Design and implementation of robotic devices for physical therapy of distal upper extremity

According to statistics of World Health Organization, hand injuries count for 1/3 of all injuries with more than one million emergency cases annually. Physical rehabilitation accounts for most of the recovery experienced by patients suffering from hand injury. Robotic devices decrease the cost of therapy while providing repetitive exercises with quantitative measurements. In this study, we present the design and implementation of two robotic devices for hand therapy. After kinematic type selection ensuring safety, ergonomics and adjustability; both of the devices are optimally dimensioned to achieve best kinematic and dynamic performance. The primary use for the first device is to assist flexion/extension motions of a finger within its full range, in a natural and coordinated manner, while keeping the tendon tension within acceptable limits to avoid rupture of the suture. The second device is designed for forearm/wrist and grasp therapy of a neurologically injured human arm and hand. Emphasizing the importance of coordinated movements of the wrist and the hand while performing activities of daily living (ADL) tasks, the device possesses 3 degrees of freedom and is designed to assist abduction/adduction and palmar/dorsal flexion of the wrist or pronation/supination of the forearm, concurrently with the grasping and releasing movements of the hand. Thanks to its modular, interchangeable end effectors, the device supports ADL exercises. Both devices are built and experimentally characterized. Human subject experiments and usability tests have been conducted for the devices and the efficacy of devices to deliver desired wrist and hand therapies have been demonstrated

A multi-functional rehabilitation device to assist forearm/wrist and grasp therapies

We present a novel rehabilitation device for forearm/wrist and grasp therapy of a neurologically injured human arm and hand. Emphasizing the importance of coordinated movements of the wrist and hand while performing activities of daily living (ADL) tasks, the device is designed to assist abduction/adduction and palmar/dorsal flexion of the wrist and pronation/supination of the forearm, concurrently with grasping and releasing movements of hand. Thanks to its modular, interchangeable end-effectors, the device supports ADL exercises, such as door opening. It can also be used as a measurement device, to characterize the range of motion and the isometric strength of the injured forearm/wrist and hand. Usability studies have been conducted and accuracy of the measurements provided with the device has been characterized

AssistOn-Finger: An under-actuated finger exoskeleton for robot-assisted tendon therapy

We present AssistOn-Finger, a novel under-actuated active exoskeleton for robot-assisted tendon therapy of human fingers. The primary use for the exoskeleton is to assist flexion/extension motions of a finger within its full range, while decreasing voluntary muscle contractions helping to keep the tendon tension levels to stay within acceptable limits, avoiding gap formation or rupture of the suture. The device can also be employed to administer range of motion (RoM)/strengthening exercises. AssistOn-Finger is designed to be passively back-driveable, can cover the whole RoM of patients, and can do so in a natural and coordinated manner. In particular, the device employs human finger as an integral part of its kinematics and when coupled to a human operator, the parallel kinematic structure of exoskeleton supports three independent degrees of freedom, dictated by the kinematics of the human finger. Automatically aligning its joint axes to match finger joint axes, AssistOn-Finger can guarantee ergonomy and comfort throughout the therapy. The self-aligning feature also significantly shortens the setup time required to attach the patient to the exoskeleton. We present the kinematic type selection for the exoskeleton to satisfy the design requirements for tendon therapy applications, detail optimal dimensional synthesis of the device considering trade-offs between multiple design criteria and discuss implementation details of the exoskeleton. We also present feasibility studies conducted on healthy volunteers and provide statistical evidence on the efficacy of exoskeleton driven exercises in keeping the average muscle recruitment and the maximum tendon tension levels as low as human guided therapies

Comparison of the Cyclic Fatigue Resistance of 5 Different Rotary Pathfinding Instruments Made of Conventional Nickel-Titanium Wire, M-wire, and Controlled Memory Wire

WOS: 000353076700019PubMed ID: 25510316Introduction: This study compared the cyclic fatigue resistance of current nickel-titanium rotary path-finding instruments. Methods: Five types of nickel-titanium rotary pathfinding instruments were used in steel canals with a 90 degrees curvature and a curvature radius of 3 mm (n = 10) and 5 mm (n = 10). The cyclic fatigue of the following instruments was tested at 4 mm from the tip: PathFile (#16 and a .02 taper; Dentsply Maillefer, Ballaigues, Switzerland), G-File (#12 and a .03 taper; Micro-Mega, Besancon Cedex, France), Scout Race (#15 and a .02 taper; FKG Dentaire, La Chaux-de-Fonds, Switzerland), HyFlex GPF (#15 and a .02 taper; Coltene-Whaledent, Allstetten, Switzerland), and ProGlider (#16 with a mean taper of .04125 and a .02 at the first 4 mm from the tip, Dentsply Maillefer). The length of the fractured parts was measured, and the number of cycles to fracture (NCF) was calculated. The data were statistically analyzed using Kruskal-Wallis and MannWhitney tests (alpha =.05). After Bonferroni correction, the new P value was set as .005. Results: The difference in the cyclic fatigue of all the files at both curvatures was statistically significant (P values from .0035 to less than .0001). The ranking of the instruments from the highest to the lowest NCF was as follows: HyFlex GPF, G files, ProGlider, PathFile, and Scout Race. The length of the fractured part of the instruments was similar in all the groups > .05). All the tested instruments had a lower NCF at a curvature radius of 3 mm when compared with a curvature radius of 5 mm (P < .0001). Conclusions: Within the limitations of this study, the cyclic fatigue resistance of the HyFlex GPF instrument was the highest, and the curvature radius had a significant effect on the fatigue resistance

The Role of Serum Caspase 3 Levels in Prediction of Endometriosis Severity

Background/Aims: To identify the role of serum caspase 3, Annexin A2 (ANXA2), and Soluble Fas Ligand (sFasL) levels in the prediction of endometriosis severity. Methods: The study was performed on 90 women who were candidates for laparoscopic surgery due to endometrioma or any other benign ovarian cysts detected by ultrasound examination, pelvic pain, or infertility. The control group comprised 29 patients. The second group comprised 29 patients with stage I-II endometriosis and the third group comprised 30 patients with stage III-IV endometriosis. Results: Significant differences were detected between the control and stage III-IV endometriosis groups and between stage I-II and stage III-IV endometriosis groups in terms of caspase-3 levels (both, p < 0.001), ANXA2 levels (p = 0.007 and p = 0.002), and sFasL levels (p = 0.022 and p = 0.044). After receiver operating characteristic analysis, the area under curve was 93% (95% CI 57-82) at 10.7 ng/mL cut-off level for caspase-3 with 90% sensitivity and 87% specificity. Conclusion: Serum caspase-3 level may be a reliable predictor of endometriosis severity. (c) 2018 S. Karger AG, Base