Development and preliminary evaluation of a novel low cost VR-based upper limb stroke rehabilitation platform using Wii technology.

Abstract Purpose: This paper proposes a novel system (using the Nintendo Wii remote) that offers customised, non-immersive, virtual reality-based, upper-limb stroke rehabilitation and reports on promising preliminary findings with stroke survivors. Method: The system novelty lies in the high accuracy of the full kinematic tracking of the upper limb movement in real-time, offering strong personal connection between the stroke survivor and a virtual character when executing therapist prescribed adjustable exercises/games. It allows the therapist to monitor patient performance and to individually calibrate the system in terms of range of movement, speed and duration. Results: The system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed, with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated. Conclusions: Given the preliminary findings, it would be beneficial to extend the case study in terms of duration and participants and to conduct an acceptability and feasibility study with community dwelling survivors. Implications for Rehabilitation Low-cost, off-the-shelf game sensors, such as the Nintendo Wii remote, are acceptable by stroke survivors as an add-on to upper limb stroke rehabilitation but have to be bespoked to provide high-fidelity and real-time kinematic tracking of the arm movement. Providing therapists with real-time and remote monitoring of the quality of the movement and not just the amount of practice, is imperative and most critical for getting a better understanding of each patient and administering the right amount and type of exercise. The ability to translate therapeutic arm movement into individually calibrated exercises and games, allows accommodation of the wide range of movement difficulties seen after stroke and the ability to adjust these activities (in terms of speed, range of movement and duration) will aid motivation and adherence - key issues in rehabilitation. With increasing pressures on resources and the move to more community-based rehabilitation, the proposed system has the potential for promoting the intensity of practice necessary for recovery in both community and acute settings.The National Health Service (NHS) London Regional Innovation Fund

Design and Validation of a MR-compatible Pneumatic Manipulandum

The combination of functional MR imaging and novel robotic tools may provide unique opportunities to probe the neural systems underlying motor control and learning. Here, we describe the design and validation of a MR-compatible, 1 degree-of-freedom pneumatic manipulandum along with experiments demonstrating its safety and efficacy. We first validated the robot\u27s ability to apply computer-controlled loads about the wrist, demonstrating that it possesses sufficient bandwidth to simulate torsional spring-like loads during point-to-point flexion movements. Next, we verified the MR-compatibility of the device by imaging a head phantom during robot operation. We observed no systematic differences in two measures of MRI signal quality (signal/noise and field homogeneity) when the robot was introduced into the scanner environment. Likewise, measurements of joint angle and actuator pressure were not adversely affected by scanning. Finally, we verified device efficacy by scanning 20 healthy human subjects performing rapid wrist flexions against a wide range of spring-like loads. We observed a linear relationship between joint torque at peak movement extent and perturbation magnitude, thus demonstrating the robot\u27s ability to simulate spring-like loads in situ. fMRI revealed task-related activation in regions known to contribute to the control of movement including the left primary sensorimotor cortex and right cerebellum

Empowering and assisting natural human mobility: The simbiosis walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staf

Developing Predictive Models for Upper Extremity Post–Stroke Motion Quality Estimation Using Decision Trees and Bagging Forest

Stroke is one of the leading causes of long–term disability. Approximately twothirds of stroke survivors require long-term rehabilitation, which suggests the importance of understanding the post-stroke recovery process during his activities of daily living. This problem is formulated as quantifying and estimating the poststroke movement quality in real world settings. To address this need, we have developed an approach that quantifies physical activities and can evaluate the performance quality. Wearable accelerometer and gyroscope are used to measure the upper extremity motions and to develop a mathematical framework to objectively relates sensors’ data to clinical performance indices. In this article we employ two machine learning classification methods, Bootstrap Aggregating (Bagging) Forest and Decision Tree (DT), to relate the post-stroke kinematic data to quality of the corresponding motion. We then compare the accuracy of the resulted two prediction models using cross-validation approaches. Our findings indicate that Bagging forest approach is superior to the computationally simpler DTs for unstable data sets including those derived from stroke survivors in this project

Motion symmetry evaluation using accelerometers and energy distribution

Analysis of motion symmetry constitutes an important area with many applications in engineering, robotics, neurology and biomedicine. This paper presents the use ofmicroelectromechanical sensors (MEMS), including accelerometers and gyrometers, to acquire data via mobile devices so as to monitor physical activities and their irregularities. Special attention is devoted to the analysis of the symmetry of the motion of the body when the same exercises are performed by the right and the left limb. The analyzed data include the motion of the legs on a home exercise bike under different levels of load. The method is based on signal analysis using the discrete wavelet transform and the evaluation of signal segment features such as the relative energy at selected decomposition levels. The subsequent classification of the evaluated features is performed by k-nearest neighbours, a Bayesian approach, a support vector machine, and neural networks. The highest average classification accuracy attained is 91.0% and the lowest mean cross-validation error is 0.091, resulting from the use of a neural network. This paper presents the advantages of the use of simple sensors, their combination and intelligent data processing for the numerical evaluation of motion features in the rehabilitation and monitoring of physical activities. © 2019 by the authors.Ministry of Health of the Czech Republic [FN HK 00179906]; Charles University in Prague, Czech Republic [PROGRES Q40]; project PERSONMED - European Regional Development Fund (ERDF) [CZ.02.1.010.00.017_0480007441]; governmental budget of the Czech Republi

Design and Validation of a Portable Wireless Data Acquisition System for Measuring Human Joint Angles in Medical Applications

A prototype sensor system to capture and measure human joint movements in medical applications was developed. An algorithm that uses measurements from two IMU sensors to estimate the angle of one human joint was developed. Custom-made hardware and software were developed. Validation results showed 0.67° maximum error in static condition, 1.56° maximum RMSE for dynamic measurements and 2.5° average error during fast movements’ tests. The prototype has been successfully used by medical teams

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