Graceful User Following for Mobile Balance Assistive Robot in Daily Activities Assistance

Numerous diseases and aging can cause degeneration of people's balance ability resulting in limited mobility and even high risks of fall. Robotic technologies can provide more intensive rehabilitation exercises or be used as assistive devices to compensate for balance ability. However, With the new healthcare paradigm shifting from hospital care to home care, there is a gap in robotic systems that can provide care at home. This paper introduces Mobile Robotic Balance Assistant (MRBA), a compact and cost-effective balance assistive robot that can provide both rehabilitation training and activities of daily living (ADLs) assistance at home. A three degrees of freedom (3-DoF) robotic arm was designed to mimic the therapist arm function to provide balance assistance to the user. To minimize the interference to users' natural pelvis movements and gait patterns, the robot must have a Human-Robot Interface(HRI) that can detect user intention accurately and follow the user's movement smoothly and timely. Thus, a graceful user following control rule was proposed. The overall control architecture consists of two parts: an observer for human inputs estimation and an LQR-based controller with disturbance rejection. The proposed controller is validated in high-fidelity simulation with actual human trajectories, and the results successfully show the effectiveness of the method in different walking modes

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

<p>Abstract</p> <p>Background</p> <p>Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the <it>HapticKnob</it>, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function.</p> <p>Methods</p> <p>A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the <it>HapticKnob</it>. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up.</p> <p>Results</p> <p>Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot.</p> <p>Conclusions</p> <p>The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.</p

Advanced Robotic Therapy Integrated Centers (ARTIC): an international collaboration facilitating the application of rehabilitation technologies

Background: The application of rehabilitation robots has grown during the last decade. While meta-analyses have shown beneficial effects of robotic interventions for some patient groups, the evidence is less in others. We established the Advanced Robotic Therapy Integrated Centers (ARTIC) network with the goal of advancing the science and clinical practice of rehabilitation robotics. The investigators hope to exploit variations in practice to learn about current clinical application and outcomes. The aim of this paper is to introduce the ARTIC network to the clinical and research community, present the initial data set and its characteristics and compare the outcome data collected so far with data from prior studies. Methods: ARTIC is a pragmatic observational study of clinical care. The database includes patients with various neurological and gait deficits who used the driven gait orthosis Lokomat® as part of their treatment. Patient characteristics, diagnosis-specific information, and indicators of impairment severity are collected. Core clinical assessments include the 10-Meter Walk Test and the Goal Attainment Scaling. Data from each Lokomat® training session are automatically collected. Results: At time of analysis, the database contained data collected from 595 patients (cerebral palsy: n = 208; stroke: n = 129; spinal cord injury: n = 93; traumatic brain injury: n = 39; and various other diagnoses: n = 126). At onset, average walking speeds were slow. The training intensity increased from the first to the final therapy session and most patients achieved their goals. Conclusions: The characteristics of the patients matched epidemiological data for the target populations. When patient characteristics differed from epidemiological data, this was mainly due to the selection criteria used to assess eligibility for Lokomat® training. While patients included in randomized controlled interventional trials have to fulfill many inclusion and exclusion criteria, the only selection criteria applying to patients in the ARTIC database are those required for use of the Lokomat®. We suggest that the ARTIC network offers an opportunity to investigate the clinical application and effectiveness of rehabilitation technologies for various diagnoses. Due to the standardization of assessments and the use of a common technology, this network could serve as a basis for researchers interested in specific interventional studies expanding beyond the Lokomat®

Longitudinal analysis of the recovery of trunk control and upper extremity following stroke: An individual growth curve approach

Background and Purpose: Trunk control is thought to contribute to upper extremity function. It is unclear whether recovery of trunk control has an impact on the recovery of the upper extremity in people with stroke. This longitudinal study monitored the recovery of trunk control and upper extremity in the first 6 months following stroke.Methods: Forty-five participants with stroke were assessed monthly for 6 months following stroke. Trunk control was assessed using the Trunk Impairment Scale (TIS); upper extremity impairment and function were assessed with the Fugl-Meyer (FMA) and Streamlined Wolf Motor Function Test (SWMFT) respectively. The SWMFT included the performance time (SWMFT-Time) and functional ability scale (SWMFT-FAS). The individual growth curve modeling was used to analyze the longitudinal data.Results: The recovery curve of TIS, FMA, SWMFT-Time and SWMFT-FAS followed a quadratic trend, with the rate of recovery decreasing from the first to sixth month. As TIS score improved over time, FMA, SWMFT-Time and SWMFT-FAS improved in parallel with the TIS score. TIS at each time point was found to be a significant predictor of FMA, SWMFT-Time and SWMFT-FAS at 6 months post stroke.Conclusion: Our work has provided, for the first time, substantial evidence that the pattern of recovery of trunk control is similar to that of the recovery of upper extremity following stroke. In addition, this study provides evidence on which to design a prospective study to evaluate whether improvement in trunk control early post-stroke results in better long-term upper extremity function

Personalized Healthcare: A Comprehensive Approach for Symptom Diagnosis and Hospital Recommendations Using AI and Location Services

Utilizing digital advancements, an integrated Flask-based platform has been engineered to centralize personal health records and facilitate informed healthcare decisions. The platform utilizes a Random Forest model-based symptom checker and an OpenAI API-powered chatbot for preliminary disease diagnosis and integrates Google Maps API to recommend proximal hospitals based on user location. Additionally, it contains a comprehensive user profile encompassing general information, medical history, and allergies. The system includes a medicine reminder feature for medication adherence. This innovative amalgamation of technology and healthcare fosters a user-centric approach to personal health management

Fall inducing movable platform (FIMP) for overground trips and slips

Background: The study of falls and fall prevention/intervention devices requires the recording of true falls incidence. However, true falls are rare, random, and difficult to collect in real world settings. A system capable of producing falls in an ecologically valid manner will be very helpful in collecting the data necessary to advance our understanding of the neuro and musculoskeletal mechanisms underpinning real-world falls events. Methods: A fall inducing movable platform (FIMP) was designed to arrest or accelerate a subject’s ankle to induce a trip or slip. The ankle was arrested posteriorly with an electromagnetic brake and accelerated anteriorly with a motor. A power spring was connected in series between the ankle and the brake/motor to allow freedom of movement (system transparency) when a fall is not being induced. A gait phase detection algorithm was also created to enable precise activation of the fall inducing mechanisms. Statistical Parametric Mapping (SPM1D) and one-way repeated measure ANOVA were used to evaluate the ability of the FIMP to induce a trip or slip. Results: During FIMP induced trips, the brake activates at the terminal swing or mid swing gait phase to induce the lowering or skipping strategies, respectively. For the lowering strategy, the characteristic leg lowering and subsequent contralateral leg swing was seen in all subjects. Likewise, for the skipping strategy, all subjects skipped forward on the perturbed leg. Slip was induced by FIMP by using a motor to impart unwanted forward acceleration to the ankle with the help of friction-reducing ground sliding sheets. Joint stiffening was observed during the slips, and subjects universally adopted the surfing strategy after the initial slip. Conclusion: The results indicate that FIMP can induce ecologically valid falls under controlled laboratory conditions. The use of SPM1D in conjunction with FIMP allows for the time varying statistical quantification of trip and slip reactive kinematics events. With future research, fall recovery anomalies in subjects can now also be systematically evaluated through the assessment of other neuromuscular variables such as joint forces, muscle activation and muscle forces.National Medical Research Council (NMRC)National Research Foundation (NRF)Published versionThis research is supported by the National Research Foundation Singapore under its National Innovation Challenge on Active and Confident Ageing (MOH/NIC/EIG01/2017) and administered by the Singapore Ministry of Health’s National Medical Research Council

Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis

BACKGROUND: Post-stroke trunk control is reported to be associated with trunk performance and recovery of the upper limb, but the evidence for the influence of trunk exercise on both of these is unclear.Objective: To evaluate the effect of trunk exercises on trunk performance post-stroke, and to determine if these exercises result in improved upper limb function.METHODS: A comprehensive search of the literature published between January 1990 and February 2017 was conducted using the following electronic databases; AMED, CINAHL, Cochrane Library, EMBASE, MEDLINE, PsychInfo and SPORTDiscus. Only randomized, controlled trials, published in English, evaluating the effect of trunk exercises on trunk performance and/or upper limb function post-stroke, were included.RESULTS: A total of 17 studies involving 599 participants were analysed. Meta-analysis showed that trunk exercises had large significant effect on trunk performance post-stroke. This effect varied from very large for acute stroke to medium for subacute and chronic stroke. None of the included studies had measured the effect of trunk exercise on upper limb impairment or functional activity.CONCLUSIONS: Trunk exercises improve trunk performance for people with acute, subacute and chronic stroke. As yet there is no evidence to support the effect of trunk exercise on upper limb function.<br/

Instrumented Trunk Impairment Scale (iTIS): a reliable measure of trunk impairment in the stroke population

Background: the Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS).Objective: this study aims to investigate the intra-rater and inter-rater reliability of the iTIS in chronic stroke patients.Method: trunk impairment was assessed in 20 patients with stroke using the iTIS Valedo system; three sensors were fixed to the skin on the sternum, L1 and S1 levels. Interclass correlation coefficients were used to assess the inter-rater and intra-rater reliability (between days) with 95% CI.Results: reliability for the dynamic subscale parameters was good to excellent (intra-rater ICC = 0.60–0.95; inter-rater ICC = 0.59–0.93); however, reliability for the coordination parameters was poor to good (intra-rater ICC = 0.05–0.72) and poor to excellent (inter-rater ICC = 0.04–0.78).Conclusion: the iTIS demonstrates an acceptable level of reliability for dynamic subscale measurement in research and clinical practice. Further studies could use larger sample sizes and improve the iTIS methodology by employing additional sensors on the limbs to detect compensatory movements.<br/

Concurrent validity of a novel wireless inertial measurement system for assessing trunk impairment in people with stroke

Background: The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk impairment post-stroke. Objective: This study investigates the concurrent and discriminant ability of the iTIS in chronic stroke participants. Method: Forty participants (20 with chronic stroke, 20 healthy, age-matched) were assessed using the TIS and iTIS simultaneously. A Spearman rank correlation coefficient was used to examine concurrent validity. A ROC curve was used to determine whether the iTIS could distinguish between stroke participants with and without trunk impairment. Results: A moderate relationship was found between the observed iTIS parameters and the clinical scores, supporting the concurrent validity of the iTIS. The small sample size meant definitive conclusions could not be drawn about the parameter differences between stroke groups (participants scoring zero and one on the clinical TIS) and the parameter cut-off points. Conclusion: The iTIS can detect small changes in trunk ROM that cannot be observed clinically. The iTIS has important implications for objective assessments of trunk impairment in clinical practice.</p