Posts Tagged UE

[Abstract+References] Robot assisted rehabilitation of the arm after stroke: prototype design and clinical evaluation

Abstract

Robot assisted rehabilitation training is a promising tool for post-stroke patients’ recovery, and some new challenges are imposed on robot design, control, and clinical evaluation. This paper presents a novel upper limb rehabilitation robot that can provide safe and compliant force feedbacks to the patient for the benefits of its stiff and low-inertia parallel structure, highly backdrivable capstan-cable transmission, and impedance control method in the workspace. The “assist-as-needed” (AAN) clinical training principle is implemented through the “virtual tunnel” force field design, the “assistance threshold” strategy, as well as the virtual environment training games, and preliminary clinical results show its effectiveness for motor relearning for both acute and chronic stroke patients, especially for coordinated movements of shoulder and elbow.

Supplementary material

11432_2017_9076_MOESM1_ESM.pdf (1.7 mb)

Robot assisted rehabilitation of the arm after stroke: prototype design and clinical evaluation
11432_2017_9076_MOESM2_ESM.mp4 (96.2 mb)

Supplementary material, approximately 96.2 MB.
11432_2017_9076_MOESM3_ESM.mp4 (43.6 mb)

Supplementary material, approximately 43.6 MB.

Source: Robot assisted rehabilitation of the arm after stroke: prototype design and clinical evaluation | SpringerLink

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[Abstract+References] A Low-Cost and Lightweight Alternative to Rehabilitation Robots: Omnidirectional Interactive Mobile Robot for Arm Rehabilitation 

Abstract

Robotic rehabilitation is a growing field. Robots facilitate repetitive therapies, which have positive effects on the rehabilitation of patients who lack arm control because of central nervous system lesions. However, the use of such rehabilitation robots is rare due to high costs and low acceptance among patients. Therefore, this study is focused on the development and control of a novel low-cost omnidirectional interactive mobile robotic platform with force feedback to assist and guide a patient’s hand during therapy. The primary goals for such a mobile robot are to minimize its weight and dimensions, which are significant factors in patient acceptance. Position-based stiffness control was employed with a proportional derivative controller to control the position of the robot and to assist the patient during motion. A user interface with given tasks was built to manage tasks, obtain test results and set control variables. Test results showed that the developed experimental mobile robot successfully assisted and guided the user during the test period.

References

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Source: A Low-Cost and Lightweight Alternative to Rehabilitation Robots: Omnidirectional Interactive Mobile Robot for Arm Rehabilitation | SpringerLink

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[Abstract] Comparisons of Intrinsic Motivation for Novel Stroke Rehabilitation Interventions

 

Abstract

An estimated 80% of individuals with stroke experience upper limb dysfunction and 60% of stroke survivors will not regain full use of the affected arm. Improvement in motor function is possible even in the chronic phase of stroke through motor rehabilitation. Rehabilitation is a lengthy process and has little chance of success if a patient is not dedicated to his or her regime. Highly motivated patients are more likely to adhere to a rehabilitation program and motivation has been linked to better therapeutic outcomes in many studies.

This study evaluated how motivating participants of experimental stroke rehabilitation interventions found their upper extremity (UE) rehabilitation regime and compared those scores to the data gathered in the Human Performance Laboratory (HPL).

A literature review was conducted. Interventions were sorted into the categories gaming, gaming with assistance, robotic training, mixed reality, and conventional therapy. Six studies from the HPL were used. Mean interest/enjoyment (I/E) subscale scores of the Intrinsic Motivation Inventory (IMI) were gathered for each category and the level of intrinsic motivation was determined.

All categories produced a highly positive I/E scores. All of the categories except conventional therapy produced a higher mean score for reported I/E than the HPL.

Personality traits of the participants can likely account for these higher-than-average levels of intrinsic motivation. Though the HPL did not outperform the other categories, it is comparable to other gaming interventions and has the unique advantages of affordability and accessibility these lack. Future work in personalized virtual reality (PVR) therapy that seeks to make interventions more intrinsically motivating may consider the potential benefits that lie within these other approaches to UE rehabilitation including using specialized games for persons with stroke and providing external support to the players.

Source: “Comparisons of Intrinsic Motivation for Novel Stroke Rehabilitation In” by Dorothy Kalmbach

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[Abstract] A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy. 1: Heterogeneous EMG Changes despite Consistent Improvements in Clinical Assessments

Post-stroke weakness on the more-affected side may arise from reduced corticospinal drive, disuse muscle atrophy, spasticity, and abnormal co-ordination. This study investigated changes in muscle activation patterns to understand therapy-induced improvements in motor-function in chronic stroke compared to clinical assessments, and to identify the effect of motor-function level on muscle activation changes.

Electromyography (EMG) was recorded from 5 upper-limb muscles on the more-affected side of 24 patients during early- and late-therapy sessions of an intensive 14-day program of Wii-based Movement Therapy, and for a subset of 13 patients at 6-month follow-up. Patients were classified according to residual voluntary motor capacity with low, moderate or high motor-function. The area under the curve was calculated from EMG amplitude and movement duration. Clinical assessments of upper-limb motor-function pre- and post-therapy included the Wolf Motor Function Test, Fugl-Meyer Assessment and Motor Activity Log Quality of Movement scale.

Clinical assessments improved over time (p<0.01) with an effect of motor-function level (p<0.001). The pattern of EMG change by late-therapy was complex and variable, with differences between patients with low compared to moderate or high motor-function. The area under the curve (p=0.028) and peak amplitude (p=0.043) during Wii-tennis backhand increased for patients with low motor-function whereas EMG decreased for patients with moderate and high motor-function. The reductions included: movement duration during Wii-golf (p=0.048, moderate; p=0.026, high), and Wii-tennis backhand (p=0.046, moderate; p=0.023, high) and forehand (p=0.009, high); and the area under the curve during Wii-golf (p=0.018, moderate) and Wii-baseball (p=0.036, moderate). For the pooled data over time there was an effect of motor-function (p=0.016) and an interaction between time and motor-function (p=0.009) for Wii-golf movement duration. Wii-baseball movement duration decreased as a function of time (p=0.022). There was an effect on Wii-tennis forehand duration for time (p=0.002) and interaction of time and motor-function (p=0.005); and an effect of motor-function level on the area under the curve (p=0.034) for Wii-golf.

This study demonstrated different patterns of EMG changes according to residual voluntary motor-function levels despite heterogeneity within each level that was not evident following clinical assessments alone. Thus, rehabilitation efficacy might be underestimated by analyses of pooled data.

Source: Frontiers | A Longitudinal EMG Study of Complex Upper-limb Movements in Post-stroke Therapy. 1: Heterogeneous EMG Changes despite Consistent Improvements in Clinical Assessments | Neurology

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[WEB SITE] What Is Gravity Compensation – Saebo

What is Gravity Compensation?

Weight supported systems assist patients with making more meaningful movements during the rehabilitation process. It counteracts the effects of gravity making it possible for clients to functionally integrate their affected arm during various tasks. Additionally, by “unweighting” the limb, compensation and fatigue are minimized thereby intensifying treatment and driving neural changes.

Why Mobile Arm Supports?

Mobile Arm Supports are gravity supported mechanical devices typically mounted on wheelchairs, tables or base frames. They are used to support the weak upper limb to improve function and movement. These devices allow patients with proximal weakness to perform self-care tasks such as feeding, hygiene, grooming, and writing.

Compensatory and Remedial.

In addition to using mobile arm supports to perform activities of daily living, recent scientific studies have shown that supporting the hemiparetic limb leads to improved motor recovery.

Increase strength and coordination
Relearn normal movement
Reduce abnormal synergy patterns
Decrease compensation

Ring Out the Old.

Teaditional Arm Training

Therapist providing hand-over-hand assistance to help move the affected arm.

Traditionally, arm training has primarily been performed by the clinician, or caregiver, using manual techniques such as hand-over-hand assistance. More recently, arm training, using zero-gravity devices, have become increasingly popular as a new way to intensify rehabilitation. Regardless of the diagnosis, scientific evidence suggests that intensive therapy is required to make meaningful progress. With Saebo’s unweighting technology, clients can now maximize their recovery in the clinic and at home.

 

Source: What Is Gravity Compensation | Saebo

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[Abstract] Gross Motor AbiLity predictS Response to upper extremity rehabilitation in chronic stroke  

Abstract

The majority of rehabilitation research focuses on the comparative effectiveness of different interventions in groups of patients, while much less is currently known regarding individual factors that predict response to rehabilitation. In a recent article, authors presented a prognostic model to identify the sensorimotor characteristics predictive of the extent of motor recovery after Constraint-Induced Movement (CI) therapy amongst individuals with chronic mild-to-moderate motor deficit using the enhanced probabilistic neural network (EPNN). This follow-up paper examines which participant characteristics are robust predictors of rehabilitation response irrespective of the training modality. To accomplish this, EPNN was first applied to predict treatment response amongst individuals who received a virtual-reality gaming intervention (utilizing the same enrollment criteria as the prior study). The combinations of predictors that yield high predictive validity for both therapies, using their respective datasets, were then identified. High predictive classification accuracy was achieved for both the gaming (94.7%) and combined datasets (94.5%). Though CI therapy employed primarily fine-motor training tasks and the gaming intervention emphasized gross-motor practice, larger improvements in gross motor function were observed within both datasets. Poorer gross motor ability at pre-treatment predicted better rehabilitation response in both the gaming and combined datasets. The conclusion of this research is that for individuals with chronic mild-to-moderate upper extremity hemiparesis, residual deficits in gross motor function are highly responsive to motor restorative interventions, irrespective of the modality of training.

Source: Gross Motor AbiLity predictS Response to upper extremity rehabilitation in chronic stroke – ScienceDirect

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[VIDEO] Pablo Product Film – YouTube

Δημοσιεύτηκε στις 18 Ιουλ 2017

The PABLO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for arms and hands. The new design and the specially developed tyroS software make the PABLO more flexible and offer an expanded spectrum of therapy options.

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[WEB SITE] FDA Clears SaeboVR Virtual ADL Rehabilitation System

SaeboVR, a virtual ADL (activities of daily living) rehabilitation system designed to provide real-life challenges to help neurological patients rehabilitate their upper extremities, has recently received clearance from the US Food and Drug Administration.

Manufactured by medical device company Saebo Inc, SaeboVR features an ADL-focused virtual world that provides patients with real-life situations challenging patients to use their impaired upper limbs to perform, such as picking up, transferring, and manipulating virtual objects. Recreations include making breakfast, taking care of a pet, or planting a virtual garden.

Additional features include a virtual assistant to educate users and provide feedback, as well as the ability to be customized to challenge patients’ endurance, speed, range of motion, coordination, timing, and cognitive demand.

After each session, SaeboVR displays graphical reports, according to a media release from Saebo.

The system was borne from National Institutes of Health-sponsored research demonstrating the efficacy of using virtual ADL to help rehabilitate the upper extremities.

“The release of SaeboVR culminates 5 years of NIH-sponsored R&D and successful clinical trials that have provided a solid body of evidence for the efficacy of simulated ADLs in improving upper extremity motor function in individuals with acquired brain injury,” says Richard Adams, PhD, from Barron Associates Inc, which has partnered with Saebo Inc to create the system.

SaeboVR opens new possibilities for clinicians and patients,” notes Saebo Inc’s co-founder, Henry Hoffman, per the release. “Prior to this break-through technology, motion capture programs were primarily focused on games rather than real-life functional tasks. Although computer-based exercises can be beneficial, often times, therapists report that games are not always appropriate for a certain patient population or lack significance to maintain a client’s motivation and engagement.”

[Source(s): Saebo Inc, PR Newswire]

Source: FDA Clears SaeboVR Virtual ADL Rehabilitation System – Rehab Managment

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[Abstract] Efficacy and safety of botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analysis.

Abstract

INTRODUCTION:

Muscle spasticity is a positive symptom after stroke and traumatic brain injury. Botulinum toxin type A (BoNT-A) injection is widely used for treating post stroke and traumatic brain injury spasticity. This study aimed to evaluate efficacy and safety of BoNT-A for upper limb spasticity after stroke and traumatic brain injury and investigate reliability and conclusiveness of available evidence for BoNT-A intervention.

EVIDENCE ACQUISITION:

We searched electronic databases from inception to September 10 of 2016. Randomized controlled trials comparing the effectiveness between BoNT-A and placebo in stroke or traumatic brain injury adults with upper limb spasticity were included. Reliability and conclusiveness of the available evidence were examined with trial sequential analysis.

EVIDENCE SYNTHESIS:

From 489 citations identified, 22 studies were included, reporting results for 1804 participants. A statistically significant decrease of muscle tone was observed at each time point after BoNT-A injection compared to placebo (SMD at week 4=-0.98, 95% CI: -1.28 to -0.68; I2=66%, P=0.004; SMD at week 6=-0.85, 95% CI: -1.11 to -0.59, I2=1.2%, P=0.409; SMD at week 8=-0.87, 95% CI: -1.15 to -0.6, I2=0%, P=0.713; SMD at week 12=-0.67, 95% CI: -0.88 to -0.46, I2=0%, P=0.896; and SMD over week 12=-0.73, 95% CI: -1.21 to -0.24, I2=63.5%, P=0.065).Trial sequential analysis showed that as of year 2004 sufficient evidence had been accrued to show significant benefit of BoNT-A four weeks after injection over placebo control. BoNT-A treatment also significantly reduced Disability Assessment Scale Score than placebo at 4, 6 and 12-week follow-up period (WMD=-0.33, 95% CI: -0.63 to -0.03, I2=60%, P=0.114; WMD=-0.54, 95% CI: -0.74 to -0.33, I2= 0%, P=0.596 and WMD=-0.3, 95% CI: -0.45 to -0.14, I2=0%, P=0.426 respectively), and significantly increased patients’ global assessment score at week 4 and 6 after injection (SMD=0.56, 95% CI: 0.28 to 0.83; I2=0%, P=0.681 and SMD=1.11, 95% CI: 0.4 to 1.77; I2=72.8%, P=0.025 respectively). No statistical difference was observed in the frequency of adverse events between BoNT-A and placebo group (RR=1.36, 95% CI [0.82, 2.27]; I2=0%, P=0.619).

CONCLUSIONS:

As compared with placebo, BoNT-A injections have beneficial effects with improved muscle tone and well-tolerated treatment for patients with upper limb spasticity post stroke or traumatic brain injury.

Source: Efficacy and safety of botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analy… – PubMed – NCBI

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[WEB SITE] Hocoma and Saebo Partner to Deliver Compact, Affordable Rehabilitation Solution for Upper Extremities

ArmeoSenso with SaeboMas Mini Body Weight Support System (Photo: Business Wire).

July 17, 2017 10:00 AM Eastern Daylight Time

ZURICH & CHARLOTTE, N.C.–(BUSINESS WIRE)–Hocoma and Saebo today announced a partnership to improve the training possibilities for patients with moderate to mild impairments of the upper extremities. Together, the SaeboMas Mini and the ArmeoSenso deliver an easy-to-use, compact solution at an affordable price.

“Saebo is committed to helping patients around the globe achieve a new level of independence”

“Saebo is committed to helping patients around the globe achieve a new level of independence,” said Henry Hoffman, co-founder of Saebo. “Together with an industry leader such as Hocoma, we believe we can maximize the potential of our affordable and evidence-based solutions.”

“We are very excited to be working with Saebo,” said Hocoma CEO and co-founder Dr. Gery Colombo. “Neurological disorders afflict thousands of people each year and by teaming up with another leading player in the industry, we expect to be able to help even more patients recover faster and with better long-term outcomes than conventional rehabilitation therapy can offer.”

In the future, Saebo and Hocoma plan to deepen their partnership. Further solutions are expected to be optimized so that they complement each other as perfectly as the SaeboMas Mini and the ArmeoSenso. Dr. Gery Colombo added: “Our ultimate goal is to provide all patients with a compact, affordable rehabilitation solution – regardless of the specific body parts affected by neurological damage.”

The new partnership can be experienced live at Rehabweek in London from July 17-21.

About Hocoma

A successful therapy begins in patients’ heads. In the firm belief that – step by step – they can reach their goals and regain quality of life.

This is what we work for at the Swiss medtech company Hocoma. With technologies and ideas that look at functional movement therapy from a completely different angle. Because they enable independent exercises and create maximum motivation. Because they challenge people to take courage and support their hopes with personal achievements.

We are committed to creating the ideal therapy. Our awarded robotic and sensor-based devices offer solutions for intensive gait therapy (Lokomat®, Andago®), functional therapy of the upper extremities (Armeo®), robotic mobilization and functional electrical stimulation in early rehabilitation (Erigo®) as well as functional movement therapy within low back pain treatment (Valedo® Therapy Concept) at home and at the clinic. They are the result of intensive research, consistent development and continuous exchange with patients, therapists and partners in research and science.

Those who see to break new grounds need to stay open to exceptional ideas. They have the potential of being exceptionally effective. This guiding principle by Hocoma founder and CEO Dr. Gery Colombo has accompanied us since our start in 2000 and is still lived and implemented by our dedicated employees around the world. At the headquarters in Volketswil near Zurich (Switzerland) and the subsidiaries in the USA, Singapore and Slovenia they achieved a turnover of 30 million CHF in 2016.

About Saebo

Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 250,000 clients around the globe achieve a new level of independence.

For more information about Saebo, please visit: www.saebo.com.

Product Disclaimer

All Hocoma products are medical devices and must be used in strict adherence to the User Manual; failure to do so may result in serious personal injury. It is strongly recommended that you regularly consult Hocoma’s website (www.hocoma.com/legalnotes) for the latest available information. Please contact Hocoma in case of any questions.

Use only under the supervision of qualified medical personnel. However, certain Hocoma products are marketed for home use and must be strictly used according to the recommendations of your medical care provider who is knowledgeable about your specific needs. Consult the User Manual and Hocoma’s website (www.hocoma.com/legalnotes) for appropriate product designation. Failure to obtain and follow the recommendations of your medical care provider may result in serious personal injury.

This information provides details about medical products which may not be available in all countries and may not have received approval or market clearance by all governmental regulatory bodies throughout the world. Nothing herein should be construed as a solicitation or promotion of any product or of an indication of any specific use for any product which is not authorized by the laws and regulations of the country where the reader of this information resides.

Contacts

Hocoma AG
Mike Fuhrmann, +41 43 444 23 65
Chief Creative Officer
media@hocoma.com
Fax: +41 43 444 22 01
www.hocoma.com

Source: Hocoma and Saebo Partner to Deliver Compact, Affordable Rehabilitation Solution for Upper Extremities | Business Wire

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