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Rajashekar D, Boyer A, Larkin-Kaiser KA, Dukelow SP. Technological Advances in Stroke Rehabilitation: Robotics and Virtual Reality. Phys Med Rehabil Clin N Am 2024; 35:383-398. [PMID: 38514225 DOI: 10.1016/j.pmr.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Robotic technology and virtual reality (VR) have been widely studied technologies in stroke rehabilitation over the last few decades. Both technologies have typically been considered as ways to enhance recovery through promoting intensive, repetitive, and engaging therapies. In this review, we present the current evidence from interventional clinical trials that employ either robotics, VR, or a combination of both modalities to facilitate post-stroke recovery. Broadly speaking, both technologies have demonstrated some success in improving post-stroke outcomes and complementing conventional therapy. However, more high-quality, randomized, multicenter trials are required to confirm our current understanding of their role in precision stroke recovery.
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Affiliation(s)
- Deepthi Rajashekar
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexa Boyer
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Schulich School of Engineering: Department of Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Kelly A Larkin-Kaiser
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Ablerta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Cho KH, Lee DG, Song WK, Lee G. Usefulness of one-arm motorized gait device for chronic hemiplegic stroke survivors. Technol Health Care 2024; 32:335-342. [PMID: 37661897 DOI: 10.3233/thc-230197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND After stroke, gait training is a key component of rehabilitation, and most individuals use a variety of walking aids depending on their physical condition and environment. OBJECTIVE This study aimed to investigate the potential effect of a one-arm motorized gait device for gait assist of chronic hemiplegic stroke survivors through comparison with traditional gait devices (parallel bar and hemi-walker). METHODS This study was conducted on 14 chronic hemiplegic stroke survivors. The participants were asked to walk under three conditions using different gait devices, and their gait parameters during walking were collected and analyzed. The first condition involved walking on parallel bars; second condition, walking using hemi-walkers; and third condition, walking using one-arm motorized gait devices. With the use of a gait analysis system, the spatio-temporal gait parameters in each condition were collected, such as gait velocity, cadence, step length, stride length, single support time, and double support time. RESULTS In the results by repeated-measures ANOVA or the Friedman test, a significant difference was found in the gait parameters among all three conditions (p< 0.05). The post-hoc test showed a significant change in the spatio-temporal gait parameters (especially, velocity, cadence and affected side single and double support time) when one-arm motorized gait device were used compared with parallel bars and hemi-walkers (p< 0.05). CONCLUSION The results of this study suggest that one-arm motorized gait devices developed for hemiplegic stroke survivors may be more effective potentially than parallel bars and hemi-walkers in gait assistance of chronic hemiplegic stroke survivors.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Jeungpyeong, Korea
| | - Dong-Geon Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Won-Kyung Song
- Department of Rehabilitative and Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Korea
| | - Gyuchang Lee
- Outreach Physical, Occupational, and Speech Therapy, New York, NY, USA
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Yang J, Gong Y, Yu L, Peng L, Cui Y, Huang H. Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials. BMJ Open 2023; 13:e074481. [PMID: 37709309 PMCID: PMC10503387 DOI: 10.1136/bmjopen-2023-074481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Numbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training (ERAT) on gait function of stroke survivors, especially during the chronic period. We conducted a systematic review to investigate the efficacy of ERAT on gait function for chronic stroke survivors. DESIGN This review followed the Participant, Intervention, Comparison and Outcome principle. DATA SOURCES PubMed, Cochrane Library, Web of Science, Embase and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched until December 2022. ELIGIBILITY CRITERIA Only randomised controlled trials (RCTs) were included and these RCTs took patients who had a chronic stroke as participants, exoskeleton robot-assisted gait training as intervention, regular rehabilitation therapy as comparison and gait-related functional assessments as outcomes. DATA EXTRACTION AND SYNTHESIS Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. RESULTS Out of 278 studies, a total of 10 studies (n=323, mean age 57.6 years, 63.2% males) were identified in this systematic review. According to the Cochrane risk of bias, the quality of these studies was assessed as low risk. Six studies reported favourable effects of ERAT on gait function involving gait performance, balance function and physical endurance, and the ERAT group was significantly superior when compared with the control group. In contrast, the other four trials showed equal or negative effects of ERAT considering different study designs. All the included studies did not claim any serious adverse events. CONCLUSION ERAT could be an efficient intervention to improve gait function for individuals who had a chronic stroke. However, more rigorously designed trials are required to draw more solid evidence. PROSPERO REGISTRATION NUMBER CRD42023410796.
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Affiliation(s)
- Jinchao Yang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Gong
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Yu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Laiying Peng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuanfen Cui
- Department of Pain Management, Wuhan No 1 Hospital, Wuhan, China
| | - Hailong Huang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Catalán JM, Trigili E, Nann M, Blanco-Ivorra A, Lauretti C, Cordella F, Ivorra E, Armstrong E, Crea S, Alcañiz M, Zollo L, Soekadar SR, Vitiello N, García-Aracil N. Hybrid brain/neural interface and autonomous vision-guided whole-arm exoskeleton control to perform activities of daily living (ADLs). J Neuroeng Rehabil 2023; 20:61. [PMID: 37149621 PMCID: PMC10164333 DOI: 10.1186/s12984-023-01185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/26/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND The aging of the population and the progressive increase of life expectancy in developed countries is leading to a high incidence of age-related cerebrovascular diseases, which affect people's motor and cognitive capabilities and might result in the loss of arm and hand functions. Such conditions have a detrimental impact on people's quality of life. Assistive robots have been developed to help people with motor or cognitive disabilities to perform activities of daily living (ADLs) independently. Most of the robotic systems for assisting on ADLs proposed in the state of the art are mainly external manipulators and exoskeletal devices. The main objective of this study is to compare the performance of an hybrid EEG/EOG interface to perform ADLs when the user is controlling an exoskeleton rather than using an external manipulator. METHODS Ten impaired participants (5 males and 5 females, mean age 52 ± 16 years) were instructed to use both systems to perform a drinking task and a pouring task comprising multiple subtasks. For each device, two modes of operation were studied: synchronous mode (the user received a visual cue indicating the sub-tasks to be performed at each time) and asynchronous mode (the user started and finished each of the sub-tasks independently). Fluent control was assumed when the time for successful initializations ranged below 3 s and a reliable control in case it remained below 5 s. NASA-TLX questionnaire was used to evaluate the task workload. For the trials involving the use of the exoskeleton, a custom Likert-Scale questionnaire was used to evaluate the user's experience in terms of perceived comfort, safety, and reliability. RESULTS All participants were able to control both systems fluently and reliably. However, results suggest better performances of the exoskeleton over the external manipulator (75% successful initializations remain below 3 s in case of the exoskeleton and bellow 5s in case of the external manipulator). CONCLUSIONS Although the results of our study in terms of fluency and reliability of EEG control suggest better performances of the exoskeleton over the external manipulator, such results cannot be considered conclusive, due to the heterogeneity of the population under test and the relatively limited number of participants.
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Affiliation(s)
- José M Catalán
- Robotics and Artificial Intelligence Group of the Bioengineering Institute, Miguel Hernandez University, 03202, Elche, Spain.
| | - Emilio Trigili
- BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Marius Nann
- Clinical Neurotechnology Laboratory, Charité, Universitätsmedizin Berlin, 10117, Belin, Germany
| | - Andrea Blanco-Ivorra
- Robotics and Artificial Intelligence Group of the Bioengineering Institute, Miguel Hernandez University, 03202, Elche, Spain
| | - Clemente Lauretti
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, 00128, Rome, Italy
| | - Francesca Cordella
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, 00128, Rome, Italy
| | - Eugenio Ivorra
- University Institute for Human-Centered Technology Research (Human-Tech), Universitat Politècnica de València, 46022, Valencia, Spain
| | | | - Simona Crea
- BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mariano Alcañiz
- University Institute for Human-Centered Technology Research (Human-Tech), Universitat Politècnica de València, 46022, Valencia, Spain
| | - Loredana Zollo
- Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, 00128, Rome, Italy
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Charité, Universitätsmedizin Berlin, 10117, Belin, Germany
| | - Nicola Vitiello
- BioRobotics Institute, Scuola Superiore Sant'Anna, 56025, Pontedera, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Nicolás García-Aracil
- Robotics and Artificial Intelligence Group of the Bioengineering Institute, Miguel Hernandez University, 03202, Elche, Spain
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Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci 2023; 13:brainsci13050717. [PMID: 37239189 DOI: 10.3390/brainsci13050717] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
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Laszlo C, Munari D, Maggioni S, Knechtle D, Wolf P, De Bon D. Feasibility of an Intelligent Algorithm Based on an Assist-as-Needed Controller for a Robot-Aided Gait Trainer (Lokomat) in Neurological Disorders: A Longitudinal Pilot Study. Brain Sci 2023; 13:brainsci13040612. [PMID: 37190576 DOI: 10.3390/brainsci13040612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Most robotic gait assisted devices are designed to provide constant assistance during the training without taking into account each patient’s functional ability. The Lokomat offers an assist-as-needed control via the integrated exercise “Adaptive Gait Support” (AGS), which adapts the robotic support based on the patient’s abilities. The aims of this study were to examine the feasibility and characteristics of the AGS during long-term application. Ten patients suffering from neurological diseases underwent an 8-week Lokomat training with the AGS. They additionally performed conventional walking tests and a robotic force measurement. The difference between robotic support during adaptive and conventional training and the relationship between the robotic assessment and the conventional walking and force tests were examined. The results show that AGS is feasible during long-term application in a heterogeneous population. The support during AGS training in most of the gait phases was significantly lower than during conventional Lokomat training. A relationship between the robotic support level determined by the AGS and conventional walking tests was revealed. Moreover, combining the isometric force data and AGS data could divide patients into clusters, based on their ability to generate high forces and their level of motor control. AGS shows a high potential in assessing patients’ walking ability, as well as in providing challenging training, e.g., by automatically adjusting the robotic support throughout the whole gait cycle and enabling training at lower robotic support.
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Affiliation(s)
- Caroline Laszlo
- Sensory-Motor Systems (SMS) Lab, ETH Zurich, 8006 Zurich, Switzerland
| | | | | | - Deborah Knechtle
- Revigo, Rehaklinik Zihlschlacht AG, 8604 Volketswil, Switzerland
| | - Peter Wolf
- Sensory-Motor Systems (SMS) Lab, ETH Zurich, 8006 Zurich, Switzerland
| | - Dino De Bon
- Revigo, Rehaklinik Zihlschlacht AG, 8604 Volketswil, Switzerland
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Tian J, Wang H, Zheng S, Ning Y, Zhang X, Niu J, Vladareanu L. sEMG-Based Gain-Tuned Compliance Control for the Lower Limb Rehabilitation Robot during Passive Training. SENSORS (BASEL, SWITZERLAND) 2022; 22:7890. [PMID: 36298256 PMCID: PMC9611623 DOI: 10.3390/s22207890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
The lower limb rehabilitation robot is a typical man-machine coupling system. Aiming at the problems of insufficient physiological information and unsatisfactory safety performance in the compliance control strategy for the lower limb rehabilitation robot during passive training, this study developed a surface electromyography-based gain-tuned compliance control (EGCC) strategy for the lower limb rehabilitation robot. First, the mapping function relationship between the normalized surface electromyography (sEMG) signal and the gain parameter was established and an overall EGCC strategy proposed. Next, the EGCC strategy without sEMG information was simulated and analyzed. The effects of the impedance control parameters on the position correction amount were studied, and the change rules of the robot end trajectory, man-machine contact force, and position correction amount analyzed in different training modes. Then, the sEMG signal acquisition and feature analysis of target muscle groups under different training modes were carried out. Finally, based on the lower limb rehabilitation robot control system, the influence of normalized sEMG threshold on the robot end trajectory and gain parameters under different training modes was experimentally studied. The simulation and experimental results show that the adoption of the EGCC strategy can significantly enhance the compliance of the robot end-effector by detecting the sEMG signal and improve the safety of the robot in different training modes, indicating the EGCC strategy has good application prospects in the rehabilitation robot field.
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Affiliation(s)
- Junjie Tian
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Hongbo Wang
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
- Academy for Engineering & Technology, Fudan University, Shanghai 200433, China
| | - Siyuan Zheng
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Yuansheng Ning
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Xingchao Zhang
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Jianye Niu
- Parallel Robot and Mechatronic System Laboratory of Hebei Province, Yanshan University, Qinhuangdao 066004, China
| | - Luige Vladareanu
- Institute of Solid Mechanics of the Romanian Academy, 010141 Bucharest, Romania
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