[Abstract + References] Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections

Abstract

Introduction

In relation to wrist imaging, the accepted requirement is two orthogonal projections obtained at 90°, each with the wrist in neutral position. However, the literature and anecdotal experience suggests that this principle is not universally applied.

Method

This multiphase study was undertaken across eight different hospitals sites. Compliance with standard UK technique was confirmed if there was a change in ulna orientation between the dorsi-palmar (DP) and lateral wrist projections. A baseline evaluation for three days was randomly identified from the preceding three months. An educational intervention was implemented using a poster to demonstrate standard positioning. To measure the impact of the intervention, further evaluation took place at two weeks (early) and three months (late).

Results

Across the study phases, only a minority of radiographs demonstrated compliance with the standard technique, with an identical anatomical appearance of the distal ulna across the projections. Initial compliance was 16.8% (n = 40/238), and this improved to 47.8% (n = 77/161) post-intervention, but declined to 32.8% (n = 41/125) within three months. The presence of pathology appeared to influence practice, with a greater proportion of those with an abnormal radiographic examination demonstrating a change in ulna appearances in the baseline cohort (p < 0.001) and the late post-intervention group (p = 0.002) but not in the examinations performed two weeks after staff education (p = 0.239).

Conclusion

Assessment of image quality is critical for diagnosis and treatment monitoring. Yet poor compliance with standard anatomical principles was evident. A simple educational intervention resulted in a transient improvement in wrist positioning, but the impact was not sustained over time.

References

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via Improving wrist imaging through a multicentre educational intervention: The challenge of orthogonal projections – Beverly Snaith, Scott Raine, Lynsey Fowler, Christopher Osborne, Sophie House, Ryan Holmes, Emma Tattersall, Emma Pierce, Melanie Dobson, James W Harcus,

[Patent Application] FINGER JOINT REHABILITATION DEVICE – Full Text

Abstract

A finger joint rehabilitation device comprising: at least one of an index finger joint rehabilitation exercise aid part, a middle finger joint rehabilitation exercise aid part, a ring finger joint rehabilitation exercise aid part, a little finger joint rehabilitation exercise aid part and a thumb joint rehabilitation exercise aid part; at least one corrugated tube; one protective brace fixed on a wrist and a palm; and the index finger joint rehabilitation exercise aid part, the middle finger joint rehabilitation exercise aid part, the ring finger joint rehabilitation exercise aid part, the little finger joint rehabilitation exercise aid part and the thumb joint rehabilitation exercise aid part are all provided with the corrugated tube and are all fixed on the protective brace.

Continue —->  FINGER JOINT REHABILITATION DEVICE – BEIJING HENGTONG XINJIA TECHNOLOGY DEVELOPMENT CO, LTD.

[NEWS] Researchers at the UI create robotic rehabilitation device to help increase range of motion in the wrist

Assistant professors in the University of Iowa College of Engineering have developed a robotic device to help people increase their range of motion in the wrist using artificial muscles to increase flexibility.

Caterina Lamuta (left) and Venanzio Cichella (right) pose for a portrait in front of their home on Saturday, April 25, 2020. Both mechanical engineering professors at the University of Iowa, the couple is a part of the team working to create a new robotic rehabilitation device.

Two mechanical-engineering assistant professors at the University of Iowa have created a robotic device to give people with limb impairment a wider range of motion. Right now, the pair is focused on the upper limbs and their first prototype increases mobility in the wrist.

The researchers, Venanzio Cichella and Caterina Lamuta, worked together to develop a flexible, lightweight device that can be powered with a small battery. Lamuta and her students are designing and developing the device itself and Cichella and his student are developing the controls of the device.

The device fits over the hand and wrist like a glove, and uses artificial muscles made from carbon fibers which are strong and flexible, Lamuta said. The muscles can lift 12,600 times their weight, and a lot of these artificial muscles can be used to reproduce the arrangement of human muscle. A small battery can be used to power the device, she said.

“So, the idea is to use this more flexible artificial muscle as an alternative for noisy and heavy traditional actuators like electrical motors or hydraulic or pneumatic actuators,” Lamuta said.

The current prototype can perform a few degrees of wrist extension and flexion, she said, but the researchers are working to increase the motion capabilities of the device.

The actuators the researchers are using are very inexpensive, Cichella said. This allows them to not only create a device that is portable and cheap, he said, but allows them to put more of the actuators in the device.

Related: UI researchers say people with spinal-cord injuries can exercise muscles by electrical stimulation

With so many actuators, the question eventually became how to move each of them in order to get the desired action or movement, he said.

Cichella is developing robust control algorithms that can be implemented in the device. He and his student are developing theoretical tools that will help find the optimal controls for the device, Cichella said, and the goal is to implement the algorithms on the side of the device.

Amid spread of the novel coronavirus, some orders for supplies to build sensors have been delayed and working from home makes it so they can’t use larger machinery in the labs, Lamuta said, so they’re going to have delays in their work.

“Part of our research takes place in the lab, which now is the living room of our house and our students’ houses, and also on paper and pen, so it (the challenge) spans both for theoretical and experimental,” Cichella said.

Two UI Ph.D. students and a visiting scholar from Italy are helping with the development of the algorithms and prototypes of the device.

Thilina Weerakkody, a Ph.D. student, and Carlo Greco, the visiting scholar, are working with Lamuta to develop the device itself.

Weerakkody, who has a background in biomedical-device development, has worked on the device, which is similar to an exoskeleton hand, to control it with external feedback. Now, he’s in the process of developing external sensors for the device, he said.

The first prototype only had a single degree of freedom for the wrist, he added.

“Now in the second prototype, we’ve developed a 3D-printed prototype, so in this phase we are trying to elicit two freedom instances,” Weerakkody said.

Greco helped design the muscle used in the glove, choosing the dimension and length of the muscles and studying the schematics of the wrist, he said. The glove was initially able to move up and down in one motion, Greco said, but now they are working to improve movement in the other direction.

“Our testing now is done on a 3D-printed hand with a forearm and we can measure the displacement of the angle of rotation,” Greco said. “…[If] a person does a motion on his own hand and our hand [should] do the same motion in the same [amount of] time.”

Calvin Kielas-Jensen, a Ph.D. student, has worked with Cichella to develop the control algorithms for the device. They’re working with a motion-capture system to give them submillimeter accuracy for the positions of the wrist.

With a background in electrical engineering, Kielas-Jensen has helped with the electronics in the device. He is providing feedback for what kind of sensors should be used and what kind of algorithms should be used to read the data, Kielas-Jensen added.

“It’s a rehabilitation device, so there are plenty of rehabilitation doctors that say that it’s really good to have people do something with their hands,” he said. “It’s one thing to give a patient a stress ball to squeeze, but it gets tired — it gets boring.”

via Researchers at the UI create robotic rehabilitation device to help increase range of motion in the wrist – The Daily Iowan

[Abstract] An interactive and innovative application for hand rehabilitation through virtual reality

Abstract

Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients’ motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients’ wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.

 

via An interactive and innovative application for hand rehabilitation through virtual reality: International Journal of Advanced Intelligence Paradigms: Vol 15, No 3

[Abstract] Motor Imagery Based Brain-Computer Interface Control of Continuous Passive Motion for Wrist Extension Recovery in Chronic Stroke Patients

Highlights

• Twenty-one patients successfully recovered active wrist extension.
• Motor imagery based BCI control of wrist CPM training was applied.
• Typical spatial and spectrum patterns of ERD/ERS formed after training.

Abstract

Motor recovery of wrist and fingers is still a great challenge for chronic stroke survivors. The present study aimed to verify the efficiency of motor imagery based brain-computer interface (BCI) control of continuous passive motion (CPM) in the recovery of wrist extension due to stroke. An observational study was conducted in 26 chronic stroke patients, aged 49.0 ± 15.4 years, with upper extremity motor impairment. All patients showed no wrist extension recovery. A 24-channel highresolution electroencephalogram (EEG) system was used to acquire cortical signal while they were imagining extension of the affected wrist. Then, 20 sessions of BCI-driven CPM training were carried out for 6 weeks. Primary outcome was the increase of active range of motion (ROM) of the affected wrist from the baseline to final evaluation. Improvement of modified Barthel Index, EEG classification and motor imagery pattern of wrist extension were recorded as secondary outcomes. Twenty-one patients finally passed the EEG screening and completed all the BCI-driven CPM trainings. From baseline to the final evaluation, the increase of active ROM of the affected wrists was (24.05 ± 14.46)˚. The increase of modified Barthel Index was 3.10 ± 4.02 points. But no statistical difference was detected between the baseline and final evaluations (P > 0.05). Both EEG classification and motor imagery pattern improved. The present study demonstrated beneficial outcomes of MI-based BCI control of CPM training in motor recovery of wrist extension using motor imagery signal of brain in chronic stroke patients.

 

Graphical abstract

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via Motor Imagery Based Brain-Computer Interface Control of Continuous Passive Motion for Wrist Extension Recovery in Chronic Stroke Patients – ScienceDirect

 

[Abstract] Autonomous Use of the Home Virtual Rehabilitation System: A Feasibility and Pilot Study

Abstract

Objective: This article describes the findings of a study examining the ability of persons with strokes to use home virtual rehabilitation system (HoVRS), a home-based rehabilitation system, and the impact of motivational enhancement techniques on subjects’ motivation, adherence, and motor function improvements subsequent to a 3-month training program.

Materials and Methods: HoVRS integrates a Leap Motion controller, a passive arm support, and a suite of custom-designed hand rehabilitation simulations. For this study, we developed a library of three simulations, which include activities such as flexing and extending fingers to move a car, flying a plane with wrist movement, and controlling an avatar running in a maze using reaching movements. Two groups of subjects, the enhanced motivation (EM) group and the unenhanced control (UC) group, used the system for 12 weeks in their homes. The EM group trained using three simulations that provided 8–12 levels of difficulty and complexity. Graphics and scoring opportunities increased at each new level. The UC group performed the same simulations, but difficulty was increased utilizing an algorithm that increased difficulty incrementally, making adjustments imperceptible.

Results: Adherence to both the EM and UC protocols exceeded adherence to home exercise programs described in the stroke rehabilitation literature. Both groups demonstrated improvements in upper extremity function. Intrinsic motivation levels were better for the EM group and motivation levels were maintained for the 12-week protocol.

Conclusion: A 12-week home-based training program using HoVRS was feasible. Motivational enhancement may have a positive impact on motivation, adherence, and motor outcome.

 

via Autonomous Use of the Home Virtual Rehabilitation System: A Feasibility and Pilot Study | Games for Health Journal

[ARTICLE] Gamification in a Physical Rehabilitation Setting: Developing a Proprioceptive Training Exercise for a Wrist Robot – Full Text

Proprioception or body awareness is an essential sense that aids in the neural control of movement. Proprioceptive impairments are commonly found in people with neurological conditions such as stroke and Parkinson’s disease. Such impairments are known to impact the patient’s quality of life. Robot-aided proprioceptive training has been proposed and tested to improve sensorimotor performance. However, such robot-aided exercises are implemented similar to many physical rehabilitation exercises, requiring task-specific and repetitive movements from patients. Monotonous nature of such repetitive exercises can result in reduced patient motivation, thereby, impacting treatment adherence and therapy gains. Gamification of exercises can make physical rehabilitation more engaging and rewarding. In this work, we discuss our ongoing efforts to develop a game that can accompany a robot-aided wrist proprioceptive training exercise.

 

Figure 1: Left. WristBot being used by a participant. Right. Screenshot of the virtual environment showing an avatar controlled by user’s wrist movements.

1 INTRODUCTION

Proprioception, the sense of body awareness, is essential for normal motor function. Proprioceptive deficits are common in neurological conditions [Coupar et al. 2012; Konczak et al. 2009]. Such deficits cause a decline in precision of goal-directed movements, and altered postural and spinal reflexes resulting in balance and gait problems [Rothwell et al. 1982]. Proprioceptive training is an intervention aiming to improve proprioceptive function [Aman et al. 2015]. Previous work has established the efficacy of a robot-aided proprioceptive training using WristBot [Elangovan et al. 2017, 2018, 2019]. The WristBot (Figure 1. Left) is a three degrees-of-freedom (3-DoF) exoskeleton robot that allows full range of motion (ROM), delivers precise haptic, position, and velocity stimuli at the wrist, and accurately encodes wrist position across time. Additional details about the WristBot can found in [Cappello et al. 2015].

Nevertheless, while the WristBot has demonstrated its efficacy, it shares a limitation that is often encountered in rehabilitation settings. In a clinical setting, patients are often required to perform task-specific and repetitive movements [Kwakkel et al. 1999]. Initial patient enthusiasm to complete such activities rapidly declines as a result of the monotonous nature of movements. Patient engagement can be improved by complementing therapy with a virtual environment (VE). Prior research has shown that users have favored exercises complemented with a VE rather than conventional approaches [Hoffman et al. 2014]. Thus, our project objective is to turn these tedious movements into an interactive VE experience.

2 GAMIFICATION OF PROPRIOCEPTIVE TRAINING

Gamification process accounted for two key considerations: (1) the game should foster patient motivation and attention (2) and be clinically meaningful. To address these objectives, we reviewed the literature on game development [Bond 2014; Fullerton 2018] and identified four essential components: (1) Variability, (2) Feedback, (3) Rewards, and (4) a Compelling Purpose. The user will be gradually exposed to increasing levels of difficulty, which will likely reduce user frustrations. The user will receive meaningful feedback on concurrent metrics (e.g., Optimal ROM), as well as on previous treatment sessions. During game progress, the user will be alerted about deviations from the target movement requirements. Achievement badges will be rewarded to the user upon reaching therapy milestones, such as target ROM. Lastly, to encourage game completion, we establish an interesting backstory and a meaningful character arc for our virtual avatars. The developed game will be adaptable based on the user’s current clinical status, thus, making the game clinically meaningful. The clinician will have the ability to prescribe exercises based on user needs such as 1 DoF vs 3 DoF movements, continuous vs discrete movements, and strength training vs mobility training. WristBot will provide supportive forces aiding the user to achieve therapy milestones.

Gamified exercise is being developed using the Unity Game Engine, Python and libraries which interface with the WristBot. The game closely resembles an endless runner type game (Figure 1. Right) and utilizes the WrsitBot’s 3-DoF functionality to interact with the VE. Wrist flexion, extension, and abduction can be used to traverse their environment. The remaining 3 movements will allow interactions with their VE in unique ways, such as opening/closing doors, crouching, and pulling levers. In the VE, coins are strategically placed to maximize and improve the use of available ROM. Upon contact with either a wall or obstacle, visual feedback will be provided in the form of avatar damage and coin deduction. Consequently, users achieve improved mobility.

In Python, the connection between Unity and the WristBot library is managed through the use of a local WebSocket, a protocol for two-way communication over a single Transmission Control Protocol (TCP) connection [Fette and Melnikov 2011]. Through the WebSocket, reciprocal data are transferred between the WristBot and Unity. For example, wrist kinematic data will be streamed to the game while game progress is being relayed to the WristBot library. Game progress data will be utilized to compute and deliver haptic feedback to the user. Haptic feedback provided in the form of haptic assistance will aid users to improve their available ROM, while haptic resistance will improve muscle strength within the desired ROM. The clinical motive of the game is to transition the user from use of haptic assistance to resistance during game play. WristBot will adapt haptic feedback based on time spent and progress achieved in game play.

3 USABILITY TESTING

Usability testing will be conducted to ensure proper game usage by the clinical population and healthcare professionals. Specifically, the usability testing will evaluate areas such as 1) ease of game play, 2) game efficiency, and 3) user engagement. We will test the assumptions in each of these areas are accurately depicted in game development and met during game play. For example, we expect online visual feedback of deviations from target to help user focus on achieving the movement requirements. The users will be asked to verify the benefits of visual feedback in modifying their movements. Similarly, other assumptions such as performance badges and coins as rewards, and increase in difficulty levels will be evaluated. A common pitfall of usability studies involving physical rehabilitation setting is not recruiting from the representative population, most notably elderly population [Laver et al. 2017] as age has been shown to interfere with interactions in VE [Meldrum et al. 2012]. Therefore, to ensure our game is intuitive, we will recruit representative users from our patient populations.

ACKNOWLEDGMENTS

This project was supported by National Science Foundation Partnerships For Innovation Technology Translation Award to Jürgen Konczak (1919036). Christopher Curry was supported by National Research Trainee-Understanding the Brain: Graduate Training Program in Sensory Science: Optimizing the Information Available for Mind and Brain (1734815).

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via Gamification in a Physical Rehabilitation Setting: Developing a Proprioceptive Training Exercise for a Wrist Robot

[Abstract] A 5-Degrees-of-Freedom Lightweight Elbow-Wrist Exoskeleton for Forearm Fine-Motion Rehabilitation

Abstract

Exoskeleton robots have been demonstrated to effectively assist the rehabilitation of patients with upper or lower limb disabilities. To make exoskeletons more accessible to patients, they need to be lightweight and compact without major performance tradeoffs. Existing upper-limb exoskeletons focus on assistance with coarse-motion of the upper arm while forearm fine-motion rehabilitation is often ignored. This paper presents an elbow-wrist exoskeleton with five degrees-of-freedom (DoFs). Using geared bearings, slider crank mechanisms, and a spherical mechanism for the wrist and elbow modules, this exoskeleton can provide 5-DoF rotary motion forearm assistance. The optimized exoskeleton dimensions allow sufficient rotation output while the motors are placed parallel to the forearm and elbow joint. Thus compactness and less inertia loading can be achieved. Linear and rotary series elastic actuators (SEAs) with high torque-to-weight ratios are proposed to accurately measure and control interaction force and impedance between exoskeleton and forearm. The resulting 3-kg exoskeleton can be used alone or easily in combination with other exoskeleton robots to provide various robot-aided upper limb rehabilitation.

via A 5-Degrees-of-Freedom Lightweight Elbow-Wrist Exoskeleton for Forearm Fine-Motion Rehabilitation – IEEE Journals & Magazine

[Abstract] Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

Abstract

Spasticity and contractures are secondary to most neurological and orthopaedic pathologies. The most conservative method of management of spasticity and contractures is passive stretching exercises. Robotic rehabilitation aims to provide a solution to this problem. We describe in details the design of a powered wearable orthosis especially designed for managing spasticity and contractures. The device is fully portable, allowing the patient to undergo repeated-passive-dynamic exercises outside the hospital environment. The design of the device is modular to make it adaptable to different anatomies and pathologies. The device is also fitted with electrogoniometers and torque sensors to record kinematics and dynamics of the patient, improving the insight of the clinicians to the rehabilitation of the patient, as well as providing data for further clinical and scientific investigations. The mechanical integrity of the device elements is simulated and verified.

via Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

[Abstract + References] A Feasibility Study on Wrist Rehabilitation Using the Leap Motion – Conference paper

Abstract

Wrist and hand rehabilitation are common as people suffer injuries during work and exercise. Typically, the rehabilitation involves the patient and the therapist, which is both time consuming and cost burdening. It is desirable to use advanced telemedicine technologies such that the patient is able to enjoy the freedom of performing the required exercise at their own time and pace, while the healthcare system can operate more efficiently. The Leap Motion Controller (LMC), an inexpensive motion detection device, seems to be a good candidate for remote wrist rehabilitation. In this paper, the functionality and capability of the LMC are examined. Experiments are carried out with a total of twelve people performing twelve different movements. From the experimental results, the feasibility of using the LMC as a rehabilitation device is discussed.

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