There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.

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Review of control strategies for robotic movement training after neurologic injury

This document provides a review of the techniques and therapies used in gait rehabilitation after stroke. It also examines the possible benefits of including assistive robotic devices and brain-computer interfaces in this field, according to a top-down approach, in which rehabilitation is driven by neural plasticity. The methods reviewed comprise classical gait rehabilitation techniques (neurophysiological and motor learning approaches), functional electrical stimulation (FES), robotic devices, and brain-computer interfaces (BCI). From the analysis of these approaches, we can draw the following conclusions. Regarding classical rehabilitation techniques, there is insufficient evidence to state that a particular approach is more effective in promoting gait recovery than other. Combination of different rehabilitation strategies seems to be more effective than over-ground gait training alone. Robotic devices need further research to show their suitability for walking training and their effects on over-ground gait. The use of FES combined with different walking retraining strategies has shown to result in improvements in hemiplegic gait. Reports on non-invasive BCIs for stroke recovery are limited to the rehabilitation of upper limbs; however, some works suggest that there might be a common mechanism which influences upper and lower limb recovery simultaneously, independently of the limb chosen for the rehabilitation therapy. Functional near infrared spectroscopy (fNIRS) enables researchers to detect signals from specific regions of the cortex during performance of motor activities for the development of future BCIs. Future research would make possible to analyze the impact of rehabilitation on brain plasticity, in order to adapt treatment resources to meet the needs of each patient and to optimize the recovery process.

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Rehabilitation of gait after stroke: a review towards a top-down approach.

This paper presents a survey of existing robotic systems for lower-limb rehabilitation. It is a general assumption that robotics will play an important role in therapy activities within rehabilitation treatment. In the last decade, the interest in the field has grown exponentially mainly due to the initial success of the early systems and the growing demand caused by increasing numbers of stroke patients and their associate rehabilitation costs. As a result, robot therapy systems have
been developed worldwide for training of both the upper and lower extremities. This work reviews all current robotic systems to date for lower-limb rehabilitation, as well as main clinical tests performed with them, with the aim of showing a clear starting point in the field. It also remarks some challenges that current systems still have to meet in order to obtain a broad clinical and market acceptance.

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Lower-Limb Robotic Rehabilitation: Literature Review and Challenges

This article discusses the pros and cons of compliant actuation for rehabilitation robots on the example of LOPES, focusing on the cons. After illustrating the bandwidth limitations, a new result has been derived: if stability in terms of passivity of the haptic device is desired, the renderable stiffness is bounded by the stiffness of the SEA's elastic component. In practical experiments with the VMC, the aforementioned limitations affected the control performance. Desired gait modifications were not tracked exactly, because the subjects were able to deviate from the prescribed pattern even in the stiffest possible configuration. Despite the limitations, the practical experiments also demonstrated the general effectiveness of the realization. Manipulation of selected gait parameters is possible, whereby other parameters are left unaffected. This high selectivity is made possible by the low level of undesired interaction torques, which is achieved by elastic decoupling of motor mass and a lightweight exoskeleton. The discrepancy between theoretical bounds and rendered stiffness indicated that healthy subjects might represent a stabilizing component of the coupled system, which could be different for patients. In light of the theoretical stability analysis and with the focus on patients, the LOPES actuation was slightly modified. The robot was equipped with stiffer springs to obtain sufficient stiffness and to ensure stability without relying on stabilizing effects of the human. For this application, the disadvantages of compliant actuation can thus be tolerated or dealt with, and they are small compared with the advantages. Given that a rehabilitation robot, in the first place, is supposed to imitate therapist action, the limitations of bandwidth and stiffness do not pose severe problems. In contrast, safety and backdrivability are highly relevant, and they can be ensured easier with a compliant actuator. Therefore, we conclude that compliant actuation and a lightweight exoskeleton provide effective means to accomplish the desired AAN behavior of a rehabilitation robot. The next step is to evaluate the robot behavior, control performance, and therapeutic effectiveness in patient studies.

Compliant actuation of rehabilitation robots

One of the challenges facing prosthetic designers and engineers is to restore the missing sensory function inherit to hand amputation. Several different techniques can be employed to provide amputees with sensory feedback: sensory substitution methods where the recorded stimulus is not only transferred to the amputee, but also translated to a different modality (modality-matched feedback), which transfers the stimulus without translation and direct neural stimulation, which interacts directly with peripheral afferent nerves. This paper presents an overview of the principal works and devices employed to provide upper limb amputees with sensory feedback. The focus is on sensory substitution and modality matched feedback; the principal features, advantages and disadvantages of the different methods are presented.

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Sensory feedback in upper limb prosthetics.

The KineAssist is a robotic device for gait and balance training. A user-needs analysis led us to focus on increasing the level of challenge to a patient's ability to maintain balance during gait training, and also on maintaining direct involvement of a physical therapist (rather than attempting robotic replacement.) The KineAssist provides partial body weight support and postural torques on the torso; allows many axes of motion of the trunk as well as of the pelvis; leaves the patient's legs accessible to a physical therapist during walking; servo-follows a patient's walking motions overground in forward, rotation, and sidestepping directions; and catches a patient who begins to fall. Design and development of the KineAssist proceeded more rapidly in the context of a small company than would have been possible in most research contexts. A prototype KineAssist has been constructed, and has received FDA approval and IRB clearance for initial human studies. We describe the KineAssist's motivation, design, and use.

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KineAssist: a robotic overground gait and balance training device

We have developed three different versions of a multifunction haptic device that can display touch, pressure, vibration, shear force, and temperature to the skin of an upper extremity amputee, especially the one who has undergone targeted nerve reinnervation (TR) surgery. In TR patients, sensation from the reinnervated skin is projected to the missing hand. This paper addresses the design of the mechanical display, the portion responsible for contact, pressure, vibration, and shear force. A variety of different overall design approaches satisfying the design specifications and the performance requirements are considered. The designs of the fully prototyped haptic devices are compared through open-loop frequency response, closed-loop force response, and tapping response in constrained motion. We emphasize the tradeoffs between key design factors, including force capability, workspace, size, bandwidth, weight, and mechanism complexity.

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On the Design of Miniature Haptic Devices for Upper Extremity Prosthetics

We have been developing a miniature haptic device - a tactor that can display pressure, vibration, shear force, and temperature to the skin of upper extremity amputees, especially those who have undergone targeted nerve rein-nervation (TRI) surgery. In TRI patients, regions of the rein-nervated skin are perceived as being on the phantom hand. This paper presents the mechanical design of the tactor.

J.J. Santos-Munne

Papers

KineAssist: a robotic overground gait and balance training device

On the Design of Miniature Haptic Devices for Upper Extremity Prosthetics

A Miniature Tactor Design for Upper Extremity Prosthesis