Rehabilitation interventions for improving balance following stroke: an overview of systematic reviews

Background The aim of this study was to synthesize evidence from systematic reviews, to summarise the effects of rehabilitation interventions for improving balance in stroke survivors. Methods We conducted an overview of systematic reviews (SRs). We included Cochrane Systematic Reviews and non-Cochrane Systematic Reviews of randomized-controlled clinical trials and not-randomized clinical trials, in all types of stroke, comparing the effects of interventions, control interventions and no interventions on balance-related outcomes. We conducted a comprehensive search of electronic databases, from inception to December 2017. Data extracted included: number and type of participants, type of intervention, control intervention, method of assessing risk of bias of primary studies, balance outcome measures and results of statistical meta-analyses. Methodological quality of included reviews was assessed using AMSTAR 2. A narrative description of the characteristics of the SRs was provided and results of meta-analyses summarised with reference to their methodological quality. Results 51 SRs (248 primary studies and 10,638 participants) met the inclusion criteria and were included in the overview. All participants were adults with stroke. A wide variety of different balance and postural control outcomes were included. 61% of SRs focussed on the effectiveness of physical therapy, 20% virtual reality, 6% electromechanical devices, 4% Tai-Chi, whole body vibration and circuit training intervention, and 2% cognitive rehabilitation. The methodology of 54% of SRs were judged to be of a \u201clow or critically low\u201d quality, 23% \u201cmoderate\u201d quality and 22% \u201chigh\u201d quality. Conclusions There are 51 SRs of evidence relating to the effectiveness of interventions to improve balance in people with stroke, but the majority of these are of poor methodological quality, limiting our ability to draw clear implications. Only 22% of these SRs were judged to be of high quality, highlighting the need to address important methodological issues within rehabilitation research

Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study

Background: Friedreich’s ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. Methods: Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using the Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. Results: All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. Conclusions: Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients’ dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive

Feedback Control of an Exoskeleton for Paraplegics: Toward Robustly Stable Hands-free Dynamic Walking

This manuscript presents control of a high-DOF fully actuated lower-limb exoskeleton for paraplegic individuals. The key novelty is the ability for the user to walk without the use of crutches or other external means of stabilization. We harness the power of modern optimization techniques and supervised machine learning to develop a smooth feedback control policy that provides robust velocity regulation and perturbation rejection. Preliminary evaluation of the stability and robustness of the proposed approach is demonstrated through the Gazebo simulation environment. In addition, preliminary experimental results with (complete) paraplegic individuals are included for the previous version of the controller.Comment: Submitted to IEEE Control System Magazine. This version addresses reviewers' concerns about the robustness of the algorithm and the motivation for using such exoskeleton

Influence of Muscle Fatigue on Electromyogram-Kinematic Correlation During Robot-Assisted Upper Limb Training

© The Author(s) 2020. Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us. sagepub.com/en-us/nam/open-access-at-sage).Introduction: Studies on adaptive robot-assisted upper limb training interactions do not often consider the implications of muscle fatigue sufficiently. Methods: In order to explore this, we initially assessed muscle fatigue in 10 healthy subjects using electromyogram features (average power and median power frequency) during an assist-as-needed interaction with HapticMASTER robot. Spearman’s correlation study was conducted between EMG average power and kinematic force components. Since the robotic assistance resulted in a variable fatigue profile across participants, a completely tiring experiment, without a robot in the loop, was also designed to confirm the results. Results: A significant increase in average power and a decrease in median frequency were observed in the most active muscles. Average power in the frequency band of 0.8-2.5Hz and median frequency in the band of 20-450Hz are potential fatigue indicators. Also, comparing the correlation coefficients across trials indicated that correlation was reduced as the muscles were fatigued. Conclusions: Robotic assistance based on user’s performance has resulted in lesser muscle fatigue, which caused an increase in the EMG-force correlation. We now intend to utilize the electromyogram and kinematic features for the auto-adaptation of therapeutic human-robot interactions.Peer reviewedFinal Published versio

State of the Art Lower Limb Robotic Exoskeletons for Elderly Assistance

https://ieeexplore.ieee.org/document/8759880/keywords#keywordsThe number of elderly populations is rapidly increasing. Majority of elderly people face difficulties while walking because the muscular activity or other gait-related parameters start to deteriorate with aging. Therefore, the quality of life among them can be suffered. To make their life more comfortable, service providing robotic solutions in terms of wearable powered exoskeletons should be realized. Assistive powered exoskeletons are capable of providing additional torque to support various activities, such as walking, sit to stand, and stand to sit motions to subjects with mobility impairments. Specifically, the powered exoskeletons try to maintain and keep subjects' limbs on the specified motion trajectory. The state of the art of currently available lower limb assistive exoskeletons for weak and elderly people is presented in this paper. The technology employed in the assistive devices, such as actuation and power supply types, control strategies, their functional abilities, and the mechanism design, is thoroughly described. The outcome of studied literature reveals that there is still much work to be done in the improvement of assistive exoskeletons in terms of their technological aspects, such as choosing proper and effective control methods, developing user friendly interfaces, and decreasing the costs of device to make it more affordable, meanwhile ensuring safe interaction for the end-users

Electromechanical and robotic devices for gait and balance rehabilitation of children with neurological disability: a systematic review

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols\u2019 and devices\u2019 descriptions

Effectiveness of Platform-Based Robot-Assisted Rehabilitation for Musculoskeletal or Neurologic Injuries: A Systematic Review

During the last ten years the use of robotic-assisted rehabilitation has increased significantly. Compared with traditional care, robotic rehabilitation has several potential advantages. Platform-based robotic rehabilitation can help patients recover from musculoskeletal and neurological conditions. Evidence on how platform-based robotic technologies can positively impact on disability recovery is still lacking, and it is unclear which intervention is most effective in individual cases. This systematic review aims to evaluate the effectiveness of platform-based robotic rehabilitation for individuals with musculoskeletal or neurological injuries. Thirty-eight studies met the inclusion criteria and evaluated the efficacy of platform-based rehabilitation robots. Our findings showed that rehabilitation with platform-based robots produced some encouraging results. Among the platform-based robots studied, the VR-based Rutgers Ankle and the Hunova were found to be the most effective robots for the rehabilitation of patients with neurological conditions (stroke, spinal cord injury, Parkinson’s disease) and various musculoskeletal ankle injuries. Our results were drawn mainly from studies with low-level evidence, and we think that our conclusions should be taken with caution to some extent and that further studies are needed to better evaluate the effectiveness of platform-based robotic rehabilitation devices

Feature Analysis for Classification of Physical Actions using surface EMG Data

Based on recent health statistics, there are several thousands of people with limb disability and gait disorders that require a medical assistance. A robot assisted rehabilitation therapy can help them recover and return to a normal life. In this scenario, a successful methodology is to use the EMG signal based information to control the support robotics. For this mechanism to function properly, the EMG signal from the muscles has to be sensed and then the biological motor intention has to be decoded and finally the resulting information has to be communicated to the controller of the robot. An accurate detection of the motor intention requires a pattern recognition based categorical identification. Hence in this paper, we propose an improved classification framework by identification of the relevant features that drive the pattern recognition algorithm. Major contributions include a set of modified spectral moment based features and another relevant inter-channel correlation feature that contribute to an improved classification performance. Next, we conducted a sensitivity analysis of the classification algorithm to different EMG channels. Finally, the classifier performance is compared to that of the other state-of the art algorithm

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

A New 4-DOF Robot for Rehabilitation of Knee and Ankle-Foot Complex: Simulation and Experiment

Stationary robotic trainers are lower limb rehab robots which often incorporate an exoskeleton attached to a stationary base. The issue observed in the stationery trainers for simultaneous knee and ankle-foot complex joints is that they restrict the natural motion of ankle-foot in the rehab trainings due to the insufficient Degrees of Freedom (DOFs) of these trainers. A new stationary knee-ankle-foot rehab robot with all necessary DOFs is developed here. A typical rehab training is first implemented in simulation, and then tested on a healthy subject. Results show that the proposed system functions naturally and meets the requirements of the desired rehab training.Comment: 23 pages, 14 figure