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

A neuroprothesis for tremor management

Tremor is the most common movement disorder, affecting ∼ 15 % of people over 50 years old according to some estimates. It appears due to a number of syndromes, being essential tremor and Parkinson's disease the most prevalent among them. None of these conditions is fully understood. Tremor is currently treated through drugs or neurosurgery, but unfortunately, it is not managed effectively in ∼25 % of the patients. Therefore, it constitutes a major cause of loss of independence and quality of life. Various alternative approaches for tremor management are reported in the literature. Among them, those devices that rely on the application of forces to the tremulous segments show a considerable potential. A number of prototypes that exploit this principle are available, spanning fixed devices and orthoses. However, none of them has fulfilled user's expectation for continuous use during daily living. This thesis presents the development and validation of a neuroprosthesis for tremor management. A neuroprosthesis is a system that restores or compensates for a neurological function that is lost. In this case, the neuroprosthesis aims at compensating the functional disability caused by the tremor. To this end, it applies forces to the tremulous limb through the control of muscle contraction, which is modulated according to the characteristics of the tremor. The concept design envisions the device as a textile that is worn on the affected limb, thus meeting the usability requirements defined by the patients. The development of the neuroprosthesis comprised the following tasks: 1. The development of a concept design of the neuroprosthesis, which incorporates state of the art knowledge on tremor, and user's needs. 2. The design and validation of a cognitive interface that parameterizes the tremor in functional contexts. This interface provides the information that the neuroprosthesis uses for tremor suppression. Two versions are developed: a multimodal interface that integrates the recordings of the whole neuromusculoskeletal system, and an interface incorporating only wearable movement sensors. The latter is intended for the functional validation of the neuroprosthesis, while the former is a proof of concept of an optimal interface for this type of applications. 3. The development of a novel approach for tremor suppression through transcutaneous neurostimulation. The approach relies on the modulation of muscle cocontraction as a means of attenuating the tremor without the need of conventional actuators. The experimental validation here provided demonstrates the feasibility and interest of the approach. In parallel with the validation of the neuroprosthesis, I performed a detailed study on the physiology of motoneurons in tremor, given the lack of a complete description of its behavior. The outcome of this study contributes to the interpretation of the results obtained with the neuroprosthesis, and opens new research lines, both related to alternative interventions and basic neuroscience. In summary, the results here presented demonstrate that tremor may be accurately parameterized while the patient performs functional activities, and that this information may be exploited to drive a neuroprosthesis for tremor management. Furthermore, the novel approach for tremor suppression presented in this dissertation constitutes a potential approach for treating upper limb tremor, either alone, or as a complement to pharmacotherapy. These results encourage the validation of the neuroprosthesis in a large cohort of patients, in order to enable its translation to the market. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------El temblor es el trastorno del movimiento más común, afectando, según algunas estimaciones, al ∼15 % de la población de más de 50 años. Existen diversos "síndromes" que causan temblor, siendo el temblor esencial y la enfermedad de Parkinson los que presentan mayor prevalencia. Además, cabe resaltar que no existe una descripción completa de ninguno de ellos. En la actualidad el temblor se trata mediante una serie de fármacos o neurocirugía. A pesar de ello, el ∼ 25 % de los pacientes sufren problemas funcionales debido a su condición. Por tanto, es evidente que el temblor constituye una de las principales causas de dependencia y pérdida de calidad de vida. Realizando una revisión de las publicaciones científicas sobre el temblor, se observa que se ha propuesto un considerable número de tratamientos alternativos. Entre ellos destacan los dispositivos que se fundamentan en la aplicación de fuerzas sobre los segmentos afectados por el temblor, de los que ya se ha evaluado una serie de prototipos. Estos abarcan desde dispositivos fijados a otras estructuras hasta ortesis. Sin embargo, ninguno de ellos satisface las expectativas de los usuarios para su uso durante el día a día. Esta tesis presenta el diseño y validación de una neruoprótesis para el tratamiento del temblor. Una neuroprótesis es un sistema que reemplaza o compensa una función neurológica perdida. En este caso, la neuroprótesis tiene como objetivo compensar la discapacidad motora causada por el temblor. Para ello aplica fuerzas al miembro afectado a través del control del nivel de contracción muscular, que se modula según las características del temblor. El diseño conceptual contempla al dispositivo como un textil que se viste en el brazo afectado, satisfaciendo los requisitos de usabilidad definidos por los pacientes. El desarrollo de la neuroprótesis abarcó las siguientes tareas: 1. El desarrollo del diseño conceptual de la neuroprótesis, que incorpora el conocimiento actual sobre el temblor, y las necesidades de los usuarios. 2. El diseño y validación de una interfaz cognitiva que parametriza el temblor durante tareas funcionales. La información obtenida con esta interfaz es usada por la neuroprótesis para modular la corriente aplicada mediante técnicas de neuroestimulación. Se desarrollan dos versiones de la interfaz cognitiva: una interfaz multimodal que integra información de todo el sistema neuromusculoesquelético, y una interfaz que implementa únicamente sensores vestibles de movimiento. La segunda interfaz fue la que se usó durante la validación funcional de la neuroprótesis, mientras que la primera es una prueba de concepto de una interfaz óptima para este tipo de aplicaciones. 3. El desarrollo de una nueva aproximación para la supresión del temblor mediante neuroestimulación transcutánea. Dicha aproximación se fundamenta en la modulación del grado de co-contracción de los músculos afectados como forma de atenuar el temblor, sin necesidad de usar actuadores convencionales. La evaluación experimental sirvió para demostrar la viabilidad e interés de la intervención. En paralelo a la validación de la neuroprótesis, llevé a cabo un estudio detallado de la fisiología de las motoneuronas en el caso del temblor, dado que no existe una descripción del funcionamiento de las mismas en el caso de este trastorno. Este estudio sirve para ayudar a la interpretación de los resultados de la neuroprótesis, y para abrir una serie de líneas futuras de investigación, tanto sobre nuevas intervenciones para el temblor, como sobre neurociencia básica. En resumen, los resultados que se presentan en esta tesis demuestran que es posible parametrizar de una forma precisa el temblor durante la realización de tareas funcionales, y que esta información sirve para controlar una neuroprótesis para el tratamiento del temblor. Además, la nueva aproximación para la compensación del temblor que se presenta tiene el potencial de convertirse en un tratamiento alternativo para el temblor de miembro superior, ya sea de forma independiente o como complemento a los fármacos. Estos resultados alientan la validación de la neuroprótesis en una cohorte grande de pacientes, con el objetivo de facilitar su transferencia al mercado

A Wearable Mechatronic Device for Hand Tremor Monitoring and Suppression: Development and Evaluation

Tremor, one of the most disabling symptoms of Parkinson\u27s disease (PD), significantly affects the quality of life of the individuals who suffer from it. These people live with difficulties with fine motor tasks, such as eating and writing, and suffer from social embarrassment. Traditional medicines are often ineffective, and surgery is highly invasive and risky. The emergence of wearable technology facilitates an externally worn mechatronic tremor suppression device as a potential alternative approach for tremor management. However, no device has been developed for the suppression of finger tremor that has been validated on a human. It has been reported in the literature that tremor can be selectively suppressed by mechanical loading. Therefore, the objectives of this thesis were to develop a wearable tremor suppression device that can suppress tremor at the wrist and the fingers, and to evaluate it on individuals with PD in a pre-clinical trial. To address these objectives, several experiments were performed to quantify hand tremor; an enhanced high-order tremor estimator was developed and evaluated for tremor estimation; and a wearable tremor suppression glove (WTSG) was developed to suppress tremor in the index finger metacarpophalangeal (MCP) joint, the thumb MCP joint, and the wrist. A total of 18 individuals with PD were recruited for characterizing tremor. The frequencies and magnitudes of the linear acceleration, angular velocity, and angular displacement of tremor in the index finger MCP joint, the thumb MCP joint, and the wrist were quantified. The results showed that parkinsonian tremor consists of multiple harmonics, and that the second and third harmonics cannot be ignored. With the knowledge of the tremor characteristics, an enhanced high-order tremor estimator was developed to acquire better tremor estimation accuracy than its lower-order counterpart. In addition, the evaluation of the WTSG was conducted on both a physical tremor simulator and on one individual with PD. The results of the simulation study proved the feasibility of using the WTSG to suppress tremor; and the results of the evaluation on a human subject showed that the WTSG can suppress tremor motion while allowing the user to perform voluntary motions. The WTSG developed as a result of this work has demonstrated the feasibility of managing hand tremor with a mechatronic device, and its validation on a human subject has provided useful insights from the user\u27s perspectives, which facilitate the transition of the WTSG from the lab to the clinic, and eventually to commercial use. Lastly, an evaluation studying the impact of suppressed tremor on unrestricted joints was conducted on 14 individuals with PD. The results showed a significant increase in tremor magnitude in the unrestricted distal joints when the motions of the proximal joints were restricted. The average increase of the tremor magnitude of the index finger MCP joint, the thumb MCP joint, the wrist and the elbow are 54%, 96%, 124%, and 98% for resting tremor, and 50%, 102%, 49%, and 107% for postural tremor, respectively. Such a result provided additional clinical justification for the significance of the development of a wearable mechatronic device for hand tremor management. Although the focus of this thesis is on hand tremor management, the development and evaluation of a full upper-limb tremor suppression device is required as a future step, in order to advance the use of wearable mechatronic devices as one of the valid tremor treatment approaches