Electronic supplementary materialStudies of stroke patients undergoing robot-assisted rehabilitation have revealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the effectiveness of rehabilitation program is undermined. This paper presents a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-137) contains supplementary material, which is available to authorized users.
Intervention of robotic devices in the field of physical gait therapy can help in providing repetitive, systematic, and economically viable training sessions. Interactive or assist-as-needed (AAN) gait training encourages patient voluntary participation in the robotic gait training process which may aid in rapid motor function recovery. In this paper, a lightweight robotic gait training orthosis with two actuated and four passive degrees of freedom (DOFs) is proposed. The actuated DOFs were powered by pneumatic muscle actuators. An AAN gait training paradigm based on adaptive impedance control was developed to provide interactive robotic gait training. The proposed adaptive impedance control scheme adapts the robotic assistance according to the disability level and voluntary participation of human subjects. The robotic orthosis was operated in two gait training modes, namely, inactive mode and active mode, to evaluate the performance of the proposed control scheme. The adaptive impedance control scheme was evaluated on ten neurologically intact subjects. The experimental results demonstrate that an increase in voluntary participation of human subjects resulted in a decrease of the robotic assistance and vice versa. Further clinical evaluations with neurologically impaired subjects are required to establish the therapeutic efficacy of the adaptive-impedance-control-based AAN gait training strategy.
ObjectiveThe aim of this study was to provide a systematic review of studies that investigated the effectiveness of robot-assisted therapy on ankle motor and function recovery from musculoskeletal or neurologic ankle injuries.MethodsThirteen electronic databases of articles published from January, 1980 to June, 2012 were searched using keywords ‘ankle*’, ‘robot*’, ‘rehabilitat*’ or ‘treat*’ and a free search in Google Scholar based on effects of ankle rehabilitation robots was also conducted. References listed in relevant publications were further screened. Eventually, twenty-nine articles were selected for review and they focused on effects of robot-assisted ankle rehabilitation.ResultsTwenty-nine studies met the inclusion criteria and a total of 164 patients and 24 healthy subjects participated in these trials. Ankle performance and gait function were the main outcome measures used to assess the therapeutic effects of robot-assisted ankle rehabilitation. The protocols and therapy treatments were varied, which made comparison among different studies difficult or impossible. Few comparative trials were conducted among different devices or control strategies. Moreover, the majority of study designs met levels of evidence that were no higher than American Academy for Cerebral Palsy (CP) and Developmental Medicine (AACPDM) level IV. Only one study used a Randomized Control Trial (RCT) approach with the evidence level being II.ConclusionAll the selected studies showed improvements in terms of ankle performance or gait function after a period of robot-assisted ankle rehabilitation training. The most effective robot-assisted intervention cannot be determined due to the lack of universal evaluation criteria for various devices and control strategies. Future research into the effects of robot-assisted ankle rehabilitation should be carried out based on universal evaluation criteria, which could determine the most effective method of intervention. It is also essential to conduct trials to analyse the differences among different devices or control strategies.
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