国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題

basic research and clinical data in an attempt to derive a cohesive model which explains the behavioral effects of the drug. Johnson is an experimental psychologist, and his work underlies many of the chapters which suggest that lithium decreases the behavioral response to novel external stimuli. He then utilizes this foundation to propose a cognitive model for lithium's anti-manic action, its inhibition of violent impulsivity, and its prophylactic effects in recurrent depression. Previous formulations which were clinically based, such as that of Mabel Blake Cohen and her associates, stressed the primacy of depression and noted the \"manic defense\" as an attempt to ward off intolerable depression. In direct contrast, Johnson views mania as the primary disturbance in bipolar disorder. He considers depression in bipolar disease as an over-zealous homeostatic inhibitory responsf to a maniaassociated cognitive overload. Consistent with this, he believes, lit lum exerts its anti-manic effect by decreasing cognitive processing in a manner analogous to his animal studies. Johnson also suggests that lithium exerts its prophylactic effect in recurrent depressions by treating subclinical mania. These concepts are supported by the work of Johnson's associate, Kukopulos, to whom the book is dedicated. The bulk of the research which describes the cognitive disturbance in mania is complex, however, and uncomfortably open to multiple interpretations. Recognized as a preliminary effort, Johnson's formulation may help to guide further research. Although Johnson clearly traces lithium actions through a broad range of subjects, his discussion of the neurophysiological aspects of this drug is notably spotty. In particular, Johnson ignores the work of Svensson, DeMontigny, Aghajanian, and others who suggest that serotonergic systems may play an important role in the antidepressant actions of lithium. As a result, he fails to discuss one of the most important current uses of lithium: as an agent used in conjunction with antidepressant medications to increase treatment response in medication-resistant forms of depression. Lithium augmentation of antidepressant medication also challenges the formulation presented by Johnson. This formulation suggests that lithium should have no therapeutic value in patients, such as those with endogenous depression, who already \"under-process\" cognitive information. The omission of lithium augmentation in depression is clearly unfortunate in this text. Overall, this volume demonstrates the benefits of a single-authored text. It it clearly organized and readable. The bibliography is also broad and useful. In this book, Johnson primarily addresses a research audience, and his model seems designed to stimulate thought rather than to improve clinical technique. In this capacity, his book will be of most interest to behavioral psychologists. Other books, focusing purely on clinical data, may be more useful to clinicians. Nevertheless, the clear organization, the large bibliography, and the thoughtful presentation may make this text a useful addition to a clinical library as well.

The Body in Pain: The Making and Unmaking of the World.

Purpose—The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods—Writing group members were nominated by th...

Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association

Advances in soft robotics, materials science, and stretchable electronics have enabled rapid progress in soft grippers. Here, a critical overview of soft robotic grippers is presented, covering different material sets, physical principles, and device architectures. Soft gripping can be categorized into three technologies, enabling grasping by: a) actuation, b) controlled stiffness, and c) controlled adhesion. A comprehensive review of each type is presented. Compared to rigid grippers, end-effectors fabricated from flexible and soft components can often grasp or manipulate a larger variety of objects. Such grippers are an example of morphological computation, where control complexity is greatly reduced by material softness and mechanical compliance. Advanced materials and soft components, in particular silicone elastomers, shape memory materials, and active polymers and gels, are increasingly investigated for the design of lighter, simpler, and more universal grippers, using the inherent functionality of the materials. Embedding stretchable distributed sensors in or on soft grippers greatly enhances the ways in which the grippers interact with objects. Challenges for soft grippers include miniaturization, robustness, speed, integration of sensing, and control. Improved materials, processing methods, and sensing play an important role in future research.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/adma.201707035

Soft Robotic Grippers.

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

Objective To classify and evaluate outcome measures currently used in robot-assisted exercise trials (RAET) in stroke, and to determine selection criteria for outcome measures in future trials. Methods Outcome measures used in RAET were identified from MEDLINE, EMBASE, CINAHL, PubMed and PsychINFO databases. The scale items were categorized into International Classification of Functioning Disability and Health (ICF) domains. The psychometric properties of scale were rated using a standardized pro forma. Results Thirty outcome measures were identified from 28 published RAET. Commonly used ICF body function scales were: Fugl-Meyer (FM) (24 studies), Modified Ashworth Scale (13 studies), Medical Research Council (11 studies), Kinematic measures (8 studies) and Motor Status Score (6 studies); ICF activity scale was Functional Independence Measure (FIMTM) (9 studies); ICF participation, personal and environmental factors scales were rarely used. Standard-ized rating identified that FM, kinematic measures, Action Research Arm Test, Wolf Motor Function Test, FIMTM, and ABILHAND have adequate measurement properties for use in RAET. Conclusion Some of the currently used outcome measures seem appropriate for RAET. The use of the ICF framework enables selection of an appropriate combination of outcome measures depending on patient characteristics, such as severity of weakness and chronicity of stroke impairments.

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Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke.

An integrated vehicle dynamics control system which aims to improve vehicle handling and stability by coordinating active front steering (AFS) and dynamic stability control (DSC) subsystems is developed in this paper. The DSC subsystem includes driveline-based, brake-based, and driveline plus brake-based DSC subsystems. The influence of varying forward speed and lateral acceleration on the lateral vehicle dynamics is investigated first. The AFS controller, which is used to improve vehicle steerability in the low to mid-range lateral acceleration, and the DSC controller, which manages to maintain vehicle stability during extreme driving situations, are then designed by using the sliding mode control (SMC) technique and phase plane method respectively. Based on the two independently developed controllers, a rule-based integration scheme is proposed to optimize the overall vehicle performance by minimizing interactions between the two subsystems and extending functionalities of individual subsystems. Computer simulation results confirm the effectiveness of the proposed control system and the overall improvements in vehicle handling and stability.

Coordination of active steering, driveline, and braking for integrated vehicle dynamics control

This paper describes the development and use of the cooperative control scheme used by the intelligent pneumatic arm movement (iPAM) system to deliver safe, therapeutic treatment of the upper limb during voluntary reaching exercises. A set of clinical and engineering requirements for the control scheme are identified and detailed, which entail controlled, coordinated movement of a dual robot system with respect to the human upper limb. This is achieved by using a 6-DOF model of the upper limb that forms the controller's coordinate system. An admittance control scheme is developed by using this coordinate system such that robotic assistance can be varied as appropriate. Key controller components are derived, including kinematic and force transformations between the upper limb model and the dual robot task space. The controller is tested using a computational simulation and with a stroke subject in the iPAM system. The results demonstrate that the control scheme can reliably coordinate the dual robots to assist upper limb movements. A discussion considers the ramifications of using the system in practice, including the effects of measurement errors and controller limitations. In conclusion, the iPAM system has been shown to be effective at delivering variable levels of assistance to the upper limb joints during therapeutic movements in a clinically appropriate manner.

A Control Strategy for Upper Limb Robotic Rehabilitation With a Dual Robot System

Robotic devices are traditionally actuated by hydraulic systems or electric motors. However, with the desire to make robotic systems more compact and versatile, new actuator technologies are required. In this paper, the control of ionic polymer metal composite actuators is investigated from a practical perspective. The actuator characteristics are examined through the unblocked maximum displacement and blocked force output. An open-loop position control and closed-loop position proportional-integral-derivative (PID) control are then applied to a strip of actuators. Finally, the performance of the polymer is investigated when implementing an impedance controller (force/position control).

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Control of ionic polymer metal composites

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The current literature has a paucity of robotic devices that have been tested in a home environment. The aim of this research project was to evaluate a robotic device Home-based Computer Assisted Arm Rehabilitation (hCAAR) that can be used independently at home by stroke survivors with upper limb weakness. hCAAR device comprises of a joystick handle moved by the weak upper limb to perform tasks on the computer screen. The device provides assistance to the movements depending on users ability. Nineteen participants (stroke survivors with upper limb weakness) were recruited. Outcome measures performed at baseline (A0), at end of 8-weeks of hCAAR use (A1) and 1 month after end of hCAAR use (A2) were: Optotrak kinematic variables, Fugl Meyer Upper Extremity motor subscale (FM-UE), Action Research Arm Test (ARAT), Medical Research Council (MRC) and Modified Ashworth Scale (MAS), Chedoke Arm and Hand Activity Inventory (CAHAI) and ABILHAND. Two participants were unable to use hCAAR: one due to severe paresis and the other due to personal problems. The remaining 17 participants were able to use the device independently in their home setting. No serious adverse events were reported. The median usage time was 433 minutes (IQR 250 – 791 min). A statistically significant improvement was observed in the kinematic and clinical outcomes at A1. The median gain in the scores at A1 were by: movement time 19%, path length 15% and jerk 19%, FM-UE 1 point, total MAS 1.5 point, total MRC 2 points, ARAT 3 points, CAHAI 5.5 points and ABILHAND 3 points. Three participants showed clinically significant improvement in all the clinical outcomes. The hCAAR feasibility study is the first clinical study of its kind reported in the current literature; in this study, 17 participants used the robotic device independently for eight weeks in their own homes with minimal supervision from healthcare professionals. Statistically significant improvements were observed in the kinematic and clinical outcomes in the study.

/pdf/home-based-computer-assisted-arm-rehabilitation-hcaar-4b364ckm6l.pdf

Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting

Martin Levesley

Papers

Systematic review of outcome measures used in the evaluation of robot-assisted upper limb exercise in stroke.

Coordination of active steering, driveline, and braking for integrated vehicle dynamics control

A Control Strategy for Upper Limb Robotic Rehabilitation With a Dual Robot System

Control of ionic polymer metal composites

Home-based Computer Assisted Arm Rehabilitation (hCAAR) robotic device for upper limb exercise after stroke: results of a feasibility study in home setting