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Journal ArticleDOI

Design, Development, and Testing of an Intelligent Wearable Robotic Exoskeleton Prototype for Upper Limb Rehabilitation.

10 Aug 2021-Sensors (Multidisciplinary Digital Publishing Institute)-Vol. 21, Iss: 16, pp 5411
TL;DR: In this article, a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms is presented, which allows flexion-extension at the elbow joint, where the chosen materials render it compact.
Abstract: Neuromotor rehabilitation and recovery of upper limb functions are essential to improve the life quality of patients who have suffered injuries or have pathological sequels, where it is desirable to enhance the development of activities of daily living (ADLs). Modern approaches such as robotic-assisted rehabilitation provide decisive factors for effective motor recovery, such as objective assessment of the progress of the patient and the potential for the implementation of personalized training plans. This paper focuses on the design, development, and preliminary testing of a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms that are fully embedded in the device. The proposed exoskeleton is a 1-DoF system that allows flexion-extension at the elbow joint, where the chosen materials render it compact. Different operation modes are supported by a hierarchical control strategy, allowing operation in autonomous mode, remote control mode, or in a leader-follower mode. Laboratory tests validate the proper operation of the integrated technologies, highlighting a low latency and reasonable accuracy. The experimental result shows that the device can be suitable for use in providing support for diagnostic and rehabilitation processes of neuromotor functions, although optimizations and rigorous clinical validation are required beforehand.
Citations
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Journal ArticleDOI
TL;DR: After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.
Abstract: A cerebrovascular accident, or a stroke, can cause significant neurological damage, inflicting the patient with loss of motor function in their hands. Standard rehabilitation therapy for the hand increases demands on clinics, creating an avenue for powered hand rehabilitation devices. Hand rehabilitation devices (HRDs) are devices designed to provide the hand with passive, active, and active-assisted rehabilitation therapy; however, HRDs do not have any standards in terms of development or design. Although the categorization of an injury’s severity can guide a patient into seeking proper assistance, rehabilitation devices do not have a set standard to provide a solution from the beginning to the end stages of recovery. In this paper, HRDs are defined and compared by their mechanical designs, actuation mechanisms, control systems, and therapeutic strategies. Furthermore, devices with conducted clinical trials are used to determine the future development of HRDs. After evaluating the abilities of 35 devices, it is inferred that standard characteristics for HRDs should include an exoskeleton design, the incorporation of challenge-based and coaching therapeutic strategies, and the implementation of surface electromyogram signals (sEMG) based control.

10 citations

Journal ArticleDOI
08 Sep 2022-Designs
TL;DR: In this article , a three-degrees-of-freedom (DOF) active upper-body exoskeleton for medical rehabilitation named SAMA was presented, which was manufactured and assembled into an ergonomic custom-made wheelchair in a sitting posture.
Abstract: Modern neuromuscular rehabilitation engineering and assistive technology research have been constantly developing in the last 20 years. The upper body exoskeleton is an example of an assistive rehabilitation device. However, in order to solve its technological problems, interdisciplinary research is still necessary. This paper presents a new three-degrees of freedom (DOF) active upper-body exoskeleton for medical rehabilitation named “SAMA”. Its mechanical structure is inspired by the geometry and biomechanics of the human body, particularly the ranges of motion (ROM) and the needed torque. The SAMA exoskeleton was manufactured and assembled into an ergonomic custom-made wheelchair in a sitting posture in order to provide portability and subject comfort during experimental testing and rehabilitation exercises. Dynamic modeling using MATLAB–Simulink was used for calculating the inverse kinematics, dynamic analysis, trajectory generation and implementation of proportional–integral–derivative (PID) computed torque control (PID-CTC). A new framework has been developed for rapid prototyping (the dynamic modeling, control, and experimentation of SAMA) based on the integration between MATLAB–Simulink and the Robot Operating System (ROS) environment. This framework allows the robust position and torque control of the exoskeleton and real-time monitoring of SAMA and its subject. Two joints of the developed exoskeleton were successfully tested experimentally for the desired arm trajectory. The angular position and torque controller responses were recorded and the exoskeleton joints showed a maximum delay of 200° and a maximum steady state error of 0.25°. These successful results encourage further development and testing for different subjects and more control strategies.

3 citations

Journal ArticleDOI
25 May 2022-Sensors
TL;DR: In this article , the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs were evaluated using an external high-precision optical tracking system.
Abstract: Robotic exoskeletons are active devices that assist or counteract the movements of the body limbs in a variety of tasks, including in industrial environments or rehabilitation processes. With the introduction of textile and soft materials in these devices, the effective motion transmission, mechanical support of the limbs, and resistance to physical disturbances are some of the most desirable structural features. This paper proposes an evaluation protocol and assesses the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs. Since this prototype was built from soft materials, it is necessary to evaluate the mechanical behavior in the areas that support the arm. Some of the rehabilitation-supporting movements such as elbow flexion and extension, as well as increased muscle tone (spasticity), are emulated. Measurements are taken using the reference supplied to the system’s control stage and then compared with an external high-precision optical tracking system. As a result, it is evidenced that the use of soft materials provides satisfactory outcomes in the motion transfer and support to the limb. In addition, this study lays the groundwork for a future assessment of the prototype in a controlled laboratory environment using human test subjects.

3 citations

Journal ArticleDOI
TL;DR: In this paper , the structural design and electronic control design of an exoskeleton hand rehabilitation robot was studied, and the kinematics parameters were obtained by kinematic simulation and the lightweight design was completed by using topology optimization.
Abstract: As one of the most influential symptoms of daily life after stroke, hand dysfunction has seriously affected the quality of life of patients and families. At present, the commonly used rehabilitation method is to carry out continuous passive training on the patient’s fingers with the help of physical therapists, so as to promote the rehabilitation of the hands. However, this kind of therapist-assisted rehabilitation greatly increases the cost of rehabilitation treatment and is not conducive to the promotion of household use. Many exoskeleton hand rehabilitation robots still lack in overall weight and control, resulting in the application potential of exoskeleton hand rehabilitation robots not being fully developed, and the commercial and clinical success cases are limited. The research of this paper focuses on the structural design and electronic control design of the exoskeleton hand rehabilitation robot. Through the design of an exoskeleton hand rehabilitation robot suitable for human hands, the kinematics parameters are obtained by kinematics simulation, and the lightweight design of the hand rehabilitation robot is completed by using topology optimization. At the same time, this paper shows the development technology of the rehabilitation robot control system. We hope that through the subsequent product development, the exoskeleton hand rehabilitation robot studied in this paper can be applied in the future.

2 citations

Journal ArticleDOI
TL;DR: In this paper , the authors present the possibilities of personalizing 3D-printed medical devices based on their own experience in functional user assessment and the material selection, design, optimization using artificial intelligence and production and testing of several generations of different upper limb exoskeletons, incorporating the considerations of the Medical Device Regulation (MDR), ISO 13485 and ISO 10993 standards.
Abstract: The human hand is the most precise and versatile tool that nature has given man, and any deficits in this area affect the functional capabilities and quality of human life. Scientists, engineers and clinicians are constantly looking for solutions in the field of diagnosis, treatment, rehabilitation and care of patients with hand function deficits. One such solution is a hand exoskeleton. In the process of designing and testing the hand exoskeleton, emphasis should be placed on the full usability and comfort of the system; hence, the issues of personalization, matching and testing are crucial for the development of the discussed group of solutions. The aim of this paper is to present the possibilities of personalizing 3D-printed medical devicesbased on our own experience in functional user assessment andthe material selection, design, optimization using artificial intelligence and production and testing of several generations of different upper limb exoskeletons, incorporatingthe considerations of the Medical Device Regulation (MDR), ISO 13485 and ISO 10993 standards.The novelty and possible contribution of the proposed approach consist of the possibilities and limitations of the personalization of the upper limb exoskeleton discussed in the article as well as the directions of further development of significant scientific, technical and clinical importance.

1 citations

References
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Journal ArticleDOI
Theo Vos1, Theo Vos2, Theo Vos3, Stephen S Lim  +2416 moreInstitutions (246)
TL;DR: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates, and there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries.

5,802 citations

Journal ArticleDOI
TL;DR: This is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their disabling illness or injury.

760 citations

Journal ArticleDOI
TL;DR: The alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.
Abstract: Background The working alliance, or collaborative bond, between client and psychotherapist has been found to be related to outcome in psychotherapy. Purpose The purpose of this study was to investigate whether the working alliance is related to outcome in physical rehabilitation settings. Data Sources A sensitive search of 6 databases identified a total of 1,600 titles. Study Selection Prospective studies of patients undergoing physical rehabilitation were selected for this systematic review. Data Extraction For each included study, descriptive data regarding participants, interventions, and measures of alliance and outcome—as well as correlation data for alliance and outcomes—were extracted. Data Synthesis Thirteen studies including patients with brain injury, musculoskeletal conditions, cardiac conditions, or multiple pathologies were retrieved. Various outcomes were measured, including pain, disability, quality of life, depression, adherence, and satisfaction with treatment. The alliance was most commonly measured with the Working Alliance Inventory, which was rated by both patient and therapist during the third or fourth treatment session. The results indicate that the alliance is positively associated with: (1) treatment adherence in patients with brain injury and patients with multiple pathologies seeking physical therapy, (2) depressive symptoms in patients with cardiac conditions and those with brain injury, (3) treatment satisfaction in patients with musculoskeletal conditions, and (4) physical function in geriatric patients and those with chronic low back pain. Limitations Among homogenous studies, there were insufficient reported data to allow pooling of results. Conclusions From this review, the alliance between therapist and patient appears to have a positive effect on treatment outcome in physical rehabilitation settings; however, more research is needed to determine the strength of this association.

465 citations

Journal ArticleDOI
TL;DR: In this paper, a review of physical rehabilitation approaches for stroke patients is presented, where the authors explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), MCI, neurophysiological intervention (passive), cardiopulmonary intervention, assistive device or modality.
Abstract: Background Various approaches to physical rehabilitation may be used after stroke, and considerable controversy and debate surround the effectiveness of relative approaches. Some physiotherapists base their treatments on a single approach; others use a mixture of components from several different approaches. Objectives To determine whether physical rehabilitation approaches are effective in recovery of function and mobility in people with stroke, and to assess if any one physical rehabilitation approach is more effective than any other approach. For the previous versions of this review, the objective was to explore the effect of 'physiotherapy treatment approaches' based on historical classifications of orthopaedic, neurophysiological or motor learning principles, or on a mixture of these treatment principles. For this update of the review, the objective was to explore the effects of approaches that incorporate individual treatment components, categorised as functional task training, musculoskeletal intervention (active), musculoskeletal intervention (passive), neurophysiological intervention, cardiopulmonary intervention, assistive device or modality. In addition, we sought to explore the impact of time after stroke, geographical location of the study, dose of the intervention, provider of the intervention and treatment components included within an intervention. Search methods We searched the Cochrane Stroke Group Trials Register (last searched December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 12, 2012), MEDLINE (1966 to December 2012), EMBASE (1980 to December 2012), AMED (1985 to December 2012) and CINAHL (1982 to December 2012). We searched reference lists and contacted experts and researchers who have an interest in stroke rehabilitation. Selection criteria Randomised controlled trials (RCTs) of physical rehabilitation approaches aimed at promoting the recovery of function or mobility in adult participants with a clinical diagnosis of stroke. Outcomes included measures of independence in activities of daily living (ADL), motor function, balance, gait velocity and length of stay. We included trials comparing physical rehabilitation approaches versus no treatment, usual care or attention control and those comparing different physical rehabilitation approaches. Data collection and analysis Two review authors independently categorised identified trials according to the selection criteria, documented their methodological quality and extracted the data. Main results We included a total of 96 studies (10,401 participants) in this review. More than half of the studies (50/96) were carried out in China. Generally the studies were heterogeneous, and many were poorly reported. Physical rehabilitation was found to have a beneficial effect, as compared with no treatment, on functional recovery after stroke (27 studies, 3423 participants; standardised mean difference (SMD) 0.78, 95% confidence interval (CI) 0.58 to 0.97, for Independence in ADL scales), and this effect was noted to persist beyond the length of the intervention period (nine studies, 540 participants; SMD 0.58, 95% CI 0.11 to 1.04). Subgroup analysis revealed a significant difference based on dose of intervention (P value < 0.0001, for independence in ADL), indicating that a dose of 30 to 60 minutes per day delivered five to seven days per week is effective. This evidence principally arises from studies carried out in China. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.003, for independence in ADL). We found physical rehabilitation to be more effective than usual care or attention control in improving motor function (12 studies, 887 participants; SMD 0.37, 95% CI 0.20 to 0.55), balance (five studies, 246 participants; SMD 0.31, 95% CI 0.05 to 0.56) and gait velocity (14 studies, 1126 participants; SMD 0.46, 95% CI 0.32 to 0.60). Subgroup analysis demonstrated a significant difference based on dose of intervention (P value 0.02 for motor function), indicating that a dose of 30 to 60 minutes delivered five to seven days a week provides significant benefit. Subgroup analyses also suggest significant benefit associated with a shorter time since stroke (P value 0.05, for independence in ADL). No one physical rehabilitation approach was more (or less) effective than any other approach in improving independence in ADL (eight studies, 491 participants; test for subgroup differences: P value 0.71) or motor function (nine studies, 546 participants; test for subgroup differences: P value 0.41). These findings are supported by subgroup analyses carried out for comparisons of intervention versus no treatment or usual care, which identified no significant effects of different treatment components or categories of interventions. Authors' conclusions Physical rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke. Evidence related to dose of physical therapy is limited by substantial heterogeneity and does not support robust conclusions. No one approach to physical rehabilitation is any more (or less) effective in promoting recovery of function and mobility after stroke. Therefore, evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin.

389 citations

Journal ArticleDOI
TL;DR: The study aims to review the increasing trends of wearable devices and need of multimodal recognition for continuous or discontinuous monitoring of human activity, biological signals such as Electroencephalogram (EEG), Electrooculogram (EOG), Electromyogram (EMG, Electrocardiogram (ECG) and parameters along with other symptoms.

231 citations