[WEB SITE] Hong Kong researchers create robotic arm to help stroke patients

  A research team at Hong Kong Polytechnic University (PolyU) has developed a robotic arm to facilitate self-help and upper-limb mobile rehabilitation for stroke patients after discharge from hospital.

Referred to as a mobile exo-neuro-musculo-skeleton, the robotic arm enables intensive and effective self-help rehabilitation exercise.

The lightweight device is said to be the first of its kind to combine exo-skeleton, soft robot and exo-nerve stimulation technologies. It is intended to cater to the increasing need for outpatient rehabilitation service for stroke patients.

“Referred to as a mobile exo-neuro-musculo-skeleton, the robotic arm enables intensive and effective self-help rehabilitation exercise.”

PolyU Department of Biomedical Engineering researcher Hu Xiaoling said: “We are confident that with our mobile exo-neuro-musculo-skeleton, stroke patients can conduct rehabilitation training anytime and anywhere, turning the training into part of their daily activities.

“We hope such flexible self-help training can well supplement traditional outpatient rehabilitation services, helping stroke patients achieve a much better rehabilitation progress.”

Designed to be flexible and easy-to-use, the robotic arm is compact in size, has fast responses and requires a minimal power supply.

It comprises different components for the wrist/hand, elbow, and fingers that can be worn separately or together for various functional training needs. The device can also be connected to a mobile application, where users can manage their training.

The exo-skeleton and soft robot components of the device offer external mechanical forces guided by voluntary muscle signals in order to facilitate the desired joint movement for the patients.

PolyU improved the rehabilitation by adding its Neuro-muscular Electrical Stimulation (NMES) technology, which allows the robotic arm to contract user’s muscles when electromyography signals are detected.

When tested in a clinical trial involving ten stroke patients, the robotic arm is reported to have led to better muscle coordination, wrist and finger functions, and lower muscle spasticity following 20 two-hour training sessions.

The researchers plan to collaborate with hospitals and clinics for conducting additional trials.

via Hong Kong researchers create robotic arm to help stroke patients

[WEB SITE] PolyU develops robotic arm for self-help mobile rehabilitation for stroke patients

CAPTION
The PolyU-developed robotic arm is the first-of-its-kind integration of exo-skeleton, soft robot and exo-nerve stimulation technologies. It is light in weight, compact in size, fast in response and demands minimal power supply, thus suitable for use in both indoor and outdoor environment.
CREDIT
The Hong Kong Polytechnic University

 

(October 31, 2018) The Hong Kong Polytechnic University (PolyU) recently developed a robotic arm to facilitate self-help and upper-limb mobile rehabilitation for stroke patients. The lightweight device enables the patients to engage in intensive and effective self-help rehabilitation exercise anywhere, anytime after they are discharged from hospital. The robotic arm, called “mobile exo-neuro-musculo-skeleton”, is the first-of-its-kind integration of exo-skeleton, soft robot and exo-nerve stimulation technologies.

Stroke is the third leading cause of disability worldwide. In Hong Kong, there are about 25,000 new incidences of stroke annually in recent years. Research studies have proven that intensive, repeated and long-term rehabilitation training are critical for enhancing the physical mobility of stroke patients, thus help alleviating post-stroke symptoms such as disability. However, access to the outpatient rehabilitation service for stroke patients has been difficult. Due to the overwhelming demand for rehabilitation services, patients have to queue up for a long time to get a slot for rehabilitation training. As such, they can’t get timely support and routine rehabilitation exercises. Stroke patients also find it challenging to travel from home to outpatient clinics.

The “mobile exo-neuro-musculo-skeleton”, developed by Dr Hu Xiao-ling and her research team in the Department of Biomedical Engineering (BME) of PolyU, features lightweight design (up to 300g for wearable upper limb components, which are fit for different functional training needs), low power demand (12V rechargeable battery supply for 4-hour continuous use), and sportswear features. The robotic arm thus provides a flexible, self-help, easy-to-use, mobile tool for patients to supplement their rehabilitation sessions at the clinic. The innovative training option can effectively enhance the rehabilitation progress.

Dr Hu Xiaoling said development of the novel device was inspired by the feedback of many stroke patients who were discharged from hospital. They faced problems in having regular and intensive rehabilitation training crucial for limb recovery. “We are confident that with our mobile exo-neuro-musculo-skeleton, stroke patients can conduct rehabilitation training anytime and anywhere, turning the training into part of their daily activities. We hope such flexible self-help training can well supplement traditional outpatient rehabilitation services, helping stroke patients achieve a much better rehabilitation progress.” Her team anticipated that the robotic arm can be commercialised in two years.

The BME innovation integrates exo-skeleton and soft robot structural designs – the two technologies commonly adopted in existing upper-limb rehabilitation training devices for stroke patients as well as the PolyU-patented exo-nerve stimulation technology.

Integration of exo-skeleton, soft robot and exo-nerve stimulation technologies

The working principle of both exo-skeleton and soft robot designs is to provide external mechanical forces driven by voluntary muscle signals to assist the patient’s desired joint movement. Conventional exo-skeleton structure is mainly constructed by orthotic materials such as metal and plastic, simulating external bones of the patient. Although it is compact in size, it is heavy and uncomfortable to wear. Soft robot, made of air-filled or liquid-filled pipes to simulate one’s external muscles, is light in weight but very bulky in size. Both types of structures demand high electrical power for driving motors or pumps, thus it is not convenient for patients to use them outside hospitals or rehabilitation centres. Combining the advantages of both structural designs, the BME innovative robotic arm is light in weight, compact in size, fast in response and demands minimal power supply, therefore it is suitable for use in both indoor and outdoor environment.

The robotic arm is unique in performing outstanding rehabilitation effect by further integrating the external mechanical force design with the PolyU-patented Neuro-muscular Electrical Stimulation (NMES) technology. Upon detecting the electromyography signals at the user’s muscles, the device will respond by applying NMES to contract the muscles, as well as exerting external mechanical forces to assist the joint’s desired voluntary movement. Research studies found that the combination of muscle strength triggered by NMES and external mechanical forces is 40% more effective for stroke rehabilitation than applying external mechanical forces alone.

Rehabilitation effect proven in trials

An initial trial of the robotic arm on 10 stroke patients indicated better muscle coordination, wrist and finger functions, and lower muscle spasticity of all after they have completed 20 two-hour training sessions. Further clinical trials will be carried out in collaboration with hospitals and clinics.

The robotic arm consists of components for wrist/hand, elbow, and fingers which can be worn separately or together for different functional training needs. The sportswear design, using washable fabric with ultraviolet protection and good ventilation, also makes the robotic arm a comfortable wear for the patients.

The device also has a value-added feature of connecting to a mobile application (APP) where user can use the APP interface to control their own training. The APP also records real-time training data for better monitoring of the rehabilitation progress by both healthcare practitioners and the patients themselves. It can also serve as a social network platform for stroke patients to communicate online with each other for mutual support.

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Press Contacts:

Dr Hu Xiaoling, Assistant Professor
Department of Biomedical Engineering, PolyU
Telephone : 3400 3206
Email : htxlhu@polyu.edu.hk

 

via PolyU develops robotic arm for self-help mobile rehabilitation for stroke patients | EurekAlert! Science News

[Abstract] Design and testing of a soft rehabilitation glove integrating finger and wrist function

Abstract

This work presents a lightweight soft rehabilitation glove that integrates finger and wrist function by developing and applying the Double-DOF soft Pneumatic Bending Actuators (DPBAs). The proposed soft glove can achieve separate as well as coordinated motion exercises of fingers and the wrist, which benefits stroke patients that have complicated hand impairment. It consists of a commercial glove extended by a customized wrist bracer, on which are installed three dorsal DPBAs through fingers (index/middle/ring) and the wrist, two dorsal SPBAs (Single-DOF Pneumatic Bending Actuators) through thumb/pinky, and three palmar SPBAs through wrist. The proposed DPBA has two independent bendable segments to actuate flexion of finger and wrist respectively, whose multi-gait bending conforms with multi-pattern flexion of the biological hand. The SPBAs are used for actuating wrist extension or finger flexion. The proposed wrist bracer is designed as an extension of the glove to install the soft actuators and transfer their motion and force to the wearer’s wrist efficiently as well as minimize unactuated restriction on the hand. To verify its feasibility, we evaluate the range of motion, strength and speed of five subjects’ hands assisted by the glove in six different passive motions. Results show that the proposed glove can provide sufficient assistance for stroke patients in hand rehabilitation exercise. Furthermore, the soft glove has potential in extending the hand functional training from simple exercises such as closing/opening and gripping to complex ones such as weightlifting, writing and screwing/unscrewing.

 

via Article | Journal of Mechanisms and Robotics | ASME DC

[Abstract + References] A Wearable Hand Neuroprosthesis for Hand Rehabilitation After Stroke: Preliminary Results of the RETRAINER S2 Randomized Controlled Trial – Conference paper

Abstract

Stroke is the main cause of permanent and complex long-term disability in adults. RETRAINER S2 is a system able to recover and support person’s ability to perform Activities of Daily Living (ADL) in early stage after stroke. The system is based on exercises for hand and wrist performed using Neuro Muscular Electrical Stimulation (NMES). This work describes the preliminary results of a multi-center Randomized Controlled Trial (RCT) aimed at evaluating effectiveness of the system. The preliminary results were calculated on 18 patients who completed the protocol. Data is promising, the RETRANER S2 system seems to be a good tool for stroke rehabilitation. Data confirms also a general good usability of the system.

Research supported by European Union’s Horizon 2020 research and innovation program under grant agreement No 644721.

References

1. 1.
   Coupar, F., et al.: Simultaneous bilateral training for improving arm function afterstroke. Cochrane Database Syst. Rev. (4), Article No. CD006432 (2010)Google Scholar
2. 2.
   Hatem, S.M., et al.: Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front. Hum. Neurosci. 13 (2016)Google Scholar
3. 3.
   Mangold, S., et al.: Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation. Neurorehabil. Neural Repair 23(2), 184–190 (2009)CrossRefGoogle Scholar
4. 4.
   Crema, A., et al.: Development of a hand neuroprosthesis for grasp rehabilitation after stroke: state of art and perspectives. In: IEEE International Conference on Neurorehabilitation, Pisa, October 2018Google Scholar

via A Wearable Hand Neuroprosthesis for Hand Rehabilitation After Stroke: Preliminary Results of the RETRAINER S2 Randomized Controlled Trial | SpringerLink

[Abstract] Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: a pilot double-blind randomized trial

Description

Aims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity?

Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting.

Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant.

Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted.

via Addition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: a pilot double-blind randomized trial

[Abstract] Self-measured wrist range of motion by wrist-injured and wrist-healthy study participants using a built-in iPhone feature as compared with a universal goniometer

Highlights

• •Wrist ROM measured with a smartphone agrees strongly with ROM measured by a goniometer.
• •Patients are able to reliably self-measure wrist ROM using a smartphone.
• •The iPhone 5 can accurately measure ROM in wrist-injured population wrist- healthy populations.
• •This in-built feature is free and pre-installed on iPhones and does not require English literacy.

Abstract

Study Design

Cross-sectional cohort.

Introduction

Smartphone gyroscope and goniometer applications have been shown to be a reliable way to measure wrist ROM when used by researchers or trained staff. If wrist-injured patients could reliably measure their own ROM, rehabilitation efforts could be more effectively tailored.

Purpose of the Study

To assess agreement of self-measured ROM by wrist-injured and wrist-healthy study participants using a built-in iPhone 5 level feature as compared to researcher-measured ROM using a universal goniometer (UG).

Methods

Thirty wrist-healthy and 30 wrist-injured subjects self-measured wrist flexion, extension, supination, and pronation ROM using the built-in preinstalled digital level feature on an iPhone 5. Simultaneously a researcher measured ROM with a UG.

Results

Average absolute deviation between the self-measured iPhone 5 level feature and researcher-measured UG ROM was less than 2° for all 4 movements individually and combined was found to be 1.6° for both populations. Intraclass correlation coefficient showed high correlation with values over 0.94 and Bland-Altman plots showed very strong agreement. There was no statistical difference in the ability of wrist-injured and healthy patients to self-measure wrist ROM.

Discussion

Both populations showed very high agreement between their self-measured ROM using the built-in level feature on an iPhone 5 and the researcher-measured ROM using the UG. Both populations were able to use the iPhone self-measurement equally well and the injury status of the subject did not affect the agreement results.

Conclusion

Wrist-healthy and wrist-injured subjects were able to reliably and independently measure ROM using a smartphone level feature.

 

via Self-measured wrist range of motion by wrist-injured and wrist-healthy study participants using a built-in iPhone feature as compared with a universal goniometer – Journal of Hand Therapy

[Abstract] Recent Patents on Wrist Rehabilitation Equipment

Abstract

Background: Wrist activity is very frequent in our daily routine, and is under heavy load during the movement such as supporting and push-pull. So wrist can get damaged very easily in daily life. Based on the rehabilitation medicine and ergonomics, the particularity and complexity of human limbs should be considered in the design process. During the treatment process, the wrist joint rehabilitation equipment can provide stable, accurate, safe and comfortable repeated rehabilitation training for patients. The use of rehabilitation training equipment can greatly reduce the cost of treatment and improve the rehabilitation efficiency.

Objective: The related patents of rehabilitation training equipment for wrist joint will be reviewed, and the structure and working principle of these equipments will be illustrated. The results of the analysis provide some meaningful reference for the optimal design of the wrist joint.

Methods: Based on the comparative analysis of the latest patents related to wrist rehabilitation equipment, the key problems and future development of the rehabilitation equipment are put forward.

Results: The patents of the rehabilitation training equipment for the wrist are classified in the paper. Studies show that remarkable improvements have been achieved in the invention of the wrist rehabilitation equipment.

Conclusion: In the future, the mechanical design, control system and rehabilitation strategy of wrist rehabilitation equipment should be further studied.

 

via Recent Patents on Wrist Rehabilitation Equipment: Ingenta Connect

[Abstract] Design and development of an upper limb rehabilitation robotic system – IEEE Conference Publication

Abstract

This paper presents ongoing research activities for the designing and development of an upper limb rehabilitation robotic system needed by the Prokinetic Rehabilitation Clinic. Prokinetic therapists identified the need of a passive rehabilitation robotic system (RRS) with 3 degrees of freedom for upper limb. The medical and technical requirements analysis for an upper limb rehabilitation robotic system, the video motion analysis were carried out, and the mechanical, actuation, control systems and human-machine interface of the RRS were designed and developed. The results of designing and developing an upper limb rehabilitation robotic system are presented here.

Published in: 2018 19th International Carpathian Control Conference (ICCC)

Date of Conference: 28-31 May 2018

 

via Design and development of an upper limb rehabilitation robotic system – IEEE Conference Publication

[Abstract] Kinematic analysis and control for upper limb robotic rehabilitation system – IEEE Conference Publication

Abstract

Present physical rehabilitation practice implies one-to-one therapist — patient interactions. This leads to shortage of therapists and high costs for patient or healthcare insurance systems. Along with Prokinetic Rehabilitation Clinic, we proposed a new intelligent, adaptive robotic system (RAPMES), which can provide the rehabilitation protocols, defined by a therapist, for the wrist and elbow of upper limb, considering the patient reactions and based on real-time feedback. RAPMES is a passive rehabilitation robotic system (RRS) with 3 degrees of freedom, and assists the rehabilitation process for elbow, forearm and wrist movements. Computation of the kinematic model for the RAPMES robotic device is required in order to determine the parameters associated with the mechanical joints, so that the experimental model executes certain trajectories in space. In this paper, we will present both forward and inverse kinematics determined for the experimental model. The kinematic model was implemented in Matlab environment, and we present a series of simulations, conducted in order to validate the proposed kinematic model. Then, we impose the functional movements (determined using the real-time video motion analysis system, as polynomial movement functions) as input to the kinematic model, and we present a series of simulations and results. The RAPMES control algorithm includes the kinematic model, and uses the polynomial movement functions as control input.

Published in: 2018 19th International Carpathian Control Conference (ICCC)

Date of Conference: 28-31 May 2018

 

I. Introduction

Statistics shows that, at European Union level, the upper limb is second common body part injured, as a result of unintentional physical injury [1]. Also, one can note the shortage of therapists and high costs for patient or healthcare insurance systems. Current development in robotics may offer a solution for this problem [2], allowing the creation of robotic devices to support the rehabilitation process, in a supervised or unsupervised way, in physiotherapy clinics or at home. In this context, we proposed RAPMES, a new intelligent, adaptive robotic system, which can provide the rehabilitation protocols, defined by a therapist, for the wrist and elbow of upper limb, considering the patient reactions and based on real-time feedback. RAPMES robotic system is designed on an ongoing research project, which implies several stages of development. In a first stage, we conducted a study involving therapists, the personnel and devices existent in a physiotherapy clinic. The role of this study was to determine the requirements for the robotic device, and to reveal the specific therapeutic needs of patients with rehabilitation indications at wrist and elbow level. On a second stage, we used a real-time video motion analysis system, to determine and understand specific functional movements frequently made with the dominant upper limb, by healthy persons. One of our research objectives is to include these movements as a part of RAPMES control algorithm, as they may offer a better rehabilitation of the upper limb, for specific moves. Next, we designed the robotic device, based on findings described above, and realized an experimental model of the robotic device.

via Kinematic analysis and control for upper limb robotic rehabilitation system – IEEE Conference Publication

[WEB SITE] Scientists develop combined therapy for stroke victim recovery

Scientists in Switzerland have demonstrated that combining a brain-computer interface (BCI) with functional electrical stimulation (FES) can help stroke victims recover greater use of their paralysed limbs – even years after the stroke.

 

 

Paralysis of an arm and/or leg is one of the most common results of a stroke. However, a team of scientists at the Defitech Foundation Chair in Brain-Machine Interface, in association with other members of EPFL’s Center for Neuroprosthetics, the Clinique Romande de Réadaptation in Sion, and the Geneva University Hospitals, have developed a technique aimed at enabling stroke victims to recover greater use of their paralysed limbs. The scientists’ pioneering approach utilises two existing therapies – a brain-computer interface (BCI) and functional electrical stimulation (FES).

Explaining the key to their approach, José del R. Millán, who holds the Defitech Chair at EPFL, said: “The key is to stimulate the nerves of the paralysed arm precisely when the stroke-affected part of the brain activates to move the limb, even if the patient can’t actually carry out the movement. That helps re-establish the link between the two nerve pathways where the signal comes in and goes out.”.

Combined therapy tested on stroke patients

Twenty-seven patients aged between 36 and 76 took part in the clinical trial. All had a similar lesion that resulted in moderate to severe arm paralysis following a stroke occurring at least ten months earlier. Half of the patients were treated with the scientists’ dual-therapy approach and reported clinically significant improvements. The other half were treated only with FES and served as a control group.

For the first group, the scientists used a BCI system to link the patients’ brains to computers by means of electrodes. This enabled them to pinpoint exactly where the electrical activity occurred in the brain tissue when the patients tried to reach out their hands. Each time the electrical activity was identified the system immediately stimulated the arm muscle controlling the corresponding wrist and finger movements. The patients in the second group also had their arm muscles stimulated, but at random times. This control group enabled the scientists to determine how much of the additional motor-function improvement could be attributed to the BCI system.

New technology could dramatically shorten diagnosis time of stroke patients…

 

The scientists noted a significant improvement in arm mobility among patients in the first group after just ten one-hour sessions. When the full round of treatment was completed, some of the first-group patients’ scores on the Fugl-Meyer Assessment – a test used to evaluate motor recovery among patients with post-stroke hemiplegia – were over twice as high as those of the second group.

“Patients who received the BCI treatment showed more activity in the neural tissue surrounding the affected area. Due to their plasticity, they could help make up for the functioning of the damaged tissue,” says Millán.

 

Electroencephalographies (EEGs) of the patients clearly showed an increase in the number of connections among the motor cortex regions of their damaged brain hemisphere, which corresponded with the increased ease in carrying out the associated movements. In addition, the enhanced motor function didn’t seem to diminish with time. Evaluated again 6-12 months later, the patients were found to have lost none of their recovered mobility.

The study results were published in Nature Communications.

via Scientists develop combined therapy for stroke victim recovery