Assessment of upper limb spasticity in stroke patients using the robotic device REAplan

Children with physical disabilities often have limited performance in daily activities, hindering their physical development, social development and mental health. Therefore, rehabilitation is essential to mitigate the adverse effects of the different causes of physical disabilities and improve independence and quality of life. In the last decade, robotic rehabilitation has shown the potential to augment traditional physical rehabilitation. However, to date, most robotic rehabilitation devices are designed for adult patients who differ in their needs compared to paediatric patients, limiting the devices’ potential because the paediatric patients’ needs are not adequately considered. With this in mind, the current work reviews the existing literature on robotic rehabilitation for children with physical disabilities, intending to summarise how the rehabilitation robots could fulfil children’s needs and inspire researchers to develop new devices. A literature search was conducted utilising the Web of Science, PubMed and Scopus databases. Based on the inclusion–exclusion criteria, 206 publications were included, and 58 robotic devices used by children with a physical disability were identified. Different design factors and the treated conditions using robotic technology were compared. Through the analyses, it was identified that weight, safety, operability and motivation were crucial factors to the successful design of devices for children. The majority of the current devices were used for lower limb rehabilitation. Neurological disorders, in particular cerebral palsy, were the most common conditions for which devices were designed. By far, the most common actuator was the electric motor. Usually, the devices present more than one training strategy being the assistive strategy the most used. The admittance/impedance method is the most popular to interface the robot with the children. Currently, there is a trend on developing exoskeletons, as they can assist children with daily life activities outside of the rehabilitation setting, propitiating a wider adoption of the technology. With this shift in focus, it appears likely that new technologies to actuate the system (e.g. serial elastic actuators) and to detect the intention (e.g. physiological signals) of children as they go about their daily activities will be required.

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“… Picture of upper limb end-effectors rehabilitation robots: a Inmotion2/Mitmanus [ 79 ], b wrist robot [ 80 ], c REAPlan [ 81 ] …”

Section: Methodsmentioning

confidence: 99%

Robotic devices for paediatric rehabilitation: a review of design features

et al. 2021

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“…Although the quick-stretch technique is an easy, common strategy by which clinicians can induce abnormal muscle tone, and the MAS assessment is widely used clinically as well, the inconsistency of the force applied from the examiners and the subjective scoring are concerns that should not be ignored [11] , [13] – [16] . To solve the problems related to the current muscle tone scoring system, previous researchers have used EMG, torque, or force sensors to quantify muscle tone [10] , [12] , [17] – [27] . However, these methods established in previous studies have not been practically used in clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…To quantitively measure muscle tone, many research groups have used EMG, torque, or force sensors to record spasticity data [10] , [12] , [17] – [27] . Although the results were found to be valid, this approach has still not been widely applied.…”

Section: Discussionmentioning

confidence: 99%

“…They simultaneously recorded the velocity or position of the joint and the joint reflex torque as well, which was used for quantifying muscle tone based on the difference in the measured torque from the baseline torque [12] , [17] – [20] . Some other studies utilized the Biodex Rehabilitation/Testing System or custom measuring systems incorporating EMG or force transducers by actively or passively guiding the limb via clinicians or machines to induce abnormal muscle tone and then quantify it, especially with a focus on determining the level of spasticity [10] , [21] – [27] . Inconsistent results between the measured torque and MAS were found among some of these previous reports.…”

Section: Introductionmentioning

confidence: 99%

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A Novel and Clinically Feasible Instrument for Quantifying Upper Limb Muscle Tone and Motor Function via Indirect Measure Methods

Hsu

Lin

Hsu

et al. 2022

IEEE J. Transl. Eng. Health Med.

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Objective: Quantifying muscle tone is often based on a tester’s subjective judgment in clinical settings. There is, however, a lack of suitable tools that can be used to objectively assess muscle tone. This study thus introduces a reliable, clinically-feasible device, called the Arm Circumference Motor Evaluation System (ACMES), for quantifying the muscle tone of upper limbs without using mechanical torque transducers. Methods: While the ACMES conducts continuously passive arm circumduction motions, the voltage and current of the driving motor is transduced into torque values via a least square approximation. A torque sensor and springs with different spring constants were used for the validity and reliability test in the first part of this study. Fifteen healthy adults and two patients who had experienced a stroke participated in the second part, which was a clinical experiment used to examine the in-vivo test-retest reliability and to explore the inspection differences between healthy and patient participants. Results: The results showed that the ACMES has high validity (R 2 : ~0.99) and reliability (R 2 : 0.96~0.99). The reliability of the ACMES used on human subjects was acceptable (R 2 : 0.83~0.85). The various muscle tone patterns could be found among healthy and stroke subjects via the ACMES. Conclusion: Clinically, abnormal muscle tone, which seriously affects motion performance, will be found in many diagnoses, such as stroke or cerebral palsy. However, objectively and feasibly measuring abnormal tone in modern clinical settings is still a challenging task. Thus, the ACMES was developed and tested to verify its feasibility as a measurement system for detecting the mechanical torque associated with muscle tone.

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“…On the first experimental day (D1), the patients/HIs trained their paretic/nondominant UL on a MSkL task with an SAT (CIRCUIT) 20 , 21 that was implemented on a REAplan neurorehabilitation robot 22 , 23 (Axinesis, Wavre, Belgium; used for motor measures: throughout the study, it did not deliver assistance). To quantify motor control within the same environment, they performed a REACHING task on each day.…”

Section: Methodsmentioning

confidence: 99%

Evidence of Motor Skill Learning in Acute Stroke Patients Without Lesions to the Thalamus and Internal Capsule

Riga

Gathy

Ghinet

et al. 2022

Stroke

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Background: It is currently unknown whether motor skill learning (MSkL) with the paretic upper limb is possible during the acute phase after stroke and whether lesion localization impacts MSkL. Here, we investigated MSkL in acute (1–7 days post) stroke patients compared with healthy individuals (HIs) and in relation to voxel-based lesion symptom mapping. Methods: Twenty patients with acute stroke and 35 HIs were trained over 3 consecutive days on a neurorehabilitation robot measuring speed, accuracy, and movement smoothness variables. Patients used their paretic upper limb and HI used their nondominant upper limb on an MSkL task involving a speed/accuracy trade-off. Generalization was evaluated on day 3. All patients underwent a 3-dimensional magnetic resonance imaging used for VSLM. Results: Most patients achieved MSkL demonstrated by day-to-day retention and generalization of the newly learned skill on day 3. When comparing raw speed/accuracy trade-off values, HI achieved larger MSkL than patients. However, relative speed/accuracy trade-off values showed no significant differences in MSkL between patients and HI on day 3. In patients, MSkL progression correlated with acute motor and cognitive impairments. The voxel-based lesion symptom mapping showed that acute vascular damage to the thalamus or the posterior limb of the internal capsule reduced MSkL. Conclusions: Despite worse motor performance for acute stroke patients compared with HI, most patients were able to achieve MSkL with their paretic upper limb. Damage to the thalamus and posterior limb of the internal capsule, however, reduced MSkL. These data show that MSkL could be implemented into neurorehabilitation during the acute phase of stroke, particularly for patients without lesions to the thalamus and posterior limb of the internal capsule. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01519843.

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Assessment of upper limb spasticity in stroke patients using the robotic device REAplan

Abstract: This study proposes a new, valid, reliable and sensitive protocol to quantify upper limb resistance force using the REAplan, as a reflection of upper limb spasticity.

Cited by 24 publications

References 18 publications

Robotic devices for paediatric rehabilitation: a review of design features

Robotic devices for paediatric rehabilitation: a review of design features

A Novel and Clinically Feasible Instrument for Quantifying Upper Limb Muscle Tone and Motor Function via Indirect Measure Methods

Evidence of Motor Skill Learning in Acute Stroke Patients Without Lesions to the Thalamus and Internal Capsule

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