Posts Tagged Upper limb rehabilitation

[ARTICLE] An Evaluation of the Design and Usability of a Novel Robotic Bilateral Arm Rehabilitation Device for Patients with Stroke – Full Text

Introduction: Robot-assisted therapy for upper limb rehabilitation is an emerging research topic and its design process must integrate engineering, neurological pathophysiology, and clinical needs.

Purpose of the study: This study developed/evaluated the usefulness of a novel rehabilitation device, the MirrorPath, designed for the upper limb rehabilitation of patients with hemiplegic stroke.

Methods: The process follows Tseng’s methodology for innovative product design and development, namely two stages, device development and usability assessment. During the development process, the design was guided by patients’ rehabilitation needs as defined by patients and their therapists. The design applied synchronic movement of the bilateral upper limbs, an approach that is compatible with the bilateral movement therapy and proprioceptive neuromuscular facilitation theories. MirrorPath consists of a robotic device that guides upper limb movement linked to a control module containing software controlling the robotic movement.

Results: Five healthy subjects were recruited in the pretest, and 4 patients, 4 caregivers, and 4 therapists were recruited in the formal test for usability. All recruited subjects were allocated to the test group, completed the evaluation, and their data were all analyzed. The total system usability scale score obtained from the patients, caregivers, and therapists was 71.8 ± 11.9, indicating a high level of usability and product acceptance.

Discussion and conclusion: Following a standard development process, we could yield a design that meets clinical needs. This low-cost device provides a feasible platform for carrying out robot-assisted bilateral movement therapy of patients with hemiplegic stroke.

Clinical Trial Registration: identifier NCT02698605.

Introduction

The World Health Organization (WHO) has reported that stroke is the third leading cause of death in developed countries and involves approximately 15 million stoke events annually. One-third of stroke patients die and a further one-third of events results in permanent disability. Depending on the location of the brain insult, stroke can lead to a wide range of functional impairments (Mackay et al., 2004); these include language, cognition, sensation, and motor functions. Motor impairment impacts the patient’s ability to perform activities of daily living. For the majority of patients, recovery of motor function involving an upper limb is slower than that of lower limb (Feys et al., 1998). Indeed, most activities of daily living rely the functioning of the upper limb, thus emphasizing the need for effective upper limb rehabilitation.

With an attempt to enhance the effectiveness of upper limb rehabilitation among stroke patients, a series of rehabilitation techniques have been developed and refined in recent decades; these include task-oriented motor training, constraint-induced movement therapy, mirror therapy, and bilateral movement training. Each of these methods has a number of theoretical advocates and each has been shown to be effective clinically. For instance, bilateral movement therapy, which involves coordinated movement of the bilateral upper limbs, has been shown to enhance upper limb recovery and coordination between the hands. Stoykov et al. (2009) found that bilateral arm training is more effective than unilateral training when restoring proximal upper limb function because it seems to improve the functional linkages between the bilateral hemispheres.

Even after receiving a full course of conventional rehabilitation, 60% of stroke patients still have difficulties when using their affected upper limb (Kwakkel et al., 1999). As a result, it has become the upmost importance to develop novel rehabilitation strategies that are able to help patients reach a higher level of recovery. One such approach is robot-assisted rehabilitation, which incorporates robotic technologies into the rehabilitation processes. Several well-known robot-assisted movement therapies for the upper limb has been implemented clinically, including MIT-Manus (Krebs et al., 1998), Bi-Manu-Track (Hesse et al., 2003), BATRAC (Cauraugh et al., 2010), and MIME (Burgar et al., 2000), each of which follows different movement therapy theories. Regarding the body parts that are mainly involved in therapy, Bi-Manu-Track focuses on the bilateral forearms and wrists, while BATRAC and MIME focus on the shoulder and elbow of the affected limb. Regarding the movement dimension, BATRAC involves movement in one-dimension, while MIME allows three-dimensional movement. In fact, the higher the degrees of freedom adopted during the movement therapy, the more complex is the design of the robotic device. As a result, it has become important to come up with a feasible design that fulfills the patient’s rehabilitation needs while avoiding the high costs that can be associated with instrument acquirement and maintenance. Furthermore, the effectiveness of the system needs to be comparable to that provided by conventional therapies so that a motivation to pursue this therapeutic option can be established (Kwakkel et al., 2008; Lo et al., 2010).

As an approach to the development of mechanical rehabilitation devices for hemiplegic upper limbs, Timmermans et al. (2009) proposed that three design domains are required; these were the therapy techniques used, the motivation of the patient, and resulting performance rewards. An online survey of physical therapists, 233 in total, indicated that a preferred upper limb robotic device needs to accommodate different hand movements, to be able to be used while in a seated position, to be able to provide the user with feedback, to focus on the restoration of activities of daily living, to able to be used at home, to have adjustable resistance levels and to cost less than US$6,000 (Lu et al., 2011).

In terms of usability, the interaction between the user and the machine tends to be overlooked during the development stage. Although a variety of upper limb rehabilitation machines have been proposed, only a few have been commercialized. This low market acceptance can be attributed to the high cost of these devices, safety concerns, and poor usability (Lee et al., 2005). To this end, the aim of this study was to design a bilateral upper limb rehabilitation device called MirrorPath for the rehabilitation of stroke patients that follows the theories of bilateral movement therapy and proprioceptive neuromuscular facilitation (PNF). These two theories were initially developed by Knott and Kabat and have been shown to have a positive effect on the range of active and passive motions needed by stroke patients (Sharman et al., 2006). Our device will guide the patient’s upper limbs, each of which moves along a diagonal motion path on the horizontal plane. The position and velocity of motion of the bilateral limbs are perfectly mirrored across the midline on the table. Finally, usability testing was conducted on the completed prototype.

Continue —>  Frontiers | An Evaluation of the Design and Usability of a Novel Robotic Bilateral Arm Rehabilitation Device for Patients with Stroke | Frontiers in Neurorobotics

Figure 2. (A) A patient performed bilateral diagonal movements using the device; (B) due to weakness of right upper limb, the patient’s grip was assisted with an elastic bandage, and the patient’s elbow was support by a sling; (C) the application scenario.

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[ARTICLE] Compensating the effects of FES-induced muscle fatigue by rehabilitation robotics during arm weight support – Full Text

Abstract

Motor functions can be hindered in consequence to a stroke or a spinal cord injury. This often results in partial paralyses of the upper limb. The effectiveness of rehabilitation therapy can be improved by the use of rehabilitation robotics and Functional Electrical Stimulation (FES). We consider a hybrid arm weight support combining both.

In order to compensate the effect of FES-induced muscle fatigue, we introduce a method to substitute the decreasing level of FES support by cable-driven robotics. We evaluated the approach in a trial with one healthy subject performing repetitive arm lifting. The controller automatically adapted the support and thus no increase in user generated volitional effort was observed when FES induced muscle fatigue occured.

Continue —> Compensating the effects of FES-induced muscle fatigue by rehabilitation robotics during arm weight support : Current Directions in Biomedical Engineering

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[ARTICLE] Vision-Based Pose Estimation for Robot-Mediated Hand Telerehabilitation – Full Text PDF/HTML

Abstract

Vision-based Pose Estimation (VPE) represents a non-invasive solution to allow a smooth and natural interaction between a human user and a robotic system, without requiring complex calibration procedures. Moreover, VPE interfaces are gaining momentum as they are highly intuitive, such that they can be used from untrained personnel (e.g., a generic caregiver) even in delicate tasks as rehabilitation exercises.

In this paper, we present a novel master–slave setup for hand telerehabilitation with an intuitive and simple interface for remote control of a wearable hand exoskeleton, named HX. While performing rehabilitative exercises, the master unit evaluates the 3D position of a human operator’s hand joints in real-time using only a RGB-D camera, and commands remotely the slave exoskeleton. Within the slave unit, the exoskeleton replicates hand movements and an external grip sensor records interaction forces, that are fed back to the operator-therapist, allowing a direct real-time assessment of the rehabilitative task.

Experimental data collected with an operator and six volunteers are provided to show the feasibility of the proposed system and its performances. The results demonstrate that, leveraging on our system, the operator was able to directly control volunteers’ hands movements.

1. Introduction

Traditional rehabilitation is performed in a one-to-one fashion, namely one therapist (or sometimes several) working with one patient, leading to high personnel and management costs, especially for demanding patients such as those with brain or post surgery injuries. Due to the high hospitalization costs, all these patients are leaving clinics and returning to their homes sooner than in the past [1], when their rehabilitative program is not yet finished. These patients can greatly benefit from a telerehabilitation equipment, which is able to provide remote assistance and relief without the burden of going to the clinic on a daily basis. On the other hand, therapists can surely benefit from non-invasive systems capable of acquiring information about their movements which are then sent to the patient (or even to many patients), possibly in real-time to allow a direct control; modern vision-based techniques offer interesting sparks in such way. The possibility to provide high quality rehabilitation programs regardless of patients physical location and leveraging on vision is thus certainly attractive.

Continue —> Sensors | Free Full-Text | Vision-Based Pose Estimation for Robot-Mediated Hand Telerehabilitation | HTML

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Figure 2. HX while holding the sensorized object in a pinch (a) and lateral (b) grasping exercise. The DoMs of the HX device are: (1) the flexion/extension of the index MCP; (2) of the index P-DIP (under-actuated); (3) of the thumb MCP and IP (under-actuated) and (4) the CMC opposition. Other Degrees-of-Freedom (DoF), like thumb intra/extra rotation and the index abduction/adduction, are passive [29]. The HX is used to grasp the sensorized object, whose squeezable soft-pads provide force information on the basis of a optoelectronic deformation transduction [34].

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[ARTICLE] Development of a Soft Actuated Upper Extremity Exoskeleton Employing Series Elastic Actuator for Post Stroke Rehabilitation – Full Text PDF

9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005

Abstract

The integration of robotic devices and conventional physiotherapy is becoming more and more acceptable worldwide. When an exoskeleton is in the conceptual design phase, the actuator selection is one of the most crucial sections.

In this paper a rotary Seies Elastic Actuator(SEA) is introduced, designed and developed for upper limb application used in the rehabilitation exoskeleton. Albeit the SEA had been used in the lower extremity,it is not utilized for the upper limb rehabilitation yet. This paper will design,implement and analyze the advantages of using SEA in the upper limb instead of conventional electric motors and shows the stability of this system when implemented on the proposed exoskeleton.

Actually the designed exoskeleton is performing simultaneous tasks of elbow and shoulder flexion/extension by means of just one electric motor and a SEA mounted on the elbow joint.

Full Text PDF

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[ARTICLE] REAL TIME BIOSIGNAL-DRIVEN ILLUSION SYSTEM FOR UPPER LIMB REHABILITATION

Abstract

This paper presents design and development of real time biosignal-driven illusion system: Augmented Reality based Illusion System (ARIS) for upper limb motor rehabilitation. ARIS is a hospital / home based self- motivated whole arm rehabilitation system that aims to improve and restore the lost upper limb functions due to Cerebrovascular Accident (CVA) or stroke.

Taking the advantage of human brain plasticity nature, the system incorporates with number of technologies to provide fast recovery by re-establishing the neural pathways and synapses that able to control the mobility. These technologies include Augmented Reality (AR) where illusion environment is developed, computer vision technology to track multiple colors in real time, EMG acquisition system to detect the user intention in real time and 3D modelling library to develop Virtual Arm (VA) model where human biomechanics are applied to mimic the movement of real arm. The system operates according to the user intention via surface electromyography (sEMG) threshold level. In the case of real arm cannot reach to the desired position, VA will take over the job of real arm to complete the exercise.

The effectiveness of the developed ARIS has evaluated via questionnaire, graphical and analytical measurements which provided with positive results.

via [Abstract] REAL TIME BIOSIGNAL-DRIVEN ILLUSION SYSTEM FOR UPPER LIMB REHABILITATION.

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[ARTICLE] UPPER LIMB MOTOR REHABILITATION INTEGRATED WITH VIDEO GAMES FOCUSING ON TRAINING FINGERS’ FINE MOVEMENTS

In this article, we discuss the development of a novel upper limb rehabilitation robot integrated with video games. Our solution is operated via a novel human–computer interface, which stimulates shoulder, elbow movements, and fine finger movements. It is capable to train patients with partially recovered motor control ability. The interface enables therapists to select motivating and engaging motor training exercises represented as video games and specify rehabilitation exercises for patients using a grasping and upper limb interface. The paper presents concept of this novel interface, discusses the implementation issues and demonstrates technical and practical feasibility of our concept through a number of application examples.

via [Abstract] UPPER LIMB MOTOR REHABILITATION INTEGRATED WITH VIDEO GAMES FOCUSING ON TRAINING FINGERS’ FINE MOVEMENTS.

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ARTICLE: Current Trends in Robot-Assisted Upper-Limb Stroke Rehabilitation: Promoting Patient Engagement in Therapy – Full Text

…Robotic therapy devices enable unique methods for promoting patient engagement by providing assistance only as needed and by detecting patient movement intent to drive to the device. Use of these methods has demonstrated improvements in functional outcomes, but careful comparisons between methods remain to be done…

via Current Trends in Robot-Assisted Upper-Limb Stroke Rehabilitation: Promoting Patient Engagement in Therapy – Springer.

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ARTICLE: Non-invasive Brain Stimulation in Physical Medicine and Rehabilitation – Full Text

…The non-invasive brain stimulation techniques of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have developed considerably over the last 25 years. Recent studies have used these techniques to enhance motor and cognitive function, modulate psychiatric symptoms, and reduce pain. Here, we briefly present TMS and tDCS techniques, discuss their safety, and provide examples of studies applying these interventions to enhance movement function following stroke. Though further studies are required, investigations so far provide important first steps in the use of non-invasive brain stimulation techniques to aid routine rehabilitation therapy. We discuss future directions for the field in terms of study development, choice of motor task, and target sites for stimulation…

via Non-invasive Brain Stimulation in Physical Medicine and Rehabilitation – Springer.

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