Towards the Development of a Wearable Tremor Suppression Glove

Patients diagnosed with Parkinson’s disease (PD) often associate with tremor. Among other symptoms of PD, tremor is the most aggressive symptom and it is difficult to control with traditional treatments. This thesis presents the assessment of Parkinsonian hand tremor in both the time domain and the frequency domain, the performance of a tremor estimator using different tremor models, and the development of a novel mechatronic transmission system for a wearable tremor suppression device. This transmission system functions as a mechatronic splitter that allows a single power source to support multiple independent applications. Unique features of this transmission system include low power consumption and adjustability in size and weight. Tremor assessment results showed that the hand tremor signal often presents a multi-harmonics pattern. The use of a multi-harmonics tremor model produced a better estimation result than using a monoharmonic tremor model

Tremor Control Devices for Essential Tremor: A Systematic Literature Review

Background: There is a growing interest in nonpharmacological approaches for essential tremor (ET), including tremor cancelation devices. However, the true efficacy of such devices in ET remains unclear. Methods: A systematic literature review was conducted using standardized criteria regarding efficacy and comfortability. Devices focused on design or experimental testing in which tremor was simulated in a robot were excluded. Results: Out of 324 articles initially identified, 12 articles were included. Orthoses using biomechanical loading and neuromodulation with electrical stimulation, and external tremor cancelation devices, were the main interventions used to suppress tremor. All devices were designed to control tremor of the upper limbs at different anatomical locations. Overall, an average tremor attenuation of 50–98% was reported (level of evidence III). Interference with voluntary movements and portability was described as the main drawback. Discussion: In conclusion, this review highlights the growing interest in emerging tremor control devices and the importance of assessing comfort without affecting voluntary movements. However, the level of evidence regarding the efficacy of these tremor control devices remains low. An integrated multidisciplinary combination approach of engineering, robotics, physiology, physiotherapy, and clinical assessment is needed to improve the quality of non-pharmacological interventions for ET

Rehabilitation Engineering

Population ageing has major consequences and implications in all areas of our daily life as well as other important aspects, such as economic growth, savings, investment and consumption, labour markets, pensions, property and care from one generation to another. Additionally, health and related care, family composition and life-style, housing and migration are also affected. Given the rapid increase in the aging of the population and the further increase that is expected in the coming years, an important problem that has to be faced is the corresponding increase in chronic illness, disabilities, and loss of functional independence endemic to the elderly (WHO 2008). For this reason, novel methods of rehabilitation and care management are urgently needed. This book covers many rehabilitation support systems and robots developed for upper limbs, lower limbs as well as visually impaired condition. Other than upper limbs, the lower limb research works are also discussed like motorized foot rest for electric powered wheelchair and standing assistance device

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

Magneto-rheological fluid orthosis for suppressing tremor

Tremor is a common movement disorder that occurs with specific neurological conditions. This condition may seriously impact daily living activities. The aim of the present study is to evaluate the possibility of the development of a wearable technology that is capable of exerting torques at a user\u27s joints for suppressing tremor. This thesis is based on the concept of smart structures which are made of Magneto-Rheological (MR) fluid that can dynamically alter its viscosity under magnetic field. The wearable tremor suppressing orthosis needs several conditions. It should be safe, light weight, simple and small in structure, and easily attachable. An MR fluid orthosis satisfies these conditions. This thesis shows the physical properties of MR fluid and the basic concept of a rotational MR fluid damper for suppressing tremor. Specifically, an MR fluid friction damper experimentally provides a damping coefficient capable of suppressing tremor. A simulation confirms that the damping moment of the MR fluid friction damper is sufficient to suppress that of the wrist tremor, with realistic peak to peak torque 0.022 Nm. This allows slower intentional movement to occur with only moderate attenuation. The results of this work show that it is possible to design an MR fluid orthosis that is wearable and capable of suppressing tremors at the wrist. The proportionality of the tremor-reducing torque to electric current allows the potential for both user adjustment as well as automatic feedback control

A flexible sensor technology for the distributed measurement of interaction pressure

We present a sensor technology for the measure of the physical human-robot interaction pressure developed in the last years at Scuola Superiore Sant'Anna. The system is composed of flexible matrices of opto-electronic sensors covered by a soft silicone cover. This sensory system is completely modular and scalable, allowing one to cover areas of any sizes and shapes, and to measure different pressure ranges. In this work we present the main application areas for this technology. A first generation of the system was used to monitor human-robot interaction in upper- (NEUROExos; Scuola Superiore Sant'Anna) and lower-limb (LOPES; University of Twente) exoskeletons for rehabilitation. A second generation, with increased resolution and wireless connection, was used to develop a pressure-sensitive foot insole and an improved human-robot interaction measurement systems. The experimental characterization of the latter system along with its validation on three healthy subjects is presented here for the first time. A perspective on future uses and development of the technology is finally drafted