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

Changes in circle area after gravity compensation training in chronic stroke patients

After a stroke, many people experience difficulties to selectively activate muscles. As a result many patients move the affected arm in stereotypical patterns. Shoulder abduction is often accompanied by elbow flexion, reducing the ability to extend the elbow. This involuntary coupling reduces the patient's active range of motion. Gravity compensation reduces the activation level of shoulder abductors which limits the amount of coupled elbow flexion. As a result, stroke patients can instantaneously increase their active range of motion [1]. The objective of the present study is to examine whether training in a gravity compensated environment can also lead to an increased range of motion in an unsupported environment. Parts of this work have been presented at EMBC2009, Minneapolis, USA

Feasibility of a second iteration wrist and hand supported training system for self-administered training at home in chronic stroke

Telerehabilitation allows continued rehabilitation at home after discharge. The use of rehabilitation technology supporting wrist and hand movements within a motivational gaming environment could enable patients to train independently and ultimately serve as a way to increase the dosage of practice. This has been previously examined in the European SCRIPT project using a first prototype, showing potential feasibility, although several usability issues needed further attention. The current study examined feasibility and clinical changes of a second iteration training system, involving an updated wrist and hand supporting orthosis and larger variety of games with respect to the first iteration. Nine chronic stroke patients with impaired arm and hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility and arm and hand function were assessed before and after training. Median weekly training duration was 113 minutes. Participants accepted the six weeks of training (median Intrinsic Motivation Inventory = 4.4 points and median System Usability Scale = 73%). After training, significant improvements were found for the Fugl Meyer assessment, Action Research Arm Test and self-perceived amount of arm and hand use in daily life. These findings indicate that technology-supported arm and hand training can be a promising tool for self-administered practice at home after stroke.Final Accepted Versio

Tuning the effects of Landau-level mixing on anisotropic transport in quantum Hall systems

Electron-electron interactions in half-filled high Landau levels in two-dimensional electron gases in a strong perpendicular magnetic field can lead to states with anisotropic longitudinal resistance. This longitudinal resitance is generally believed to arise from broken rotational invariance, which is indicated by charge density wave (CDW) order in Hartree-Fock calculations. We use the Hartree-Fock approximation to study the influence of externally tuned Landau level mixing on the formation of interaction induced states that break rotational invariance in two-dimensional electron and hole systems. We focus on the situation when there are two non-interacting states in the vicinity of the Fermi level and construct a Landau theory to study coupled charge density wave order that can occur as interactions are tuned and the filling or mixing are varied. We examine in detail a specific example where mixing is tuned externally through Rashba spin-orbit coupling. We calculate the phase diagram and find the possibility of ordering involving coupled striped or triangular charge density waves in the two levels. Our results may be relevant to recent transport experiments on quantum Hall nematics in which Landau-level mixing plays an important role.Comment: 25 pages, 6 figure

The ras-related mouse ypt1 protein can functionally replace the YPT1 gene product in yeast.

The protein-coding region of the essential Saccharomyces cerevisiae YPT1 gene coding for a ras-related, guanine-nucleotide-binding protein was exchanged in chromosome VI by the protein-coding segment of either the mouse ypt1 gene or the v-Ki-ras gene, and different chimeric YPT1-v-Ki-ras genes. The mouse ypt1 protein with 71% of identical residues compared with the yeast Ypt1 protein could functionally fully replace its yeast homologue as long as the mouse gene was overexpressed under transcriptional control of the inducible GAL10 promoter. In contrast, neither the viral Ki-ras nor the hybrid proteins were able to substitute for the loss of YPT1 gene function. This study suggests that different parts of the yeast Ypt1 protein are required for the interaction with cellular targets and that these essential parts are conserved in the mammalian ypt1 protein

Spinful Composite Fermions in a Negative Effective Field

In this paper we study fractional quantum Hall composite fermion wavefunctions at filling fractions \nu = 2/3, 3/5, and 4/7. At each of these filling fractions, there are several possible wavefunctions with different spin polarizations, depending on how many spin-up or spin-down composite fermion Landau levels are occupied. We calculate the energy of the possible composite fermion wavefunctions and we predict transitions between ground states of different spin polarizations as the ratio of Zeeman energy to Coulomb energy is varied. Previously, several experiments have observed such transitions between states of differing spin polarization and we make direct comparison of our predictions to these experiments. For more detailed comparison between theory and experiment, we also include finite-thickness effects in our calculations. We find reasonable qualitative agreement between the experiments and composite fermion theory. Finally, we consider composite fermion states at filling factors \nu = 2+2/3, 2+3/5, and 2+4/7. The latter two cases we predict to be spin polarized even at zero Zeeman energy.Comment: 17 pages, 5 figures, 4 tables. (revision: incorporated referee suggestions, note added, updated references

Anyon Wave Function for the Fractional Quantum Hall Effect

An anyon wave function (characterized by the statistical factor $n$) projected onto the lowest Landau level is derived for the fractional quantum Hall effect states at filling factor $\nu = n/(2pn+1)$ ($p$ and $n$ are integers). We study the properties of the anyon wave function by using detailed Monte Carlo simulations in disk geometry and show that the anyon ground-state energy is a lower bound to the composite fermion one.Comment: Reference adde

Optical Hall Effect in the Integer Quantum Hall Regime

Optical Hall conductivity $\sigma_{xy}(\omega)$ is measured from the Faraday rotation for a GaAs/AlGaAs heterojunction quantum Hall system in the terahertz frequency regime. The Faraday rotation angle ($\sim$ fine structure constant $\sim$ mrad) is found to significantly deviate from the Drude-like behavior to exhibit a plateau-like structure around the Landau-level filling $\nu=2$. The result, which fits with the behavior expected from the carrier localization effect in the ac regime, indicates that the plateau structure, although not quantized, still exists in the terahertz regime.Comment: 4 pages, 4 figure