Usability evaluation of an interactive leg press training robot for children with neuromuscular impairments.

BACKGROUND The use of robotic technology for neurorehabilitative applications has become increasingly important for adults and children with different motor impairments. OBJECTIVE The aim of this study was to evaluate the technical feasibility and usability of a new interactive leg-press training robot that was developed to train leg muscle strength and control, suitable for children with neuromuscular impairments. METHODS An interactive robotic training system was designed and constructed with various control strategies, actuators and force/position sensors to enable the performance of different training modes (passive, active resistance, and exergames). Five paediatric patients, aged between 7 and 16 years (one girl, age 13.0 ± 3.7 years, [mean ± SD]), with different neuromuscular impairments were recruited to participate in this study. Patients evaluated the device based on a user satisfaction questionnaire and Visual Analog Scale (VAS) scores, and therapists evaluated the device with the modified System Usability Scale (SUS). RESULTS One patient could not perform the training session because of his small knee range of motion. Visual Analog Scale scores were given by the 4 patients who performed the training sessions. All the patients adjudged the training with the interactive device as satisfactory. The average SUS score given by the therapists was 61.2 ± 18.4. CONCLUSION This study proposed an interactive lower limb training device for children with different neuromuscular impairments. The device is deemed feasible for paediatric rehabilitation applications, both in terms of technical feasibility and usability acceptance. Both patients and therapists provided positive feedback regarding the training with the device

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

BACKGROUND:Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. OBJECTIVE:To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. METHODS:A pilot randomised controlled trial was conducted. Stroke participants had 18 one-hour sessions of RT (Armeo®Spring) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session. The primary outcome measure was the Fugl-Meyer assessment (FMA) for UL impairments and secondary were: UL function, activities and stroke impact collected at baseline, post-intervention and three-month follow-up. RESULTS:22 participants (12 sub-acute and 10 chronic) completed the trial. No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up (p = 0.123). A significant ‘time’ x ‘stage of stroke’ was found for FMA (p = 0.016). A higher percentage improvement was noted in UL function, activities and stroke impact in people with sub-acute compared to chronic stroke. CONCLUSIONS:Adding tDCS did not result in an additional effect on UL impairment in stroke. RT may be of more benefit in the sub-acute than chronic phase

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

Development of a wearable assistive soft robotic device for elbow rehabilitation

The loss of motor function at the elbow joint can result as a consequence of stroke. Stroke is a clinical illness resulting in long lasting neurological deficits often affecting somatosensory and motor cortices. More than half of those that recover from a stroke survive with disability in their upper arm and need rehabilitation therapy to help in regaining functions of daily living. In this paper, we demonstrated a prototype of a low-cost, ultra-light and wearable soft robotic assistive device that could aid administration of elbow motion therapies to stroke patients. In order to assist the rotation of the elbow joint, the soft modules which consist of soft wedge-like cellular units was inflated by air to produce torque at the elbow joint. Highly compliant rotation can be naturally realised by the elastic property of soft silicone and pneumatic control of air. Based on the direct visual-actuation control, a higher control loop utilised visual processing to apply positional control, the lower control loop was implemented by an electronic circuit to achieve the desired pressure of the soft modules by Pulse Width Modulation. To examine the functionality of the proposed soft modular system, we used an anatomical model of the upper limb and performed the experiments with healthy participants

Robot Assisted Shoulder Rehabilitation: Biomechanical Modelling, Design and Performance Evaluation

The upper limb rehabilitation robots have made it possible to improve the motor recovery in stroke survivors while reducing the burden on physical therapists. Compared to manual arm training, robot-supported training can be more intensive, of longer duration, repetitive and task-oriented. To be aligned with the most biomechanically complex joint of human body, the shoulder, specific considerations have to be made in the design of robotic shoulder exoskeletons. It is important to assist all shoulder degrees-of-freedom (DOFs) when implementing robotic exoskeletons for rehabilitation purposes to increase the range of motion (ROM) and avoid any joint axes misalignments between the robot and human’s shoulder that cause undesirable interaction forces and discomfort to the user. The main objective of this work is to design a safe and a robotic exoskeleton for shoulder rehabilitation with physiologically correct movements, lightweight modules, self-alignment characteristics and large workspace. To achieve this goal a comprehensive review of the existing shoulder rehabilitation exoskeletons is conducted first to outline their main advantages and disadvantages, drawbacks and limitations. The research has then focused on biomechanics of the human shoulder which is studied in detail using robotic analysis techniques, i.e. the human shoulder is modelled as a mechanism. The coupled constrained structure of the robotic exoskeleton connected to a human shoulder is considered as a hybrid human-robot mechanism to solve the problem of joint axes misalignments. Finally, a real-scale prototype of the robotic shoulder rehabilitation exoskeleton was built to test its operation and its ability for shoulder rehabilitation

Sistemas de rehabilitación para la muñeca: una revisión centrada en el traumatismo de la articulación cúbito-radio

In the performance of repetitive tasks or excessive use of electronic devices frequent conditions of the main nerves of the hand occur. At this article highlights the results obtained from a documentary research that establishes a state of the art of wrist rehabilitation systems, focused on injuries or traumas of the cubic-radius joint. After categorizing and subcategorizing the topic, different databases are used to determine the indexed sources of information that at the Latin American and Colombian levels have explained it in the last decade. Based on the above and the corresponding interpretation, we propose a metacarpal rehabilitation system -for the Colombian context- which allows to carry out exercises, store relevant information about the use of the device and consult the records both in a cellular application and on a computer. It is shown that the system has adequate performance, but that, however, it needs to be clinically validated.En la realización de tareas repetitivas o uso excesivo de dispositivos electrónicos se presentan frecuentes afecciones de los nervios principales de la mano. En el presente artículo se evidencian los resultados obtenidos de una investigación documental que establece un estado del arte de los sistemas de rehabilitación para la muñeca, enfocados a lesiones o traumas de la articulación cúbito-radio. Luego de categorizar y subcategorizar la temática, se utilizan diferentes bases de datos para determinar las fuentes indexadas de información que a nivel latinoamericano y colombiano la han explicado en la última década. Con base en lo anterior y en la correspondiente interpretación, se propone un sistema de rehabilitación metacarpiana -para el contexto colombiano- el cual permite llevar a cabo ejercicios, almacenar información relevante del uso del dispositivo y consultar los registros tanto en una aplicación de celular como en un computador. Se muestra que el sistema tiene un desempeño adecuado, pero que, sin embargo, requiere ser validado clínicamente

Robotics in health care: Perspectives of robot-aided interventions in clinical practice for rehabilitation of upper limbs

This article belongs to the Special Issue Rehabilitation Robotics: Recent Advancements and New Perspectives about Training and Assessment of Sensorimotor Functions.Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice.This work was supported in part by the Spanish Ministry of Economy and Competitiveness via the ROBOESPASproject (DPI2017-87562-C2-1-R) and in part by the RoboCity2030-DIH-CMMadrid Robotics Digital Innovation Hub ("Robótica aplicada a la mejora de la calidad de vida de los ciudadanos, Fase IV"; S2018/NMT-4331), which is funded by the Programas de Actividades I+DComunidad de Madrid and cofunded by the Structural Funds of the EU

MOSAR: A Soft-Assistive Mobilizer for Upper Limb Active Use and Rehabilitation

In this study, a soft assisted mobilizer called MOSAR from (Mobilizador Suave de Asistencia y Rehabilitación) for upper limb rehabilitation was developed for a 11 years old child with right paretic side. The mobilizer provides a new therapeutic approach to augment his upper limb active use and rehabilitation, by means of exerting elbow (flexion-extension), forearm (pronation-supination) and (flexion-extension along with ulnar-radial deviations) at the wrist. Preliminarily, the design concept of the soft mobilizer was developed through Reverse Engineering of his upper limb: first casting model, silicone model, and later computational model were obtained by 3D scan, which was the parameterized reference for MOSAR development. Then, the manufacture of fabric inflatable soft actuators for driving the MOSAR system were carried out. Lastly, a law close loop control for the inflation-deflation process was implemented to validate FISAs performance. The results demonstrated the feasibility and effectiveness of the FISAs for being a functional tool for upper limb rehabilitation protocols by achieving those previous target motions similar to the range of motion (ROM) of a healthy person or being used in other applications