke rehabilitation using leap motion”, Applied System Innovation (ICASI) 2017 International Conference on, pp. 386-388, 2017.

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20. L. Di Tommaso, S. Aubry, J. Godard, H. Katranji, J. Pauchot, “A new human machine interface in neurosurgery: The leap motion (®). technical note regarding a new touchless interface”, Neuro-Chirurgie, vol. 62, no. 3, pp. 178-181, 2016.

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[Abstract] Towards an Immersive Virtual Reality Game for Smarter Post-Stroke Rehabilitation


Traditional forms of physical therapy and rehabilitation are often based on therapist observation and judgment, coincidentally this process oftentimes can be inaccurate, expensive, and non-timely. Modern immersive Virtual Reality systems provide a unique opportunity to make the therapy process smarter. In this paper, we present an immersive virtual reality stroke rehabilitation game based on a widely accepted therapy method, Constraint-Induced Therapy, that was evaluated by nine post-stroke participants. We implement our game as a dynamically adapting system that can account for the user’s motor abilities while recording real-time motion capture and behavioral data. The game also can be used for tele-rehabilitation, effectively allowing therapists to connect with the participant remotely while also having access to +90Hz real-time biofeedback data. Our quantitative and qualitative results suggest that our system is useful in increasing affordability, accuracy, and accessibility of post-stroke motor treatment.

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[Abstract + References] Towards a framework for rehabilitation and assessment of upper limb motor function based on Serious Games – IEEE Conference Publication


 Serious Games and Virtual Reality (VR) are being considered at present as an alternative to traditional rehabilitation therapies. In this paper, the ongoing development of a framework focused on rehabilitation and assessment of the upper limb motor function based on serious games as a source of entertainment for physiotherapy patients is described. A set of OpenSource Serious Games for rehabilitation has been developed, using the last version of Microsoft1® Kinect™ as low cost monitoring sensor and the software Unity. These Serious Games captures 3D human body data and it stored them in the patient database to facilitate a later clinical analysis to the therapist. Also, a VR-based system for the automated assessment of motor function based on Fugl-Meyer Assessment Test (FMA) is addressed. The proposed system attempts to be an useful therapeutic tool for tele-rehabilitation in order to reduce the number of patients, time spent and cost to

I. Introduction

Biomechanical analysis is an important feature during the evaluation and clinical diagnosis of motor deficits caused by traumas or neurological diseases. For that reason Motion capture (MoCap) systems are widely used in biomechanical studies, in order to collect position data from anatomical landmarks with high accuracy. Their results are used to estimate joint movements, positions, and muscle forces. These quantitative results improve the tracking of changes in motor functions over time, being more accurately than clinical ratings [1]. For clinical applications, these results are usually transformed into clinically meaningful and interpretable parameters, such as gait speed, motion range of joints and body balance.


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[Master’s thesis] Tracking, monitoring and feedback of patient exercises using depth camera technology for home based rehabilitation – ANNA RIDDERSTOLPE – Full Text PDF


Neurological and chronic diseases have profound impacts on a person’s life. Rehabilitation is essential in order to maintain and promote maximal level of recovery by pushing the bounds of physical, emotional and cognitive impairments. However, due to the low physical mobility and poor overall condition of many patients, traveling back and forth to doctors, nurses and rehabilitation centers can be exhausting tasks. In this thesis a game-based rehabilitation platform for home usage, supporting stroke and COPD rehabilitation is presented. The main goal is to make rehabilitation more enjoyable, individualized and easily accessible for the patients.

The game-based rehabilitation tool consists of three systems with integrated components: the caregiver’s planning and follow-up system, the patient’s gaming system and the connecting server system. The server back end components allow the storage of patient specific information that can be transmitted between the patient and the caregiver system for planning, monitoring and feedback purposes. The planning and follow-up system is a server system accessed through a web-based front-end, where the caregiver schedules the rehabilitation program adjusted for each individual patient and follow up on the rehabilitation progression. The patient system is the game platform developed in this project, containing 16 different games and three assessment tests. The games are based on specific motion patterns produced in collaboration with rehabilitation specialists. Motion orientation and guidance functions is implemented specifically for each exercise to provide feedback to the user of the performed motion and to ensure proper execution of the desired motion pattern.

The developed system has been tested by several people and with three real patients. The participants feedback supported the use of the game-based platform for rehabilitation as an entertaining alternative for rehabilitation at home. Further implementation work and evaluation with real patients are necessary before the product can be used for commercial purpose.

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[STUDY] – Design of a physiologically informed virtual reality based interactive platform for individuals with upper limb impairment

A large number of stroke-surviving individuals exhibit deficits related to upper limb movement, thereby making post stroke rehabilitation a critical part of patients’ health care system. The patients are typically treated with conventional occupational therapy at the hospital after stroke. However, due to economic pressures and limited health care resources often the patients receive less therapy than required causing them to be deprived of the potential therapeutic benefits. Thus implementing a cost-effective home based technology-assisted rehabilitation system which is capable of providing intensive, adaptive and individualized rehabilitation service is critical. Virtual reality (VR) based rehabilitation system seems to address this challenge effectively. VR technology for rehabilitation allows us to create an interactive environment with precise control over intensity of practice that influence one’s motor control in an individualized manner. In this study we developed an interactive VR-based platform which challenges the coordination skill of individuals with upper limb impairment. Additionally, we used patient’s physiological indices to understand their stress level while they interact with the VR-based rehabilitation environment. The system developed in this work is a first step to understand its potential to provide individualized home-based rehabilitative service with minimal dependency on physiotherapist. In our initial study designed as a proof-of-concept application, one stroke-surviving patient participated in the interactive VR-based task. The preliminary results obtained from this initial study indicate the potential of mapping one’s stress level to his physiological indices. Thus these results indicate the potential applicability of such a system for various stroke-rehabilitation applications

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