Tobias Nef

Bio: Tobias Nef is an academic researcher from University of Bern. The author has contributed to research in topics: Medicine & Neglect. The author has an hindex of 37, co-authored 166 publications receiving 5015 citations. Previous affiliations of Tobias Nef include MedStar National Rehabilitation Hospital & ETH Zurich.

Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial

Abstract: Summary Background Arm hemiparesis secondary to stroke is common and disabling. We aimed to assess whether robotic training of an affected arm with ARMin—an exoskeleton robot that allows task-specific training in three dimensions—reduces motor impairment more effectively than does conventional therapy. Methods In a prospective, multicentre, parallel-group randomised trial, we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerland. Eligible patients were randomly assigned (1:1) to receive robotic or conventional therapy using a centre-stratified randomisation procedure. For both groups, therapy was given for at least 45 min three times a week for 8 weeks (total 24 sessions). The primary outcome was change in score on the arm (upper extremity) section of the Fugl-Meyer assessment (FMA-UE). Assessors tested patients immediately before therapy, after 4 weeks of therapy, at the end of therapy, and 16 weeks and 34 weeks after start of therapy. Assessors were masked to treatment allocation, but patients, therapists, and data analysts were unmasked. Analyses were by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00719433. Findings Between May 4, 2009, and Sept 3, 2012, 143 individuals were tested for eligibility, of whom 77 were eligible and agreed to participate. 38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses. Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy ( F =4·1, p=0·041; mean difference in score 0·78 points, 95% CI 0·03–1·53). No serious adverse events related to the study occurred. Interpretation Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy. However, the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance, which leaves the clinical relevance in question. Funding Swiss National Science Foundation and Bangerter-Rhyner Stiftung.

ARMin III --arm therapy exoskeleton with an ergonomic shoulder actuation

Abstract: Rehabilitation robots have become important tools in stroke rehabilitation. Compared to manual arm training, robot-supported training can be more intensive, of longer duration and more repetitive. Therefore, robots have the potential to improve the rehabilitation process in stroke patients. Whereas a majority of previous work in upper limb rehabilitation robotics has focused on end-effector-based robots, a shift towards exoskeleton robots is taking place because they offer a better guidance of the human arm, especially for movements with a large range of motion. However, the implementation of an exoskeleton device introduces the challenge of reproducing the motion of the human shoulder, which is one of the most complex joints of the body. Thus, this paper starts with describing a simplified model of the human shoulder. On the basis of that model, a new ergonomic shoulder actuation principle that provides motion of the humerus head is proposed, and its implementation in the ARMin III arm therapy robot is described. The focus lies on the mechanics and actuation principle. The ARMin III robot provides three actuated degrees of freedom for the shoulder and one for the elbow joint. An additional module provides actuated lower arm pro/supination and wrist flexion/extension. Five ARMin III devices have been manufactured and they are currently undergoing clinical evaluation in hospitals in Switzerland and in the United States.

Robot-aided neurorehabilitation of the upper extremities.

Abstract: Task-oriented repetitive movements can improve muscle strength and movement co-ordination in patients with impairments due to neurological lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate and document the rehabilitation of movements. The paper provides an overview of existing devices that can support movement therapy of the upper extremities in subjects with neurological pathologies. The devices are critically compared with respect to technical function, clinical applicability, and, if they exist, clinical outcomes.

ARMin: a robot for patient-cooperative arm therapy.

Abstract: Task-oriented, repetitive and intensive arm training can enhance arm rehabilitation in patients with paralyzed upper extremities due to lesions of the central nervous system. There is evidence that the training duration is a key factor for the therapy progress. Robot-supported therapy can improve the rehabilitation allowing more intensive training. This paper presents the kinematics, the control and the therapy modes of the arm therapy robot ARMin. It is a haptic display with semi-exoskeleton kinematics with four active and two passive degrees of freedom. Equipped with position, force and torque sensors the device can deliver patient-cooperative arm therapy taking into account the activity of the patient and supporting him/her only as much as needed. The haptic display is combined with an audiovisual display that is used to present the movement and the movement task to the patient. It is assumed that the patient-cooperative therapy approach combined with a multimodal display can increase the patient's motivation and activity and, therefore, the therapeutic progress.

ARMin II - 7 DoF rehabilitation robot: mechanics and kinematics

Abstract: Task-oriented repetitive movements can improve motor recovery in patients with neurological or orthopaedic lesions. The application of robotics can serve to assist, enhance, evaluate, and document neurological and orthopaedic rehabilitation. ARMin II is the second prototype of a robot for arm therapy applicable to the training of activities of daily living. ARMin II has a semi-exoskeletal structure with seven active degrees of freedom (two of them coupled), five adjustable segments to fit in with different patient sizes, and is equipped with position and force sensors. The mechanical structure, the actuators and the sensors of the robot are optimized for patient-cooperative control strategies based on impedance and admittance architectures. This paper describes the mechanical structure and kinematics of ARMin II.

Principles of Neural Science

Abstract: I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or

스크린 위의 삶 = Life on the screen : identity in the age of the internet

Abstract: From the Publisher: A Question of Identity Life on the Screen is a fascinating and wide-ranging investigation of the impact of computers and networking on society, peoples' perceptions of themselves, and the individual's relationship to machines. Sherry Turkle, a Professor of the Sociology of Science at MIT and a licensed psychologist, uses Internet MUDs (multi-user domains, or in older gaming parlance multi-user dungeons) as a launching pad for explorations of software design, user interfaces, simulation, artificial intelligence, artificial life, agents, "bots," virtual reality, and "the on-line way of life." Turkle's discussion of postmodernism is particularly enlightening. She shows how postmodern concepts in art, architecture, and ethics are related to concrete topics much closer to home, for example AI research (Minsky's "Society of Mind") and even MUDs (exemplified by students with X-window terminals who are doing homework in one window and simultaneously playing out several different roles in the same MUD in other windows). Those of you who have (like me) been turned off by the shallow, pretentious, meaningless paintings and sculptures that litter our museums of modern art may have a different perspective after hearing what Turkle has to say. This is a psychoanalytical book, not a technical one. However, software developers and engineers will find it highly accessible because of the depth of the author's technical understanding and credibility. Unlike most other authors in this genre, Turkle does not constantly jar the technically-literate reader with blatant errors or bogus assertions about how things work. Although I personally don't have time or patience for MUDs,view most of AI as snake-oil, and abhor postmodern architecture, I thought the time spent reading this book was an extremely good investment.

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

Abstract: 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...