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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Johansen T, Sørensen L, Kolskår KK, Strøm V, Wouda MF. Effectiveness of robot-assisted arm exercise on arm and hand function in stroke survivors - A systematic review and meta-analysis. J Rehabil Assist Technol Eng 2023; 10:20556683231183639. [PMID: 37426037 PMCID: PMC10327418 DOI: 10.1177/20556683231183639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Objective: To examine the treatment effect of commercially available robotic-assisted devices, compared to traditional occupational- and physiotherapy on arm and hand function in persons with stroke. Methods: A systematic literature search was conducted in Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials up to January 2022. Randomized controlled trials (RCT's) involving persons with stroke of all ages and robot-assisted exercise as method for arm and hand function, compared to traditional therapy methods were included. Three authors performed the selection independently. The quality of evidence across studies was assessed using GRADE. Results: Eighteen RCT's were included in the study. A random effects meta-analysis showed a statistically significantly higher treatment effect in the robotic-assisted exercise group (p=<0.0001) compared to the traditional treatment group, with a total effect size of 0.44 (CI = 0.22-0.65). Heterogeneity was high, measured with I2 of 65%). Subgroup analyses showed no significant effects of the type of robotic device, treatment frequency or duration of intervention. Discussion and conclusion: Even though the analysis showed significant improvement in arm and hand function in favor of the robotic-assisted exercise group, the results in this systematic review should be interpreted with caution. This is due to high heterogeneity among the studies included and the presence of possible publication bias. Results of this study highlight the need for larger and more methodological robust RCT's, with a focus on reporting training intensity during robotic exercise.
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Affiliation(s)
- Truls Johansen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Linda Sørensen
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Innovation, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Knut K Kolskår
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
| | - Matthijs F Wouda
- Department of Research, Sunnaas Rehabilitation Hospital, Oslo, Norway
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Serrano-López Terradas PA, Criado Ferrer T, Jakob I, Calvo-Arenillas JI. Quo Vadis, Amadeo Hand Robot? A Randomized Study with a Hand Recovery Predictive Model in Subacute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:690. [PMID: 36613027 PMCID: PMC9820043 DOI: 10.3390/ijerph20010690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Early identification of hand-prognosis-factors at patient's admission could help to select optimal synergistic rehabilitation programs based on conventional (COHT) or robot-assisted (RAT) therapies. METHODS In this bi-phase cross-over prospective study, 58 stroke patients were enrolled in two randomized groups. Both groups received same treatments A + B (A = 36 COHT sessions for 10 weeks; B = 36 RAT sessions for 10 weeks; 45 min/session; 3 to 5 times per week). Outcome repeated measures by blinded assessors included FMUL, BBT, NHPT, Amadeo Robot (AHR) and AMPS. Statistical comparisons by Pearson's rank correlations and one-way analyses of variance (ANOVA) with Bonferroni posthoc tests, with size effects and statistic power, were reported. Multiple backward linear regression models were used to predict the variability of sensorimotor and functional outcomes. RESULTS Isolated COHT or RAT treatments improved hand function at 3 months. While "higher hand paresis at admission" affected to sensorimotor and functional outcomes, "laterality of injury" did not seem to affect the recovery of the hand. Kinetic-kinematic parameters of robot allowed creating a predictive model of hand recovery at 3 and 6 months from 1st session. CONCLUSIONS Hand impairment is an important factor in define sensorimotor and functional outcomes, but not lesion laterality, to predict hand recovery.
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Affiliation(s)
- Pedro Amalio Serrano-López Terradas
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Occupational Thinks Research Group, Occupational Therapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Teresa Criado Ferrer
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Zuccon G, Lenzo B, Bottin M, Rosati G. Rehabilitation robotics after stroke: a bibliometric literature review. Expert Rev Med Devices 2022; 19:405-421. [PMID: 35786139 DOI: 10.1080/17434440.2022.2096438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is the leading cause of long-term disability in developed countries. Due to population aging, the number of people requiring rehabilitation after stroke is going to rise in the coming decades. Robot-mediated neurorehabilitation has the potential to improve clinical outcomes of rehabilitation treatments. A statistical analysis of the literature aims to focus on the main trend of this topic. AREAS COVERED A bibliometric survey on post-stroke robotic rehabilitation was performed through a database collection of scientific publications in the field of rehabilitation robotics. By covering the last 20 years, 17429 sources were collected. Relevant patterns and statistics concerning the main research areas were analyzed. Leading journals and conferences which publish and disseminate knowledge in the field were identified. A detailed nomenclature study was carried out. The time trends of the research field were captured. Opinions and predictions of future trends that are expected to shape the near future of the field were discussed. EXPERT OPINION Data analysis reveals the continuous expansion of the research field over the last two decades, which is expected to rise considerably in near future. More attention will be paid to the lower limbs rehabilitation and disease/design specific applications in early-stage patients.
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Affiliation(s)
- Giacomo Zuccon
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Basilio Lenzo
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Matteo Bottin
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Giulio Rosati
- Department of Industrial Engineering, University of Padua, Padua, Italy
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Abstract
Abstract
With diverse areas of applications, wearable robotic exoskeleton devices have gained attention in the past decade. These devices cover one or more human limbs/joints and have been presented for rehabilitation, strength augmentation and interaction with virtual reality. This research is focused towards design, modeling and control of a novel series elastic actuation (SEA) based index finger exoskeleton with a targeted torque rendering capability of 0.3 Nm and a force control bandwidth of 3 Hz. The proposed design preserves the natural range of motion of the finger by incorporating five passive and two actively actuated joints and provides active control of metacarpophalangeal and proximal interphalangeal joints. Forward and inverse kinematics for both position and velocity have been solved using closed loop vector analysis by including human finger as an integral part of the system. For accurate force control, a cascaded control structure has been presented. Force controlled trajectories have been proposed to guide the finger along preprogrammed virtual paths. Such trajectories serve to gently guide the finger towards the correct rehabilitation protocol, thus acting as an effective replacement of intervention by a human therapist. Extensive computer simulations have been performed before fabricating a prototype and performing experimental validation. Results show accurate modeling and control of the proposed design.
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Zhao M, Wang G, Wang A, Cheng LJ, Lau Y. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 2022; 43:1641-1657. [PMID: 35089447 DOI: 10.1007/s10072-022-05913-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.
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Affiliation(s)
- Menglu Zhao
- The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | | | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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Xie C, Yang Q, Huang Y, Su S, Xu T, Song R. A Hybrid Arm-Hand Rehabilitation Robot With EMG-Based Admittance Controller. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:1332-1342. [PMID: 34813476 DOI: 10.1109/tbcas.2021.3130090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reach-and-grasp is one of the most fundamental activities in daily life, while few rehabilitation robots provide integrated and active training of the arm and hand for patients after stroke to improve their mobility. In this study, a novel hybrid arm-hand rehabilitation robot (HAHRR) was built for the reach-and-grasp task. This hybrid structure consisted of a cable-driven module for three-dimensional arm motion and an exoskeleton for hand motion, which enabled assistance of the arm and hand simultaneously. To implement active compliance control, an EMG-based admittance controller was applied to the HAHRR. Experimental results showed that the HAHRR with the EMG-based admittance controller could not only assist the subject in fulfilling the reach-and-grasp task, but also generate smoother trajectories compared with the force-sensing-based admittance controller. These findings also suggested that the proposed approach might be applicable to post-stroke arm-hand rehabilitation training.
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YOON DAESEOK, LEE SEUNGBOK, CHO SANGHYUN, PARK HAEYEAN, KIM JONGBAE. A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.
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Affiliation(s)
- DAESEOK YOON
- Department of Occupational Therapy, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul KS013, Republic of Korea
| | - SEUNGBOK LEE
- Yonsei Enabling Science and Technology Research Center, Yonsei University, Wonju KS007, Republic of Korea
| | - SANG-HYUN CHO
- Department of Physical Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - HAEYEAN PARK
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - JONGBAE KIM
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
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YOON DAESEOK, LEE SEUNGBOK, CHO SANGHYUN, PARK HAEYEAN, KIM JONGBAE. A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS. J MECH MED BIOL 2021; 21. [DOI: https:/doi.org/10.1142/s0219519421400406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.
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Affiliation(s)
- DAESEOK YOON
- Department of Occupational Therapy, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Seoul KS013, Republic of Korea
| | - SEUNGBOK LEE
- Yonsei Enabling Science and Technology Research Center, Yonsei University, Wonju KS007, Republic of Korea
| | - SANG-HYUN CHO
- Department of Physical Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - HAEYEAN PARK
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
| | - JONGBAE KIM
- Department of Occupational Therapy, Yonsei University, College of Health Sciences, Wonju KS007, Republic of Korea
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New Rehabilitation Assessment Method of the End-Effector Finger Rehabilitation Robot Based on Multi-Sensor Source. Healthcare (Basel) 2021; 9:healthcare9101251. [PMID: 34682931 PMCID: PMC8535290 DOI: 10.3390/healthcare9101251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
In the process of rehabilitation, the objectivity and the accuracy of rehabilitation assessment have an obvious impact on the follow-up training. To improve this problem, using a multi-sensor source, this paper attempts to establish a comprehensive assessment method of the finger rehabilitation effect, including three indicators of finger muscle strength, muscle fatigue degree, and range of motion. Firstly, on the basis of the fingertip pressure sensor of the End-Effector Finger Rehabilitation Robot, a mathematical model of finger muscle strength estimation was established, and the estimated muscle strength was scored using the entropy weight method. Secondly, using an sEMG signal sensor, a fatigue monitoring system was designed in the training process, and the fatigue degree was determined on the basis of the change trend of the eigenvalues of MAV and RMS. Lastly, a human-machine motion coupling model was established, and the joint range of motion acquisition and scoring model were obtained on the basis of the motor encoder. According to the above three indicators, using the AHP assessment method to establish a comprehensive rehabilitation assessment method, the effectiveness of the method was verified by experiments. This paper provides a potential new idea and method for objective, accurate, and convenient assessment of finger function rehabilitation, which is of positive significance for alleviating the burden on rehabilitation doctors and improving rehabilitation efficiency.
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Mawase F, Cherry-Allen K, Xu J, Anaya M, Uehara S, Celnik P. Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke. Neurorehabil Neural Repair 2021; 34:733-745. [PMID: 32845230 PMCID: PMC7457456 DOI: 10.1177/1545968320939563] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.
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Affiliation(s)
- Firas Mawase
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kendra Cherry-Allen
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jing Xu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Manuel Anaya
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shintaro Uehara
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Fujita Health University, Toyoake, Aichi, Japan
| | - Pablo Celnik
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Moggio L, de Sire A, Marotta N, Demeco A, Ammendolia A. Exoskeleton versus end-effector robot-assisted therapy for finger-hand motor recovery in stroke survivors: systematic review and meta-analysis. Top Stroke Rehabil 2021; 29:539-550. [PMID: 34420498 DOI: 10.1080/10749357.2021.1967657] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The growing number of stroke survivors with residual hand disabilities requires the development of efficient recovery therapy, and robotic rehabilitation can play an important role. OBJECTIVE The study aims to compare the relative effects of end-effector (EE) and exoskeleton (EXO) hand devices in motor recovery of patients with finger-hand motor impairment stroke. METHODS We identified randomized controlled trials (RCTs) through search in database on PubMed, Embase, MEDLINE, Cochrane library until October 2020. We included as outcomes: motricity index (MI), quick version of disabilities of the arm, shoulder, and hand (QuickDASH) questionnaire, and Fugl-Meyer assessment for upper extremity (FMAUE). We performed a systematic review, a meta-analysis, and a surface under the cumulative ranking analysis (SUCRA). RESULTS We included five RTCs and 149 subjects. MI showed a signifìcant improvement (p < .05) in robotic intervention group compared to control group (effect size, ES: 9.47; confidence interval, CI: 3.91, 15.03). QuickDASH reported a significant reduction (p < .05) in EXO group (ES: -6.71; CI: -9.17, -4.25). FMAUE showed a significant improvement (p < .05) in the EE group (ES:3; CI:1.97, 4.04). SUCRA analysis of MI demonstrated that robotic interventions are more likely to be the best option for motor recovery (97.3% of probability EXO; 48.3% EE; 4.4% control). CONCLUSION Despite the limited number of studies included, exoskeleton robotic devices might be a better option than end-effector devices in the treatment of fingers motor impairment in stroke patients. Further studies are still needed to confirm the findings and should focus on a direct comparison of the two devices.
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Affiliation(s)
- Lucrezia Moggio
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Nicola Marotta
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Andrea Demeco
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro,Magna Graecia, Catanzaro, Italy
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Wardhani P, Triyani I, Ardiansyah F, Matos FAD. Finger Exoskeleton in Simple Motor Rehabilitation Therapy on Arm and Hand Muscle Ability of Post-Stroke Sufferers. JURNAL INFO KESEHATAN 2021. [DOI: 10.31965/infokes.vol19.iss1.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Post-stroke sufferers will generally experience weakness on one side of the body, balance, vision, sensory, motor, and cognitive. In West Kalimantan, the estimated stroke sufferer in 2013 was 25,195 people. Based on data from the Public Hospital of Dr. Soedarso Pontianak shows a significant increase from January 2018 to December 2018 totaling 722 people. The research objective was to assess the effectiveness of the finger exoskeleton tool in simple motor therapy on the ability of the client's arm and hand muscles after a stroke. This study used a quantitative approach with a quasi-experimental design. Pre-test and Post-test Nonequivalent Control Group with two groups, which were the control group of 12 people and the intervention group of 12 people with finger exoskeleton tools. The statistical test used was the independent t test and paired t test. Measurement of muscle ability with the Action Research Arm Test. Analysis of the difference in total scores between before and after treatment in the intervention group using Paired T-Test obtained a p-value of 0.000 (p value <0.05) and in the control group using the Wilcoxon test a p-value of 0.016 (p value <0.05). It shows that there is a significant difference in the total score between before and after finger exoskeleton therapy and range of motion. Intervention of finger exoskeleton assistive devices in simple motor rehabilitation therapy is effective in increasing the ability of the client's arm and hand muscles after stroke. It is recommended to make another finger rehabilitation tool with a more optimal design according to the parameters, which are the severity of the client after stroke, subject kinematics, control of movement torque and adaptation between the subject and the robotic device used.
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15
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Budhota A, Chua KSG, Hussain A, Kager S, Cherpin A, Contu S, Vishwanath D, Kuah CWK, Ng CY, Yam LHL, Loh YJ, Rajeswaran DK, Xiang L, Burdet E, Campolo D. Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands. Front Neurol 2021; 12:622014. [PMID: 34149587 PMCID: PMC8206540 DOI: 10.3389/fneur.2021.622014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/23/2021] [Indexed: 01/31/2023] Open
Abstract
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628.
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Affiliation(s)
- Aamani Budhota
- Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.,Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Karen S G Chua
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Asif Hussain
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Adèle Cherpin
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sara Contu
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Deshmukh Vishwanath
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher W K Kuah
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chwee Yin Ng
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Lester H L Yam
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Yong Joo Loh
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Domenico Campolo
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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16
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Mechanical Design and Analysis of the End-Effector Finger Rehabilitation Robot (EFRR) for Stroke Patients. MACHINES 2021. [DOI: 10.3390/machines9060110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most existing finger rehabilitation robots are structurally complex and cannot be adapted to multiple work conditions, such as clinical and home. In addition, there is a lack of attention to active adduction/abduction (A/A) movement, which prevents stroke patients from opening the joint in time and affects the rehabilitation process. In this paper, an end-effector finger rehabilitation robot (EFRR) with active A/A motion that can be applied to a variety of applications is proposed. First, the natural movement curve of the finger is analyzed, which is the basis of the mechanism design. Based on the working principle of the cam mechanism, the flexion/extension (F/E) movement module is designed and the details used to ensure the safety and reliability of the device are introduced. Then, a novel A/A movement module is proposed, using the components that can easily individualized design to achieve active A/A motion only by one single motor, which makes up for the shortcomings of the existing devices. As for the control system, a fuzzy proportional-derivative (PD) adaptive impedance control strategy based on the position information is proposed, which can make the device more compliant, avoid secondary injuries caused by excessive muscle tension, and protect the fingers effectively. Finally, some preliminary experiments of the prototype are reported, and the results shows that the EFRR has good performance, which lays the foundation for future work.
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17
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Baldan F, Turolla A, Rimini D, Pregnolato G, Maistrello L, Agostini M, Jakob I. Robot-assisted rehabilitation of hand function after stroke: Development of prediction models for reference to therapy. J Electromyogr Kinesiol 2021; 57:102534. [PMID: 33618325 DOI: 10.1016/j.jelekin.2021.102534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recovery of hand function after stroke represents the hardest target for clinicians. Robot-assisted therapy has been proved to be effective for hand recovery. Nevertheless, studies aimed to refer patients to the best therapy are missing. METHODS With the aim to identify which clinical features are predictive for referring to robot-assisted hand therapy, 174 stroke patients were assessed with: Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), Reaching Performance Scale (RPS), Box and Block Test (BBT), Modified Ashworth Scale (MAS), Nine Hole Pegboard Test (NHPT). Moreover, patients ability to control the robot with residual force and surface EMG (sEMG) independently, was checked. ROC curves were calculated to determine which of the measures were the predictors of the event. RESULTS sEMG control (AUC = 0.925) was significantly determined by FMA upper extremity (FMUE) (>24/66) and sensation (>23/24) sections, MAS at Flexor Carpi (<3/4) and total MAS (>4/20). Force control (AUC = 0.928) was correlated only with FMUE (>24/66). CONCLUSIONS FMUE and MAS were the best predictors of preserved ability to control the device by two different modalities. This finding opens the possibility to plan specific therapies aimed at maximizing the highest functional outcome achievable after stroke.
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Affiliation(s)
- Francesca Baldan
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy.
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Daniele Rimini
- Medical Physics Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Lorenza Maistrello
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
| | - Michela Agostini
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, Venice, Italy
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Lee HC, Kuo FL, Lin YN, Liou TH, Lin JC, Huang SW. Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study. Am J Occup Ther 2021; 75:7501205020p1-7501205020p11. [PMID: 33399050 DOI: 10.5014/ajot.2021.038232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN Randomized, crossover-controlled, assessor-blinded study. SETTING Rehabilitation clinic. PARTICIPANTS Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.
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Affiliation(s)
- Hsin-Chieh Lee
- Hsin-Chieh Lee, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fen-Ling Kuo
- Fen-Ling Kuo, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Yen-Nung Lin, MD, MS, is Physiatrist, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, and Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan
| | - Tsan-Hon Liou
- Tsan-Hon Liou, MD, PhD, is Physiatrist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chi Lin
- Jui-Chi Lin, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan;
| | - Shih-Wei Huang
- Shih-Wei Huang, MD, is Physiatrist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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19
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Neurocognitive robot-assisted rehabilitation of hand function: a randomized control trial on motor recovery in subacute stroke. J Neuroeng Rehabil 2020; 17:115. [PMID: 32831097 PMCID: PMC7444058 DOI: 10.1186/s12984-020-00746-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hand function is often impaired after stroke, strongly affecting the ability to perform daily activities. Upper limb robotic devices have been developed to complement rehabilitation therapy offered to persons who suffered a stroke, but they rarely focus on the training of hand sensorimotor function. The primary goal of this study was to evaluate whether robot-assisted therapy of hand function following a neurocognitive approach (i.e., combining motor training with somatosensory and cognitive tasks) produces an equivalent decrease in upper limb motor impairment compared to dose-matched conventional neurocognitive therapy, when embedded in the rehabilitation program of inpatients in the subacute stage after stroke. Methods A parallel-group, randomized controlled trial was conducted on subjects with subacute stroke receiving either conventional or robot-assisted neurocognitive hand therapy using a haptic device. Therapy was provided for 15, 45-min sessions over four weeks, nested within the standard therapy program. Primary outcome was the change from baseline in the upper extremity part of the Fugl-Meyer Assessment (FMA-UE) after the intervention, which was compared between groups using equivalence testing. Secondary outcome measures included upper limb motor, sensory and cognitive assessments, delivered therapy dose, as well as questionnaires on user technology acceptance. Results Thirty-three participants with stroke were enrolled. 14 subjects in the robot-assisted and 13 subjects in the conventional therapy group completed the study. At the end of intervention, week 8 and week 32, the robot-assisted/conventional therapy group improved by 7.14/6.85, 7.79/7.31, and 8.64/8.08 points on the FMA-UE, respectively, establishing that motor recovery in the robot-assisted group is non-inferior to that in the control group. Conclusions Neurocognitive robot-assisted therapy of hand function allows for a non-inferior motor recovery compared to conventional dose-matched neurocognitive therapy when performed during inpatient rehabilitation in the subacute stage. This allows the early familiarization of subjects with stroke to the use of such technologies, as a first step towards minimal therapist supervision in the clinic, or directly at home after hospital discharge, to help increase the dose of hand therapy for persons with stroke. Trial registration EUDAMED database (CIV-13-02-009921), clinicaltrials.gov (NCT02096445). Registered 26 March 2014 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02096445
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20
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Cho KH, Song WK. Effects of two different robot-assisted arm training on upper limb motor function and kinematics in chronic stroke survivors: A randomized controlled trial. Top Stroke Rehabil 2020; 28:241-250. [PMID: 32791945 DOI: 10.1080/10749357.2020.1804699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient's functional level. OBJECTIVES This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients. METHODS In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl-Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance. RESULTS The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05). CONCLUSIONS Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Chungbuk, Republic of Korea
| | - Won-Kyung Song
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Republic of Korea
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Parker J, Powell L, Mawson S. Effectiveness of Upper Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: Systematic Review. J Med Internet Res 2020; 22:e15981. [PMID: 31913131 PMCID: PMC6996755 DOI: 10.2196/15981] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.
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Germanotta M, Gower V, Papadopoulou D, Cruciani A, Pecchioli C, Mosca R, Speranza G, Falsini C, Cecchi F, Vannetti F, Montesano A, Galeri S, Gramatica F, Aprile I. Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke. J Neuroeng Rehabil 2020; 17:1. [PMID: 31900169 PMCID: PMC6942416 DOI: 10.1186/s12984-019-0634-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/12/2019] [Indexed: 02/14/2023] Open
Abstract
Background The majority of stroke survivors experiences significant hand impairments, as weakness and spasticity, with a severe impact on the activity of daily living. To objectively evaluate hand deficits, quantitative measures are needed. The aim of this study is to assess the reliability, the validity and the discriminant ability of the instrumental measures provided by a robotic device for hand rehabilitation, in a sample of patients with subacute stroke. Material and methods In this study, 120 patients with stroke and 40 controls were enrolled. Clinical evaluation included finger flexion and extension strength (using the Medical Research Council, MRC), finger spasticity (using the Modified Ashworth Scale, MAS) and motor control and dexterity during ADL performance (by means of the Frenchay Arm Test, FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the Intraclass Correlation Coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using the Spearman’s Correlation Coefficient (r). Finally, we investigated the ability of the robotic measures to distinguish between patients with stroke and healthy subjects, by means of Mann-Whitney U tests. Results All the investigated measures were able to discriminate patients with stroke from healthy subjects (p < 0.001). Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone. Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT). Discussion Finger strength (in both flexion and extension) and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales. Changes higher than the obtained MDC in these robotic measures could be considered as clinically relevant and used to assess the effect of a rehabilitation treatment in patients with subacute stroke.
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Affiliation(s)
- Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Valerio Gower
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Arianna Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Rita Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Gabriele Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Catuscia Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Angelo Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Furio Gramatica
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
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Kim YH. Robotic assisted rehabilitation therapy for enhancing gait and motor function after stroke. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2019.00065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
People with hemiparesis after stroke appear to recover 70% to 80% of the difference between their baseline and the maximum upper extremity Fugl-Meyer (UEFM) score, a phenomenon called proportional recovery (PR). Two recent commentaries explained that PR should be expected because of mathematical coupling between the baseline and change score. Here we ask, If mathematical coupling encourages PR, why do a fraction of stroke patients (the "nonfitters") not exhibit PR? At the neuroanatomical level of analysis, this question was answered by Byblow et al-nonfitters lack corticospinal tract (CST) integrity at baseline-but here we address the mathematical and behavioral causes. We first derive a new interpretation of the slope of PR: It is the average probability of scoring across remaining scale items at follow-up. PR therefore breaks when enough test items are discretely more difficult for a patient at follow-up, flattening the slope of recovery. For the UEFM, we show that nonfitters are most unlikely to recover the ability to score on the test items related to wrist/hand dexterity, shoulder flexion without bending the elbow, and finger-to-nose movement, supporting the finding that nonfitters lack CST integrity. However, we also show that a subset of nonfitters respond better to robotic movement training in the chronic phase of stroke. These persons are just able to move the arm out of the flexion synergy and pick up small blocks, both markers of CST integrity. Nonfitters therefore raise interesting questions about CST function and the basis for response to intensive movement training.
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Wrist Rehabilitation System Using Augmented Reality for Hemiplegic Stroke Patient Rehabilitation: A Feasibility Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9142892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: Our objective was to investigate the effect of the rehabilitation system using augmented reality (AR) on upper extremity motor performance of patients with stroke. Methods: The system using AR applying mirror therapy mechanism provides the intervention protocol for the patient with hemiplegia after stroke. The system consists of a patient positioning tool (a chair), a white surface table, an image acquisition unit, an image processing unit, an image displaying unit, an arm holder, a Velcro-strap, and two blue circle stickers. To assess the feasibility of our system in motor function recovery, a stroke patient was recruited to receive the AR intervention. The treatment was performed two times a day for ten minutes over two weeks (ten days of treating weeks), except for the time of installation, calibration, and three minute breaks. Jebsen Taylor hand function test and Arm Motor Fugl-Meyer assessment were used as primary and secondary outcome measures, respectively, to evaluate the effect of motor function recovery. Additionally, stroke impact scale, Korean version-Modified Barthel Index (K-MBI), active range of motion of wrist joint (ROM), and the grasp force in Newtons were measured. Participants’ feedback and adverse effects were recorded as well. Results: Motor function improvements were exhibited in wrist and hand subtest of Arm Motor Fugl-Meyer (baseline: 19; post-intervention: 23), proximal arm subtest of Fugl-Meyer (baseline: 31; post-intervention: 34), ROM (extending ROM: 10° and 3° for flexion and extension, repeatedly), stroke impact scale (baseline: 46; post-intervention: 54), K-MBI (baseline: 92; post-intervention: 95), nine-hole pegboard (baseline: 30 s; post-intervention: 25 s), and grasp force in Newtons (baseline: 12.7; post-intervention: 17.7). However, the adverse effects were reported after the intervention. Conclusion: The system using AR applying mirror therapy mechanism demonstrated the feasibility in motor function recovery for the stroke patient.
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Robotics in Health Care: Perspectives of Robot-Aided Interventions in Clinical Practice for Rehabilitation of Upper Limbs. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9132586] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice.
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Chowdhury A, Nishad SS, Meena YK, Dutta A, Prasad G. Hand-Exoskeleton Assisted Progressive Neurorehabilitation using Impedance Adaptation based Challenge Level Adjustment Method. IEEE TRANSACTIONS ON HAPTICS 2018; 12:128-140. [PMID: 30371388 DOI: 10.1109/toh.2018.2878232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper presents an underactuated design of a robotic hand exoskeleton and a challenge based neurorehabilitation strategy. The exoskeleton is designed to reproduce natural human fingertip paths during extension and grasping, keeping minimal kinematic complexity. It facilitates an impedance adaptation based trigged assistance control strategy by a switching between active non-assist and passive assistance modes. In active non-assist mode, the exoskeleton motion follows the applied fingertip forces based on an impedance model. If the applied fingertip forces are inadequate, the passive assistance mode is triggered. The impedance parameters are updated at regular intervals based on the user performance, to implement a challenge based rehabilitation strategy. A six-week long hand therapy, conducted on four chronic stroke patients results in significant (p-value<0.05) increase in force generation capacity and decrease (p-value<0.05) in the required assistance. Also, there was a significant (p-value<0.05) increase in the system impedance parameters which adequately challenged the patients. The change in the Action-Research-Arm-Test (ARAT) scores from baseline are also found to be significant (p-value<0.05) and beyond the minimal clinically important difference (MCID) limit. Thus the results prove that the proposed control strategy with has the potential to be a clinically effective solution for personalized rehabilitation of poststroke hand functionality.
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de Sousa DG, Harvey LA, Dorsch S, Glinsky JV. Interventions involving repetitive practice improve strength after stroke: a systematic review. J Physiother 2018; 64:210-221. [PMID: 30245180 DOI: 10.1016/j.jphys.2018.08.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTIONS Do interventions involving repetitive practice improve strength after stroke? Are any improvements in strength accompanied by improvements in activity? DESIGN Systematic review of randomised trials with meta-analysis. PARTICIPANTS Adults who have had a stroke. INTERVENTION Any intervention involving repetitive practice compared with no intervention or a sham intervention. OUTCOME MEASURES The primary outcome was voluntary strength in muscles trained as part of the intervention. The secondary outcomes were measures of lower limb and upper limb activity. RESULTS Fifty-two studies were included. The overall SMD of repetitive practice on strength was examined by pooling post-intervention scores from 46 studies involving 1928 participants. The SMD of repetitive practice on strength when the upper and lower limb studies were combined was 0.25 (95% CI 0.16 to 0.34, I2=44%) in favour of repetitive practice. Twenty-four studies with a total of 912 participants investigated the effects of repetitive practice on upper limb activity after stroke. The SMD was 0.15 (95% CI 0.02 to 0.29, I2=50%) in favour of repetitive practice on upper limb activity. Twenty studies with a total of 952 participants investigated the effects of repetitive practice on lower limb activity after stroke. The SMD was 0.25 (95% CI 0.12 to 0.38, I2=36%) in favour of repetitive practice on lower limb activity. CONCLUSION Interventions involving repetitive practice improve strength after stroke, and these improvements are accompanied by improvements in activity. REVIEW REGISTRATION PROSPERO CRD42017068658. [de Sousa DG, Harvey LA, Dorsch S, Glinsky JV (2018) Interventions involving repetitive practice improve strength after stroke: a systematic review. Journal of Physiotherapy 64: 210-221].
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Affiliation(s)
- Davide G de Sousa
- Graythwaite Rehabilitation Centre, Ryde Hospital; John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
| | - Simone Dorsch
- Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute; Sydney Medical School Northern, University of Sydney
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Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2018; 9:CD006876. [PMID: 30175845 PMCID: PMC6513114 DOI: 10.1002/14651858.cd006876.pub5] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables. MAIN RESULTS We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high-quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high-quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high-quality evidence). Electromechanical and robot-assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI -0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high-quality evidence), and adverse events were rare. AUTHORS' CONCLUSIONS People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.
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Affiliation(s)
- Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Thomas Platz
- Ernst‐Moritz‐Arndt‐Universität GreifswaldNeurorehabilitation Centre and Spinal Cord Injury Unit, BDH‐Klinik GreifswaldKarl‐Liebknecht‐Ring 26aGreifswaldGermany17491
- Ernst‐Moritz‐Arndt‐UniversitätNeurowissenschaftenGreifswaldGermany
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Bernhard Elsner
- Dresden Medical School, Technical University DresdenDepartment of Public HealthFetscherstr. 74DresdenSachsenGermany01307
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A Review of Robotics in Neurorehabilitation: Towards an Automated Process for Upper Limb. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9758939. [PMID: 29707189 PMCID: PMC5901488 DOI: 10.1155/2018/9758939] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/26/2018] [Accepted: 02/08/2018] [Indexed: 11/17/2022]
Abstract
Robot-mediated neurorehabilitation is a growing field that seeks to incorporate advances in robotics combined with neuroscience and rehabilitation to define new methods for treating problems related with neurological diseases. In this paper, a systematic literature review is conducted to identify the contribution of robotics for upper limb neurorehabilitation, highlighting its relation with the rehabilitation cycle, and to clarify the prospective research directions in the development of more autonomous rehabilitation processes. With this aim, first, a study and definition of a general rehabilitation process are made, and then, it is particularized for the case of neurorehabilitation, identifying the components involved in the cycle and their degree of interaction between them. Next, this generic process is compared with the current literature in robotics focused on upper limb treatment, analyzing which components of this rehabilitation cycle are being investigated. Finally, the challenges and opportunities to obtain more autonomous rehabilitation processes are discussed. In addition, based on this study, a series of technical requirements that should be taken into account when designing and implementing autonomous robotic systems for rehabilitation is presented and discussed.
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Agarwal P, Deshpande AD. Subject-Specific Assist-as-Needed Controllers for a Hand Exoskeleton for Rehabilitation. IEEE Robot Autom Lett 2018. [DOI: 10.1109/lra.2017.2768124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study. J Stroke Cerebrovasc Dis 2018; 27:221-228. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 08/16/2017] [Indexed: 10/18/2022] Open
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Yue Z, Zhang X, Wang J. Hand Rehabilitation Robotics on Poststroke Motor Recovery. Behav Neurol 2017; 2017:3908135. [PMID: 29230081 PMCID: PMC5688261 DOI: 10.1155/2017/3908135] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 12/21/2022] Open
Abstract
The recovery of hand function is one of the most challenging topics in stroke rehabilitation. Although the robot-assisted therapy has got some good results in the latest decades, the development of hand rehabilitation robotics is left behind. Existing reviews of hand rehabilitation robotics focus either on the mechanical design on designers' view or on the training paradigms on the clinicians' view, while these two parts are interconnected and both important for designers and clinicians. In this review, we explore the current literature surrounding hand rehabilitation robots, to help designers make better choices among varied components and thus promoting the application of hand rehabilitation robots. An overview of hand rehabilitation robotics is provided in this paper firstly, to give a general view of the relationship between subjects, rehabilitation theories, hand rehabilitation robots, and its evaluation. Secondly, the state of the art hand rehabilitation robotics is introduced in detail according to the classification of the hardware system and the training paradigm. As a result, the discussion gives available arguments behind the classification and comprehensive overview of hand rehabilitation robotics.
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Affiliation(s)
- Zan Yue
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Xue Zhang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Jing Wang
- School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an 710049, China
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Hand Passive Mobilization Performed with Robotic Assistance: Acute Effects on Upper Limb Perfusion and Spasticity in Stroke Survivors. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2796815. [PMID: 29094043 PMCID: PMC5637828 DOI: 10.1155/2017/2796815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
Abstract
This single arm pre-post study aimed at evaluating the acute effects induced by a single session of robot-assisted passive hand mobilization on local perfusion and upper limb (UL) function in poststroke hemiparetic participants. Twenty-three patients with subacute or chronic stroke received 20 min passive mobilization of the paretic hand with robotic assistance. Near-infrared spectroscopy (NIRS) was used to detect changes in forearm tissue perfusion. Muscle tone of the paretic UL was assessed by the Modified Ashworth Scale (MAS). Symptoms concerning UL heaviness, joint stiffness, and pain were evaluated as secondary outcomes by self-reporting. Significant (p = 0.014) improvements were found in forearm perfusion when all fingers were mobilized simultaneously. After the intervention, MAS scores decreased globally, being the changes statistically significant for the wrist (from 1.6 ± 1.0 to 1.1 ± 1.0; p = 0.001) and fingers (from 1.2 ± 1.1 to 0.7 ± 0.9; p = 0.004). Subjects reported decreased UL heaviness and stiffness after treatment, especially for the hand, as well as diminished pain when present. This study supports novel evidence that hand robotic assistance promotes local UL circulation changes, may help in the management of spasticity, and acutely alleviates reported symptoms of heaviness, stiffness, and pain in subjects with poststroke hemiparesis. This opens new scenarios for the implications in everyday clinical practice. Clinical Trial Registration Number is NCT03243123.
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Huang X, Naghdy F, Du H, Naghdy G, Murray G. Design of adaptive control and virtual reality-based fine hand motion rehabilitation system and its effects in subacute stroke patients. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2017.1343687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Xianwei Huang
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Fazel Naghdy
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Haiping Du
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
| | - Golshah Naghdy
- School of Electrical, Computer and Telecommunications Engineering (SECTE), University of Wollongong, Wollongong, Australia
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Huang X, Naghdy F, Naghdy G, Du H, Todd C. Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey. ACTA ACUST UNITED AC 2017. [DOI: 10.1515/ijdhd-2016-0035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractRecent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training. This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI). Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed. A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.
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Do KH, Chun MH. Clinical Use of Robots as a Part of Rehabilitation Medicine. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Min Ho Chun
- Department of Physical Medicine and Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Agarwal P, Neptune RR, Deshpande AD. A Simulation Framework for Virtual Prototyping of Robotic Exoskeletons. J Biomech Eng 2016; 138:061004. [PMID: 27018453 DOI: 10.1115/1.4033177] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Indexed: 11/08/2022]
Abstract
A number of robotic exoskeletons are being developed to provide rehabilitation interventions for those with movement disabilities. We present a systematic framework that allows for virtual prototyping (i.e., design, control, and experimentation (i.e. design, control, and experimentation) of robotic exoskeletons. The framework merges computational musculoskeletal analyses with simulation-based design techniques which allows for exoskeleton design and control algorithm optimization. We introduce biomechanical, morphological, and controller measures to optimize the exoskeleton performance. A major advantage of the framework is that it provides a platform for carrying out hypothesis-driven virtual experiments to quantify device performance and rehabilitation progress. To illustrate the efficacy of the framework, we present a case study wherein the design and analysis of an index finger exoskeleton is carried out using the proposed framework.
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Veerbeek JM, Langbroek-Amersfoort AC, van Wegen EEH, Meskers CGM, Kwakkel G. Effects of Robot-Assisted Therapy for the Upper Limb After Stroke. Neurorehabil Neural Repair 2016; 31:107-121. [PMID: 27597165 DOI: 10.1177/1545968316666957] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the paretic upper limb (RT-UL). OBJECTIVE To systematically review the effects of poststroke RT-UL on measures of motor control of the paretic arm, muscle strength and tone, upper limb capacity, and basic activities of daily living (ADL) in comparison with nonrobotic treatment. METHODS Relevant RCTs were identified in electronic searches. Meta-analyses were performed for measures of motor control (eg, Fugl-Meyer Assessment of the arm; FMA arm), muscle strength and tone, upper limb capacity, and basic ADL. Subgroup analyses were applied for the number of joints involved, robot type, timing poststroke, and treatment contrast. RESULTS Forty-four RCTs (N = 1362) were included. No serious adverse events were reported. Meta-analyses of 38 trials (N = 1206) showed significant but small improvements in motor control (~2 points FMA arm) and muscle strength of the paretic arm and a negative effect on muscle tone. No effects were found for upper limb capacity and basic ADL. Shoulder/elbow robotics showed small but significant effects on motor control and muscle strength, while elbow/wrist robotics had small but significant effects on motor control. CONCLUSIONS RT-UL allows patients to increase the number of repetitions and hence intensity of practice poststroke, and appears to be a safe therapy. Effects on motor control are small and specific to the joints targeted by RT-UL, whereas no generalization is found to improvements in upper limb capacity. The impact of RT-UL started in the first weeks poststroke remains unclear. These limited findings could mainly be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline as well as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.
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Affiliation(s)
- Janne M Veerbeek
- 1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands.,2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.,3 VU University Medical Center, Amsterdam, the Netherlands
| | | | - Erwin E H van Wegen
- 1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands.,2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.,3 VU University Medical Center, Amsterdam, the Netherlands
| | - Carel G M Meskers
- 1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands.,2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.,3 VU University Medical Center, Amsterdam, the Netherlands.,5 Northwestern University, Evanston, IL, USA
| | - Gert Kwakkel
- 1 MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, the Netherlands.,2 Neuroscience Campus Amsterdam, Amsterdam, the Netherlands.,3 VU University Medical Center, Amsterdam, the Netherlands.,5 Northwestern University, Evanston, IL, USA.,6 Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands
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Hatem SM, Saussez G, Della Faille M, Prist V, Zhang X, Dispa D, Bleyenheuft Y. Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery. Front Hum Neurosci 2016; 10:442. [PMID: 27679565 PMCID: PMC5020059 DOI: 10.3389/fnhum.2016.00442] [Citation(s) in RCA: 391] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/18/2016] [Indexed: 12/27/2022] Open
Abstract
Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients' mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.
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Affiliation(s)
- Samar M Hatem
- Physical and Rehabilitation Medicine, Brugmann University HospitalBrussels, Belgium; Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Faculty of Medicine and Pharmacy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit BrusselBrussels, Belgium
| | - Geoffroy Saussez
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Margaux Della Faille
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
| | - Vincent Prist
- Physical and Rehabilitation Medicine, Centre Hospitalier de l'Ardenne Libramont, Belgium
| | - Xue Zhang
- Movement Control and Neuroplasticity Research Group, Motor Control Laboratory, Department of Kinesiology, Katholieke Universiteit Leuven Leuven, Belgium
| | - Delphine Dispa
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de LouvainBrussels, Belgium; Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de LouvainBrussels, Belgium
| | - Yannick Bleyenheuft
- Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain Brussels, Belgium
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Mak MKY, Lau ETL, Tam VWK, Woo CWY, Yuen SKY. Use of Jebsen Taylor Hand Function Test in evaluating the hand dexterity in people with Parkinson's disease. J Hand Ther 2016; 28:389-94; quiz 395. [PMID: 26227308 DOI: 10.1016/j.jht.2015.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/13/2015] [Accepted: 05/11/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the test-retest reliability of JTT in older patients with Parkinson's disease (PD); and to compare the Jebsen Taylor Hand Function Test (JTT) scores between PD and healthy subjects. STUDY DESIGN Cross-sectional comparative study. METHODS Fifteen PD and fifteen healthy subjects performed the JTT and the time taken to complete the JTT was recorded. RESULTS Test-retest reliabilities of JTT subtests and total score of both dominant and non-dominant hand were good to excellent (ICCs = 0.77-0.97) except J5 checkers which had moderate reliability. PD subjects required significantly longer time to finish subtests and the whole JTT (p < 0.05), except the subtest J1 writing of dominant hand that showed marginal significance (p = 0.059). CONCLUSION JTT is a reliable and easily available assessment tool for assessing the hand function of PD subjects. PD subjects took a longer time to complete the JTT, suggesting that they have deficits in gross and fine functional dexterity.
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Affiliation(s)
- M K Y Mak
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - E T L Lau
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - V W K Tam
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - C W Y Woo
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - S K Y Yuen
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Vanoglio F, Bernocchi P, Mulè C, Garofali F, Mora C, Taveggia G, Scalvini S, Luisa A. Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: a randomized pilot controlled study. Clin Rehabil 2016; 31:351-360. [PMID: 27056250 DOI: 10.1177/0269215516642606] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the feasibility and efficacy of robot-assisted hand rehabilitation in improving arm function abilities in sub-acute hemiplegic patients. DESIGN Randomized controlled pilot study. SETTING Inpatient rehabilitation centers. PARTICIPANTS Thirty hemiplegic stroke patients (Ashworth spasticity index <3) were recruited and randomly divided into a Treatment group (TG) and Control group (CG). INTERVENTIONS Patients in the TG received intensive hand training with Gloreha, a hand rehabilitation glove that provides computer-controlled, repetitive, passive mobilization of the fingers, with multisensory feedback. Patients in the CG received the same amount of time in terms of conventional hand rehabilitation. MAIN OUTCOME MEASURES Hand motor function (Motricity Index, MI), fine manual dexterity (Nine Hole Peg Test, NHPT) and strength (Grip and Pinch test) were measured at baseline and after rehabilitation, and the differences, (Δ) mean(standard deviation), compared between groups. Results Twenty-seven patients concluded the program: 14 in the TG and 13 in the CG. None of the patients refused the device and only one adverse event of rheumatoid arthritis reactivation was reported. Baseline data did not differ significantly between the two groups. In TG, ΔMI 23(16.4), ΔNHPT 0.16(0.16), ΔGRIP 0.27(0.23) and ΔPINCH 0.07(0.07) were significantly greater than in CG, ΔMI 5.2(9.2), ΔNHPT 0.02(0.07), ΔGRIP 0.03(0.06) and ΔPINCH 0.02(0.03)] ( p=0.002, p=0.009, p=0.003 and p=0.038, respectively). CONCLUSIONS Gloreha Professional is feasible and effective in recovering fine manual dexterity and strength and reducing arm disability in sub-acute hemiplegic patients.
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Affiliation(s)
- Fabio Vanoglio
- 1 Neurological Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Palmira Bernocchi
- 2 Care Continuity Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Chiara Mulè
- 3 Habilita Hospital, Sarnico, Bergamo, Italy
| | - Francesca Garofali
- 1 Neurological Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Chiara Mora
- 1 Neurological Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
| | | | - Simonetta Scalvini
- 2 Care Continuity Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Alberto Luisa
- 1 Neurological Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Institute of Lumezzane, Brescia, Italy
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Colomer C, Llorens R, Noé E, Alcañiz M. Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil 2016; 13:45. [PMID: 27169462 PMCID: PMC4864937 DOI: 10.1186/s12984-016-0153-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors. Methods Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory). Results Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating. Conclusions Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Roberto Llorens
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain. .,Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Av. Sos Baynat s/n, Univesity of Jaume I, Castellón, 12071, Spain
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Bissolotti L, Villafañe JH, Gaffurini P, Orizio C, Valdes K, Negrini S. Changes in skeletal muscle perfusion and spasticity in patients with poststroke hemiparesis treated by robotic assistance (Gloreha) of the hand. J Phys Ther Sci 2016; 28:769-73. [PMID: 27134356 PMCID: PMC4842437 DOI: 10.1589/jpts.28.769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case series was to determine the effects of robot-assisted
hand rehabilitation with a Gloreha device on skeletal muscle perfusion, spasticity, and
motor function in subjects with poststroke hemiparesis. [Subjects and Methods] Seven
patients, 2 women and 5 men (mean ± SD age: 60.5 ±6.3 years), with hemiparesis (>6
months poststroke), received passive mobilization of the hand with a Gloreha (Idrogenet,
Italy), device (30 min per day; 3 sessions a week for 3 weeks). The outcome measures were
the total hemoglobin profiles and tissue oxygenation index (TOI) in the muscle tissue
evaluated through near-infrared spectroscopy. The Motricity Index and modified Ashworth
Scale for upper limb muscles were used to assess mobility of the upper extremity.
[Results] Robotic assistance reduced spasticity after the intervention by 68.6% in the
upper limb. The Motricity Index was unchanged in these patients after treatment. Regarding
changes in muscle perfusion, significant improvements were found in total hemoglobin.
There were significant differences between the pre- and posttreatment modified Ashworth
scale. [Conclusion] The present work provides novel evidence that robotic assistance of
the hand induced changes in local muscle blood flow and oxygen supply, diminished
spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects
with post-stroke hemiparesis.
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Affiliation(s)
- Luciano Bissolotti
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Paolo Gaffurini
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | - Claudio Orizio
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Stefano Negrini
- IRCCS Don Gnocchi Foundation, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2015; 2015:CD006876. [PMID: 26559225 PMCID: PMC6465047 DOI: 10.1002/14651858.cd006876.pub4] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 3), MEDLINE (1950 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), SPORTDiscus (1949 to March 2015), PEDro (searched April 2015), Compendex (1972 to March 2015), and Inspec (1969 to March 2015). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables. MAIN RESULTS We included 34 trials (involving 1160 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.37, 95% confidence interval (CI) 0.11 to 0.64, P = 0.005, I² = 62%), arm function (SMD 0.35, 95% CI 0.18 to 0.51, P < 0.0001, I² = 36%), and arm muscle strength (SMD 0.36, 95% CI 0.01 to 0.70, P = 0.04, I² = 72%), but the quality of the evidence was low to very low. Electromechanical and robot-assisted arm training did not increase the risk of participant drop-out (RD 0.00, 95% CI -0.02 to 0.03, P = 0.84, I² = 0%) with moderate-quality evidence, and adverse events were rare. AUTHORS' CONCLUSIONS People who receive electromechanical and robot-assisted arm and hand training after stroke might improve their activities of daily living, arm and hand function, and arm and hand muscle strength. However, the results must be interpreted with caution because the quality of the evidence was low to very low, and there were variations between the trials in the intensity, duration, and amount of training; type of treatment; and participant characteristics.
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Affiliation(s)
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzGermany01896
| | | | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Bernhard Elsner
- Faculty of Medicine Carl Gustav Carus, TU DresdenDepartment of Public HealthFetscherstr. 74DresdenGermany01307
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Agarwal P, Fox J, Yun Y, O’Malley MK, Deshpande AD. An index finger exoskeleton with series elastic actuation for rehabilitation: Design, control and performance characterization. Int J Rob Res 2015. [DOI: 10.1177/0278364915598388] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rehabilitation of the hands is critical for the restoration of independence in activities of daily living for individuals exhibiting disabilities of the upper extremities. There is initial evidence that robotic devices with force-control-based strategies can help in effective rehabilitation of human limbs. However, to the best of our knowledge, none of the existing hand exoskeletons allow for accurate force or torque control. In this work, we present a novel index finger exoskeleton with Bowden-cable-based series elastic actuation allowing for bidirectional torque control of the device with high backdrivability and low reflected inertia. We present exoskeleton and finger joint torque controllers along with an optimization-based offline parameter estimator. Finally, we carry out tests with the developed prototype to characterize its kinematics, dynamics, and controller performance. Results show that the device preserves the characteristics of natural motion of finger and can be controlled to achieve both exoskeleton and finger joint torque control. Finally, dynamic transparency tests show that the device can be controlled to offer minimal resistance to finger motion. Beyond the present application of the device as a hand rehabilitation exoskeleton, it has the potential to be used as a haptic device for teleoperation.
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Affiliation(s)
- Priyanshu Agarwal
- Mechanical Engineering Department, The University of Texas at Austin, Austin, TX, USA
| | - Jonas Fox
- Mechanical Engineering Department, The University of Texas at Austin, Austin, TX, USA
| | - Youngmok Yun
- Mechanical Engineering Department, The University of Texas at Austin, Austin, TX, USA
| | | | - Ashish D. Deshpande
- Mechanical Engineering Department, The University of Texas at Austin, Austin, TX, USA
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Basteris A, Nijenhuis SM, Stienen AHA, Buurke JH, Prange GB, Amirabdollahian F. Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review. J Neuroeng Rehabil 2014; 11:111. [PMID: 25012864 PMCID: PMC4108977 DOI: 10.1186/1743-0003-11-111] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 06/23/2014] [Indexed: 01/19/2023] Open
Abstract
Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.
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Affiliation(s)
- Angelo Basteris
- Adaptive Systems Research Group, School of Computer Science, University of Hertfordshire, College Lane, AL95HX Hatfield, United Kingdom.
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Seo HG, Beom J, Oh BM, Han TR. Effects of Robot-assisted Upper Limb Training on Hemiplegic Patients. BRAIN & NEUROREHABILITATION 2014. [DOI: 10.12786/bn.2014.7.1.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Jaewon Beom
- Department of Rehabilitation Medicine, Chungnam National University Hospital, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tai Ryoon Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
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Robotic technologies and rehabilitation: new tools for stroke patients' therapy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:153872. [PMID: 24350244 PMCID: PMC3852950 DOI: 10.1155/2013/153872] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/18/2013] [Indexed: 11/23/2022]
Abstract
Introduction. The role of robotics in poststroke patients' rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients' rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient's characteristics to be successfully enrolled to this treatment.
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Agarwal P, Kuo PH, Neptune RR, Deshpande AD. A novel framework for virtual prototyping of rehabilitation exoskeletons. IEEE Int Conf Rehabil Robot 2013; 2013:6650382. [PMID: 24187201 DOI: 10.1109/icorr.2013.6650382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Human-worn rehabilitation exoskeletons have the potential to make therapeutic exercises increasingly accessible to disabled individuals while reducing the cost and labor involved in rehabilitation therapy. In this work, we propose a novel human-model-in-the-loop framework for virtual prototyping (design, control and experimentation) of rehabilitation exoskeletons by merging computational musculoskeletal analysis with simulation-based design techniques. The framework allows to iteratively optimize design and control algorithm of an exoskeleton using simulation. We introduce biomechanical, morphological, and controller measures to quantify the performance of the device for optimization study. Furthermore, the framework allows one to carry out virtual experiments for testing specific "what-if" scenarios to quantify device performance and recovery progress. To illustrate the application of the framework, we present a case study wherein the design and analysis of an index-finger exoskeleton is carried out using the proposed framework.
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