Age Effects on Upper Limb Kinematics Assessed by the REAplan Robotin Healthy School-Aged Children

The use of kinematics is recommended to quantitatively evaluate upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish norms in healthy children. Ninetythree healthy children, aged 3–12 years, participated in this study. Twenty-eight kinematic indices were computed from four tasks. Each task was performed with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-four of the 28 indices showed an improvement during childhood. Indeed, older children showed better upper limb movements. This study was the first to use a robotic device to show the age effects on upper limb kinematics and establish norms in healthy children

The impact of job-demand-control-support on leptin and ghrelin as biomarkers of stress in emergency healthcare workers

Despite the available literature on the consequences of night shiftwork on stress and food intake, its impact on leptin and ghrelin has never been studied. We previously demonstrated that leptin and ghrelin were biomarkers related to stress, and acute stress-induced a decrease in leptin levels and an increase in ghrelin levels. We performed a prospective observational study to assess the influence of night work, nutrition, and stress on the levels of ghrelin and leptin among emergency healthcare workers (HCWs). We took salivary samples at the beginning of a day shift and/or at the end of a night shift. We also monitored stress using the job demand-control-support model of Karasek. We recorded 24-h food intake during the day shift and the consecutive night shift and during night work and the day before. We included 161 emergency HCWs. Emergency HCWs had a tendency for decreased levels of leptin following the night shift compared to before the dayshift (p = 0.067). Furthermore, the main factors explaining the decrease in leptin levels were an increase in job-demand (coefficient −54.1, 95 CI −99.0 to −0.92) and a decrease in job control (−24.9, −49.5 to −0.29). Despite no significant changes in ghrelin levels between shifts, social support was the main factor explaining the increase in ghrelin (6.12, 0.74 to 11.5). Food intake (kcal) also had a negative impact on leptin levels, in addition to age. Ghrelin levels also decreased with body mass index, while age had the opposite effect. In conclusion, we confirmed that ghrelin and leptin as biomarkers of stress were directly linked to the job demand-control-support model of Karasek, when the main cofounders were considered

A Very Large Number of GABAergic Neurons Are Activated in the Tuberal Hypothalamus during Paradoxical (REM) Sleep Hypersomnia

We recently discovered, using Fos immunostaining, that the tuberal and mammillary hypothalamus contain a massive population of neurons specifically activated during paradoxical sleep (PS) hypersomnia. We further showed that some of the activated neurons of the tuberal hypothalamus express the melanin concentrating hormone (MCH) neuropeptide and that icv injection of MCH induces a strong increase in PS quantity. However, the chemical nature of the majority of the neurons activated during PS had not been characterized. To determine whether these neurons are GABAergic, we combined in situ hybridization of GAD67 mRNA with immunohistochemical detection of Fos in control, PS deprived and PS hypersomniac rats. We found that 74% of the very large population of Fos-labeled neurons located in the tuberal hypothalamus after PS hypersomnia were GAD-positive. We further demonstrated combining MCH immunohistochemistry and GAD67 in situ hybridization that 85% of the MCH neurons were also GAD-positive. Finally, based on the number of Fos-ir/GAD+, Fos-ir/MCH+, and GAD+/MCH+ double-labeled neurons counted from three sets of double-staining, we uncovered that around 80% of the large number of the Fos-ir/GAD+ neurons located in the tuberal hypothalamus after PS hypersomnia do not contain MCH. Based on these and previous results, we propose that the non-MCH Fos/GABAergic neuronal population could be involved in PS induction and maintenance while the Fos/MCH/GABAergic neurons could be involved in the homeostatic regulation of PS. Further investigations will be needed to corroborate this original hypothesis

Conception d’un robot interactif pour la rééducation des membres supérieurs de patients cérébrolésés

Many areas of medicine perceive in the progress of robotics, data processing and in the field of multimedia, an opportunity of developing robotic assistance tools to improve the therapist working conditions and to provide more efficient and better care to patients. Physical and rehabilitation medicine, being aware of the above scientific advancement, has developed upper limbs rehabilitation robots for hemiplegic patients. However, existing solutions show significant gaps in terms of mobility, ergonomics and safety. Based on this observation, the present thesis aims to develop a solution that meets these high level criteria. It presents an original design approach, based on preliminary choices offering a significant advantage : the ability to decouple the electromechanical robot structure aspects from those related to its control. In terms of structure, the proposed solution consists of five modules governing the movements of the shoulder, the elbow and the wrist, and operating on an original action principle which, contrary to classical exoskeletons, can clearly disregard the problem related to the alignment of the robot and patient degrees of freedom. In terms of control, the proposed solution uses an admittance virtual system to reproduce a compliant behaviour, like a real therapist, through different operating modes. This control process is validated in laboratory and hospital by implementing it on a planar end-effector robot.De nombreux domaines de la médecine voient dans les progrès réalisés en robotique, en traitement de l’information et dans le domaine des multimédias, une opportunité de développer des outils d’assistance robotisés permettant, non seulement d’améliorer les conditions de travail des médecins, mais aussi de proposer aux patients des soins plus efficaces et de meilleure qualité. La médecine physique et de réadaptation n’est pas passée à côté de cette évolution, notamment en développant des robots dédicacés à la rééducation des membres supérieurs de patients hémiplégiques. Cependant, il existe dans le chef des solutions existantes des lacunes importantes en termes de mobilité, d'ergonomie et de sécurité. Partant de ce constat, cette thèse a pour objectif de développer une solution répondant à ces critères de haut niveau. Ainsi, elle présente une démarche de conception basée sur des choix préliminaires offrant un avantage majeur. Ce dernier réside dans la possibilité de découpler les aspects liés à la structure électromécanique du robot de ceux liés à sa commande. Au niveau de la structure, la solution proposée est formée de cinq modules prenant en charge les mouvements de l’épaule, du coude et du poignet, et fonctionnant suivant un principe d’action original, qui, contrairement aux exosquelettes classiques, permet de s’affranchir de la problématique liée à l'alignement des degrés de liberté du robot et du patient. Au niveau de la commande, la solution retenue met en œuvre un système virtuel en admittance permettant de reproduire un comportement compliant, à l'image d'un vrai kinésithérapeute, au travers de différents modes de fonctionnement. Cette loi de commande est validée en laboratoire et en milieu hospitalier, en l’implémentant sur un manipulateur à effecteur distal plan.(FSA 3) -- UCL, 201

Upper limbs rehabilitating, monitoring and/or evaluating interactive device

The present invention relates to a two-degree-of-freedom planar rehabilitating, monitoring and/or evaluating device comprising a first guiding mechanism (2), a second guiding mechanism (3), substantially parallel to the first guiding mechanism (2), a third guiding mechanism (4), substantially perpendicular to the first and second guiding mechanisms (2, 3), and an end-effector (5), wherein the third guiding mechanism (4) is connected to the first and second guiding mechanisms (2,3), and wherein the endeffector (5) is connected to the third guiding mechanism (4). The present invention also relates to a two-degree-of-freedom planar rehabilitating, monitoring and/or evaluating interactive device adapted for rehabilitation, monitoring and/or assessment of the upper limbs of a subject, comprising said device

Rehabilitation system and method

A rehabilitation system for rehabilitation of a subject comprising at least one end-effector for interacting with the subject, the said end-effector having at least two degrees of freedom of motion, at least one actuator for actuating the at least one end-effector, at least one sensor for measuring at least the position and the speed of the at least one endeffector; at least one sensor for measuring the interaction force between the subject and the end-effector; a memory comprising at least two initial coefficients and a session comprising at least one exercise including at least one reference trajectory to be carried out by the subject through actuation of the end effector ; and a controlling unit for controlling the actuator; wherein the memory is connected to the controlling unit for delivering the initial coefficients and the session, the sensors are connected to the controlling unit for delivering measurement signals, and the controlling unit is adapted to provide a force-controlled feedback based on the said initial coefficients

Optimal Design of an Alignment-Free Two-DOF Rehabilitation Robot for the Shoulder Complex

This paper presents the optimal design of an alignment-free exoskeleton for the rehabilitation of the shoulder complex. This robot structure is constituted of two actuated joints and is linked to the arm through passive degrees of freedom (DOFs) to drive the flexion-extension and abductionadduction movements of the upper arm. The optimal design of this structure is performed through two steps. The first step is a multi-objective optimization process aiming to find the best parameters characterizing the robot and its position relative to the patient. The second step is a comparison process aiming to select the best solution from the optimization results on the basis of several criteria related to practical considerations. The optimal design process leads to a solution outperforming an existing solution on aspects as kinematics or ergonomics while being more simple

Rehabilitation robot

The invention relates to a device for mobilising and rehabilitating an upper limb of a patient and to a method for assembling such a device. Said device comprises an assembly of at least two adjacent elements selected from a group including a shoulder module (105) (Shoulde RO), an arm module (205) (ROThum), an elbow module (305) (el BOT), a forearm module (405) (ROTuln), a wrist module (505) (wrist IC), a back support device (107), an elbow shell (CC) and a hand shell (514). Each of the elements (105; 205; 305; 405; 505; 107; CC; 514) of the group is adapted to be rigidly connectable to at least one other adjacent element (105; 205; 305; 405; 505; 107; CC; 514) of the group, at least a first element being assembled with a second element by inserting a male part (600) rigidly connected to the first element into a female part (610) rigidly connected to the second element in an insertion direction that is not subject to any force when the device is operational, and locking said male part (600) in said female part (610) by a means that can be unlocked by pulling in the direction opposite to the insertion direction

On the types and roles of demonstrators for designing medical devices

Unlike many fields that make the most of advances in numerical modeling and simulation, actors involved in medical technologies R&D have more and more recourse to demonstrators when designing a product. These concrete materializations are a handy support at certain stages, but an inadequate use of mock-ups and prototypes can lead to tackling the problem in a roundabout way, at the risk of ending with an unsuitable product that does not meet the users’ needs. Based on our own experience in research projects in close collaboration with clinicians, this paper tries to sort out the different types and characteristics of demonstrators, regarding their potential uses at the successive stages of the design process. The general discussion is clarified by several illustrative examples that underline the important roles demonstrators play to help designers finding the right way on the winding path towards an innovative and useful medical device