Current trends and challenges in pediatric access to sensorless and sensor-based upper limb exoskeletons

ABSTRACT: Sensorless and sensor-based upper limb exoskeletons that enhance or support daily motor function are limited for children. This review presents the different needs in pediatrics and the latest trends when developing an upper limb exoskeleton and discusses future prospects to improve accessibility. First, the principal diagnoses in pediatrics and their respective challenge are presented. A total of 14 upper limb exoskeletons aimed for pediatric use were identified in the literature. The exoskeletons were then classified as sensorless or sensor-based, and categorized with respect to the application domain, the motorization solution, the targeted population(s), and the supported movement(s). The relative absence of upper limb exoskeleton in pediatrics is mainly due to the additional complexity required in order to adapt to children’s growth and answer their specific needs and usage. This review highlights that research should focus on sensor-based exoskeletons, which would benefit the majority of children by allowing easier adjustment to the children’s needs. Sensor-based exoskeletons are often the best solution for children to improve their participation in activities of daily living and limit cognitive, social, and motor impairments during their development

Promoting inclusiveness in exoskeleton robotics: Addressing challenges for pediatric access

Pediatric access to exoskeletons lags far behind that of adults. In this article, we promote inclusiveness in exoskeleton robotics by identifying and addressing challenges and barriers to pediatric access to this potentially life-changing technology. We first present available exoskeleton solutions for upper and lower limbs and note the variability in the absence of these. Next, we query the possible reasons for this variability in access, explicitly focusing on children, who constitute a categorically vulnerable population, and also stand to benefit significantly from the use of this technology at this critical point in their physical and emotional growth. We propose the use of a life-based design approach as a way to address some of the design challenges and offer insights toward a resolution regarding market viability and implementation challenges. We conclude that the development of pediatric exoskeletons that allow for and ensure access to health-enhancing technology is a crucial aspect of the responsible provision of health care to all members of society. For children, the stakes are particularly high, given that this technology, when used at a critical phase of a child’s development, not only holds out the possibility of improving the quality of life but also can improve the long-term health prospects

ROBOT-ASSISTED PEDIATRIC REHABILITATION OF UPPER LIMB FUNCTIONS

Ph.DDOCTOR OF PHILOSOPH

Design of a Wearable Bilateral Exoskeleton for Arm Stroke Treatment in a Home Environment

With the number of stroke patients increasing every year, it is important that new ways of approaching rehabilitation are explored. This paper introduces a novel design for a bilateral exoskeleton that aims to allow patients more flexibility in how and where they are able to carry out their rehabilitation. The Bilateral Exoskeleton for Arm Stroke Treatment (BEAST), has been designed for patients to use independently in their own home. The focus of BEAST is to allow therapists to oversee the remote rehabilitation of more patients, effectively reducing waiting times and enabling patients more independence in their recovery process. This paper discusses the design of BEAST, including the kinematics, workspace and torque calculations. It also briefly touches on how the needs of patients can be included in the design and optimisation stages of BEAST

Arquitectura de un sistema de medición de bioparámetros integrando señales inerciales-magnéticas y electromiográficas

Este trabajo presenta una arquitectura para la medición e integración de bioparámetros basado en unidades de procesamiento de movimiento inercial-magnético (MPUs) y electromiografía (EMG). Derivado de la arquitectura propuesta, se logró desarrollar un dispositivo llamado Imocap, el cual reúne y utiliza las mejores características de la tecnología MPU + EMG para realizar una medición completa en el segmento de brazo y antebrazo en el cuerpo humano. Se presenta en primer lugar la revisión bibliográfica de los métodos y herramientas para la captura del movimiento biomecánico, seguido de las técnicas y aplicaciones de la recolección de bioparámetros. Finalmente, se muestra la arquitectura y la descripción del sistema Imocap, algunas aplicaciones y discusión. Como trabajo futuro, Imocap tiene como objetivo proporcionar la información necesaria en un sistema de control electrónico para una plataforma de rehabilitación basada en exoesqueletos robóticos

A Wearable Arm and Wrist Rehabilitation Exercise Device Equipped with Monitoring System for Post Stroke Rehabilitation

An analysis of rehabilitation activity for paralyzed patient. Monitoring rehabilitation activity for post-stroke patients have increasingly common in hospitals and rehabilitation center worldwide. To develop home based and low cost device for post-stroke patients activity monitoring is challenging in rehabilitation engineering. Many technological devices have been developed like a Wearable Arm and Wrist Rehabilitation Exercise device equipped with monitoring system for post stroke rehabilitation were designed for and proposed.  In this article, we identify several functional activities of arm and wrist motoring defect is achieved by the exoskeleton system. This system is controlled by the Arduino UNO Microcontroller and the LCD is acting as monitoring unit. This allows investigating patterns of patient’s arm and wrist monitoring functional activity. These studies investigated the activation patterns in different experimental conditions such as water bottle take off, wrist stretching and grasp force. Furthermore, findings attained from this project may enable us to contribute towards the development of new arm rehabilitation monitoring device which can benefit human lives

Differences in gait parameters when crossing real versus projected everyday life obstacles in healthy children and adolescents

Practicing complex everyday life walking activities is challenging in paediatric neurorehabilitation, although it would prepare patients more comprehensively for the requirements of daily life. Floor projections allow simulation and training of such situations in therapy. Twenty healthy youths aged 6-18 years stepped over a tree trunk and balanced over kerbstones in a real and projected condition. Spatiotemporal and kinematic parameters of the two conditions were compared by equivalence analysis, using the medians of the differences between the two conditions with their bootstrapped 95% confidence intervals. Velocity, step and stride length, step width, and single support time were generally equivalent between the two conditions. Knee and hip joint angles and toe clearance decreased substantially during the execution phase of the projected tree trunk condition. The largest differences were found at the end of the execution phase in both tasks for the ankle joints. As spatiotemporal parameters were equivalent between the conditions, floor projections seem suitable to train precise foot placement. However, differences in knee and hip joint kinematics and toe clearance revealed that floor projections are not applicable for obstacles with a vertical extension. Therefore, exercises aiming at knee and hip flexion improvement should favourably be trained with real objects

Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training

Robot-assisted therapy affords effective advantages to the rehabilitation training of patients with motion impairment problems. To meet the challenge of integrating the active participation of a patient in robotic training, this study presents an admittance-based patient-active control scheme for real-time intention-driven control of a powered upper limb exoskeleton. A comprehensive overview is proposed to introduce the major mechanical structure and the real-time control system of the developed therapeutic robot, which provides seven actuated degrees of freedom and achieves the natural ranges of human arm movement. Moreover, the dynamic characteristics of the human-exoskeleton system are studied via a Lagrangian method. The patient-active control strategy consisting of an admittance module and a virtual environment module is developed to regulate the robot configurations and interaction forces during rehabilitation training. An audiovisual game-like interface is integrated into the therapeutic system to encourage the voluntary efforts of the patient and recover the neural plasticity of the brain. Further experimental investigation, involving a position tracking experiment, a free arm training experiment, and a virtual airplane-game operation experiment, is conducted with three healthy subjects and eight hemiplegic patients with different motor abilities. Experimental results validate the feasibility of the proposed scheme in providing patient-active rehabilitation training

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

Background: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®