Wearable Robotics for Impaired Upper-Limb Assistance and Rehabilitation: State of the Art and Future Perspectives

Despite more than thirty-five years of research on wearable technologies to assist the upper-limb and a multitude of promising preliminary results, the goal of restoring pre-impairment quality of life of people with physical disabilities has not been fully reached yet. Whether it is for rehabilitation or for assistance, nowadays robotics is still only used in a few high-tech clinics and hospitals, limiting the access to a small amount of people. This work provides a description of the three major 'revolutions' occurred in the field (end-effector robots, rigid exoskeletons, and soft exosuits), reviewing forty-eight systems for the upper-limb (excluding hand-only devices) used in eighty-nine studies enrolling a clinical population before June 2022. The review critically discusses the state of the art, analyzes the different technologies, and compares the clinical outcomes, with the goal of determine new potential directions to follow

Exoesqueleto de mano para eliminar los temblores del Párkinson

La enfermedad de Parkinson afecta a un gran número de personas mayores y sus síntomas impiden que los pacientes sean independientes en su vida diaria. Esta investigación se centra en el diseño de un exoesqueleto de mano para suprimir los temblores de Parkinson. El diseño de un exoesqueleto para paliar los síntomas del Parkinson es una novedosa aplicación para estos dispositivos. Además del diseño mecánico del exoesqueleto, que incluye el diseño de las partes y la transmisión de la fuerza del actuador, se realizó la sensorización del dispositivo. El exoesqueleto tiene sensores de presión que detectan los temblores y movimientos de los dedos. Después, un microcontrolador procesa los datos recibidos y suprime los temblores de Parkinson para después controlar el actuador y mover el dedo a la posición deseada del paciente sin los molestos temblores. El resultado final es un prototipo funcional que ayuda al paciente en los movimientos de agarre y bloquea los temblores producidos por el Parkinson. Sin embargo, el dispositivo aún necesita numerosas mejoras para convertirse en una solución real para el paciente.Departamento de Tecnología ElectrónicaGrado en Ingeniería en Electrónica Industrial y Automátic

Down-Conditioning of Soleus Reflex Activity using Mechanical Stimuli and EMG Biofeedback

Spasticity is a common syndrome caused by various brain and neural injuries, which can severely impair walking ability and functional independence. To improve functional independence, conditioning protocols are available aimed at reducing spasticity by facilitating spinal neuroplasticity. This down-conditioning can be performed using different types of stimuli, electrical or mechanical, and reflex activity measures, EMG or impedance, used as biofeedback variable. Still, current results on effectiveness of these conditioning protocols are incomplete, making comparisons difficult. We aimed to show the within-session task- dependent and across-session long-term adaptation of a conditioning protocol based on mechanical stimuli and EMG biofeedback. However, in contrast to literature, preliminary results show that subjects were unable to successfully obtain task-dependent modulation of their soleus short-latency stretch reflex magnitude

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