Effect of segmental muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial.

Abstract Background: Upper extremity functional impairments are common consequences of stroke. Therefore, continuous investigation of effective interventions for upper extremity functions after stroke is a necessity. Segmental muscle vibration (SMV) is one of the interventions that incorporate sensory stimulation to improve motor cortical excitability. The aim of this study was to investigate the influence of 5-minute SMV application along with supervised physical therapy (SPT) on improving activities of daily living and motor recovery on the hemiparetic upper extremity in patients with stroke. Methods: A sample of 37 patients poststroke (29 males) was randomly allocated to either SPT control group (n=18) or SPT and SMV (SPT-SMV) experimental group (n=19). All patients received 3 sessions per week of SPT for 8 weeks. The SPT-SMV experimental group received SMV at the end of each SPT session. Outcome measures used were Barthel index (BI), modified Ashworth scale, manual muscle testing, and goniometry for range of motion (ROM) assessment. Results: Thirty-four patients completed the study. Patients in both groups improved significantly after treatment in BI, elbow ROM, and elbow muscles strength. However, muscle tone in elbow joint of the hemiplegic upper extremity improved significantly after SMV only in the experimental group (SPT-SMV). Conclusion: The SPT intervention can improve functional outcomes of upper extremity in people after stroke. However, using SMV may have superior effect on improving muscle tone after stroke. Abbreviations: ADL = activities of daily living, BI = Barthel index, MAS = modified Ashworth scale, MMT = manual muscle testing, ROM = range of motion, SMV = segmental muscle vibration, SPT = supervised physical therapy, SPT-SMV = supervised physical therapy and segmental muscle vibration

Quantification of spasticity and rigidity for biceps and triceps using the PVRM (position, velocity, and resistance meter)

Spasticity and rigidity are two common types of abnormal muscle behavior seen among patients with neurological disorders (e.g., stroke, Parkinson’s Disease). Clinical assessment of increased muscle resistance during passive movement, or hypertonicity, involves qualitative and subjective scales such as the Modified Ashworth Scale (MAS) for spasticity or the Unified Parkinson’s Disease Rating Scale (UPDRS) for rigidity. Inaccurate and inconsistent assessments may occur depending on the rater’s level of experience and scale interpretation. Recently, researchers have been developing medical training simulators that mimic hypertonicity to aid the training of these clinician learners. However, there is a lack of quantitative data representing the kinetic and kinematic characteristics of these abnormal muscle behaviors. Thus, we developed a portable measurement device (the PVRM – Position, Velocity, and Resistance Meter) that measures the joint angle, velocity, and muscle resistance of the upper-arm extensor and flexor muscles. In Study 1, the accuracy and reliability of the PVRM was validated by comparing its measurements to a commercial dynamometer (Biodex), a gold standard for measuring biomechanical data. The PVRM measurements were similar to the gold standard Biodex measurements during the passive flexion movement, since the residuals for all measurements were between 1-13%. Therefore, the PVRM was able to quantify behavioral features of spasticity (e.g., catch-release behavior), rigidity (e.g., uniformly elevated muscle tone), and healthy (e.g., no muscle resistance) subjects. In Study 2, we conducted a clinical study of 38 participants using the validated PVRM to establish a database quantifying different levels of spasticity (n=15, MAS 1-4); rigidity (n=11, UPDRS 1-3), and normal healthy (n=12) behavior of the biceps and triceps during passive flexion and extension of the elbow. Spasticity subjects demonstrated stretch speed and MAS score dependent hypertonia marked by a catch-release behavior, resulting in a convex parabolic stretch speed profile. Rigidity subjects exhibited uniformly increased muscle tone that was dependent on UPDRS score but independent of stretch speed. The PVRM can provide a database for development of physical training simulators to realistically mimic hypertonicity and serve as a clinical measurement tool to reliably quantify the type and degree of hypertonicity

Robot Assisted Shoulder Rehabilitation: Biomechanical Modelling, Design and Performance Evaluation

The upper limb rehabilitation robots have made it possible to improve the motor recovery in stroke survivors while reducing the burden on physical therapists. Compared to manual arm training, robot-supported training can be more intensive, of longer duration, repetitive and task-oriented. To be aligned with the most biomechanically complex joint of human body, the shoulder, specific considerations have to be made in the design of robotic shoulder exoskeletons. It is important to assist all shoulder degrees-of-freedom (DOFs) when implementing robotic exoskeletons for rehabilitation purposes to increase the range of motion (ROM) and avoid any joint axes misalignments between the robot and human’s shoulder that cause undesirable interaction forces and discomfort to the user. The main objective of this work is to design a safe and a robotic exoskeleton for shoulder rehabilitation with physiologically correct movements, lightweight modules, self-alignment characteristics and large workspace. To achieve this goal a comprehensive review of the existing shoulder rehabilitation exoskeletons is conducted first to outline their main advantages and disadvantages, drawbacks and limitations. The research has then focused on biomechanics of the human shoulder which is studied in detail using robotic analysis techniques, i.e. the human shoulder is modelled as a mechanism. The coupled constrained structure of the robotic exoskeleton connected to a human shoulder is considered as a hybrid human-robot mechanism to solve the problem of joint axes misalignments. Finally, a real-scale prototype of the robotic shoulder rehabilitation exoskeleton was built to test its operation and its ability for shoulder rehabilitation

SISTEMA ROBÓTICO HÍBRIDO PARA REABILITAÇÃO DE MEMBRO SUPERIOR DE INDIVÍDUOS PÓS- ACIDENTE VASCULAR ENCEFÁLICO:Design Centrado no Usuário

Post-stroke individuals have upper limb motor limitations that interfere with their ability to independently perform activities of daily living, compromising functionality, affecting social participation and quality of life. Innovative rehabilitation alternatives consist of Robot- Assisted Therapy (RT) and Hybrid Robotic Rehabilitation Systems (HRRS), an approach that combines repetitive muscle practice provided by robotic therapy with muscle activation provided by Functional Electrical Stimulation (FES). Despite the proven benefits of these technologies, a lack of uptake and limited implementation in clinical practice is still observed. This is because most hybrid devices are only in the early stages of development and the robotic equipment available today, presents several disadvantages related to the difficulty of control, little functionality, aesthetics and high cost, compromising their results and applicability. The objective of this study was to develop a hybrid robotic system for use in individuals with upper limb motor impairment due to stroke with advantages over the ones currently available. The competitive differentials concern its aesthetics, structure, drive and control system, portability, joint concomitance, and low cost. An exploratory study was conducted in two stages. The first stage consisted of developing the robotic orthosis prototype and validating the biomechanical functioning through a pilot study with four participants. The second stage consisted in improving the structure and control system, adding FES to the drive, transforming it into a hybrid robotic system. A multicenter pilot study was conducted with 10 participants in order to identify the needs and preferences of users to increase the acceptance and implementation of this technology. The correct functioning of the device was verified through standardized bench tests, resulting in the acquisition of a new and promising equipment for upper limb rehabilitation, capable of aiding in the recovery of functional abilities of individuals with loss of upper limb motor function.Les personnes ayant subi un AVC présentent des limitations motrices dans le membre supérieur qui interfèrent avec la capacité d'effectuer de manière autonome les activités de la vie quotidienne, compromettant la fonctionnalité, affectant la participation sociale et la qualité de vie. Les alternatives innovantes en matière de réadaptation sont la thérapie assistée par robot (RT) et les systèmes de réadaptation hybrides robotiques (SRHR), une approche qui combine la pratique musculaire répétitive fournie par la thérapie robotique avec l'activation musculaire fournie par la stimulation électrique fonctionnelle (FES). Malgré les avantages avérés de ces technologies, on observe encore un manque d'adhésion et une mise en œuvre limitée dans la pratique clinique. En effet, la plupart des dispositifs hybrides n'en sont qu'aux premiers stades de développement et les équipements robotiques disponibles aujourd'hui présentent plusieurs inconvénients liés à la difficulté du contrôle, au peu de fonctionnalité, à l'esthétique et au coût élevé, ce qui compromet leurs résultats et leur applicabilité. L'objectif de cette étude était de développer un système robotique hybride pour les personnes souffrant d'une déficience motrice des membres supérieurs due à une AVC, avec des avantages par rapport aux systèmes actuellement disponibles. Les différentiels concurrentiels concernent son esthétique, sa structure, son système d'entraînement et de contrôle, sa portabilité et la concomitance de ses articulations. Une étude exploratoire a été réalisée en deux étapes. La première étape a consisté à développer le prototype d'orthèse robotique et à valider le fonctionnement de la partie biomécanique par une étude pilote avec quatre participants. La deuxième étape a consisté à améliorer la structure et le système de contrôle, en ajoutant le FES à l'entraînement, le transformant en un système robotique hybride. Une étude pilote multicentrique a été menée auprès de 10 participants afin d'identifier les besoins et les préférences des utilisateurs de manière à accroître l'acceptation et la mise en œuvre de cette technologie. Le bon fonctionnement de l'appareil a été vérifié au moyen d'essais au banc standardisés, ce qui a permis d'acquérir un nouvel équipement prometteur pour la rééducation des membres supérieurs, capable de contribuer à la récupération des capacités fonctionnelles des personnes ayant perdu la fonction motrice des membres supérieurs.Indivíduos pós-acidente vascular encefálico (AVE) apresentam limitações motoras no membro superior que interferem na capacidade de realizar de forma independente as atividades de vida diária, comprometendo a funcionalidade, afetando a participação social e qualidade de vida. Alternativas inovadoras de reabilitação consistem na Terapia Assistida por Robô (RT) e nos Sistemas Robóticos Híbridos de Reabilitação (SRHR), abordagem que combina a prática muscular repetitiva fornecida pela terapia robótica com a ativação muscular proporcionada pela Estimulação Elétrica Funcional (FES). Apesar dos benefícios comprovados dessas tecnologias, observa-se ainda uma falta de adesão e implementação limitada na prática clínica. Isso porque a maioria dos dispositivos híbridos estão apenas nos estágios iniciais de desenvolvimento e os equipamentos robóticos hoje disponíveis, apresentam diversas desvantagens relacionadas à dificuldade de controle, pouca funcionalidade, estética e custo elevado, comprometendo seus resultados e aplicabilidade. O objetivo deste estudo foi desenvolver um sistema robótico híbrido para uso em pessoas com comprometimento motor de membro superior decorrente de AVE com vantagens em relação aos disponíveis atualmente. Os diferenciais competitivos dizem respeito a sua estética, estrutura, sistema de acionamento e de controle, portabilidade e concomitância de articulação. Foi realizado um estudo exploratório em duas etapas. A primeira etapa consistiu no desenvolvimento do protótipo de órtese robótica e validação do funcionamento da parte biomecânica por meio de estudo piloto com quatro participantes. A segunda etapa consistiu no aprimoramento da estrutura e sistema de controle, acrescentando a FES ao acionamento, transformando-o em um sistema robótico híbrido. Foi realizado um estudo piloto multicêntrico com 10 participantes a fim de identificar as necessidades e preferências dos usuários de forma a aumentar a aceitação e implementação dessa tecnologia. Foi verificado correto funcionamento do dispositivo por meio de testes padronizados de bancada, resultando na aquisição de um novo e promissor equipamento para reabilitação de membro superior, capaz de auxiliar na recuperação das habilidades funcionais de pessoas com perda da função motora de membro superior

Engineering Dynamics and Life Sciences

From Preface: This is the fourteenth time when the conference “Dynamical Systems: Theory and Applications” gathers a numerous group of outstanding scientists and engineers, who deal with widely understood problems of theoretical and applied dynamics. Organization of the conference would not have been possible without a great effort of the staff of the Department of Automation, Biomechanics and Mechatronics. The patronage over the conference has been taken by the Committee of Mechanics of the Polish Academy of Sciences and Ministry of Science and Higher Education of Poland. It is a great pleasure that our invitation has been accepted by recording in the history of our conference number of people, including good colleagues and friends as well as a large group of researchers and scientists, who decided to participate in the conference for the first time. With proud and satisfaction we welcomed over 180 persons from 31 countries all over the world. They decided to share the results of their research and many years experiences in a discipline of dynamical systems by submitting many very interesting papers. This year, the DSTA Conference Proceedings were split into three volumes entitled “Dynamical Systems” with respective subtitles: Vibration, Control and Stability of Dynamical Systems; Mathematical and Numerical Aspects of Dynamical System Analysis and Engineering Dynamics and Life Sciences. Additionally, there will be also published two volumes of Springer Proceedings in Mathematics and Statistics entitled “Dynamical Systems in Theoretical Perspective” and “Dynamical Systems in Applications”