Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist

Byl, Nancy N.; Abrams, Gary; Pitsch, Erica A.; Fedulow, Irina; Kim, Hyunchul; Simkins, Matt; Nagarajan, Srikantan S.; Rosén, Jacob

doi:10.1016/j.jht.2013.06.001

Cited by 59 publications

(70 citation statements)

References 52 publications

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“…On the other hand, rehabilitation robots like the exoskeleton system shown in Fig. 1 have been developed to automate the training process by providing controllable and repetitive motion [4], [5]. Surprisingly, although resistance controllers have been reported in manipulandalike training devices, no robotic exoskeleton has this feature available [6].…”

Section: A Backgroundmentioning

confidence: 99%

Upper limb redundancy resolution under gravitational loading conditions: Arm postural stability index based on dynamic manipulability analysis

Shen

Hsiao

et al. 2017

2017 IEEE-RAS 17th International Conference on Humanoid Robotics (Humanoids)

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Abstract-Resistance training may be considered as one promising approach for improving the motor capabilities of post-stroke patients. A successful introduction of this depends on the proper resolution of human arm redundancy under gravitational loading. The spatially heterogeneous changes of the human arm swivel angle (which represents the upper limb redundancy) are studied under different loading conditions, the effects of which are incorporated into a modified dynamic manipulability ellipsoid model. A new scalar index describing the arm postural stability (APSI) is then proposed. As part of the experimental protocol, ten (10) healthy subjects performed multiple reaching tasks with different weights mounted on the forearm. Kinematic data was collected via a ten-camera motion capture system and the corresponding APSI was calculated for each task. APSI is found to have a strong linear correlation with the swivel angle under loading conditions. Furthermore, the data suggest that the swivel angle may serve as an indicator of arm postural stability and task difficulty. The results of additional experiments conducted with three (3) subjects indicate that the external loads could deteriorate the arm's control performance in tasks like line tracing (root mean square deviation from straight lines). These findings may be applicable to robot-based (exoskeleton) resistance therapy, assist-as-needed gravity compensation, and human-like motion control of humanoid robotic systems.

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Section: A Backgroundmentioning

confidence: 99%

Upper limb redundancy resolution under gravitational loading conditions: Arm postural stability index based on dynamic manipulability analysis

Shen

Hsiao

et al. 2017

2017 IEEE-RAS 17th International Conference on Humanoid Robotics (Humanoids)

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“…However, although protocols of some studies included in the review by Laver et al [48] allowed the inclusion of those with more severe UL deficits, in many cases it is not possible to ascertain the severity of those who actually participated and as such, the effectiveness with those with more severe deficits is unclear. Moreover, many studies inclusive of participants with moderate to severe UL impairments, have also employed the use of robotics or physical assistance from therapists in addition to VR, suggesting issues of feasibility of the systems when used alone and limited feasibility in the community [49,50,51,52]. While critical to exercise-adherence, few studies have considered patient evaluation of VR devices and when such evaluation has been performed, there has often been a lack of analytical rigour [38].…”

mentioning

confidence: 99%

The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study

Warland

Paraskevopoulos

Tsekleves

et al. 2018

Disability and Rehabilitation

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Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

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“…Most of these studies were conducted with mildly to moderately affected patients. In the remaining patient group with moderate to severe upper limp impairment, the intervention effects were more heterogeneous and affected by the impairment level, with either no or only modest additional gains in comparison to dose-matched conventional treatments (Housman et al, 2009; Byl et al, 2013; Subramanian et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation

2016

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Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing “assistance-as-needed” during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p < 0.001) in accordance with the subjects' abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p = 0.008), accuracy of movement (p = 0.01), and movement velocity (p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p = 0.001), grip force (p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.

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Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist

Cited by 59 publications

References 52 publications

Upper limb redundancy resolution under gravitational loading conditions: Arm postural stability index based on dynamic manipulability analysis

Upper limb redundancy resolution under gravitational loading conditions: Arm postural stability index based on dynamic manipulability analysis

The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study

Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation

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