Posts Tagged Upper limb rehabilitation

[Abstract] Efficient FEM Based Optimization of a Parallel Robotic System for Upper Limb Rehabilitation


Cardiovascular stroke (CVS) is one of the leading causes of motor disabilities worldwide, and unfortunately the number of cases keeps increasing, and will continue to increase until personnel shortages will make the motor rehabilitation procedure to be more challenging. The main solution for this is the automation of the rehabilitation process through the use of robotic technologies capable of providing high dosage and intensity training with minimal interference from the kinesiotherapy specialist. In this paper, the authors present a parallel robotic solution for the rehabilitation of the wrist joint. FEM based simulations are carried out on the most stressed/strained components to identify the reaction forces acting on them during the execution of a rehabilitation exercises. Furthermore the mechanical structure of the targeted components is optimized and placed under FEM analysis again to demonstrate the improvements that have been brought, while tests in medical environment are presented to validate the rehabilitation robotic system.


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[ARTICLE] Descriptive Study on Rehabilitation Treatment and Evaluation Methods for Improving Upper Limb Function in Stroke Patients – Full Text PDF


Stroke is a disease in the central nervous system in which sudden ischemia or haemorrhage in blood vessels disrupts the smooth blood supply to brain tissues, resulting in a partial loss of brain function and consequent functional disorders.

Aim and Scope: To improve upper limb function, current stroke interventions employ various treatment methods targeted at the nervous system. Interventions and studies are underway regarding continuous upper limb training programs, such as constraintinduced movement therapy, mirror therapy, imagery training, and robot therapy.

Method: In recent years, treatments using virtual reality systems have also been applied. And various evaluation methods were developed for stroke patients. However, despite the various treatment and evaluation methods introduced thus far, most therapists still insist on applying the methods that they have mainly been using. If the therapist can accurately recognize each treatment/evaluation methods and apply the appropriate treatment method to various situations, a more qualitative treatment can be applied.

Conclusion: This study intends to introduce the existing treatment and evaluation methods of improving stroke patients’ upper limb function and find ways for therapists to make better use of them through a proper understanding of each method’s characteristics.[…]

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[Abstract + References] Satisfaction of the Immersive Virtual Reality in Upper Limb Rehabilitation – Conference paper


The Immersive Virtual Reality system has been used by occupational therapists in upper limb rehabilitation treatments and has proven to improve treatment satisfaction and effectiveness. The purpose of this research was to evaluate the usage satisfaction of immersive virtual reality in rehabilitation. All subjects were required to complete a questionnaire after using the HTC Vive system. The results after recruiting a total of nineteen stroke patients in this research are as follows: (1) after using the HTC Vive system, 89% of patients agreed that their motivation to receive treatment can be improved. (2) 79% of patients think that the HTC Vive system is effective for improving upper limb functions. (3) Regarding ease of use, 42% of patients think that the HTC Vive system is not easy to operate. (5) 95% of patients were satisfied with the HTC Vive system used in upper limb rehabilitation. The research results offer design reference for future rehabilitation therapy and virtual reality game development.


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[Abstract] Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke: Use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland

The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice.

A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention.

The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation.

Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake.

via Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke: Use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland – Gillian Sweeney, Mark Barber, Andrew Kerr,

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[Abstract+ References] Upper Limb Rehabilitation Electromechanical System for Stroke Patients – Conference paper


The mechanical and electrical system of upper limb rehabilitation is a kind of medical equipment which relies on the aid of machine to help stroke patients to carry out upper limb activity training. Many stroke patients can not move independently, which greatly limits their lives. In this paper, we have learned the etiology and symptoms of stroke patients, scientifically formulated their training methods and movements, and fully considered the safety and practicability of the equipment, and used relatively light materials as far as possible. For stroke patients to provide a safe, comfortable, effective upper limb wearable exoskeleton machine, can be anytime and anywhere rehabilitation training, simple appearance, low cost, suitable for stroke patients to use, to help them recover. Realize the independence of movement.


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via Upper Limb Rehabilitation Electromechanical System for Stroke Patients | SpringerLink

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[ARTICLE] Brain–computer interface and assist-as-needed model for upper limb robotic arm – Full Text

Post-stroke paralysis, whereby subjects loose voluntary control over muscle actuation, is one of the main causes of disability. Repetitive physical therapy can reinstate lost motions and strengths through neuroplasticity. However, manually delivered therapies are becoming ineffective due to scarcity of therapists, subjectivity in the treatment, and lack of patient motivation. Robot-assisted physical therapy is being researched these days to impart an evidence-based systematic treatment. Recently, intelligent controllers and brain–computer interface are proposed for rehabilitation robots to encourage patient participation which is the key to quick recovery. In the present work, a brain–computer interface and assist-as-needed training paradigm have been proposed for an upper limb rehabilitation robot. The brain–computer interface system is implemented with the use of electroencephalography sensor; moreover, backdrivability in the actuator has been achieved with the use of assist-as-needed control approach, which allows subjects to move the robot actively using their limited motions and strengths. The robot only assists for the remaining course of trajectory which subjects are unable to perform themselves. The robot intervention point is obtained from the patient’s intent which is captured through brain–computer interface. Problems encountered during the practical implementation of brain–computer interface and achievement of backdrivability in the actuator have been discussed and resolved.

The recovery of upper limb motions and strengths in patients with damaged neuromuscular system via robotic rehabilitation devices is a promising way of enhancing existing treatments and their efficacies. Various reasons may cause limb dysfunctions, including stroke, spinal cord injuries, or even ligament rupture. According to the World Health Organization, about 15 million people globally suffer from Cerebro-Vascular Accidents (CVAs) each year and up to 65% of these need limb recovery procedures.1 Only in the last 15 years, the number of CVA or stroke patients is increased by 40%, which is the result of a more intense pace of living, deterioration of ecology, and increased aging population.2 Considering these statistics, development of new and efficient ways of rehabilitation is just as important as implementation of improved prevention strategies.

For the last 20 years, robotics-based therapy was steadily paving its way for becoming an essential practice in rehabilitation medicine.3,4 According to the systematic review of Kwakkel et al.5 on the upper limb recovery using robot-aided therapy, repetitive, meaningful, labor-intensive treatment programs implemented with robotic devices provide positive impact for the restoration of functional abilities in human limbs. In medical terminology, a device that provides support, and aligns or improves the function of movable limbs is known as orthosis, and robotic devices intended to provide such treatment are called robotic orthoses.6 Particularly, two key directions gained major attention in the medical engineering research: robot-assisted therapy and functional electrical simulation (FES) therapy. The FES therapy describes a technique that stimulates weakened or paralyzed muscles on a human limb by applying electric charges externally. The goal of FES therapy is to reactivate the neural connections between a muscle and human’s sensorimotor system to enable patients’ ability to control their limbs without assistance.7 In the study by Popovic and others, the functional electrical therapy (FET) was applied with the use of surface electrodes and it was used to stimulate arm fingers of patients, this therapy has demonstrated positive therapeutic effects.8 It was revealed that daily 30-min therapy for 1-month period allowed improvement in movement range, speed, and increased strength in muscles. There are also side effects of FES-based treatment such as pain and irritation on the affected area, autonomic dysreflexia, increased spasticity, broken bones, and mild electric shocks from faulty equipment. However, the robot-assisted rehabilitation is non-invasive and free from above risks, and it is preferred for the rehabilitation of stroke survivors.

The important advantage of robotic devices is that they can reduce the burden on health care workers who traditionally had to conduct labor-intensive training sessions for patients. Equipped with sensors, intelligent controllers, and haptic and visual interfaces, robotic orthosis can have a potential to put the recovery process to a new level by collecting relevant data about various health parameters (pulse rate, body temperature, etc.) and adjusting the training modes accordingly. Besides the positive impacts of robot-based rehabilitation, the reliability of robot-based assistance is still questionable and adversely it may worsen the recovery progress made before, and that depends on the type of assistance control robot employs.9 Assist-as-needed (AAN) control type has become one of the prominent strategies recently which has been recommended positively from clinical trials.10 In order to stabilize the system, AAN-based approach has become subject to be researched by scientists. In the work done by Wolbrecht, AAN control is obtained from the adaptive control by incorporating novel force to address and decrease the system’s parametric errors.11 There are also other works which propose AAN type of control for their systems;1214 however, there are no works which have incorporated both BCI (brain–computer interface)- and AAN-based control approach into the system.

Owing to the recent advances in biosensors, especially in their robustness and signal processing, robot controllers equipped with bio-sensing are able to achieve intelligence with less complex algorithms. One of the most recent applications of BCI is in the domain of orthoses.1517 Newer instances of orthoses combine latest advances in control theory and brain activity. Berlin Technical University in cooperation with Korean University created an exoskeleton to maneuver lower limbs. A feature of this work is the use of non-invasive electroencephalography (EEG). The study involved 11 healthy men aged 25 to 32 years.18 First upper limb exoskeleton controlled by BCI was proposed by AA Frolov et al.19 Authors concluded that BCI inclusion improves the movements of the paretic hand in post-stroke patients irrespective of severity and localization of the disease. In addition, it was shown that duration of the training also increases effectiveness of rehabilitation.

Based on the letters on the screen, it was possible to determine native language of the patient in the work done by Vasileva.20 In this work, non-invasive EEG had been used. However, it was noted that non-invasive devices have less accuracy than professional medical EEG equipment. To improve signal detection, Agapov et al.21 have developed advanced algorithm of processing visually evoked potentials. To visualize stimuli, “eSpeller” software was developed.

Motivated by the above-mentioned successes and advances, in the present work, possible use of BCI is investigated in the rehabilitation robots for the treatment of stroke survivors. The aim of this work is to develop EEG-based mechatronic system that can receive electrical brain signals, detect emotions and gestures of the patient, and intelligently control robotic arm. In addition, to ensure smooth and compliant movement of the rehabilitation robot and improve treatment efficacy, AAN control paradigm is also considered. This research used EEG package and a controller to develop BCI system and realize AAN-based control. Developed system can help patients to control robot with their thoughts and enhance their participation in the rehabilitation process. Methodology of the current work is explained in the “Methodology” section, and in the subsequent sections, results are discussed before drawing conclusions from this research work.

EEG sensor

In order to register the brain activity, 16 EEG electrodes distributed around the patient’s head have been used. To provide more information which is related to motor imaginary signals, the frequency characteristics were extracted from the data by converting them from the time domain to the frequency domain. Furthermore, to distinguish between movement intentions and rest positions, bandpass filter in the range of 5 to 40 Hz was used.22,23 Since EEG data set recording can be very large, the powerful surface Laplacian technique was applied to lower the risk of influence from the neighboring neurons on the crucial cerebral cortex neurons.24 Finally, only dominant frequency of 13 to 30 Hz, also known as beta wave frequency, was featured according to Gropper et al.25 This band distinction was benchmarker as a sensible area of resting brain activity.

Abiding by the previous works associated with EEG signal processing in Iáñez et al.26 and Hortal et al.,27 the feature selection was reduced to the group of 29 features, which later were used for the further classification and predictive model construction.

After receiving data using an EEG, algorithm needs to determine the desired effect for the user. Input data for this algorithm are EEG signals recorded during the demonstration of stimuli. In most of the currently existing studies on this subject, the problem of classifying signals is divided into three large subtasks:

  • Preprocessing the signal (in order to remove noise components);
  • Formation of a feature space;
  • Classification of objects in the constructed feature space.

It should be noted that the greatest influence on the final quality of the classification is made by the extent to which the task of forming the feature space was successfully accomplished. The general scheme of operation of BCI is depicted in Figure 1.


Figure 1. Block diagram of BCI interface.



Continue —>  Brain–computer interface and assist-as-needed model for upper limb robotic arm – Akim Kapsalyamov, Shahid Hussain, Askhat Sharipov, Prashant Jamwal, 2019


Figure 4. (a) ELA actuated upper limb rehabilitation robot, (b) upper limb rehabilitation robot in use, and (c) robotic orthosis in use with EEG sensor.


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[Abstract + References] Design and Development of a Robotic Platform Based on Virtual Reality Scenarios and Wearable Sensors for Upper Limb Rehabilitation and Visuomotor Coordination – Conference paper


The work reintegration following shoulder biomechanical overload illness is a multidimensional process, especially for those tasks requiring strength, movement control and arm dexterity. Currently different robotic devices used for upper limb rehabilitation are available on the market, but these devices are not based on activities focused on the work reintegration. Furthermore, the rehabilitation programmes aimed to the work reintegration are insufficiently focused on the recovery of the necessary skills for the re-employment.

In this study the details of the design of an innovative robotic platform integrated with wearable sensors and virtual reality scenarios for upper limbs motor rehabilitation and visuomotor coordination is presented. The design of control strategy will also be introduced. The robotic platform is based on a robotic arm characterized by seven degrees of freedom and by an adaptive control, wearable sensorized insoles, virtual reality (VR) scenarios and the Leap Motion device to track the hand gestures during the rehabilitation training. Future works will address the application of deep learning techniques for the analysis of the acquired big amount of data in order to automatically adapt both the difficulty level of the VR serious games and amount of motor assistance provided by the robot.


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via Design and Development of a Robotic Platform Based on Virtual Reality Scenarios and Wearable Sensors for Upper Limb Rehabilitation and Visuomotor Coordination | SpringerLink

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[ARTICLE] Mobile Mechatronic/Robotic Orthotic Devices to Assist–Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review – Full Text

This paper overviews the state-of-the-art in upper limb robot-supported approaches, focusing on advancements in the related mechatronic devices for the patients’ rehabilitation and/or assistance. Dedicated to the technical, comprehensively methodological and global effectiveness and improvement in this inter-disciplinary field of research, it includes information beyond the therapy administrated in clinical settings-but with no diminished safety requirements. Our systematic review, based on PRISMA guidelines, searched articles published between January 2001 and November 2017 from the following databases: Cochrane, Medline/PubMed, PMC, Elsevier, PEDro, and ISI Web of Knowledge/Science. Then we have applied a new innovative PEDro-inspired technique to classify the relevant articles. The article focuses on the main indications, current technologies, categories of intervention and outcome assessment modalities. It includes also, in tabular form, the main characteristics of the most relevant mobile (wearable and/or portable) mechatronic/robotic orthoses/exoskeletons prototype devices used to assist-rehabilitate neuromotor impairments in the upper limb.

1. Introduction–General Perspective and Main Rationales

What differentiates human beings from animals is the superior psycho-cognitive activity, including the coordinated/complex, workable, actions of its highly correlated physical effecter: the upper limb, and especially the hand—as basis of our creative and modeler/draftsman kind interactions with the environment. This profound and subtle reality has been conceptualized during history by great thinkers, such as Aristotel (2005), Descartes, Newton and Kant (Lundborg, 2014).

Accordingly, finding solutions that address rehabilitation and/or functional assistance of neuromotor impairments at this level would have a remarkable positive impact: for the beneficiaries’ quality of life (Frisoli et al., 2016) and from a socio-economical perspective, as well. The latter corresponds to the temporary regain/re-insertion of the productive resources lost because of the disabilities in their upper limbs. Moreover, it is to be considered, within the general context/trend of offering a reliable alternative for prolonged hospitalizations, the need for top of the range assistive/rehabilitative orthotic mobile devices. These should be capable to provide safe and of continuity rehabilitation (Loureiro et al., 2011) and/or functional assistance for the above mentioned topography, too, of neuromotor deficits including in the patient’s daily life context. Such endeavors are often necessary on long term, mainly imposed, in the morbidity domain we approach, by the required duration of neuroplasticity to install/act (Muresanu et al., 2012Basteris et al., 2014Xiao et al., 2014Proietti et al., 2016Mazzoleni et al., 2017), to be (re)settled in adequate engrams for the function(s) aimed at restoring, and/or of peripheral nerves’ re-growth (Guyton and Hall, 2006).

The necessity for such devices that can operate without fatigue in both clinical settings, at home and in the community is growing high (Stewart et al., 2017). This is despite of the fact that people with upper limb pathology—who do not necessarily suffer from functional issues in the lower limbs—can commonly reach clinical units (in order to receive ambulatory rehabilitative specific procedures). Another aspect is that, at the moment, there is already a “shortage” of professionals handy to deliver domiciliary physiotherapy/rehabilitation and nursing, for persons with physical impairments. This is a worrying situation, especially as it is foreseen to become more and more frequent in the years to come (Maciejasz et al., 2014).

An important related development direction consists of consolidating their wearable profile. This practically entails—subsumed to a rightful beneficiary’s desire: “several hours” per day of working performance (Allotta et al., 2015)—availability for autonomous powered duty (as for easily/rapidly rechargeable facilities, too) and respectively comfortable bearing by the consumer in the daily life (Giberti et al., 2014), limitation of encumbrances, lightweight (Rocon et al., 2007Martinez et al., 2008Song et al., 20132014Chen et al., 2014Giberti et al., 2014Andrikopoulos et al., 2015Allotta et al., 2015Polygerinos et al., 2015Guo et al., 2016Nycz et al., 2016Alavi et al., 2017Stewart et al., 2017) and modularity (Lo et al., 2010Pearce et al., 2012Noveanu et al., 2013Xiao et al., 2014Nycz et al., 2016) and/or, in some cases, “reconfigurability” (Maciejasz et al., 2014).

Considering all the necessary technical assets for such advanced devices to be mobile (Kiguchi et al., 2008aLee, 2014Nycz et al., 2016), thereby available for individual more extended use, an additional, non-technical, but derivative and decisive condition is, as well, mandatory: their cost-effectiveness (Noveanu et al., 2013).

We consider it only appropriate to iterate here a summarized idea of a previous work of ours (Onose et al., 2016) that currently there is still no such thing as an optimal, fully functional assistive-rehabilitative device (in the common sense of the term). This regards mainly: don/doff issues (Nimawat and Jailiya, 2015)–for severely disabled potential beneficiaries–, psychological acceptance (of self image/esteem kind, referring to the ensemble look of the consumer: enough miniaturization and cosmetics– thus either reaching a satisfactory clothes-like aspect or even becoming as thin as to evolve to underwear dimensions), extended power autonomy, easy and fast set-up-for professionals (Dijkers et al., 1991). Another important feature for the customers/their kin is the appropriateness for long time duty in various real life situations. One should consider also the consistent related safety, producing very low/practically imperceptible noise when in service and truly affordable/cost effective.


Continue —->Frontiers | Mobile Mechatronic/Robotic Orthotic Devices to Assist–Rehabilitate Neuromotor Impairments in the Upper Limb: A Systematic and Synthetic Review | Neuroscience

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[Abstract] Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report


Motor dysfunction of the hand and upper limb is a major cause of physical disability for patients with chronic stroke. Our aim was to investigate the effectiveness of a peripheral plus central repetitive transcranial magnetic stimulation (rTMS) treatment for upper limb motor rehabilitation in chronic stroke patients.

Material and method

We reported the case of a patient WLX, who had one ischemic stroke more than 3 years ago, and had underwent intermittent rehabilitation since then. He still had profound right upper limb paralysis and moderate spasm, accompanied with non-fluent aphasia when came to our department; and complained that his recovery had been rather slow for about two years. In addition to the custom rehabilitation, we applied a peripheral plus central rTMS paradigm to him, which included 3 sessions of peripheral magnetic stimulation to his paralyzed right forearm, followed by a session of high frequency rTMS to the bilateral sensorimotor cortex region. The total magnetic stimulation therapy lasted about 30 min a day, and was applied 5 days/week for 4 weeks.


After 4 weeks’ treatment, the patient’s Fulg–Meyer upper limb assessment (FMA) score was obviously improved (from 27 to 37 points), and the spasm was largely relieved in his right hand and arm.


Peripheral plus central rTMS might be an effective treatment for motor dysfunction of chronic stroke patients.

via Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report – ScienceDirect

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[Case Report] Case report on the use of a functional electrical orthosis in rehabilitation of upper limb function in a chronic stroke patient – Full Text PDF


Introduction. The increasing incidence of strokes and their occurrence in younger active people require the development of solutions that allow participation, despite the debilitating deficit that is not always solved by rehabilitation. The present report shows
such a potential solution.
Objective. In this presentation we will show the effects of using a functional electric orthosis, the high number of repetitions and daily electrostimulation in a young stroke patient with motor deficit in the upper limb, the difficulties encountered in attempting to
use orthosis, the results and the course of its recovery over the years.
Materials and Methods. The present report shows the evolution of a 31-year-old female patient with hemiplegia, resulting from a hemorrhagic stroke, from the moment of surgery to the moment of purchasing a functional electrical orthosis and a few months
later, highlighting a 3-week period when the training method focused on performing a large number of repetitions of a single exercise helped by the orthosis – 3 weekly physical therapy sessions, with a duration of one hour and 15 minutes, plus 2 electrostimulation sessions lasting 20 minutes each and 100 elbow extension, daily, 6 times a week. The patient was evaluated and filmed at the beginning and end of the 3 week period. The patient’s consent was obtained for the use of the data and images presented.
Results. Invalidating motor deficiency and problems specific to the use of upper limb functional electrostimulation in patients with stroke sequelae (flexion synergy, exaggeration of reflex response, wrist position during stimulation, etc.) made it impossible to use orthosis in functional activities within ADL although it allowed the achievement of a single task. Evaluation on the FuglMayer assessment does not show any quantifiable progress, although it is possible to have slightly improved the control of the
shoulder and elbow and increased the speed of task execution.
Conclusions. The use of functional orthoses of this type may be useful in patients who still have a significant functional rest in the shoulder, elbow and hand, and where the orthosis can produce an effective grasp. However for some patients, perhaps those who
would have been desirable to benefit most from this treatment, the benefit of using this orthosis is minimal.[…]

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