Application of a myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: patient perspectives

Towards the Identification of Patients' Needs for Promoting Robotics and Allied Digital Technologies in Rehabilitation: A Systematic Review

Background/Objectives: Robotic rehabilitation holds great potential for improving patient outcomes, but the integration of these technologies into clinical practice is hindered by a lack of comprehensive tools for assessing patients' needs. This systematic review aimed to identify gaps in the current literature, with a focus on methodologies and tools for evaluating such needs, particularly those based on the International Classification of Functioning, Disability, and Health (ICF) framework. Methods: A systematic review of qualitative studies published between 2021 and 2023 was conducted, updating a previous (2020) review. Studies were identified through PubMed, Scopus, and Web of Science using inclusion criteria focused on qualitative methods capturing patients' experiences with robotic and technological rehabilitation devices. Results: The review analyzed 19 new studies and 20 from the prior review, revealing a reliance on semi-structured interviews targeting small, heterogeneous populations. No studies employed standardized ICF-based tools, and gaps were noted in the exploration of conditions such as Parkinson's disease, frailty, or conditions that allowed for multi-device experiences. Conclusions: The findings emphasize the necessity for tailored surveys grounded in the ICF framework to completely evaluate the needs of patients suffering from sensory, motor, and/or cognitive disorders caused by different health conditions. This work lays the foundation for more inclusive, effective, and patient-centered robotic rehabilitation strategies.

Enhanced Functionality Using a Powered Upper Extremity Exoskeleton in Patients With Brachial Plexus Injuries

Traumatic brachial plexus injury (BPI) results in significant disability, often hindering functionality in the patient's daily life. Post- surgery, muscle strength recovery can take up to two years, with 40% of patients requiring even longer. A powered elbow orthosis can enhance functionality during activities of daily living (ADLs). This study tested a novel powered myoelectric elbow orthosis (PMEO) during ADLs. Subjects with BPI were fitted with the PMEO and divided into two groups: more impaired (Manual Muscle Test (MMT) < 3, N = 5) and less impaired (MMT≤ 3, N = 4). They performed four ADLs involving full elbow motion, including an activity requiring the subjects to lift a basket with weights. Upper extremity kinematics, electromyographic activity, weight lifted, and subject feedback on the device's form and fit were collected and analyzed. Results showed that the PMEO significantly improved elbow range of motion in the more impaired group (14 ± 23 degrees, p = 0.019) without any additional compensatory motions in the shoulder or trunk. More impaired subjects lifted an average of 1.1 ± 0.6 kg with the PMEO, whereas they could not do so without it (p = 0.011). Subjects appreciated the PMEO's weight, fit, and form. All could don and doff the device with minimal assistance. These findings demonstrate that the PMEO is a viable option to enhance ADL function for patients with BPI.

Myoelectric performance of the reconstructed elbow flexor in patients with brachial plexus injuries

Traumatic adult brachial plexus injury is a debilitating injury. Myoelectric exoskeletons are functional tools for restoring elbow flexion. Electromyography signals are used for exoskeleton control, but a characterization specific to the traumatic adult brachial plexus injury population has yet to be performed. This study evaluated if adult patients with traumatic brachial plexus injury and a reconstructed elbow flexor can control a myoelectric exoskeleton. Adult patients who underwent surgical intervention to restore elbow flexion with traumatic brachial plexus injury were recruited for this cross-sectional study. The processed elbow flexor muscle signal and activation thresholds were used to evaluate criteria for exoskeleton control algorithm development. A single activation threshold can be utilized for exoskeleton control, but the calibration routine should consider the resting signal for both extended and flexed elbow positions. The data indicated a 'settle-time' following contraction is needed to prevent unintentional movement of the exoskeleton. All patients activated their elbow flexor above the activation threshold in the supported, flexed position. However, there were different abilities to generate multiple, discrete signals. These results were not specific to surgery, nerve implemented for reconstruction, or post-operative recovery time. Patients with a brachial plexus injury and a reconstructed elbow flexor demonstrated subject-specific capabilities for exoskeleton control.

Design and Development of a Powered Myoelectric Elbow Orthosis for Neuromuscular Injuries

INTRODUCTION

Recovering from neuromuscular injuries or conditions can be a challenging journey that involves complex surgeries and extensive physical rehabilitation. During this process, individuals often rely on orthotic devices to support and enable movement of the affected limb. However, users have criticized current commercially available powered orthotic devices for their bulky and heavy design. To address these limitations, we developed a novel powered myoelectric elbow orthosis.

MATERIALS AND METHODS

The orthosis incorporates 3 mechanisms: a solenoid brake, a Bowden cable-powered constant torque elbow mechanism, and an extension limiter. The device controller and battery are in a backpack to reduce the weight on the affected arm. We performed extensive calculations and testing to ensure that the orthosis could withstand at least 15 Nm of elbow torque. We developed a custom software effectively control the orthosis, enhancing its usability and functionality. A certified orthotist fitted a subject who had undergone a gracilis free functioning muscle transfer surgery with the device. We studied the subject under Mayo clinic IRB no. 20-006849 and obtained objective measurements to assess the orthosis's impact on upper extremity functionality during daily activities.

RESULTS

The results are promising since the orthosis significantly improved elbow flexion range of motion by 40° and reduced compensatory movements at the shoulder (humerothoracic joint) by 50°. Additionally, the subject was able to perform tasks which were not possible before, such as carrying a basket with weights, highlighting the enhanced functionality provided by the orthosis.

CONCLUSION

In brief, by addressing the limitations of existing devices, this novel powered myoelectric elbow orthosis offers individuals with neuromuscular injuries/conditions improved quality of life. Further research will expand the patient population and control mechanisms.

Mechatronic Design of a Prototype Orthosis to Support Elbow Joint Rehabilitation

Injuries in the elbow area, such as lateral and medial epicondylitis, are the leading causes of consultation with health specialists. Therefore, this research proposes the mechatronic design of an orthosis with a graphic interface that supports professionals in the rehabilitation of the elbow joint through the execution of flexion–extension and pronation–supination movements. For the development of the rehabilitation prototype, mechatronic design, co-design, and IDEF0 methodologies are used, performing activities such as actuator characterization, simulations, and modeling, among others. Through the execution of a case study in a real environment, the device was validated, where the results suggest a functional and workable prototype that supports the treatment of pathologies in the elbow area through the execution of the mentioned movements, supposing that this is a low-cost alternative with elements to improve, such as the industrial design and new functionalities. The developed proposal shows potential as an economical product that health professionals can use. However, some limitations related to the design and functionalities in the application domain were identified.

Application of myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: a retrospective clinical study

BACKGROUND

Adult traumatic brachial plexus injuries (BPIs) can result in severe impairment following penetrating wounds, falls, and motor vehicle accidents or other high-energy trauma.

OBJECTIVE

Quantify functional outcomes of adult patients with a BPI using a myoelectric orthosis to restore elbow flexion.

STUDY DESIGN

Retrospective review.

METHODS

A clinic specializing in the BPI treatment at a large academic medical center tested nineteen adult patients with BPI. These patients had failed to achieve antigravity elbow flexion following their injury and observation or surgical reconstruction. They were provided a myoelectric elbow orthosis (MEO) if they had detectable electromyography signals.

RESULTS

There was significant improvement in strength and significant reductions in function and pain when using an MEO. Following initiation of the MEO, 12 of the 19 patients had clinical improvements in muscle strength, 15 patients showed improvement in their DASH, and 13 patients reported improvements in their Visual Analog Scale.

CONCLUSION

The use of an MEO improves elbow flexion strength, increases function, and reduces pain in the majority of patients with BPI and inadequate elbow flexion following observation or surgical reconstruction.