Design and development of a hand robotic rehabilitation device for post stroke patients

Development of a four-channel haptic system for remote assessment of patients with impaired hands

Haptic devices have proven effective in stimulating proprioceptive sensing in post-stroke patients. In this work, pre-existing devices were used together in a remote environment for the teleassessment of impaired hands. A four-channel bilateral control system in the presence of large and variable time delay is proposed as a proof of concept. Time delay is managed with a novel communication disturbance observer (CDOB). The system also employed a scaling down compensation value (SDCV) for the CDOB. The proposed control system was tested successfully in bilateral haptic interaction, simulating a remote motor and functional evaluation of patients' hands, guaranteeing safe and stable interaction, even in the presence of large network delays.

On the assessment of coordination between upper extremities: towards a common language between rehabilitation engineers, clinicians and neuroscientists

Well-developed coordination of the upper extremities is critical for function in everyday life. Interlimb coordination is an intuitive, yet subjective concept that refers to spatio-temporal relationships between kinematic, kinetic and physiological variables of two or more limbs executing a motor task with a common goal. While both the clinical and neuroscience communities agree on the relevance of assessing and quantifying interlimb coordination, rehabilitation engineers struggle to translate the knowledge and needs of clinicians and neuroscientists into technological devices for the impaired. The use of ambiguous definitions in the scientific literature, and lack of common agreement on what should be measured, present large barriers to advancements in this area. Here, we present the different definitions and approaches to assess and quantify interlimb coordination in the clinic, in motor control studies, and by state-of-the-art robotic devices. We then propose a taxonomy of interlimb activities and give recommendations for future neuroscience-based robotic- and sensor-based assessments of upper limb function that are applicable to the everyday clinical practice. We believe this is the first step towards our long-term goal of unifying different fields and help the generation of more consistent and effective tools for neurorehabilitation.

Bimanual elbow robotic orthoses: preliminary investigations on an impairment force-feedback rehabilitation method

Modern rehabilitation practices have begun integrating robots, recognizing their significant role in recovery. New and alternative stroke rehabilitation treatments are essential to enhance efficacy and mitigate associated health costs. Today's robotic interventions can play a significant role in advancing rehabilitation. In addition, robots have an inherent ability to perform tasks accurately and reliably and are typically well suited to measure and quantify performance. Most rehabilitation strategies predominantly target activation of the paretic arm. However, bimanual upper-limb rehabilitation research suggests potential in enhancing functional recovery. Moreover, studies suggest that limb coordination and synchronization can improve treatment efficacy. In this preliminary study, we aimed to investigate and validate our user-driven bimanual system in a reduced intensity rehab practice. A bimanual wearable robotic device (BWRD) with a Master-Slave configuration for the elbow joint was developed to carry out the investigation. The BWRD incorporates position and force sensors for which respective control loops are implemented, and offers varying modes of operation ranging from passive to active training. The proposed system enables the perception of the movements, as well as the forces applied by the hemiparetic arm, with the non-hemiparetic arm. Eight participants with chronic unilateral stroke were recruited to participate in a total of three 1-h sessions per participant, delivered in a week. Participants underwent pre- and post-training functional assessments along with proprioceptive measures. The post-assessment was performed at the end of the last training session. The protocol was designed to engage the user in an assortment of static and dynamic arm matching and opposing tasks. The training incorporates force-feedback movements, force-feedback positioning, and force matching tasks with same and opposite direction movements. We are able to suggest identification of impairment patterns in the position-force plot results. In addition, we performed a proprioception evaluation with the system. We set out to design innovative and user immersive training tasks that utilize the BWRD capabilities, and we demonstrate that the subjects were able to cooperate and accomplish the protocol. We found that the Fugl-Meyer and Wolf Motor Function Test (pre to post) measured improvements (15 and 19%, respectively). Recognizing the brevity of the training, we focus our report primarily on the proprioception testing (32% significant improvement, p prop = 0.033) and protocol distinctive features and results. This paper presents the electromechanical features and performance of the BWRD, the testing protocol, and the assessments utilized. Outcome measures and results are presented and demonstrate the successful application and operation of the system.

Medical Robotics

Many research and development projects are being performed worldwide to develop new products and applications for computer-assisted and medical robotic systems. In this paper, an overview of selected state-of-the-art applications of robotic technology in medicine is presented. Four key areas of image-guided surgery, virtual reality in medicine, surgical robots, and robotic rehabilitation systems, are studied. As well, current challenges in research and development are discussed.

A systematic review of bilateral upper limb training devices for poststroke rehabilitation

Introduction. In stroke rehabilitation, bilateral upper limb training is gaining ground. As a result, a growing number of mechanical and robotic bilateral upper limb training devices have been proposed. Objective. To provide an overview and qualitative evaluation of the clinical applicability of bilateral upper limb training devices. Methods. Potentially relevant literature was searched in the PubMed, Web of Science, and Google Scholar databases from 1990 onwards. Devices were categorized as mechanical or robotic (according to the PubMed MeSH term of robotics). Results. In total, 6 mechanical and 14 robotic bilateral upper limb training devices were evaluated in terms of mechanical and electromechanical characteristics, supported movement patterns, targeted part and active involvement of the upper limb, training protocols, outcomes of clinical trials, and commercial availability. Conclusion. Initial clinical results are not yet of such caliber that the devices in question and the concepts on which they are based are firmly established. However, the clinical outcomes do not rule out the possibility that the concept of bilateral training and the accompanied devices may provide a useful extension of currently available forms of therapy. To actually demonstrate their (surplus) value, more research with adequate experimental, dose-matched designs, and sufficient statistical power are required.

Wrist-RoboHab: a robot for treatment and evaluation of brain injury patients

This article, introduces a new haptic robot, wrist-RoboHab, for upper limb rehabilitation of post stroke, orthopedic and Parkinson patients., The robot is designed for hand movement therapy and could be used for both treatment and evaluation purposes in three operational states; forearm supination/pronation, wrist flexion/extension and ulnar/radial deviation. At first the mechanical design and control system are described. Then the results of a case study are demonstrated. Clinical results, showed an improvement in Fugle-Meyer, AROM, power and the biomechanical assessment of the spasticity in a chronic patient. Furthermore, it was approved that the robot can have a good interaction with both, patient and therapist.

Reaction force/torque sensing in a master-slave robot system without mechanical sensors

In human-robot cooperative control systems, force feedback is often necessary in order to achieve high precision and high stability. Usually, traditional robot assistant systems implement force feedback using force/torque sensors. However, it is difficult to directly mount a mechanical force sensor on some working terminals, such as in applications of minimally invasive robotic surgery, micromanipulation, or in working environments exposed to radiation or high temperature. We propose a novel force sensing mechanism for implementing force feedback in a master-slave robot system with no mechanical sensors. The system consists of two identical electro-motors with the master motor powering the slave motor to interact with the environment. A bimanual coordinated training platform using the new force sensing mechanism was developed and the system was verified in experiments. Results confirm that the proposed mechanism is capable of achieving bilateral force sensing and mirror-image movements of two terminals in two reverse control directions.