A framework for user adaptation and profiling for social robotics in rehabilitation

Physical rehabilitation therapies for children present a challenge, and its success—the improvement of the patient’s condition—depends on many factors, such as the patient’s attitude and motivation, the correct execution of the exercises prescribed by the specialist or his progressive recovery during the therapy. With the aim to increase the benefits of these therapies, social humanoid robots with a friendly aspect represent a promising tool not only to boost the interaction with the pediatric patient, but also to assist physicians in their work. To achieve both goals, it is essential to monitor in detail the patient’s condition, trying to generate user profile models which enhance the feedback with both the system and the specialist. This paper describes how the project NAOTherapist—a robotic architecture for rehabilitation with social robots—has been upgraded in order to include a monitoring system able to generate user profile models through the interaction with the patient, performing user-adapted therapies. Furthermore, the system has been improved by integrating a machine learning algorithm which recognizes the pose adopted by the patient and by adding a clinical reports generation system based on the QUEST metricThis work is partially funded by grant RTI2018-099522-B-C43 of FEDER/Ministerio de Ciencia e Innovación - Ministerio de Universidades - Agencia Estatal de Investigació

Personalized neuromusculoskeletal modeling to improve treatment of mobility impairments: a perspective from European research sites

Mobility impairments due to injury or disease have a significant impact on quality of life. Consequently, development of effective treatments to restore or replace lost function is an important societal challenge. In current clinical practice, a treatment plan is often selected from a standard menu of options rather than customized to the unique characteristics of the patient. Furthermore, the treatment selection process is normally based on subjective clinical experience rather than objective prediction of post-treatment function. The net result is treatment methods that are less effective than desired at restoring lost function. This paper discusses the possible use of personalized neuromusculoskeletal computer models to improve customization, objectivity, and ultimately effectiveness of treatments for mobility impairments. The discussion is based on information gathered from academic and industrial research sites throughout Europe, and both clinical and technical aspects of personalized neuromusculoskeletal modeling are explored. On the clinical front, we discuss the purpose and process of personalized neuromusculoskeletal modeling, the application of personalized models to clinical problems, and gaps in clinical application. On the technical front, we discuss current capabilities of personalized neuromusculoskeletal models along with technical gaps that limit future clinical application. We conclude by summarizing recommendations for future research efforts that would allow personalized neuromusculoskeletal models to make the greatest impact possible on treatment design for mobility impairments

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

Cerebral Palsy

Nowadays, cerebral palsy (CP) rehabilitation, along with medical and surgical interventions in children with CP, leads to better motor and postural control and can ensure ambulation and functional independence. In achieving these improvements, many modern practices may be used, such as comprehensive multidisciplinary assessment, clinical decision making, multilevel surgery, botulinum toxin applications, robotic ambulation applications, treadmill, and other walking aids to increase the quality and endurance of walking. Trainings are based on neurodevelopmental therapy, muscle training and strength applications, adaptive equipment and orthotics, communication, technological solves, and many others beyond the scope of this book. In the years of clinical and academic experiences, children with cerebral palsy have shown us that the world needs a book to give clinical knowledge to health professionals regarding these important issue. This book is an attempt to fulfill and to give “current steps” about CP. The book is intended for use by physicians, therapists, and allied health professionals who treat/rehabilitate children with CP. We focus on the recent concepts in the treatment of body and structure problems and describe the associated disability, providing suggestions for further reading. All authors presented the most frequently used and accepted treatment methods with scientifically proven efficacy and included references at the end of each chapter

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

The Effectiveness of Robot-Assisted, Task-Specific Ankle Training in Improving Deficits Across the Three Domains of the ICF in Children with Cerebral Palsy (CP)

Indiana University-Purdue University Indianapolis (IUPUI)Cerebral Palsy (CP) is considered to be the leading cause of motor disability among children. Children with CP present with multiple physical impairments including decreased strength and range of motion (ROM), increased spasticity, and poor balance and coordination. These impairments often lead to limitations in ankle motor control that impacts balance and gait function, which puts children at a higher risk for developing other problems. In recent studies, robotic devices have been developed to address poor motor control of the upper and lower extremities. Aim: The aim of this study is to investigate the extent to which the robot-assisted, taskspecific ankle trainer improve deficits across the three domains of the International Classification of Functioning, Disability and Health (ICF) in children with CP. Method: This is a quasi-experimental, single group, repeated measure design with four time-testing points through a set training session/protocol. A convenience sample of 5 children with CP were enrolled in the study. All children received 6-weeks of ankle robot training that included two 45-60 minute sessions per week, for a total of 12 sessions. Data from Tardieu Scale of spasticity, Boyd and Graham selective motor control, Pediatric Balance Scale, goniometer, hand held dynamometer, gait mat analysis, accelerometer, LIFE-H for children questionnaires, ultrasound, and robotic evaluation were collected at the different time points (1 week and 1 month pre training and 1 week and 1 month post training). Descriptive statistics and repeated measure (ANOVA) were used with SPSS software for data analysis. Results: All participants showed improvement in 1. Body Function and Structures (ROM, tone, strength, balance, ankle control and performance, and muscle architecture), 2. Activity (gait and activity counts) and 3. Participations over the course of the study. Conclusion: The results revealed the potential of robot-assisted, task-specific ankle training to improve motor performance and capacity at the body function, activity and participation level. Training appeared to have a lasting impact as most gains were maintained one month following training

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

Rehabilitation of gait after stroke: a review towards a top-down approach

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity