Taking a Lesson From Patients' Recovery Strategies to Optimize Training During Robot-Aided Rehabilitation

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GENTLE/A - Adaptive Robotic Assistance for Upper-Limb Rehabilitation

Advanced devices that can assist the therapists to offer rehabilitation are in high demand with the growing rehabilitation needs. The primary requirement from such rehabilitative devices is to reduce the therapist monitoring time. If the training device can autonomously adapt to the performance of the user, it can make the rehabilitation partly self-manageable. Therefore the main goal of our research is to investigate how to make a rehabilitation system more adaptable. The strategy we followed to augment the adaptability of the GENTLE/A robotic system was to (i) identify the parameters that inform about the contribution of the user/robot during a human-robot interaction session and (ii) use these parameters as performance indicators to adapt the system. Three main studies were conducted with healthy participants during the course of this PhD. The first study identified that the difference between the position coordinates recorded by the robot and the reference trajectory position coordinates indicated the leading/lagging status of the user with respect to the robot. Using the leadlag model we proposed two strategies to enhance the adaptability of the system. The first adaptability strategy tuned the performance time to suit the user’s requirements (second study). The second adaptability strategy tuned the task difficulty level based on the user’s leading or lagging status (third study). In summary the research undertaken during this PhD successfully enhanced the adaptability of the GENTLE/A system. The adaptability strategies evaluated were designed to suit various stages of recovery. Apart from potential use for remote assessment of patients, the work presented in this thesis is applicable in many areas of human-robot interaction research where a robot and human are involved in physical interaction

Adaptive Robot Mediated Upper Limb Training Using Electromyogram Based Muscle Fatigue Indicators

© 2020 Thacham Poyil et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Studies on improving the adaptability of upper limb rehabilitation training do not often consider the implications of muscle fatigue sufficiently. In this study, electromyogram features were used as fatigue indicators in a context of human-robot interaction, and were utilised for auto-adaptation of the task difficulty, which resulted in a prolonged training interaction.The electromyogram data was collected from three gross-muscles of the upper limb in 30 healthy participants.The experiment followed a protocol for increasing the muscle strength by progressive strength training, that was an implementation of a known method in sports science for muscle training, in a new domain of robotic adaptation in muscle training.The study also compared how the change in task difficulty levels was perceived by the participants, when the robot adjusted the difficulty, when the difficulty was manually adjusted, and also when there was no difficulty adjustment at all.Three experimental conditions were chosen, one benefiting from robotic adaptation (Intervention group) and the other two presenting control groups 1 and 2.The results indicated that the participants could perform a prolonged progressive strength training exercise with more repetitions with the help of a fatigue-based robotic adaptation, compared to the training interactions, which were based on manual/no adaptation.This study showed that using fatigue indicators, it is possible to alter the level of challenge, and thus, increase the interaction time.The results of the study are expected to be extended to stroke patients in the future by utilizing the potential for adapting the training difficulty according to the patient's muscular state, and also to have large number repetitions in a robot-assisted training environment.Peer reviewe

Patient-cooperative control increases active participation of individuals with SCI during robot-aided gait training

ABSTRACT: BACKGROUND: Manual body weight supported treadmill training and robot-aided treadmill training are frequently used techniques for the gait rehabilitation of individuals after stroke and spinal cord injury. Current evidence suggests that robot-aided gait training may be improved by making robotic behavior more patient-cooperative. In this study, we have investigated the immediate effects of patient-cooperative versus non-cooperative robot-aided gait training on individuals with incomplete spinal cord injury (iSCI). METHODS: Eleven patients with iSCI participated in a single training session with the gait rehabilitation robot Lokomat. The patients were exposed to four different training modes in random order: During both non-cooperative position control and compliant impedance control, fixed timing of movements was provided. During two variants of the patient-cooperative path control approach, free timing of movements was enabled and the robot provided only spatial guidance. The two variants of the path control approach differed in the amount of additional support, which was either individually adjusted or exaggerated. Joint angles and torques of the robot as well as muscle activity and heart rate of the patients were recorded. Kinematic variability, interaction torques, heart rate and muscle activity were compared between the different conditions. RESULTS: Patients showed more spatial and temporal kinematic variability, reduced interaction torques, a higher increase of heart rate and more muscle activity in the patient-cooperative path control mode with individually adjusted support than in the non-cooperative position control mode. In the compliant impedance control mode, spatial kinematic variability was increased and interaction torques were reduced, but temporal kinematic variability, heart rate and muscle activity were not significantly higher than in the position control mode. CONCLUSIONS: Patient-cooperative robot-aided gait training with free timing of movements made individuals with iSCI participate more actively and with larger kinematic variability than non-cooperative, position-controlled robot-aided gait training

Multimodal adaptive interfaces for 3D robot-mediated upper limb neuro-rehabilitation: An overview of bio-cooperative systems

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Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project

YesChanges in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one’s home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy. Objective: this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke. Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient’s exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation. Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability. Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction.This work has been partially funded under Grant FP7-ICT-288698(SCRIPT) of the European Community Seventh Framework Programme

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

A portable robotic rehabilitation system towards improving impaired function of the hand due to stroke

Background: Stroke is the leading cause of adult disability with 70 to 85% of initial strokes resulting in hemiparesis. Physical imparity as a result of stroke tends to be severe and majority of impairments are upper limb-related. Impairment is usually accompanied by long term functional loss which requires dedicated post-stroke rehabilitation to regain motor function. The incidence of stroke is increasing rapidly while there remains a shortage of therapists to provide sufficient rehabilitation. There is therefore a high demand for therapists to attend to the rising number of stroke survivors. Robot-aided therapy has emerged as a beneficial tool for providing continuous rehabilitation of the upper limb and is widely being implemented. With this technology, there is great potential to reduce the ill-effects brought about by the low therapist-patient ratio which has hindered sufficient rehabilitation and consequently the effective recovery of motor function among stroke survivors. Hypothesis: The use of a portable robotic rehabilitation system, as a complementary tool, in hand therapy, would promote continuous rehabilitation by encouraging repetition of task oriented exercises which would enhance motor function of an impaired hand. Task-oriented writing practice would potentially improve hand coordination and result in better accuracy while repetitive training would potentially increase hand motor strength. Objectives: 1.To design and manufacture a portable robotic rehabilitation system. 2. To test the performance and usability of the system. Methods: The system was manufactured and its performance tested in a pilot pre-clinical trial involving three participants. The system's ease of use was assessed using a standardised usability scale. Writing accuracy and hand motor strength were also assessed and the results analysed at the end of the study. Results: The average overall score of usability for the rehabilitation system was a few points higher than the average score. The users of the system also experienced increased motivation whilst performing the repetitive and task oriented exercises. There was an improvement in the completion time of the writing accuracy test and the tasks of the trace sample test. The variation in grip strength of the non-dominant hand during the rehabilitation period was small for each of the participants. Conclusion: The rehabilitation system motivated its users to repetitively perform rehabilitative training which may have improved writing accuracy

Bioinspired robotic rehabilitation tool for lower limb motor learning after stroke

Mención Internacional en el título de doctorEsta tesis doctoral presenta, tras repasar la marcha humana, las principales patologíıas y condiciones que la afectan, y los distintos enfoques de rehabilitación con la correspondiente implicación neurofisiológica, el camino de investigación que desemboca en la herramienta robótica de rehabilitación y las terapias que se han desarrollado en el marco de los proyectos europeos BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills y HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients, y probado bajo el paraguas del proyecto europeo ASTONISH: Advancing Smart Optical Imaging and Sensing for Health y el proyecto nacional ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This doctoral thesis presents, after reviewing human gait, the main pathologies and conditions that affect it, and the different rehabilitation approaches with the corresponding neurophysiological implications, the research journey that leads to the development of the rehabilitation robotic tool, and the therapies that have been designed, within the framework of the European projects BioMot: Smart Wearable Robots with Bioinspired Sensory-Motor Skills and HANK: European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients and tested under the umbrella of the European project ASTONISH: Advancing Smart Optical Imaging and Sensing for Health and the national project ASSOCIATE: A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury.This work has been carried out at the Neural Rehabilitation Group (NRG), Cajal Institute, Spanish National Research Council (CSIC). The research presented in this thesis has been funded by the Commission of the European Union under the BioMot project - Smart Wearable Robots with Bioinspired Sensory-Motor Skills (Grant Agreement number IFP7-ICT - 611695); under HANK Project - European advanced exoskeleton for rehabilitation of Acquired Brain Damage (ABD) and/or spinal cord injury’s patients (Grant Agreements number H2020-EU.2. - PRIORITY ’Industrial leadership’ and H2020-EU.3. - PRIORITY ’Societal challenges’ - 699796); also under the ASTONISH Project - Advancing Smart Optical Imaging and Sensing for Health (Grant Agreement number H2020-EU.2.1.1.7. - ECSEL - 692470); with financial support of Spanish Ministry of Economy and Competitiveness (MINECO) under the ASSOCIATE project - A comprehensive and wearable robotics based approach to the rehabilitation and assistance to people with stroke and spinal cord injury (Grant Agreement number 799158449-58449-45-514); and with grant RYC-2014-16613, also by Spanish Ministry of Economy and Competitiveness.Programa de Doctorado en Ingeniería Eléctrica, Electrónica y Automática por la Universidad Carlos III de MadridPresidente: Fernando Javier Brunetti Fernández.- Secretario: Dorin Sabin Copaci.- Vocal: Antonio Olivier

Robotic neurorehabilitation: a computational motor learning perspective

Conventional neurorehabilitation appears to have little impact on impairment over and above that of spontaneous biological recovery. Robotic neurorehabilitation has the potential for a greater impact on impairment due to easy deployment, its applicability across of a wide range of motor impairment, its high measurement reliability, and the capacity to deliver high dosage and high intensity training protocols