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Tohanean N, Tucan P, Vanta OM, Abrudan C, Pintea S, Gherman B, Burz A, Banica A, Vaida C, Neguran DA, Ordog A, Tarnita D, Pisla D. The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study. J Clin Med 2023; 12:jcm12020425. [PMID: 36675354 PMCID: PMC9866490 DOI: 10.3390/jcm12020425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.
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Affiliation(s)
- Nicoleta Tohanean
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Oana-Maria Vanta
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Cristian Abrudan
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Neurosurgery Department, Cluj-Napoca Emergency Clinical County Hospital, 400349 Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babes-Bolyai University, 400029 Cluj-Napoca, Romania
| | - Bogdan Gherman
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Alin Burz
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Alexandru Banica
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Calin Vaida
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Deborah Alice Neguran
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Andreea Ordog
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Daniela Tarnita
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Doina Pisla
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
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Gherman B, Hajjar NA, Tucan P, Radu C, Vaida C, Mois E, Burz A, Pisla D. Risk Assessment-Oriented Design of a Needle Insertion Robotic System for Non-Resectable Liver Tumors. Healthcare (Basel) 2022; 10:healthcare10020389. [PMID: 35207006 PMCID: PMC8872014 DOI: 10.3390/healthcare10020389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Medical robotics is a highly challenging and rewarding field of research, especially in the development of minimally invasive solutions for the treatment of the worldwide leading cause of death, cancer. The aim of the paper is to provide a design methodology for the development of a safe and efficient medical robotic system for the minimally invasive, percutaneous, targeted treatment of hepatocellular carcinoma, which can be extended with minimal modification for other types of abdominal cancers. Using as input a set of general medical requirements to comply with currently applicable standards, and a set of identified hazards and failure modes, specific methods, such as the Analytical Hierarchy Prioritization, Risk Analysis and fuzzy logic Failure Modes and Effect Analysis have been used within a stepwise approach to help in the development of a medical device targeting the insertion of multiple needles in brachytherapy procedures. The developed medical device, which is visually guided using CT scanning, has been tested for validation in a medical environment using a human-size ballistic gel liver, with promising results. These prove that the robotic system can be used for the proposed medical task, while the modular approach increases the chances of acceptance.
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Affiliation(s)
- Bogdan Gherman
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Nadim Al Hajjar
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Paul Tucan
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Corina Radu
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Calin Vaida
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Emil Mois
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Alin Burz
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Doina Pisla
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
- Correspondence:
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Major ZZ, Vaida C, Major KA, Tucan P, Brusturean E, Gherman B, Birlescu I, Craciunaș R, Ulinici I, Simori G, Banica A, Pop N, Burz A, Carbone G, Pisla D. Comparative Assessment of Robotic versus Classical Physical Therapy Using Muscle Strength and Ranges of Motion Testing in Neurological Diseases. J Pers Med 2021; 11:jpm11100953. [PMID: 34683094 PMCID: PMC8541455 DOI: 10.3390/jpm11100953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/02/2023] Open
Abstract
The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.
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Affiliation(s)
- Zoltán Zsigmond Major
- Neurophysiology Department, National Center for Spinal Disorders, Királyhágó u. 1, 1126 Budapest, Hungary;
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
- Correspondence: (C.V.); (D.P.)
| | - Kinga Andrea Major
- Second ICU, Neurosurgery Department, Cluj County Emergency Clinical Hospital, Strada Clinicilor 3-5, 400000 Cluj-Napoca, Romania;
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Emanuela Brusturean
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Iosif Birlescu
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Raul Craciunaș
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Ionut Ulinici
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Gábor Simori
- Neurology Department, Municipal Clinical Hospital Cluj-Napoca, 400139 Cluj-Napoca, Romania; (E.B.); (R.C.); (G.S.)
| | - Alexandru Banica
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Nicoleta Pop
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Alin Burz
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
| | - Giuseppe Carbone
- DIMEG, University of Calabria, Via Pietro Bucci, 87036 Rende, Italy;
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (P.T.); (B.G.); (I.B.); (I.U.); (A.B.); (N.P.); (A.B.)
- Correspondence: (C.V.); (D.P.)
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Tucan P, Vaida C, Ulinici I, Banica A, Burz A, Pop N, Birlescu I, Gherman B, Plitea N, Antal T, Carbone G, Pisla D. Optimization of the ASPIRE Spherical Parallel Rehabilitation Robot Based on Its Clinical Evaluation. Int J Environ Res Public Health 2021; 18:3281. [PMID: 33810042 PMCID: PMC8004699 DOI: 10.3390/ijerph18063281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
The paper presents the design optimization of the ASPIRE spherical parallel robot for shoulder rehabilitation following clinical evaluation and clinicians' feedback. After the development of the robotic structure and the implementation of the control system, ASPIRE was prepared for clinical evaluation. A set of clinical trials was performed on 24 patients with different neurological disorders to obtain the patient and clinician acceptance of the rehabilitation system. During the clinical trials, the behavior of the robotic system was closely monitored and analyzed in order to improve its reliability and overall efficiency. Along with its reliability and efficiency, special attention was given to the safety characteristics during the rehabilitation task.
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Affiliation(s)
- Paul Tucan
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Calin Vaida
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Ionut Ulinici
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Alexandru Banica
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Alin Burz
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Nicoleta Pop
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Iosif Birlescu
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Bogdan Gherman
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Nicolae Plitea
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | - Tiberiu Antal
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
| | | | - Doina Pisla
- CESTER, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania; (P.T.); (I.U.); (A.B.); (A.B.); (N.P.); (I.B.); (B.G.); (N.P.); (T.A.)
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