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Medscape

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.

/pdf/review-of-control-strategies-for-robotic-movement-training-e0fqcpvct3.pdf

Review of control strategies for robotic movement training after neurologic injury

https://www.ipd.gu.se/digitalAssets/1252/1252566_Artikel_sept_Aina_Lancet_2_.pdf

Adolescent idiopathic scoliosis.

Spinal orthoses are common in the treatment of various conditions that affect the spine. They encompass both the spine and pelvis and thus have implications for pelvic and lower-limb motion during walking in addition to a direct effect on spinal motion. The role of the spine in walking is largely ill-defined, and the consequences of restricted spinal motion on walking have yet to be explored. This study investigated the effect of spinal restriction on gait in able-bodied persons. Gait analyses were performed on 10 able-bodied subjects as they walked at five different speeds that were distributed across their comfortable range of speeds. Data were collected during walking with and without spinal restriction by a fiberglass body jacket, which is similar to a thoracolumbosacral orthosis (TLSO). With spinal restriction, peak-to-peak (PP) pelvic obliquity and rotation were significantly reduced across all walking speeds (p < 0.001), while PP pelvic tilt was significantly reduced at only the fastest walking speeds (p = 0.017). PP hip abduction-adduction motion was significantly reduced with spinal restriction across all speeds (p < 0.001), while PP hip flexion-extension significantly increased at only the slow and very slow speeds (p < 0.001 and p = 0.023, respectively). A better understanding of the effects of restricted spinal motion on gait may help clinicians predict and avoid development of additional problems from TLSO use or surgical restriction of spinal motion. An awareness of these issues will enable clinicians to monitor patients for problems that may result from decreased spine and pelvic motion.

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Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke.

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

An important goal in rehabilitation engineering is to develop technology that allows individuals with severe motor impairment to practice arm movement without continuous supervision from a rehabilitation therapist. This paper describes the development of such a system, called Therapy WREX or ("T-WREX"). The system consists of an orthosis that assists in arm movement across a large workspace, a grip sensor that detects hand grip pressure, and software that simulates functional activities. The arm orthosis is an instrumented, adult-sized version of the Wilmington Robotic Exoskeleton (WREX), which is a five degrees-of-freedom mechanism that passively counterbalances the weight of the arm using elastic bands. After providing a detailed design description of T-WREX, this paper describes two pilot studies of the system's capabilities. The first study demonstrated that individuals with chronic stroke whose arm function is compromised in a normal gravity environment can perform reaching and drawing movements while using T-WREX. The second study demonstrated that exercising the affected arm of five people with chronic stroke with T-WREX over an eight week period improved unassisted movement ability (mean change in Fugl-Meyer score was 5 points plusmn2 SD; mean change in range of motion of reaching was 10%, p<0.001). These results demonstrate the feasibility of automating upper-extremity rehabilitation therapy for people with severe stroke using passive gravity assistance, a grip sensor, and simple virtual reality software

/pdf/automating-arm-movement-training-following-severe-stroke-16dad98lxo.pdf

Automating Arm Movement Training Following Severe Stroke: Functional Exercises With Quantitative Feedback in a Gravity-Reduced Environment

STUDY DESIGN A cross-sectional study comprising the first phase of an ongoing, longitudinal prospective study was conducted. OBJECTIVE To investigate the relation between backpack use and back pain in adolescents. SUMMARY OF BACKGROUND DATA The prevalence of nonspecific back pain increases dramatically during adolescence from less than 10% in the pre-teen-age years up to 50% in 15- to 16-year-olds. There is widespread concern that heavy backpacks carried by adolescents contribute to the development of back pain. METHODS A total of 1126 children, ages 12 to 18 years, participated by completing a questionnaire about their health, activities, and backpack use. Each child's body weight, height, and backpack weight were measured. A child was classified as having back pain if one or more of the following were reported during the preceding month: neck or back pain that had interfered with school or leisure, neck or back pain with a severity rating of 2 or more on a scale 0 to 10, a visit to a physician or therapist for neck or back pain, or exemption from physical education or sports because of neck or back pain. RESULTS Of 1122 backpack users, 74.4% were classified as having back pain, validated by significantly poorer general health, more limited physical functioning, and more bodily pain. As compared with no or low use of backpacks at school, heavy use (odds ratio, 1.98; P < 0.0001) was independently associated with back pain. Female gender and larger body mass index also were significantly associated with back pain. As compared with adolescents who had no back pain, adolescents with back pain carried significantly heavier backpacks that represented a significantly greater percentage of their body weights. CONCLUSION The use of backpacks during the school day and backpack weights are independently associated with back pain.

The association of backpack use and back pain in adolescents.

A simple method to counter the effects of gravity in articulated mechanisms is proposed. The scheme uses kinematics and linear springs to produce a nonlinear restoring force to oppose the gravitational moment. The method equilibrates a rotational mechanism for all postures. A solution for one link is obtained then general equations for n links are derived. The method is simpler than previous schemes and has applications in robotics, orthotics and a host of everyday mechanisms.

A simple technique to passively gravity-balance articulated mechanisms

This paper describes the development of a pneumatic robot for functional movement training of the arm and hand after stroke. The device is based on the Wilmington Robotic Exoskeleton (WREX), a passive, mobile arm support developed for children with arm weakness caused by a debilitative condition. Previously, we scaled WREX for use by adults, instrumented it with potentiometers, and incorporated a simple grip strength sensor. The resulting passive device (Training WREX or "T-WREX") allows individuals with severe motor impairment to practice functional movements (reaching, eating, and washing) in a simple virtual reality environment called Java Therapy 2.0. However, the device is limited since it can only apply a fixed pattern of assistive forces to the arm. In addition, its gravity balance function does not restore full range of motion. Therefore, we are also developing a robotic version of WREX named Pneu-WREX, which can apply a wide range of forces to the arm during naturalistic movements. Pneu-WREX uses pneumatic actuators, non-linear force control, and passive counter-balancing to allow application of a wide range of forces during naturalistic upper extremity movements. Besides a detailed description of the mechanical design and kinematics of Pneu-WREX, we present results from a survey of 29 therapists on the use of such a robotic device.

/pdf/a-pneumatic-robot-for-re-training-arm-movement-after-stroke-32ft4t4ob5.pdf

A pneumatic robot for re-training arm movement after stroke: rationale and mechanical design

This article presents the state of the art in passive devices for enhancing limb movement in people with neuromuscular disabilities. Both upper- and lower-limb projects and devices are described. Special emphasis is placed on a passive functional upper-limb orthosis called the Wilmington Robotic Exoskeleton (WREX). The development and testing of the WREX with children with limited arm strength are described. The exoskeleton has two links and 4 degrees of freedom. It uses linear elastic elements that balance the effects of gravity in three dimensions. The experiences of five children with arthrogryposis who used the WREX are described.

/pdf/passive-exoskeletons-for-assisting-limb-movement-1f92qb27kk.pdf

Tariq Rahman

Papers

Automating Arm Movement Training Following Severe Stroke: Functional Exercises With Quantitative Feedback in a Gravity-Reduced Environment

The association of backpack use and back pain in adolescents.

A simple technique to passively gravity-balance articulated mechanisms

A pneumatic robot for re-training arm movement after stroke: rationale and mechanical design

Passive exoskeletons for assisting limb movement.