Design of a robot-assisted exoskeleton for passive wrist and forearm rehabilitation

This paper presents a new exoskeleton design for wrist and forearm rehabilitation. The contribution of this study is to offer a methodology which shows how to adapt a serial manipulator that reduces the number of actuators used on exoskeleton design for the rehabilitation. The system offered is a combination of end-effector- and exoskeleton-based devices. The passive exoskeleton is attached to the end effector of the manipulator, which provides motion for the purpose of rehabilitation process. The Denso VP 6-Axis Articulated Robot is used to control motion of the exoskeleton during the rehabilitation process. The exoskeleton is designed to be used for both wrist and forearm motions. The desired moving capabilities of the exoskeleton are flexion–extension (FE) and adduction–abduction (AA) motions for the wrist and pronation–supination (PS) motion for the forearm. The anatomical structure of a human limb is taken as a constraint during the design. The joints on the exoskeleton can be locked or unlocked manually in order to restrict or enable the movements. The parts of the exoskeleton include mechanical stoppers to prevent the excessive motion. One passive degree of freedom (DOF) is added in order to prevent misalignment problems between the axes of FE and AA motions. Kinematic feedback of the experiments is performed by using a wireless motion tracker assembled on the exoskeleton. The results proved that motion transmission from robot to exoskeleton is satisfactorily achieved. Instead of different exoskeletons in which each axis is driven and controlled separately, one serial robot with adaptable passive exoskeletons is adequate to facilitate rehabilitation exercises.</p

Robotics in health care: Perspectives of robot-aided interventions in clinical practice for rehabilitation of upper limbs

This article belongs to the Special Issue Rehabilitation Robotics: Recent Advancements and New Perspectives about Training and Assessment of Sensorimotor Functions.Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice.This work was supported in part by the Spanish Ministry of Economy and Competitiveness via the ROBOESPASproject (DPI2017-87562-C2-1-R) and in part by the RoboCity2030-DIH-CMMadrid Robotics Digital Innovation Hub ("Robótica aplicada a la mejora de la calidad de vida de los ciudadanos, Fase IV"; S2018/NMT-4331), which is funded by the Programas de Actividades I+DComunidad de Madrid and cofunded by the Structural Funds of the EU

Comparative study of actuation systems for portable upper limb exoskeletons.

During the last two decades, a large variety of upper limb exoskeletons have been developed. Out of these, majority are platform based systems which might be the reason for not being widely adopted for post-stroke rehabilitation. Despite the potential benefits of platform-based exoskeletons as being rugged and reliable, stroke patients prefer to have a portable and user-friendly device that they can take home. However, the types of actuator as well as the actuation mechanism used in the exoskeleton are the inhibiting factors why portable exoskeletons are mostly non-existent for patient use. This paper presents a quantitative analysis of the actuation systems available for developing portable upper arm exoskeletons with their specifications. Finally, it has been concluded from this research that there are not many stand-alone arm exoskeletons which can provide all forms of rehabilitation, therefore, a generic solution has been proposed as the rehabilitation strategy to get best out of the portable arm exoskeletons

Design and evaluation of a soft and wearable robotic glove for hand rehabilitation

In the modern world, due to an increased aging population, hand disability is becoming increasingly common. The prevalence of conditions such as stroke is placing an ever-growing burden on the limited fiscal resources of health care providers and the capacity of their physical therapy staff. As a solution, this paper presents a novel design for a wearable and adaptive glove for patients so that they can practice rehabilitative activities at home, reducing the workload for therapists and increasing the patient’s independence. As an initial evaluation of the design’s feasibility the prototype was subjected to motion analysis to compare its performance with the hand in an assessment of grasping patterns of a selection of blocks and spheres. The outcomes of this paper suggest that the theory of design has validity and may lead to a system that could be successful in the treatment of stroke patients to guide them through finger flexion and extension, which could enable them to gain more control and confidence in interacting with the world around them

Evaluation of an Actuated Wrist Orthosis for Use in Assistive Upper Extremity Rehabilitation

Cerebral palsy (CP) is a neurological condition caused by damage to motor control centers of the brain. This leads to physical and cognitive deficiencies that can reduce an individual’s quality of life. Specifically, motor deficiencies of the upper extremity can make it difficult for an individual to complete everyday tasks, including eating, drinking, getting dressed, or combing their hair. Physical therapy, involving repetitive tasks, has been shown to be effective in training normal motion of the limb by invoking the neuroplasticity of the brain and its ability to adapt in order to facilitate motor learning. Creating a device for use with Activities of Daily Living (ADLs) provides an additional tool for task-based therapy with the goal of improving functional outcome. A custom wrist orthotic has been designed and developed that assists flexion/extension of the wrist and rotation of the forearm, while leaving the hand open for the grasp and manipulation of objects. Actuated joints are driven with geared brushless DC motors on a lightweight, exoskeleton frame coupled to a passive arm that tracks positional changes within the task space. Control of actuation is accomplished with a custom mapping strategy, created from nominal movement profiles for 5 ADLs collected from healthy subjects. A simple relationship was created between position within the workspace and orientation necessary for task completion to determine needed assistance. Validation of the design subjected the device to three different conditions, including robot guidance of the limb, co-contraction of the forearm, and the use of alternate approaches to complete the task. Co-contraction and alternate approach conditions were used to simulate characteristics of impaired subjects, including rigidity spasticity, and lack of muscle control. Robot guidance achieved an average orientation error of 5° or less in at least 75% of iterations across all tasks, while co-contraction and alternate approach was able to do this in flexion/extension, but saw much higher errors in forearm rotation. Causes for performance deficiencies were attributed to lack of torque bandwidth at the motor and response delay due to signal filtering, aspects that will be corrected in the next iteration of the design

A Robust Fuzzy Fractional Order PID Design Based On Multi-Objective Optimization For Rehabilitation Device Control

In this context, Fuzzy Fractional Order Proportional Integral Derivative (FOPID-FLC) controllers are emerged as efficient approaches due to their flexibility and ability to handle nonlinearities and uncertainties. This paper proposes the use of a FOPID-FLC controller for a two-degree-of-freedom (2-DOF) lower limb exoskeleton. Our proposal is based on an enhanced control approach that combines fuzzy logic advantages and fractional calculus benefits. Contrary to popular existing methods, that use the FLC to tune the FOPID  parameters, the FLC in this work is used to generate the system torque depending on patient morphology. Indeed, our fundamental contribution is to design and implement an enhanced FOPID-FLC that achieves an adequate optimal control based on system rules composed of optimal torques and input data. The fractional calculus is approximated using successive first order filters. Next, a multi-objective optimization is established for the tuning of each FOPID parameters. Finally, the FLC is used to adjust the torque depending on the kid's age. The effectiveness of the proposed controller in various scenarios is validated based on numerical simulations. Extensive analyses prove that the FOPID-FLC outperforms the FOPID with a 90\% of improvement in terms of error performance indices and 20\% of improvement for the control action. Moreover, the controller exhibits improved robustness against uncertainties and disturbances encountered in rehabilitation environments

Elbow exoskeleton mechanism for multistage poststroke rehabilitation.

More than three million people are suffering from stroke in England. The process of post-stroke rehabilitation consists of a series of biomechanical exercises- controlled joint movement in acute phase; external assistance in the mid phase; and variable levels of resistance in the last phase. Post-stroke rehabilitation performed by physiotherapist has many limitations including cost, time, repeatability and intensity of exercises. Although a large variety of arm exoskeletons have been developed in the last two decades to substitute the conventional exercises provided by physiotherapist, most of these systems have limitations with structural configuration, sensory data acquisition and control architecture. It is still difficult to facilitate multistage post-stroke rehabilitation to patients sited around hospital bed without expert intervention. To support this, a framework for elbow exoskeleton has been developed that is portable and has the potential to offer all three types of exercises (external force, assistive and resistive) in a single structure. The design enhances torque to weight ratio compared to joint based actuation systems. The structural lengths of the exoskeleton are determined based on the mean anthropometric parameters of healthy users and the lengths of upperarm and forearm are determined to fit a wide range of users. The operation of the exoskeleton is divided into three regions where each type of exercise can be served in a specific way depending on the requirements of users. Electric motor provides power in the first region of operation whereas spring based assistive force is used in the second region and spring based resistive force is applied in the third region. This design concept provides an engineering solution of integrating three phases of post-stroke exercises in a single device. With this strategy, the energy source is only used in the first region to power the motor whereas the other two modes of exercise can work on the stored energy of springs. All these operations are controlled by a single motor and the maximum torque of the motor required is only 5 Nm. However, due to mechanical advantage, the exoskeleton can provide the joint torque up to 10 Nm. To remove the dependency on biosensor, the exoskeleton has been designed with a hardware-based mechanism that can provide assistive and resistive force. All exoskeleton components are integrated into a microcontroller-based circuit for measuring three joint parameters (angle, velocity and torque) and for controlling exercises. A user-friendly, multi-purpose graphical interface has been developed for participants to control the mode of exercise and it can be managed manually or in automatic mode. To validate the conceptual design, a prototype of the exoskeleton has been developed and it has been tested with healthy subjects. The generated assistive torque can be varied up to 0.037 Nm whereas resistive torque can be varied up to 0.057 Nm. The mass of the exoskeleton is approximately 1.8 kg. Two comparative studies have been performed to assess the measurement accuracy of the exoskeleton. In the first study, data collected from two healthy participants after using the exoskeleton and Kinect sensor by keeping Kinect sensor as reference. The mean measurement errors in joint angle are within 5.18 % for participant 1 and 1.66% for participant 2; the errors in torque measurement are within 8.48% and 7.93% respectively. In the next study, the repeatability of joint measurement by exoskeleton is analysed. The exoskeleton has been used by three healthy users in two rotation cycles. It shows a strong correction (correlation coefficient: 0.99) between two consecutive joint angle measurements and standard deviation is calculated to determine the error margin which comes under acceptable range (maximum: 8.897). The research embodied in this thesis presents a design framework of a portable exoskeleton model for providing three modes of exercises, which could provide a potential solution for all stages of post- stroke rehabilitation