1
|
Alves T, Gonçalves RS, Carbone G. Serious Games Strategies With Cable-Driven Robots for Bimanual Rehabilitation: A Randomized Controlled Trial With Post-Stroke Patients. Front Robot AI 2022; 9:739088. [PMID: 35252362 PMCID: PMC8892256 DOI: 10.3389/frobt.2022.739088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
Cable-driven robots can be an ideal fit for performing post-stroke rehabilitation due to their specific features. For example, they have small and lightweight moving parts and a relatively large workspace. They also allow safe human-robot interactions and can be easily adapted to different patients and training protocols. However, the existing cable-driven robots are mostly unilateral devices that can allow only the rehabilitation of the most affected limb. This leaves unaddressed the rehabilitation of bimanual activities, which are predominant within the common Activities of Daily Living (ADL). Serious games can be integrated with cable-driven robots to further enhance their features by providing an interactive experience and by generating a high level of engagement in patients, while they can turn monotonous and repetitive therapy exercises into entertainment tasks. Additionally, serious game interfaces can collect detailed quantitative treatment information such as exercise time, velocities, and force, which can be very useful to monitor a patient’s progress and adjust the treatment protocols. Given the above-mentioned strong advantages of both cable driven robots, bimanual rehabilitation and serious games, this paper proposes and discusses a combination of them, in particular, for performing bilateral/bimanual rehabilitation tasks. The main design characteristics are analyzed for implementing the design of both the hardware and software components. The hardware design consists of a specifically developed cable-driven robot. The software design consists of a specifically developed serious game for performing bimanual rehabilitation exercises. The developed software also includes BiEval. This specific software allows to quantitatively measure and assess the rehabilitation therapy effects. An experimental validation is reported with 15 healthy subjects and a RCT (Randomized Controlled Trial) has been performed with 10 post-stroke patients at the Physiotherapy’s Clinic of the Federal University of Uberlândia (Minas Gerais, Brazil). The RCT results demonstrate the engineering feasibility and effectiveness of the proposed cable-driven robot in combination with the proposed BiEval software as a valuable tool to augment the conventional physiotherapy protocols and for providing reliable measurements of the patient’s rehabilitation performance and progress. The clinical trial was approved by the Research Ethics Committee of the UFU (Brazil) under the CAAE N° 00914818.5.0000.5152 on plataformabrasil@saude.gov.br.
Collapse
Affiliation(s)
- Thiago Alves
- Laboratory of Automation and Robotics, School of Mechanical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
- *Correspondence: Thiago Alves,
| | - Rogério Sales Gonçalves
- Laboratory of Automation and Robotics, School of Mechanical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
| | - Giuseppe Carbone
- Department of Mechanical, Energy and Management Engineering, Università della Calabria, Rende, Italy
| |
Collapse
|
2
|
Quantitative Progress Evaluation of Post-stroke Patients Using a Novel Bimanual Cable-driven Robot. JOURNAL OF BIONIC ENGINEERING 2021. [DOI: 10.1007/s42235-021-00102-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
3
|
Shi B, Chen X, Yue Z, Yin S, Weng Q, Zhang X, Wang J, Wen W. Wearable Ankle Robots in Post-stroke Rehabilitation of Gait: A Systematic Review. Front Neurorobot 2019; 13:63. [PMID: 31456681 PMCID: PMC6700322 DOI: 10.3389/fnbot.2019.00063] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Stroke causes weak functional mobility in survivors and affects the ability to perform activities of daily living. Wearable ankle robots are a potential intervention for gait rehabilitation post-stroke. Objective: The aim of this study is to provide a systematic review of wearable ankle robots, focusing on the overview, classification and comparison of actuators, gait event detection, control strategies, and performance evaluation. Method: Only English-language studies published from December 1995 to July 2018 were searched in the following databases: PubMed, EMBASE, Web of Science, Scopus, IEEE Xplore, Science Direct, SAGE journals. Result: A total of 48 articles were selected and 97 stroke survivors participated in these trials. Findings showed that few comparative trials were conducted among different actuators or control strategies. Moreover, mixed sensing technology which combines kinematic with kinetic information was effective in detecting motion intention of stroke survivors. Furthermore, all the selected clinical studies showed an improvement in the peak dorsiflexion degree of the swing phase, propulsion on the paretic side during push-off, and further enhanced walking speed after a period of robot-assisted ankle rehabilitation training. Conclusions: Preliminary findings suggest that wearable ankle robots have certain clinical benefits for the treatment of hemiplegic gait post-stroke. In the near future, a multicenter randomized controlled clinical trial is extremely necessary to enhance the clinical effectiveness of wearable ankle robots.
Collapse
Affiliation(s)
- Bin Shi
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Zan Yue
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Shuai Yin
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | | - Xue Zhang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | - Jing Wang
- School of Mechanical Engineering, Institute of Robotics and Intelligent System, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Key Laboratory of Intelligent Robots, Xi'an, China
| | | |
Collapse
|
4
|
Silva-Couto MA, Siqueira AAG, Santos GL, Russo TL. Ankle torque steadiness and gait speed after a single session of robot therapy in individuals with chronic hemiparesis: a pilot study. Top Stroke Rehabil 2019; 26:630-638. [DOI: 10.1080/10749357.2019.1647984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M. A. Silva-Couto
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
- Department of Mechanical Engineering, University of São Paulo, São Carlos, Brazil
| | - A. A. G. Siqueira
- Department of Mechanical Engineering, University of São Paulo, São Carlos, Brazil
| | - Gabriela L. Santos
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
- Alfredo Nasser Faculty, Institute of Sciences and Health, Aparecida de Goiânia, Brazil
| | - Thiago L. Russo
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| |
Collapse
|
5
|
Tefertiller C, Hays K, Natale A, O'Dell D, Ketchum J, Sevigny M, Eagye CB, Philippus A, Harrison-Felix C. Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100:1409-1416. [PMID: 31009598 PMCID: PMC8594144 DOI: 10.1016/j.apmr.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI). SETTING Home-based exercise program (HEP). PARTICIPANTS Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services. MAIN OUTCOME MEASURES Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O). RESULTS No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P's <.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest. CONCLUSION This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.
Collapse
Affiliation(s)
| | - Kaitlin Hays
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Audrey Natale
- Department of Physical Therapy, Craig Hospital, Englewood, Colorado
| | - Denise O'Dell
- Department of Physical Therapy, Regis University, Denver, Colorado
| | | | - Mitch Sevigny
- Department of Research, Craig Hospital, Englewood, Colorado
| | - C B Eagye
- Department of Research, Craig Hospital, Englewood, Colorado
| | | | | |
Collapse
|
6
|
Perez-Ibarra JC, Siqueira AAG, Silva-Couto MA, de Russo TL, Krebs HI. Adaptive Impedance Control Applied to Robot-Aided Neuro-Rehabilitation of the Ankle. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2018.2885165] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
7
|
Jiang J, Lee KM, Ji J. Review of anatomy-based ankle–foot robotics for mind, motor and motion recovery following stroke: design considerations and needs. INTERNATIONAL JOURNAL OF INTELLIGENT ROBOTICS AND APPLICATIONS 2018. [DOI: 10.1007/s41315-018-0065-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
8
|
A Lower Limb Rehabilitation Robot in Sitting Position with a Review of Training Activities. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:1927807. [PMID: 29808109 PMCID: PMC5901836 DOI: 10.1155/2018/1927807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/03/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022]
Abstract
Robots for stroke rehabilitation at the lower limbs in sitting/lying position have been developed extensively. Some of them have been applied in clinics and shown the potential of the recovery of poststroke patients who suffer from hemiparesis. These robots were developed to provide training at different joints of lower limbs with various activities and modalities. This article reviews the training activities that were realized by rehabilitation robots in literature, in order to offer insights for developing a novel robot suitable for stroke rehabilitation. The control system of the lower limb rehabilitation robot in sitting position that was introduced in the previous work is discussed in detail to demonstrate the behavior of the robot while training a subject. The nonlinear impedance control law, based on active assistive control strategy, is able to define the response of the robot with more specifications while the passivity property and the robustness of the system is verified. A preliminary experiment is conducted on a healthy subject to show that the robot is able to perform active assistive exercises with various training activities and assist the subject to complete the training with desired level of assistance.
Collapse
|
9
|
Reviewing Clinical Effectiveness of Active Training Strategies of Platform-Based Ankle Rehabilitation Robots. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2858294. [PMID: 29675142 PMCID: PMC5838480 DOI: 10.1155/2018/2858294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
Objective This review aims to provide a systematical investigation of clinical effectiveness of active training strategies applied in platform-based ankle robots. Method English-language studies published from Jan 1980 to Aug 2017 were searched from four databases using key words of "Ankle∗" AND "Robot∗" AND "Effect∗ OR Improv∗ OR Increas∗." Following an initial screening, three rounds of discrimination were successively conducted based on the title, the abstract, and the full paper. Result A total of 21 studies were selected with 311 patients involved; of them, 13 studies applied a single group while another eight studies used different groups for comparison to verify the therapeutic effect. Virtual-reality (VR) game training was applied in 19 studies, while two studies used proprioceptive neuromuscular facilitation (PNF) training. Conclusion Active training techniques delivered by platform ankle rehabilitation robots have been demonstrated with great potential for clinical applications. Training strategies are mostly combined with one another by considering rehabilitation schemes and motion ability of ankle joints. VR game environment has been commonly used with active ankle training. Bioelectrical signals integrated with VR game training can implement intelligent identification of movement intention and assessment. These further provide the foundation for advanced interactive training strategies that can lead to enhanced training safety and confidence for patients and better treatment efficacy.
Collapse
|
10
|
Perez-Ibarra JC, Siqueira AAG. Comparison of kinematic and EMG parameters between unassisted, fixed- and adaptive-stiffness robotic-assisted ankle movements in post-stroke subjects. IEEE Int Conf Rehabil Robot 2017; 2017:461-466. [PMID: 28813863 DOI: 10.1109/icorr.2017.8009291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, we present an assist-as-needed scheme that effectively adapted the assistance provided by an ankle rehabilitation robot according to patient's participation and performance during therapeutic movements. We performed an error-based estimation of the ankle impedance as a valid measure of the patient participation. Then, we computed the amount of robotic assistance by three steps: normalization of the combined patient-robot stiffness, optimization of patientrobot interaction, and finally, adaptation of the level of the robotic assistance according to patient's performance while playing a serious game. Four post-stroke patients evaluated our methodology using an impedance controlled robotic system to assist alternated open-ended dorsi/plantarflexion movements in sitting position. Experimental results indicated that the proposed adaptive-stiffness method improves patient participation and performance compared to a fixed-stiffness assistive method and to an unassisted baseline. We also found that adaptive assistance could optimize the patient's muscular activity during movements. Our strategy effectively assisted with a lower stiffness allowing more kinematic variability in motions leaded by patient, decreasing the total amount of provided assistance without compromising the overall performance during therapy.
Collapse
|
11
|
Khalid YM, Gouwanda D, Parasuraman S. A review on the mechanical design elements of ankle rehabilitation robot. Proc Inst Mech Eng H 2015; 229:452-63. [DOI: 10.1177/0954411915585597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 04/10/2015] [Indexed: 12/26/2022]
Abstract
Ankle rehabilitation robots are developed to enhance ankle strength, flexibility and proprioception after injury and to promote motor learning and ankle plasticity in patients with drop foot. This article reviews the design elements that have been incorporated into the existing robots, for example, backdrivability, safety measures and type of actuation. It also discusses numerous challenges faced by engineers in designing this robot, including robot stability and its dynamic characteristics, universal evaluation criteria to assess end-user comfort, safety and training performance and the scientific basis on the optimal rehabilitation strategies to improve ankle condition. This article can serve as a reference to design robot with better stability and dynamic characteristics and good safety measures against internal and external events. It can also serve as a guideline for the engineers to report their designs and findings.
Collapse
Affiliation(s)
- Yusuf M Khalid
- School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Darwin Gouwanda
- School of Engineering, Monash University Malaysia, Bandar Sunway, Malaysia
| | | |
Collapse
|
12
|
Goodman RN, Rietschel JC, Roy A, Jung BC, Diaz J, Macko RF, Forrester LW. Increased reward in ankle robotics training enhances motor control and cortical efficiency in stroke. ACTA ACUST UNITED AC 2015; 51:213-27. [PMID: 24933720 DOI: 10.1682/jrrd.2013.02.0050] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 09/23/2013] [Indexed: 11/05/2022]
Abstract
Robotics is rapidly emerging as a viable approach to enhance motor recovery after disabling stroke. Current principles of cognitive motor learning recognize a positive relationship between reward and motor learning. Yet no prior studies have established explicitly whether reward improves the rate or efficacy of robotics-assisted rehabilitation or produces neurophysiologic adaptations associated with motor learning. We conducted a 3 wk, 9-session clinical pilot with 10 people with chronic hemiparetic stroke, randomly assigned to train with an impedance-controlled ankle robot (anklebot) under either high reward (HR) or low reward conditions. The 1 h training sessions entailed playing a seated video game by moving the paretic ankle to hit moving onscreen targets with the anklebot only providing assistance as needed. Assessments included paretic ankle motor control, learning curves, electroencephalograpy (EEG) coherence and spectral power during unassisted trials, and gait function. While both groups exhibited changes in EEG, the HR group had faster learning curves (p = 0.05), smoother movements (p </= 0.05), reduced contralesional-frontoparietal coherence (p </= 0.05), and reduced left-temporal spectral power (p </= 0.05). Gait analyses revealed an increase in nonparetic step length (p = 0.05) in the HR group only. These results suggest that combining explicit rewards with novel anklebot training may accelerate motor learning for restoring mobility.
Collapse
Affiliation(s)
- Ronald N Goodman
- Baltimore VAMC Annex, Maryland Exercise and Robotics Center of Excellence, 209 W. Fayette St, Rm 207, Baltimore, MD 21201.
| | | | | | | | | | | | | |
Collapse
|
13
|
Michmizos KP, Vaisman L, Krebs HI. A Comparative Analysis of Speed Profile Models for Ankle Pointing Movements: Evidence that Lower and Upper Extremity Discrete Movements are Controlled by a Single Invariant Strategy. Front Hum Neurosci 2014; 8:962. [PMID: 25505881 PMCID: PMC4245889 DOI: 10.3389/fnhum.2014.00962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/12/2014] [Indexed: 12/19/2022] Open
Abstract
Little is known about whether our knowledge of how the central nervous system controls the upper extremities (UE), can generalize, and to what extent to the lower limbs. Our continuous efforts to design the ideal adaptive robotic therapy for the lower limbs of stroke patients and children with cerebral palsy highlighted the importance of analyzing and modeling the kinematics of the lower limbs, in general, and those of the ankle joints, in particular. We recruited 15 young healthy adults that performed in total 1,386 visually evoked, visually guided, and target-directed discrete pointing movements with their ankle in dorsal-plantar and inversion-eversion directions. Using a non-linear, least-squares error-minimization procedure, we estimated the parameters for 19 models, which were initially designed to capture the dynamics of upper limb movements of various complexity. We validated our models based on their ability to reconstruct the experimental data. Our results suggest a remarkable similarity between the top-performing models that described the speed profiles of ankle pointing movements and the ones previously found for the UE both during arm reaching and wrist pointing movements. Among the top performers were the support-bounded lognormal and the beta models that have a neurophysiological basis and have been successfully used in upper extremity studies with normal subjects and patients. Our findings suggest that the same model can be applied to different "human" hardware, perhaps revealing a key invariant in human motor control. These findings have a great potential to enhance our rehabilitation efforts in any population with lower extremity deficits by, for example, assessing the level of motor impairment and improvement as well as informing the design of control algorithms for therapeutic ankle robots.
Collapse
Affiliation(s)
- Konstantinos P. Michmizos
- Martinos Center for Biomedical Imaging, Massachusetts Institute of Technology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lev Vaisman
- Department of Anatomy and Neurobiology, School of Medicine, Boston University, Boston, MA, USA
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Neurology, Division of Rehabilitation, School of Medicine, University of Maryland, College Park, MD, USA
- Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan
- Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, UK
| |
Collapse
|
14
|
Forrester LW, Roy A, Goodman RN, Rietschel J, Barton JE, Krebs HI, Macko RF. Clinical application of a modular ankle robot for stroke rehabilitation. NeuroRehabilitation 2014; 33:85-97. [PMID: 23949045 DOI: 10.3233/nre-130931] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advances in our understanding of neuroplasticity and motor learning post-stroke are now being leveraged with the use of robotics technology to enhance physical rehabilitation strategies. Major advances have been made with upper extremity robotics, which have been tested for efficacy in multi-site trials across the subacute and chronic phases of stroke. In contrast, use of lower extremity robotics to promote locomotor re-learning has been more recent and presents unique challenges by virtue of the complex multi-segmental mechanics of gait. OBJECTIVES Here we review a programmatic effort to develop and apply the concept of joint-specific modular robotics to the paretic ankle as a means to improve underlying impairments in distal motor control that may have a significant impact on gait biomechanics and balance. METHODS An impedance controlled ankle robot module (anklebot) is described as a platform to test the idea that a modular approach can be used to modify training and measure the time profile of treatment response. RESULTS Pilot studies using seated visuomotor anklebot training with chronic patients are reviewed, along with results from initial efforts to evaluate the anklebot's utility as a clinical tool for assessing intrinsic ankle stiffness. The review includes a brief discussion of future directions for using the seated anklebot training in the earliest phases of sub-acute therapy, and to incorporate neurophysiological measures of cerebro-cortical activity as a means to reveal underlying mechanistic processes of motor learning and brain plasticity associated with robotic training. CONCLUSIONS Finally we conclude with an initial control systems strategy for utilizing the anklebot as a gait training tool that includes integrating an Internal Model-based adaptive controller to both accommodate individual deficit severities and adapt to changes in patient performance.
Collapse
Affiliation(s)
- Larry W Forrester
- VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore,MD 21201, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Zhang M, Davies TC, Nandakumar A, Xie S. Article Commentary: An Assistance-as-Needed Control Paradigm for Robot-Assisted Ankle Rehabilitation. Rehabil Process Outcome 2014. [DOI: 10.4137/rpo.s12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Robots have been developed for treatment and rehabilitation of ankle injuries. Two reviews have been conducted involving the effectiveness of robot-assisted ankle rehabilitation and ankle assessment techniques respectively to investigate what the optimal therapy is. This study proposes an assistance-as-needed (AAN) control paradigm for potential use in robot-assisted ankle rehabilitation based on the review results. This AAN control strategy will consider real-time ankle assessment and make rehabilitation more effective.
Collapse
Affiliation(s)
- Mingming Zhang
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - T. Claire Davies
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Anoop Nandakumar
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - Shane Xie
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
16
|
Forrester LW, Roy A, Krywonis A, Kehs G, Krebs HI, Macko RF. Modular ankle robotics training in early subacute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair 2014; 28:678-87. [PMID: 24515923 DOI: 10.1177/1545968314521004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED BACKGROUND. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. OBJECTIVE To assess the feasibility and efficacy of daily anklebot training during early subacute hospitalization poststroke. METHODS Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (n = 18) or passive manual stretching (n = 16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an "assist-as-needed" approach during >200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. RESULTS Both groups walked faster at discharge; however, the robot group improved more in percentage change of temporal symmetry (P = .032) and also of step length symmetry (P = .038), with longer nonparetic step lengths in the robot (133%) versus stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak (P ≤ .001) and mean (P ≤ .01) angular speeds, and increased movement smoothness (P ≤ .01). There were no adverse events. CONCLUSION Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early subacute hospitalization is well tolerated and improves ankle motor control and gait patterning.
Collapse
Affiliation(s)
- Larry W Forrester
- University of Maryland School of Medicine, Baltimore, MD, USA VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, MD, USA
| | - Anindo Roy
- University of Maryland School of Medicine, Baltimore, MD, USA VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, MD, USA University of Maryland School of Engineering, College Park, MD, USA
| | - Amanda Krywonis
- University of Maryland Rehabilitation and Orthopaedics Institute, Baltimore, MD, USA
| | - Glenn Kehs
- University of Maryland School of Medicine, Baltimore, MD, USA University of Maryland Rehabilitation and Orthopaedics Institute, Baltimore, MD, USA
| | - Hermano Igo Krebs
- University of Maryland School of Medicine, Baltimore, MD, USA Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Richard F Macko
- University of Maryland School of Medicine, Baltimore, MD, USA VA RR&D Maryland Exercise and Robotics Center of Excellence, Baltimore, MD, USA Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA
| |
Collapse
|
17
|
Masiero S, Poli P, Rosati G, Zanotto D, Iosa M, Paolucci S, Morone G. The value of robotic systems in stroke rehabilitation. Expert Rev Med Devices 2014; 11:187-98. [PMID: 24479445 DOI: 10.1586/17434440.2014.882766] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this paper, we discuss robot-mediated neurorehabilitation as a significant emerging field in clinical medicine. Stroke rehabilitation is advancing toward more integrated processes, using robotics to facilitate this integration. Rehabilitation approaches have tremendous value in reducing long-term impairments in stroke patients during hospitalization and after discharge, of which robotic systems are a new modality that can provide more effective rehabilitation. The function of robotics in rehabilitative interventions has been examined extensively, generating positive yet not completely satisfactory clinical results. This article presents state-of-the-art robotic systems and their prospective function in poststroke rehabilitation of the upper and lower limbs.
Collapse
Affiliation(s)
- Stefano Masiero
- Department of Neuroscience, Unit of Rehabilitation, University of Padua, Padua, Italy
| | | | | | | | | | | | | |
Collapse
|
18
|
Krishnan C, Ranganathan R, Dhaher YY, Rymer WZ. A pilot study on the feasibility of robot-aided leg motor training to facilitate active participation. PLoS One 2013; 8:e77370. [PMID: 24146986 PMCID: PMC3795642 DOI: 10.1371/journal.pone.0077370] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/03/2013] [Indexed: 01/14/2023] Open
Abstract
Robot-aided gait therapy offers a promising approach towards improving gait function in individuals with neurological disorders such as stroke or spinal cord injury. However, incorporation of appropriate control strategies is essential for actively engaging the patient in the therapeutic process. Although several control algorithms (such as assist-as-needed and error augmentation) have been proposed to improve active patient participation, we hypothesize that the therapeutic benefits of these control algorithms can be greatly enhanced if combined with a motor learning task to facilitate neural reorganization and motor recovery. Here, we describe an active robotic training approach (patient-cooperative robotic gait training combined with a motor learning task) using the Lokomat and pilot-tested whether this approach can enhance active patient participation during training. Six neurologically intact adults and three chronic stroke survivors participated in this pilot feasibility study. Participants walked in a Lokomat while simultaneously performing a foot target-tracking task that necessitated greater hip and knee flexion during the swing phase of the gait. We computed the changes in tracking error as a measure of motor performance and changes in muscle activation as a measure of active subject participation. Repeated practice of the motor-learning task resulted in significant reductions in target-tracking error in all subjects. Muscle activation was also significantly higher during active robotic training compared to simply walking in the robot. The data from stroke participants also showed a trend similar to neurologically intact participants. These findings provide a proof-of-concept demonstration that combining robotic gait training with a motor learning task enhances active participation.
Collapse
Affiliation(s)
- Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois, United States of America
- * E-mail:
| | - Rajiv Ranganathan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois, United States of America
| | - Yasin Y. Dhaher
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois, United States of America
| | - William Z. Rymer
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Illinois, United States of America
| |
Collapse
|
19
|
Zhang M, Davies TC, Xie S. Effectiveness of robot-assisted therapy on ankle rehabilitation--a systematic review. J Neuroeng Rehabil 2013; 10:30. [PMID: 23517734 PMCID: PMC3636117 DOI: 10.1186/1743-0003-10-30] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries. METHODS Thirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords 'ankle*', 'robot*', 'rehabilitat*' or 'treat*' and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation. RESULTS Twenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II. CONCLUSION All the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies.
Collapse
Affiliation(s)
- Mingming Zhang
- Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand
| | - T Claire Davies
- Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Shane Xie
- Department of Mechanical Engineering, University of Auckland, Auckland, New Zealand
| |
Collapse
|