Bimanual Elbow Robotic Orthoses: Preliminary Investigations on an Impairment Force-Feedback Rehabilitation Method

Abstract

Modern rehabilitation practices have begun integrating robots, recognizing their significant role in recovery. New and alternative stroke rehabilitation treatments are essential to enhance efficacy and mitigate associated health costs. Today’s robotic interventions can play a significant role in advancing rehabilitation. In addition, robots have an inherent ability to perform tasks accurately and reliably and are typically well suited to measure and quantify performance. Most rehabilitation strategies predominantly target activation of the paretic arm. However, bimanual upper-limb rehabilitation research suggests potential in enhancing functional recovery. Moreover, studies suggest that limb coordination and synchronization can improve treatment efficacy. In this preliminary study, we aimed to investigate and validate our user-driven bimanual system in a reduced intensity rehab practice. A bimanual wearable robotic device (BWRD) with a Master–Slave configuration for the elbow joint was developed to carry out the investigation. The BWRD incorporates position and force sensors for which respective control loops are implemented, and offers varying modes of operation ranging from passive to active training. The proposed system enables the perception of the movements, as well as the forces applied by the hemiparetic arm, with the non-hemiparetic arm. Eight participants with chronic unilateral stroke were recruited to participate in a total of three 1-h sessions per participant, delivered in a week. Participants underwent pre- and post-training functional assessments along with proprioceptive measures. The post-assessment was performed at the end of the last training session. The protocol was designed to engage the user in an assortment of static and dynamic arm matching and opposing tasks. The training incorporates force-feedback movements, force-feedback positioning, and force matching tasks with same and opposite direction movements. We are able to suggest identification of impairment patterns in the position-force plot results. In addition, we performed a proprioception evaluation with the system. We set out to design innovative and user immersive training tasks that utilize the BWRD capabilities, and we demonstrate that the subjects were able to cooperate and accomplish the protocol. We found that the Fugl–Meyer and Wolf Motor Function Test (pre to post) measured improvements (15 and 19%, respectively). Recognizing the brevity of the training, we focus our report primarily on the proprioception testing (32% significant improvement, pprop = 0.033) and protocol distinctive features and results. This paper presents the electromechanical features and performance of the BWRD, the testing protocol, and the assessments utilized. Outcome measures and results are presented and demonstrate the successful application and operation of the system.

Bilateral Tactile Feedback-Enabled Training for Stroke Survivors Using Microsoft KinectTM

“…The different time length between two positionings yielded different perceptions in the participant, which is called a Tau effect [74]. Herrnstadt et al [18] have suggested that the need to memorize the location of an arm is eliminated, but the Tau effect might have been triggered, influencing the participant’s judgement. Additionally, passive arm positioning was shown to result in larger errors compared to active arm positioning [75].…”

“…They concluded that pure bilateral or active and/or passive movement training protocols do not contribute to significant motor recovery. The applications of bimanual training with robots [18,19,20] and rhythmic auditory cueing [21] were investigated in the rehabilitation of stroke survivors. The possibility of the concept of bimanual training and companied devices in extending contemporary therapies is accepted.…”

Development of a Rehabilitation Robot Combined with Functional Electrical Stimulation Controlled by Non-disabled Lower Extremity in Hemiplegic Gait

“…A master-slave system is used in robotic surgery 12) and in an upper limb rehabilitation robot. 13) Such a master-slave robot can achieve an adequate trajectory for an individual patient without any previous data or calculation. For hemiplegics, a master-slave robotic rehabilitation system for the lower limb that uses a feedback system from the non-affected limb has not before been attempted.…”

Combining Mental Training and Physical Training With Goal-Oriented Protocols in Stroke Rehabilitation: A Feasibility Case Study

“…These drawbacks motivated researchers to find solutions to minimize the human labor and thus decrease rehabilitation cost (Freeman et al, 2009 ; Poli et al, 2013 ). Most robotic devices are capable of passively delivering a high number of training repetitions to the stroke-affected limb (Freeman et al, 2009 ; Loureiro et al, 2011 ; Ren et al, 2013 ; Herrnstadt et al, 2015 ; Proietti and Crocher, 2016 ). However, clinical evidence suggests that users' engagement plays an important role to enable and augment motor recovery (Hogan et al, 2006 ; Krebs et al, 2009 ; Lo and Xie, 2012 ).…”