https://biodesign.seas.harvard.edu/files/biodesignlab/files/2015_-_polygerinos_-_soft_robotic_glove_for_combined_assistance_and_at-home_rehabilitation.pdf

Soft robotic glove for combined assistance and at-home rehabilitation

Since the late 1990s, there has been a burst of research on robotic devices for poststroke rehabilitation. Robot-mediated therapy produced improvements on recovery of motor capacity; however, so far, the use of robots has not shown qualitative benefit over classical therapist-led training sessions, performed on the same quantity of movements. Multidegree-of-freedom robots, like the modern upper-limb exoskeletons, enable a distributed interaction on the whole assisted limb and can exploit a large amount of sensory feedback data, potentially providing new capabilities within standard rehabilitation sessions. Surprisingly, most publications in the field of exoskeletons focused only on mechatronic design of the devices, while little details were given to the control aspects. On the contrary, we believe a paramount aspect for robots potentiality lies on the control side. Therefore, the aim of this review is to provide a taxonomy of currently available control strategies for exoskeletons for neurorehabilitation, in order to formulate appropriate questions toward the development of innovative and improved control strategies.

/pdf/upper-limb-robotic-exoskeletons-for-neurorehabilitation-a-1vg72yu5h7.pdf

Upper-Limb Robotic Exoskeletons for Neurorehabilitation: A Review on Control Strategies

Repeated use of brain-computer interfaces (BCIs) providing contingent sensory feedback of brain activity was recently proposed as a rehabilitation approach to restore motor function after stroke or spinal cord lesions. However, there are only a few clinical studies that investigate feasibility and effectiveness of such an approach. Here we report on a placebo-controlled, multicenter clinical trial that investigated whether stroke survivors with severe upper limb (UL) paralysis benefit from 10 BCI training sessions each lasting up to 40 min. A total of 74 patients participated: median time since stroke is 8 months, 25 and 75% quartiles [3.0; 13.0]; median severity of UL paralysis is 4.5 points [0.0; 30.0] as measured by the Action Research Arm Test, ARAT, and 19.5 points [11.0; 40.0] as measured by the Fugl-Meyer Motor Assessment, FMMA. Patients in the BCI group (n = 55) performed motor imagery of opening their affected hand. Motor imagery-related brain electroencephalographic activity was translated into contingent hand exoskeleton-driven opening movements of the affected hand. In a control group (n = 19), hand exoskeleton-driven opening movements of the affected hand were independent of brain electroencephalographic activity. Evaluation of the UL clinical assessments indicated that both groups improved, but only the BCI group showed an improvement in the ARAT's grasp score from 0 [0.0; 14.0] to 3.0 [0.0; 15.0] points (p < 0.01) and pinch scores from 0.0 [0.0; 7.0] to 1.0 [0.0; 12.0] points (p < 0.01). Upon training completion, 21.8% and 36.4% of the patients in the BCI group improved their ARAT and FMMA scores respectively. The corresponding numbers for the control group were 5.1% (ARAT) and 15.8% (FMMA). These results suggests that adding BCI control to exoskeleton-assisted physical therapy can improve post-stroke rehabilitation outcomes. Both maximum and mean values of the percentage of successfully decoded imagery-related EEG activity, were higher than chance level. A correlation between the classification accuracy and the improvement in the upper extremity function was found. An improvement of motor function was found for patients with different duration, severity and location of the stroke.

/pdf/post-stroke-rehabilitation-training-with-a-motor-imagery-appkr00z9p.pdf

Post-stroke Rehabilitation Training with a Motor-Imagery-Based Brain-Computer Interface (BCI)-Controlled Hand Exoskeleton: A Randomized Controlled Multicenter Trial

In this paper, we present the design of a soft wearable exoskeleton that comprises of a glove embedded with pneumatic actuators of variable stiffness for hand assistive and rehabilitation application. The device is lightweight and easily wearable due to the usage of soft pneumatic actuators. A key feature of the device is the variable stiffness of the actuators at different localities that not only conform to the finger profile during actuation, but also provides customizability for different hand dimensions. The actuators can achieve different bending profiles with variable stiffness implemented at different localities. Therefore, the device is able to perform different hand therapy exercises such as full fist, straight fist, hook fist and table top. The device was characterized in terms of its range of motion and maximum force output. Experiments were conducted to examine the differences between active and passive actuation. The results showed that the device could achieve hand grasping and pinching with acceptable range of motion and force.

A soft exoskeleton for hand assistive and rehabilitation application using pneumatic actuators with variable stiffness

The past decades have seen rapid and vast developments of robots for the rehabilitation of sensorimotor deficits after damage to the central nervous system (CNS). Many of these innovations were technology-driven, limiting their clinical application and impact. Yet, rehabilitation robots should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients, but many challenges remain. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. Consequently, the design of rehabilitation robots requires a combination of specialized engineering and neurophysiological knowledge. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices. This review summarizes the evolution of the field of rehabilitation robotics, as well as the current state of clinical evidence. It highlights fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury, and discusses their implications for the development of effective rehabilitation robots. It thus provides insights on essential neurophysiological mechanisms to be considered for a successful development and clinical inclusion of robots in rehabilitation.

/pdf/rehabilitation-robots-for-the-treatment-of-sensorimotor-4a5mxvvb19.pdf

Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective.

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future The patient population needing physical rehabilitation of the upper extremity is also constantly increasing Robotic devices have the potential to address this problem as noted by the results of recent research studies However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems

/pdf/a-survey-on-robotic-devices-for-upper-limb-rehabilitation-3ykq953s17.pdf

A survey on robotic devices for upper limb rehabilitation

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future. The patient population needing physical rehabilitation of the upper extremity is also constantly increasing. Robotic devices have the potential to address this problem as noted by the results of recent research studies. However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement. The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices. In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation. This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems.

A survey on robotic devices for upper limb

While contactless vital sign monitoring technologies provide the great opportunity of fast and simple measurements, all these technologies have the unavoidable drawback that they suffer from strong motion artifacts. These motion artifacts may severely disrupt the signal of interest, which could lead to false peak detections and hence, result in false conclusions or diagnoses. Extensive and robust signal processing is needed for a reliable detection of these artifacts. In this work, a mathematical model of the motion artifacts is derived based on capacitive ECG measurements, as an example for contactless heart rate estimation. Thus, for the first time, it is possible to generate an arbitrary large database of heavily distorted capacitive ECG signals to test and verify algorithms for the robust detection of motion artifacts.

/pdf/modeling-of-motion-artifacts-in-contactless-heart-rate-8gth0y02nh.pdf

Modeling of motion artifacts in contactless heart rate measurements

Adjustable compliance or variable stiffness actuators comprise an additional element to elastically decouple the actuator from the load and are increasingly applied to human-centered robotic systems. The advantages of such actuators are of paramount importance in rehabilitation robotics, where requirements demand safe interaction between the therapy system and the patient. Compliant actuator systems enable the minimization of large contact forces arising, for example, from muscular spasticity and have the ability to periodically store and release energy in cyclic movements. In order to overcome the loss of bandwidth introduced by the elastic element and to guarantee a higher range in force/torque generation, new actuator designs consider variable or nonlinear stiffness elements, respectively. These components cannot only be adapted to the walking speed or the patient condition, but also entail additional challenges for feedback control. This paper introduces a novel design method for an impedance-based controller that fulfills the control objectives and compares the performance and robustness to a classical cascaded control approach. The new procedure is developed using a non-standard positive-real Η2 controller design and is applied to a loop-shaping approach. Robust norm optimal controllers are designed with regard to the passivity of the actuator load-impedance transfer function and the servo control problem. Classical cascaded and positive-real Η2 controller designs are validated and compared in simulations and in a test bench using a passive elastic element of varying stiffness.

https://www.mdpi.com/2075-1702/2/2/134/pdf

Kurt Gerlach-Hahn

Papers

A survey on robotic devices for upper limb rehabilitation

A survey on robotic devices for upper limb

Modeling of motion artifacts in contactless heart rate measurements

Control of Adjustable Compliant Actuators

Biomimetic actuator control for a pneumatic cylinder