Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study

Background: Friedreich’s ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. Methods: Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using the Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. Results: All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. Conclusions: Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients’ dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive

Haptic wearables as sensory replacement, sensory augmentation and trainer - a review

Sensory impairments decrease quality of life and can slow or hinder rehabilitation. Small, computationally powerful electronics have enabled the recent development of wearable systems aimed to improve function for individuals with sensory impairments. The purpose of this review is to synthesize current haptic wearable research for clinical applications involving sensory impairments. We define haptic wearables as untethered, ungrounded body worn devices that interact with skin directly or through clothing and can be used in natural environments outside a laboratory. Results of this review are categorized by degree of sensory impairment. Total impairment, such as in an amputee, blind, or deaf individual, involves haptics acting as sensory replacement; partial impairment, as is common in rehabilitation, involves haptics as sensory augmentation; and no impairment involves haptics as trainer. This review found that wearable haptic devices improved function for a variety of clinical applications including: rehabilitation, prosthetics, vestibular loss, osteoarthritis, vision loss and hearing loss. Future haptic wearables development should focus on clinical needs, intuitive and multimodal haptic displays, low energy demands, and biomechanical compliance for long-term usage

Fatigue effect on task performance in haptic virtual environment for home-based rehabilitation

Stroke rehabilitation is to train the motor function of a patient’s limb. In this process, functional assessment is of importance, and it is primarily based on a patient’s task performance. The context of the rehabilitation discussed in this thesis is such that functional assessment is conducted through a computer system and the Internet. In particular, a patient performs the task at home in a haptic virtual environment, and the task performance is transmitted to the therapist over the Internet. One problem with this approach to functional assessment is that a patient’s mind state is little known to the therapist. This immediately leads to one question, that is, whether an elevated mind state will have some significant effect on the patient’s task performance? If so, this approach can result in a considerable error. The overall objective of this thesis study was to generate an answer to the aforementioned question. The study focused on a patient’s elevated fatigue state. The specific objectives of the study include: (i) developing a haptic virtual environment prototype system for functional assessment, (ii) developing a physiological-based inference system for fatigue state, and (iii) performing an experiment to generate knowledge regarding the fatigue effect on task performance. With a limited resource in recruiting patients in the experiment, the study conducted few experiments on patients but mostly on healthy subjects. The study has concluded: (1) the proposed haptic virtual environment system is effective for the wrist coordination task and is likely promising to other tasks, (2) the accuracy of proposed fatigue inference system achieves 89.54%, for two levels of fatigue state, which is promising, (3) the elevated fatigue state significantly affects task performance in the context of wrist coordination task, and (4) the accuracy of the individual-based inference approach is significantly higher than that of the group-based inference approach. The main contributions of the thesis are (1) generation of the new knowledge regarding the fatigue effect on task performance in the context of home-based rehabilitation, (2) provision of the new fatigue inference system with the highest accuracy in comparison with the existing approaches in literature, and (3) generation of the new knowledge regarding the difference between the individual-based inference and group-based inference approaches

Training modalities in robot-mediated upper limb rehabilitation in stroke : A framework for classification based on a systematic review

© 2014 Basteris et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The work described in this manuscript was partially funded by the European project ‘SCRIPT’ Grant agreement no: 288698 (http://scriptproject.eu). SN has been hosted at University of Hertfordshire in a short-term scientific mission funded by the COST Action TD1006 European Network on Robotics for NeuroRehabilitationRobot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.Peer reviewedFinal Published versio

An investigation of effects of the partial active assistance in a virtual environment based rehabilitation system

This thesis describes a study on a new active assistance in robotic rehabilitation in a haptic virtual environment for post-stroke patients. The novelty of this active assistance system lies in that the assistance is directly rendered on the result of a task performing. Active assistance will generally raise the confidence level of patients in performing a rehabilitation exercise. However, an overly high assistance level may induce cognitive fatigue with patients and thus decreases their motivation of performing a rehabilitation exercise. This thesis hypothesizes that a proper active assistance can improve the performance of a rehabilitation exercise, but will not reduce the motivation of patients in doing rehabilitation exercise. However, due to the difficulty in obtaining a proper number of patients for the experiment, the study turned to healthy people. Accordingly, a revised hypothesis is that active assistance on healthy people does not improve the task performance and not reduces the motivation of healthy people. In this thesis, first, a test-bed with the haptic virtual environment was designed and constructed. The test-bed included a simple task – i.e., following a predefined circle trajectory. Then, a statistical experiment was designed and an experiment was conducted on the test-bed. The experimental results test the hypothesis successfully. The main contributions of this thesis are: (1) the development of a new active assistance system for rehabilitation in a virtual environment and (2) the experimental study on the motivation of healthy people with the developed active assistance system. A care must, however, be taken that the experiment was conducted on healthy people and the conclusion drawn from the study may not be valid on patients

Assessing the Effect of Functional Electrical Stimulation Training with the Xcite on Hand and Arm Function in Persons with Multiple Sclerosis

The purpose of this study was to assess the effects functional electrical stimulation (FES) training of the hand and arm in persons with multiple sclerosis (MS). This is a case series of four individuals with MS with varying hand and arm dysfunction, and Expanded Disability Status Scale (EDSS) scores ranging from 3.0-7.0. Two participants completed 1-hour FES sessions, 3 times per week for 8 weeks and two participants completed 10 weeks. Every session the following four hand and arm exercises were performed on the non-dominant limb: feeding, forward reach and grasp, opposition and lumbrical pinch on the Xcite iFES Clinical Station (Restorative Therapies, Baltimore, MD). Pre and post-testing was divided into two days. The first day included the Sollerman’s hand function test, the Functional Independence Measure (FIM; self-care only), the Capabilities of Upper Extremity (CUE) instrument and the Grasp and Release Test (GRT). The second testing day participants performed grip strength testing (palmar and tip pinch) and two tasks on a haptic wrist device; a tracking task and a proprioception task to assess the effects of the FES training protocol. Pre-testing was completed within 24-72 hours prior to the first FES session and post-testing was within 72 hours of the final FES session. Three of the four participants showed marked improvements in palmar and tip pinch grip strength. Participants did not show meaningful improvement in the Sollerman’s hand function test. The grasp and release test provided mixed results, two participants improved, two were inconsistent across the 6 items. When assessing the functional questionnaires, virtually no change was seen on the FIM and the CUE. Regarding the haptic wrist device testing, some improvement was seen in the tracking and proprioception task but most was not meaningful improvement in the trained limb. Anecdotally, most of the participants reported experiencing improved function in day to day life. The results of this study suggest that thrice-weekly FES of the hand and arm with the Xcite clinical station for 8-10 weeks may elicit functional improvements in individuals with MS. However, more research is required to better understand optimal training parameters and limitations of this therapy

Robot-assisted upper limb training for patients with multiple sclerosis: an evidence-based review of clinical applications and effectiveness

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusion