Expert-in-the-Loop Multilateral Telerobotics for Haptics-Enabled Motor Function and Skills Development

Among medical robotics applications are Robotics-Assisted Mirror Rehabilitation Therapy (RAMRT) and Minimally-Invasive Surgical Training (RAMIST) that extensively rely on motor function development. Haptics-enabled expert-in-the-loop motor function development for such applications is made possible through multilateral telerobotic frameworks. While several studies have validated the benefits of haptic interaction with an expert in motor learning, contradictory results have also been reported. This emphasizes the need for further in-depth studies on the nature of human motor learning through haptic guidance and interaction. The objective of this study was to design and evaluate expert-in-the-loop multilateral telerobotic frameworks with stable and human-safe control loops that enable adaptive “hand-over-hand” haptic guidance for RAMRT and RAMIST. The first prerequisite for such frameworks is active involvement of the patient or trainee, which requires the closed-loop system to remain stable in the presence of an adaptable time-varying dominance factor. To this end, a wave-variable controller is proposed in this study for conventional trilateral teleoperation systems such that system stability is guaranteed in the presence of a time-varying dominance factor and communication delay. Similar to other wave-variable approaches, the controller is initially developed for the Velocity-force Domain (VD) based on the well-known passivity assumption on the human arm in VD. The controller can be applied straightforwardly to the Position-force Domain (PD), eliminating position-error accumulation and position drift, provided that passivity of the human arm in PD is addressed. However, the latter has been ignored in the literature. Therefore, in this study, passivity of the human arm in PD is investigated using mathematical analysis, experimentation as well as user studies involving 12 participants and 48 trials. The results, in conjunction with the proposed wave-variables, can be used to guarantee closed-loop PD stability of the supervised trilateral teleoperation system in its classical format. The classic dual-user teleoperation architecture does not, however, fully satisfy the requirements for properly imparting motor function (skills) in RAMRT (RAMIST). Consequently, the next part of this study focuses on designing novel supervised trilateral frameworks for providing motor learning in RAMRT and RAMIST, each customized according to the requirements of the application. The framework proposed for RAMRT includes the following features: a) therapist-in-the-loop mirror therapy; b) haptic feedback to the therapist from the patient side; c) assist-as-needed therapy realized through an adaptive Guidance Virtual Fixture (GVF); and d) real-time task-independent and patient-specific motor-function assessment. Closed-loop stability of the proposed framework is investigated using a combination of the Circle Criterion and the Small-Gain Theorem. The stability analysis addresses the instabilities caused by: a) communication delays between the therapist and the patient, facilitating haptics-enabled tele- or in-home rehabilitation; and b) the integration of the time-varying nonlinear GVF element into the delayed system. The platform is experimentally evaluated on a trilateral rehabilitation setup consisting of two Quanser rehabilitation robots and one Quanser HD2 robot. The framework proposed for RAMIST includes the following features: a) haptics-enabled expert-in-the-loop surgical training; b) adaptive expertise-oriented training, realized through a Fuzzy Interface System, which actively engages the trainees while providing them with appropriate skills-oriented levels of training; and c) task-independent skills assessment. Closed-loop stability of the architecture is analyzed using the Circle Criterion in the presence and absence of haptic feedback of tool-tissue interactions. In addition to the time-varying elements of the system, the stability analysis approach also addresses communication delays, facilitating tele-surgical training. The platform is implemented on a dual-console surgical setup consisting of the classic da Vinci surgical system (Intuitive Surgical, Inc., Sunnyvale, CA), integrated with the da Vinci Research Kit (dVRK) motor controllers, and the dV-Trainer master console (Mimic Technology Inc., Seattle, WA). In order to save on the expert\u27s (therapist\u27s) time, dual-console architectures can also be expanded to accommodate simultaneous training (rehabilitation) for multiple trainees (patients). As the first step in doing this, the last part of this thesis focuses on the development of a multi-master/single-slave telerobotic framework, along with controller design and closed-loop stability analysis in the presence of communication delays. Various parts of this study are supported with a number of experimental implementations and evaluations. The outcomes of this research include multilateral telerobotic testbeds for further studies on the nature of human motor learning and retention through haptic guidance and interaction. They also enable investigation of the impact of communication time delays on supervised haptics-enabled motor function improvement through tele-rehabilitation and mentoring

Haptics in Robot-Assisted Surgery: Challenges and Benefits

Robotic surgery is transforming the current surgical practice, not only by improving the conventional surgical methods but also by introducing innovative robot-enhanced approaches that broaden the capabilities of clinicians. Being mainly of man-machine collaborative type, surgical robots are seen as media that transfer pre- and intra-operative information to the operator and reproduce his/her motion, with appropriate filtering, scaling, or limitation, to physically interact with the patient. The field, however, is far from maturity and, more critically, is still a subject of controversy in medical communities. Limited or absent haptic feedback is reputed to be among reasons that impede further spread of surgical robots. In this paper objectives and challenges of deploying haptic technologies in surgical robotics is discussed and a systematic review is performed on works that have studied the effects of providing haptic information to the users in major branches of robotic surgery. It has been tried to encompass both classical works and the state of the art approaches, aiming at delivering a comprehensive and balanced survey both for researchers starting their work in this field and for the experts

Mobile assistive technologies for the visually impaired

There are around 285 million visually impaired people worldwide, and around 370,000 people are registered as blind or partially sighted in the UK. Ongoing advances in information technology (IT) are increasing the scope for IT-based mobile assistive technologies to facilitate the independence, safety, and improved quality of life of the visually impaired. Research is being directed at making mobile phones and other handheld devices accessible via our haptic (touch) and audio sensory channels. We review research and innovation within the field of mobile assistive technology for the visually impaired and, in so doing, highlight the need for successful collaboration between clinical expertise, computer science, and domain users to realize fully the potential benefits of such technologies. We initially reflect on research that has been conducted to make mobile phones more accessible to people with vision loss. We then discuss innovative assistive applications designed for the visually impaired that are either delivered via mainstream devices and can be used while in motion (e.g., mobile phones) or are embedded within an environment that may be in motion (e.g., public transport) or within which the user may be in motion (e.g., smart homes)

Spatial representation and visual impairement - Developmental trends and new technological tools for assessment and rehabilitation

It is well known that perception is mediated by the five sensory modalities (sight, hearing, touch, smell and taste), which allows us to explore the world and build a coherent spatio-temporal representation of the surrounding environment. Typically, our brain collects and integrates coherent information from all the senses to build a reliable spatial representation of the world. In this sense, perception emerges from the individual activity of distinct sensory modalities, operating as separate modules, but rather from multisensory integration processes. The interaction occurs whenever inputs from the senses are coherent in time and space (Eimer, 2004). Therefore, spatial perception emerges from the contribution of unisensory and multisensory information, with a predominant role of visual information for space processing during the first years of life. Despite a growing body of research indicates that visual experience is essential to develop spatial abilities, to date very little is known about the mechanisms underpinning spatial development when the visual input is impoverished (low vision) or missing (blindness). The thesis's main aim is to increase knowledge about the impact of visual deprivation on spatial development and consolidation and to evaluate the effects of novel technological systems to quantitatively improve perceptual and cognitive spatial abilities in case of visual impairments. Chapter 1 summarizes the main research findings related to the role of vision and multisensory experience on spatial development. Overall, such findings indicate that visual experience facilitates the acquisition of allocentric spatial capabilities, namely perceiving space according to a perspective different from our body. Therefore, it might be stated that the sense of sight allows a more comprehensive representation of spatial information since it is based on environmental landmarks that are independent of body perspective. Chapter 2 presents original studies carried out by me as a Ph.D. student to investigate the developmental mechanisms underpinning spatial development and compare the spatial performance of individuals with affected and typical visual experience, respectively visually impaired and sighted. Overall, these studies suggest that vision facilitates the spatial representation of the environment by conveying the most reliable spatial reference, i.e., allocentric coordinates. However, when visual feedback is permanently or temporarily absent, as in the case of congenital blindness or blindfolded individuals, respectively, compensatory mechanisms might support the refinement of haptic and auditory spatial coding abilities. The studies presented in this chapter will validate novel experimental paradigms to assess the role of haptic and auditory experience on spatial representation based on external (i.e., allocentric) frames of reference. Chapter 3 describes the validation process of new technological systems based on unisensory and multisensory stimulation, designed to rehabilitate spatial capabilities in case of visual impairment. Overall, the technological validation of new devices will provide the opportunity to develop an interactive platform to rehabilitate spatial impairments following visual deprivation. Finally, Chapter 4 summarizes the findings reported in the previous Chapters, focusing the attention on the consequences of visual impairment on the developmental of unisensory and multisensory spatial experience in visually impaired children and adults compared to sighted peers. It also wants to highlight the potential role of novel experimental tools to validate the use to assess spatial competencies in response to unisensory and multisensory events and train residual sensory modalities under a multisensory rehabilitation

Instructional eLearning technologies for the vision impaired

The principal sensory modality employed in learning is vision, and that not only increases the difficulty for vision impaired students from accessing existing educational media but also the new and mostly visiocentric learning materials being offered through on-line delivery mechanisms. Using as a reference Certified Cisco Network Associate (CCNA) and IT Essentials courses, a study has been made of tools that can access such on-line systems and transcribe the materials into a form suitable for vision impaired learning. Modalities employed included haptic, tactile, audio and descriptive text. How such a multi-modal approach can achieve equivalent success for the vision impaired is demonstrated. However, the study also shows the limits of the current understanding of human perception, especially with respect to comprehending two and three dimensional objects and spaces when there is no recourse to vision

Multimodal Human-Machine Interface For Haptic-Controlled Excavators

The goal of this research is to develop a human-excavator interface for the hapticcontrolled excavator that makes use of the multiple human sensing modalities (visual, auditory haptic), and efficiently integrates these modalities to ensure intuitive, efficient interface that is easy to learn and use, and is responsive to operator commands. Two empirical studies were conducted to investigate conflict in the haptic-controlled excavator interface and identify the level of force feedback for best operator performance

Safe Haptics-enabled Patient-Robot Interaction for Robotic and Telerobotic Rehabilitation of Neuromuscular Disorders: Control Design and Analysis

Motivation: Current statistics show that the population of seniors and the incidence rate of age-related neuromuscular disorders are rapidly increasing worldwide. Improving medical care is likely to increase the survival rate but will result in even more patients in need of Assistive, Rehabilitation and Assessment (ARA) services for extended periods which will place a significant burden on the world\u27s healthcare systems. In many cases, the only alternative is limited and often delayed outpatient therapy. The situation will be worse for patients in remote areas. One potential solution is to develop technologies that provide efficient and safe means of in-hospital and in-home kinesthetic rehabilitation. In this regard, Haptics-enabled Interactive Robotic Neurorehabilitation (HIRN) systems have been developed. Existing Challenges: Although there are specific advantages with the use of HIRN technologies, there still exist several technical and control challenges, e.g., (a) absence of direct interactive physical interaction between therapists and patients; (b) questionable adaptability and flexibility considering the sensorimotor needs of patients; (c) limited accessibility in remote areas; and (d) guaranteeing patient-robot interaction safety while maximizing system transparency, especially when high control effort is needed for severely disabled patients, when the robot is to be used in a patient\u27s home or when the patient experiences involuntary movements. These challenges have provided the motivation for this research. Research Statement: In this project, a novel haptics-enabled telerobotic rehabilitation framework is designed, analyzed and implemented that can be used as a new paradigm for delivering motor therapy which gives therapists direct kinesthetic supervision over the robotic rehabilitation procedure. The system also allows for kinesthetic remote and ultimately in-home rehabilitation. To guarantee interaction safety while maximizing the performance of the system, a new framework for designing stabilizing controllers is developed initially based on small-gain theory and then completed using strong passivity theory. The proposed control framework takes into account knowledge about the variable biomechanical capabilities of the patient\u27s limb(s) in absorbing interaction forces and mechanical energy. The technique is generalized for use for classical rehabilitation robotic systems to realize patient-robot interaction safety while enhancing performance. In the next step, the proposed telerobotic system is studied as a modality of training for classical HIRN systems. The goal is to first model and then regenerate the prescribed kinesthetic supervision of an expert therapist. To broaden the population of patients who can use the technology and HIRN systems, a new control strategy is designed for patients experiencing involuntary movements. As the last step, the outcomes of the proposed theoretical and technological developments are translated to designing assistive mechatronic tools for patients with force and motion control deficits. This study shows that proper augmentation of haptic inputs can not only enhance the transparency and safety of robotic and telerobotic rehabilitation systems, but it can also assist patients with force and motion control deficiencies

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion