Proprioception rehabilitation training system for stroke patients using virtual reality technology

Somatosensory Information in Skilled Motor Performance: A Narrative Review

Historically, research aimed at improving motor performance has largely focused on the neural processes involved in motor execution due to their role in muscle activation. However, accompanying somatosensory and proprioceptive sensory information is also vitally involved in performing motor skills. Here we review research from interdisciplinary fields to provide a description for how somatosensation informs the successful performance of motor skills as well as emphasize the need for careful selection of study methods to isolate the neural processes involved in somatosensory perception. We also discuss upcoming strategies of intervention that have been used to improve performance via somatosensory targets. We believe that a greater appreciation for somatosensation's role in motor learning and control will enable researchers and practitioners to develop and apply methods for the enhancement of human performance that will benefit clinical, healthy, and elite populations alike.

Digital therapeutics in neurology

Digital therapeutics (DTx) is a section of digital health defined by the DTx Alliance as “delivering evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes”. Chronic disabling diseases could greatly benefit from DTx. In this narrative review, we provide an overview of DTx in the care of patients with neurological dysfunctions.

Robotics-assisted visual-motor training influences arm position sense in three-dimensional space

Background

Performing activities of daily living depends, among other factors, on awareness of the position and movements of limbs. Neural injuries, such as stroke, might negatively affect such an awareness and, consequently, lead to degrading the quality of life and lengthening the motor recovery process. With the goal of improving the sense of hand position in three-dimensional (3D) space, we investigate the effects of integrating a pertinent training component within a robotic reaching task.

Methods

In the proof-of-concept study presented in this paper, 12 healthy participants, during a single session, used their dominant hand to attempt reaching without vision to two targets in 3D space, which were placed at locations that resembled the functional task of self-feeding. After each attempt, participants received visual and haptic feedback about their hand’s position to accurately locate the target. Performance was evaluated at the beginning and end of each session during an assessment in which participants reached without visual nor haptic feedback to three targets: the same two targets employed during the training phase and an additional one to evaluate the generalization of training.

Results

Collected data showed a statistically significant [39.81% (p=0.001)] reduction of end-position reaching error when results of reaching to all targets were combined. End-position error to the generalization target, although not statistically significant, was reduced by 15.47%.

Conclusions

These results provide support for the effectiveness of combining an arm position sense training component with functional motor tasks, which could be implemented in the design of future robot-assisted rehabilitation paradigms to potentially expedite the recovery process of individuals with neurological injuries.

Robot-Aided Upper-limb Proprioceptive Training in Three-Dimensional Space

Proprioception, the ability to sense body position and limb movements in space without visual feedback, is one of the key factors in controlling body movements and performing activities of daily living. However, this capability might be affected after neural injuries such as stroke. Robotic platforms can be used to monitor and promote arm movements and, therefore, can assist in developing rehabilitation protocols that aim to improve proprioception through repetitive reaching motions without vision. The objective of this paper is to investigate if a robotic training protocol improves the end-position reaching proprioceptive sense in three-dimensional (3D) space. As an initial step towards clinical application, a robotic platform was employed to train the end-position proprioceptive sense in six healthy participants. During the training phase, volunteers used their dominant hand to reach without vision to two different targets in 3D space. Positions of these targets were carefully chosen to create a hand movement pattern similar to that used when self-feeding, which is an important activity of daily living. At the end of each training trial, participants were provided with visual feedback to help them move their hands to the exact locations confirmed through haptic feedback. Their performance was evaluated before and after the training in an assessment phase during which participants were asked to move from the start position to the same two targets as well as an additional third one without any visual or haptic feedback. The results from this study show significant improvements in overall reaching accuracy and trajectory smoothness, demonstrated by 41% decrease in the average end-position error and 13% reduction in the average index of curvature after the training. This research suggests the potential of designing robotic rehabilitation protocols for improving 3D proprioception.

Research and Development of Rehabilitation Systems for the Upper Limbs “PLEMO” Series

The human brain has excellent plasticity in terms of recovery from a stroke. It is expected that neurorehabilitation using an apparatus that applies robotic and virtual reality technology has rehabilitation training effects on stroke patients. Rehabilitation of the upper limbs consists of rehabilitation for shoulders and elbows, and rehabilitation of the fingers and wrists. Both rehabilitations are necessary to improve activities of daily living. Many rehabilitation systems for shoulders and elbows have been effective thus far. In this review, we introduce rehabilitation systems for the shoulders, elbows, and wrists of the upper limbs “PLEMO” series using force presentation technology with brakes. Rehabilitation systems using brakes are essentially safe unlike rehabilitation systems using actuators.