Design and Control of Robotic Systems for Lower Limb Stroke Rehabilitation

Lower extremity stroke rehabilitation exhausts considerable health care resources, is labor intensive, and provides mostly qualitative metrics of patient recovery. To overcome these issues, robots can assist patients in physically manipulating their affected limb and measure the output motion. The robots that have been currently designed, however, provide assistance over a limited set of training motions, are not portable for in-home and in-clinic use, have high cost and may not provide sufficient safety or performance. This thesis proposes the idea of incorporating a mobile drive base into lower extremity rehabilitation robots to create a portable, inherently safe system that provides assistance over a wide range of training motions. A set of rehabilitative motion tasks were established and a six-degree-of-freedom (DOF) motion and force-sensing system was designed to meet high-power, large workspace, and affordability requirements. An admittance controller was implemented, and the feasibility of using this portable, low-cost system for movement assistance was shown through tests on a healthy individual. An improved version of the robot was then developed that added torque sensing and known joint elasticity for use in future clinical testing with a flexible-joint impedance controller

Design and Evaluation of a Soft Robotic Hand Orthosis with People with Severe Hand Impairment after Stroke

Fifteen million individuals worldwide experience a stroke each year with 50,000 of these cases occurring in Canada. Approximately one-third never fully recover the hand function required to perform activities of daily living independently. The goal of this thesis was to design a usable and accessible robot that provides the necessary assistive forces to move the affected hand after stroke into functional extension and grasp postures. The robot was iteratively designed with occupational therapists and people after stroke to create and update the design specifications and mechanical, electrical and software design choices. Successive design and evaluation cycles of the Hand Extension Robot Orthosis (HERO) are discussed. The successive design iterations were evaluated by a total of 30 participants with severe hand impairment after stroke. The iterations were increasingly effective in assisting flaccid and clenched finger extension, range of motion and grip force. With the final iteration, My-HERO, established criteria for clinically meaningful important difference thresholds were surpassed by all participants for the Fugl-Meyer Assessment-Hand and the majority of participants for the Chedoke Arm and Hand Activity Inventory-13. The majority of participants were satisfied with My-HERO and desired to use it in the clinic and at home for rehabilitation and assistance during their therapy and daily routines. This work presents novel robotic hand orthoses and novel methods for controlling them. This work shows how well robotic hand orthoses extend flaccid and clenched fingers, increase range of motion and grip strength, and enhance hand function and performance on daily living tasks. Therapists and people after stroke should use this information when planning how to incorporate these devices into therapy and daily routines. This work shows it is feasible to use a user-centred design process to develop usable adaptive and rehabilitation technology.Ph.D

A Field Study of Older Adults with Cognitive Impairment using Tablets for Communication at Home: Closing Technology Adoption Gaps using InTouch

This article describes how a tablet-based communication technology designed for older adults was explored for its adoption and impact on family relationships. A case study methodology was employed to collect and analyze interviews, field notes, observations and messaging activity over a 12 week period. Twelve participants, eight with a Montreal Cognitive Assessment (MoCA) score suggestive of Mild Cognitive Impairment (MCI), were paired with a student to learn and use InTouch. 1212 messages were sent, from which text, audio, photo, and video data types were used 705, 280, 143 and 84 times, respectively. Most participants voiced that personalized text messaging was not the easiest feature to use, but was their preferred mode. Two participants used audio more than text, highlighting a need for feature customization. Older adults view a simplified tablet-based interface as a valuable means of enhancing communication with friends and family. With guided weekly support older adults learned to use this technology independently and integrated its use into their daily lives.This work was supported by AGE-WELL NCE Inc., a member of the Networks of Centres of Excellence program

Hand Extension Robot Orthosis (HERO) Glove: Development and Testing With Stroke Survivors With Severe Hand Impairment

The hand extension robot orthosis (HERO) glove was iteratively designed with occupational therapists and stroke survivors to enable stroke survivors with severe hand impairment to grasp and stabilize everyday objects, while being portable, lightweight, and easy to set up and use. The robot consists of a batting glove with artificial tendons embedded into the glove's fingers. The tendons are pulled and pushed by a linear actuator to extend and flex the fingers. The robot's finger extension and grasp assistance are automated using inertial measurement unit signal thresholds. Five stroke survivors (Chedoke McMaster Stroke Assessment - Stage of Hand 1-3) put on the HERO Glove in 1-3 minutes, with assistance. The stroke survivors performed significantly better on the Box and Block Test (2.8 more blocks transferred, ) while wearing the HERO Glove than when not wearing the glove. Four stroke survivors could only transfer blocks while wearing the HERO Glove. The HERO Glove enabled these stroke survivors to more fully extend their index finger (an increase of 97.5°, ) and three of five stroke survivors were better able grasp a water bottle. Therapists and stroke survivors suggested increasing the HERO Glove's grip force assistance and valued the glove's portability, lightweight design and potential usefulness in assisting with task-based therapy

Do Stroke Survivors Activate Their Muscles to Supplement the Hand Extension Robot Orthosis (HERO) Glove's Assistance?

The Hand Extension Robot Orthosis (HERO) Glove enables stroke survivors with severe hand impairment to perform activities of daily living more independently. OBJECTIVE: To determine whether stroke survivors show voluntary activation of the forearm muscles while using the HERO Glove. METHODS: Three stroke survivors (Chedoke McMaster Stroke Assessment – Stage of Hand 1-3/7) performed maximum voluntary contractions (MVC), the box and block test and a water bottle grasp and lift task while using the HERO Glove and wearing the Myo Armband for muscle activity measurement. RESULTS: Three stroke survivors with severe hand impairment showed varied levels of muscle activation while using the HERO Glove. One participant with a Stage 3 Hand and strong grip strength (55N) showed generalized activation of the forearm flexor and extensor muscles (33% MVC) while grasping the blocks and water bottle, which supplemented the HERO Glove’s assistance. The participant relaxed the forearm muscles while releasing the blocks and water bottle. One participant with a clenched Stage 3 Hand and weak pinch strength (10N) showed generalized forearm muscle activation (30% MVC) that did not relax while releasing the blocks or water bottle. The participant with a Stage 1 Hand (flaccid paralysis) did not show muscle activation during either task. IMPLICATIONS: This analysis demonstrates that a variety of sensors, control modes and training strategies are required to detect the intent of users at higher and lower stages of recovery. This analysis provides support for using the HERO Glove as an assistive device for stroke survivors at lower stages of recovery and as a neuromuscular rehabilitation tool for stroke survivors at higher stages of recovery.Canadian Partnership for Stroke Recovery, IATSL, AGEWELL, NSERG CRSNG, UHN Toronto Rehabilitation Institute, University of Toronto, Neil Squire Society, IC-IMPACT

3-Dimensional printing in rehabilitation: feasibility of printing an upper extremity gross motor function assessment tool

Abstract Background Use of standardized and scientifically sound outcome measures is encouraged in clinical practice and research. With the development of newer rehabilitation therapies, we need technology-supported upper extremity outcome measures that are easily accessible, reliable and valid. 3‐Dimensional printing (3D-printing) has recently seen a meteoric rise in interest within medicine including the field of Physical Medicine and Rehabilitation. The primary objective of this study was to evaluate the feasibility of designing and constructing a 3D printed version of the Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT). The TRI-HFT is an upper extremity gross motor function assessment tool that measures function at the intersection of the International Classification of Function’s body structure and function, and activity domain. The secondary objective was to assess the preliminary psychometrics of this test in individuals with stroke. Results 3D design files were created using the measurements of the original TRI-HFT objects. The 3D printed objects were then compared to the original test objects to ensure that the original dimensions were preserved. All objects were successfully printed except the sponge and paper which required some modification. The error margin for weight of the objects was within 10% of the original TRI-HFT for the rest of the objects. Nine participants underwent the following assessments: the Chedoke Arm and Hand Activity Inventory (CAHAI), Fugl Meyer Assessment-Hand (FMA-Hand), Chedoke McMaster stages of recovery of the arm (CMSA-Arm) and Chedoke McMaster stages of recovery of the hand (CMSA-Hand) and the 3D TRI-HFT for assessment of psychometric properties of the test. The video recorded assessment of the 3D TRI-HFT was used for reliability testing. Construct validity was assessed by comparing the scores on 3D TRI-HFT with the scores on CAHAI, CMSA-Arm, CMSA-Hand and FMA-Hand. The 3D TRI-HFT had high inter-rater reliability (Intra-Class Correlation Co-efficient (ICC) of 0.99; P < 0.000), high intra-rater reliability (ICC of 0.99; P < 0.000) and moderate-to-strong correlation with the CMSA-Arm, CMSA-Hand and FMA-Hand scores. Conclusions The TRI-HFT could be successfully 3D printed and initial testing indicates that the test is a reliable and valid measure of upper extremity motor function in individuals with stroke