Development of a mechatronic system for the mirror therapy

This paper fits into the field of research concerning robotic systems for rehabilitation. Robotic systems are going to be increasingly used to assist fragile persons and to perform rehabilitation tasks for persons affected by motion injuries. Among the recovery therapies, the mirror therapy was shown to be effective for the functional recovery of an arm after stroke. In this paper we present a master/slave robotic device based on the mirror therapy paradigm for wrist rehabilitation. The device is designed to orient the affected wrist in real time according to the imposed motion of the healthy wrist. The paper shows the kinematic analysis of the system, the numerical simulations, an experimental mechatronic set-up, and a built 3D-printed prototype

Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation

Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration

Simultaneous bilaternal training for improving arm function after stroke

Background Simultaneous bilateral training, the completion of identical activities with both arms simultaneously, is one intervention to improve arm function and reduce impairment. Objectives To determine the effects of simultaneous bilateral training for improving arm function after stroke. Search strategy We searched the Cochrane Stroke Trials Register (last searched August 2009) and 10 electronic bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE, EMBASE, CINAHL and AMED (August 2009). We also searched reference lists and trials registers. Selection criteria Randomised trials in adults after stroke, where the intervention was simultaneous bilateral training compared to placebo or no intervention, usual care or other upper limb (arm) interventions. Primary outcomes were performance in activities of daily living (ADL) and functional movement of the upper limb. Secondary outcomes were performance in extended activities of daily living and motor impairment of the arm. Data collection and analysis Two authors independently screened abstracts, extracted data and appraised trials. Assessment of methodological quality was undertaken for allocation concealment, blinding of outcome assessor, intention-to-treat, baseline similarity and loss to follow up. Main results We included 18 studies involving 549 relevant participants, of which 14 (421 participants) were included in the analysis (one within both comparisons). Four of the 14 studies compared the effects of bilateral training with usual care. Primary outcomes: results were not statistically significant for performance in ADL (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) -0.14 to 0.63); functional movement of the arm (SMD -0.07, 95% CI -0.42 to 0.28) or hand (SMD -0.04, 95% CI -0.50 to 0.42). Secondary outcomes: no statistically significant results. Eleven of the 14 studies compared the effects of bilateral training with other specific upper limb (arm) interventions. Primary outcomes: no statistically significant results for performance of ADL (SMD -0.25, 95% CI -0.57 to 0.08); functional movement of the arm (SMD -0.20, 95% CI -0.49 to 0.09) or hand (SMD -0.21, 95% CI -0.51 to 0.09). Secondary outcomes: one study reported a statistically significant result in favour of another upper limb intervention for performance in extended ADL. No statistically significant differences were found for motor impairment outcomes. Authors' conclusions There is insufficient good quality evidence to make recommendations about the relative effect of simultaneous bilateral training compared to placebo, no intervention or usual care. We identified evidence that suggests that bilateral training may be no more (or less) effective than usual care or other upper limb interventions for performance in ADL, functional movement of the upper limb or motor impairment outcome

Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures

BACKGROUND Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. METHOD Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups. RESULTS Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP. CONCLUSION Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093

On sensorimotor function and the relationship between proprioception and motor learning

Research continues to explore the mechanisms that mediate successful motor control. Behaviourally-relevant modulation of muscle commands is dependent on sensory signals. Proprioception -- the sense of body position -- is one signal likely to be crucial for motor learning. The present thesis explores the relationship between human proprioception and motor learning. First we investigated changes to sensory function during the adaptation of arm movements to novel forces. Subjects adapted movements in the presence of directional loads over the course of learning. Psychophysical estimates of perceived hand position showed that motor learning resulted in sensed hand position becoming \emph{biased} in the direction of the experienced load. This biasing of perception occurred for four different perturbation directions and remained even after washout movements. Therefore, motor learning can result in systematic changes to proprioceptive function. In a second experiment we investigated proprioceptive changes after subjects learned highly accurate movements to targets. Subjects demonstrated improved acuity of the hand\u27s position following this type of motor learning. Interestingly, improved acuity did not generalize to the entire workspace but was instead restricted to local positions within the region of the workspace where motor learning occurred. These results provide evidence that altered sensory function from motor learning may also include sensory acuity improvements. Subsequently the duration of acuity improvements was assessed. Improved acuity of hand position was observed immediately after motor learning and 24h later, but was not reliably different from baseline at 1h or 4h. Persistent sensory change may thus be similar to retention of motor learning and may involve a sleep-dependent component. In the fourth study we investigated the ability of proprioceptive training to improve motor learning. Subjects had to match the position and speed of desired trajectories. At regular intervals during motor motor learning, subjects were presented with the desired trajectory either only visually, or with both vision and and passive proprioceptive movement through the desired trajectory using a robot. Subjects who received proprioceptive guidance indeed performed better in matching both velocity and position of desired movements, suggesting a role for passive proprioceptive training in improving motor learning

The Effect of Sensory Experience and Movement Observation on Motor Adaptation to Novel Force Perturbations

On a daily basis, humans capably and effortlessly interact with their surrounding environment through the performance of accurate movements. Movements are often perturbed through the physical influence of the surrounding environment, interaction with objects, or injury, yet adaptation is both rapid and flexible. When adapting, humans are informed by their direct trial-and-error movement experience, incrementally updating predictive control on the next movement; how the brain processes sensed errors into adaptation is not fully known. We may also learn to move through the observation of the movements of others, as visually observed movement information may be transformed into motor memories that influence subsequent motor command; the neural computations underlying such a learning process are not well understood. In this thesis, I aimed to further understand how people incrementally update their predictive motor control in novel haptic environments as a function of sensation during action and during observation. Theories of motor learning suggest that adaptation scales with the size of experienced error. Previous studies have indicated the relationship between adaptation and sensed error can be modulated by statistics of the perturbing environment. In Chapter 2, we considered how the duration of experienced force perturbations might modulate adaptive strategy and found that people becomes increasingly sensitive to kinematic and dynamic sensory signals when experiencing perturbations of decreasing duration. We further found that subjects experiencing pulsatile forces adapted their steady-state feedforward prediction of dynamics with a persistently mismatched breadth when compared to the duration of experienced forces, but learned to closely match the experienced duration of full-movement forces. In the next two sections, we considered the learning effects of movement observation. In Chapter 3, we newly designed and implemented an experimental paradigm in which movement and observation were interleaved, varying the strength of perturbations and associated kinematics from trial-to-trial. Based on previous descriptions of long-term learning by observing, we hypothesized that incremental adaptation would be corrective with respect to observed errors but more modest in magnitude than gains from physical practice. Instead, we found that the incremental adaptive response of movement observation generally countered the direction of experienced forces and was similar in magnitude to the response following action, but was not error-corrective with respect to real-valued signals. Previous research had established an initial advantage when adapting to novel dynamics following observation but the learning processes influencing this effect were unknown. In Chapter 4, we newly demonstrated that the long-term movement observation resulted in adaptive changes in feedforward predictive dynamics. We found that observation generated a small, but significant, compensatory change in reach dynamics that could be characterized by a learned scaling of perturbation-appropriate kinematic signals, suggesting a transformation of visual inputs into a neural representation of environment dynamics

Computational neurorehabilitation: modeling plasticity and learning to predict recovery

Despite progress in using computational approaches to inform medicine and neuroscience in the last 30 years, there have been few attempts to model the mechanisms underlying sensorimotor rehabilitation. We argue that a fundamental understanding of neurologic recovery, and as a result accurate predictions at the individual level, will be facilitated by developing computational models of the salient neural processes, including plasticity and learning systems of the brain, and integrating them into a context specific to rehabilitation. Here, we therefore discuss Computational Neurorehabilitation, a newly emerging field aimed at modeling plasticity and motor learning to understand and improve movement recovery of individuals with neurologic impairment. We first explain how the emergence of robotics and wearable sensors for rehabilitation is providing data that make development and testing of such models increasingly feasible. We then review key aspects of plasticity and motor learning that such models will incorporate. We proceed by discussing how computational neurorehabilitation models relate to the current benchmark in rehabilitation modeling – regression-based, prognostic modeling. We then critically discuss the first computational neurorehabilitation models, which have primarily focused on modeling rehabilitation of the upper extremity after stroke, and show how even simple models have produced novel ideas for future investigation. Finally, we conclude with key directions for future research, anticipating that soon we will see the emergence of mechanistic models of motor recovery that are informed by clinical imaging results and driven by the actual movement content of rehabilitation therapy as well as wearable sensor-based records of daily activity

Development of an upper-body robotic rehabilitation platform that furthers motor recovery after neuromuscular injuries

This dissertation presents the development of an upper-body exoskeleton and its control framework for robotic rehabilitation of the arm and shoulder after a neurological disorder such as a stroke. The first step is designing an exoskeleton hardware that supports natural mobility of the human upper body with a wide range of motion for enabling most rehabilitation exercises. The exoskeleton is equipped with torque-controllable actuation units for implementing various robotic rehabilitation protocols based on force and impedance behaviors. The control framework is designed to exhibit a highly backdrivable behavior with a gravity compensation for the robot's weight and optional gravity support for user's arm weight to promote voluntary movements of patients with motor impairments. The control framework also serves as a `substrate' of other robotic control behaviors for rehabilitation exercises by superimposing desired force or impedance profiles. A stability analysis is performed to examine the coupled stability between the robot and human. After designing the hardware and control, several experiments are carried out to test the mobility and dynamic behavior of the robot. Lastly, a human subject study evaluates the effectiveness of the robot's shoulder mechanism and control algorithm in assisting the coordination around the shoulder. The results show that the robot induces desirable coordination in the presence of abnormalities at the shoulder.Mechanical Engineerin