Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Empowering and assisting natural human mobility: The simbiosis walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staf

Automatic Setting Procedure for Exoskeleton-Assisted Overground Gait: Proof of Concept on Stroke Population

Stroke-related locomotor impairments are often associated with abnormal timing and intensity of recruitment of the affected and non-affected lower limb muscles. Restoring the proper lower limbs muscles activation is a key factor to facilitate recovery of gait capacity and performance, and to reduce maladaptive plasticity. Ekso is a wearable powered exoskeleton robot able to support over-ground gait training. The user controls the exoskeleton by triggering each single step during the gait cycle. The fine-tuning of the exoskeleton control system is crucial-it is set according to the residual functional abilities of the patient, and it needs to ensure lower limbs powered gait to be the most physiological as possible. This work focuses on the definition of an automatic calibration procedure able to detect the best Ekso setting for each patient. EMG activity has been recorded from Tibialis Anterior, Soleus, Rectus Femoris, and Semitendinosus muscles in a group of 7 healthy controls and 13 neurological patients. EMG signals have been processed so to obtain muscles activation patterns. The mean muscular activation pattern derived from the controls cohort has been set as reference. The developed automatic calibration procedure requires the patient to perform overground walking trials supported by the exoskeleton while changing parameters setting. The Gait Metric index is calculated for each trial, where the closer the performance is to the normative muscular activation pattern, in terms of both relative amplitude and timing, the higher the Gait Metric index is. The trial with the best Gait Metric index corresponds to the best parameters set. It has to be noted that the automatic computational calibration procedure is based on the same number of overground walking trials, and the same experimental set-up as in the current manual calibration procedure. The proposed approach allows supporting the rehabilitation team in the setting procedure. It has been demonstrated to be robust, and to be in agreement with the current gold standard (i.e., manual calibration performed by an expert engineer). The use of a graphical user interface is a promising tool for the effective use of an automatic procedure in a clinical context

Synchronization-Based Control of a Robotic Suit for Walking Assist

信州大学博士（工学）・学位論文・平成24年3月20日授与（甲第562号)・ZHANG XIAThesisZHANG XIA. Synchronization-Based Control of a Robotic Suit for Walking Assist. 信州大学, 2012, 153p, 博士論文doctoral thesi

A flexible sensor technology for the distributed measurement of interaction pressure

We present a sensor technology for the measure of the physical human-robot interaction pressure developed in the last years at Scuola Superiore Sant'Anna. The system is composed of flexible matrices of opto-electronic sensors covered by a soft silicone cover. This sensory system is completely modular and scalable, allowing one to cover areas of any sizes and shapes, and to measure different pressure ranges. In this work we present the main application areas for this technology. A first generation of the system was used to monitor human-robot interaction in upper- (NEUROExos; Scuola Superiore Sant'Anna) and lower-limb (LOPES; University of Twente) exoskeletons for rehabilitation. A second generation, with increased resolution and wireless connection, was used to develop a pressure-sensitive foot insole and an improved human-robot interaction measurement systems. The experimental characterization of the latter system along with its validation on three healthy subjects is presented here for the first time. A perspective on future uses and development of the technology is finally drafted

Bio-Artificial Synergies for Grasp Posture Control of Supernumerary Robotic Fingers

A new type of wrist-mounted robot, the Supernumerary Robotic (SR) Fingers, is proposed to work closely with the human hand and aid the human in performing a variety of prehensile tasks. For people with diminished functionality of their hands, these robotic fingers could provide the opportunity to live with more independence and work more productively. A natural and implicit coordination between the SR Fingers and the human fingers is required so the robot can be transformed to act as part of the human body. This paper presents a novel control algorithm, termed “Bio-Artificial Synergies”, which enables the SR and human fingers to share the task load together and adapt to diverse task conditions. Through grasp experiments and data analysis, postural synergies were found for a seven-fingered hand comprised of two SR Fingers and five human fingers. The synergy-based control law was then extracted from the experimental data using Partial Least Squares (PLS) regression and tested on the SR Finger prototype as a proof of concept

Robotic design and modelling of medical lower extremity exoskeletons

This study aims to explain the development of the robotic Lower Extremity Exoskeleton (LEE) systems between 1960 and 2019 in chronological order. The scans performed in the exoskeleton system’s design have shown that a modeling program, such as AnyBody, and OpenSim, should be used first to observe the design and software animation, followed by the mechanical development of the system using sensors and motors. Also, the use of OpenSim and AnyBody musculoskeletal system software has been proven to play an essential role in designing the human-exoskeleton by eliminating the high costs and risks of the mechanical designs. Furthermore, these modeling systems can enable rapid optimization of the LEE design by detecting the forces and torques falling on the human muscles

Powered knee orthosis for human gait rehabilitation: first advances

This paper presents a new system for a powered knee orthosis, that was designed to assist and improve the gait function of patients with gait pathologies. The system contains the orthotic device (embedded with sensors for angle and user-orthosis interaction torque measurements, and an electric actuator) and wearable sensors (inertial measurement unit, force sensitive resistors, and electromyography sensors), which allows the generation of smart rehabilitation tools and several motion assistive techniques. The main goal is to present a conceptual overview and functional description of the system and use scenarios of each component. The attachment mechanism of the orthosis to the limb is also highlighted, being composed of a straps system fixed in the mechanical links of the joint. It was noticed that users with distinct lower-limb morphologies can presents difficulties wearing the orthosis, since the device needs constant adjust to align the mechanical and human joints. The system was validated in ground-level walking on healthy subjects, with emphasis on the impact of the device in the user. The subjects reported that the orthosis is comfortable to use, easy to wear, and no issues were raised regarding the aesthetics of the device. Only the weight was assimilated as a possible hindrance (compensated in the future). Future challenges involve the inclusion of an ankle joint in the system and the use of the proposed tool in rehabilitation.This work is supported by the FCT - Fundacao para a Ciencia e Tecnologia - with the reference scholarship SFRH/BD/108309/2015, with the reference project UID/EEA/04436/2013, and by FEDER funds through the COMPETE 2020 - Programa Operacional Competitividade e Internacionalizacao (POCI) - with the reference project POCI-01-0145-FEDER-006941, and partially supported with grant RYC-2014-16613 by Spanish Ministry of Economy and Competitiveness