Robot Fully Assisted Upper-Limb Functional Movements Against Gravity to Drive Recovery in Chronic Stroke: A Pilot Study.

Background: Stroke is becoming more and more a disease of chronically disabled patients, and new approaches are needed for better outcomes. An intervention based on robot fully assisted upper-limb functional movements is presented. Objectives: To test the immediate and sustained effects of the intervention in reducing impairment in chronic stroke and to preliminarily verify the effects on activity. Methodology: Nineteen patients with mild-to-severe impairment underwent 12 40-min rehabilitation sessions, 3 per week, of robot-assisted reaching and hand-to-mouth movements. The primary outcome measure was the Fugl-Meyer Assessment (FMA) at T1, immediately after treatment (n = 19), and at T2, at a 6-month follow-up (n = 10). A subgroup of 11 patients was also administered the Wolf Motor Function Test Time (WMFT TIME) and Functional Ability Scale (WMFT FAS) and Motor Activity Log (MAL) Amount Of Use (AOU), and Quality Of Movement (QOM). Results: All patients were compliant with the treatment. There was improvement on the FMA with a mean difference with respect to the baseline of 6.2 points at T1, after intervention (n = 19, 95% CI = 4.6-7.8, p < 0.0002), and 5.9 points at T2 (n = 10, 95% CI = 3.6-8.2, p < 0.005). Significant improvements were found at T1 on the WMFT FAS (n = 11, +0.3/5 points, 95% CI = 0.2-0.4, p < 0.004), on the MAL AOU (n = 11, +0.18/5, 95% CI = 0.07-0.29, p < 0.02), and the MAL QOM (n = 11, +0.14/5, 95% CI = 0.08-0.20, p < 0.02). Conclusions: Motor benefits were observed immediately after intervention and at a 6-month follow-up. Reduced impairment would appear to translate to increased activity. Although preliminary, the results are encouraging and lay the foundation for future studies to confirm the findings and define the optimal dose-response curve. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03208634.

Assisting Operators in Heavy Industrial Tasks: On the Design of an Optimized Cooperative Impedance Fuzzy-Controller With Embedded Safety Rules.

Human-robot cooperation is increasingly demanded in industrial applications. Many tasks require the robot to enhance the capabilities of humans. In this scenario, safety also plays an important role in avoiding any accident involving humans, robots, and the environment. With this aim, the paper proposes a cooperative fuzzy-impedance control with embedded safety rules to assist human operators in heavy industrial applications while manipulating unknown weight parts. The proposed methodology is composed by four main components: (i) an inner Cartesian impedance controller (to achieve the compliant robot behavior), (ii) an outer fuzzy controller (to provide the assistance to the human operator), (iii) embedded safety rules (to limit force/velocity during the human-robot interaction enhancing safety), and (iv) a neural network approach (to optimize the control parameters for the human-robot collaboration on the basis of the target indexes of assistance performance defined for this purpose). The main achieved result refers to the capability of the controller to deal with uncertain payloads while assisting and empowering the human operator, both embedding in the controller safety features at force and velocity levels and minimizing the proposed performance indexes. The effectiveness of the proposed approach is verified with a KUKA iiwa 14 R820 manipulator in an experimental procedure where human subjects evaluate the robot performance in a collaborative lifting task of a 10 kg part.

DUALarm: An open-source and 3D-printable device for upper limb neurorehabilitation.

Positively advocating that low-cost additive 3D-printing technologies and open-source licensed software/hardware platforms represent an optimal solution to realize low-cost equipment, a mechanical and 3D-printable device for bilateral upper-limb rehabilitation is presented. The design and manufacturing process of this wheel-geared mechanism, enabling in-phase and anti-phase movements, will be openly provided online with the aim of making a set of customizable devices for neurorehabilitation exploitable all over the world even by people/countries with limited economical and technological resources. In order to characterize the interaction with the device, preliminary trials with EMG and kinematics recordings were performed on healthy subjects.

Quantitative EEG for Predicting Upper Limb Motor Recovery in Chronic Stroke Robot-Assisted Rehabilitation.

Stroke is a leading cause for adult disability, which in many cases causes motor deficits. Despite the developments in motor rehabilitation techniques, recovery of upper limb functions after stroke is limited and heterogeneous in terms of outcomes, and knowledge of important factors that may affect the outcome of the therapy is necessary to make a reasonable prediction for individual patients. In this paper, we assessed the relationship between quantitative electroencephalographic (QEEG) measures and the motor outcome in chronic stroke patients that underwent a robot-assisted rehabilitation program to evaluate the utility of QEEG indices to predict motor recovery. For this purpose, we acquired resting-state electroencephalographic signals from which the power ratio index (PRI), delta/alpha ratio, and brain symmetry index were calculated. The outcome of the motor rehabilitation was evaluated using upper limb section of the Fugl-Meyer Assessment. We found that PRI was significantly correlated with the motor recovery, suggesting that this index may provide useful information to predict the rehabilitation outcome.

Using robot fully assisted functional movements in upper-limb rehabilitation of chronic stroke patients: preliminary results.

BACKGROUND: Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. AIM: To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. DESIGN: Cohort study. SETTING: Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. POPULATION: Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. METHODS: Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. RESULTS: All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, P<0.008). CONCLUSIONS: This preliminary study shows that a robotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. CLINICAL REHABILITATION IMPACT: This intervention could be extended even to subacute stroke and other neurological disorders.

Predicting Functional Recovery in Chronic Stroke Rehabilitation Using Event-Related Desynchronization-Synchronization during Robot-Assisted Movement.

Although rehabilitation robotics seems to be a promising therapy in the rehabilitation of the upper limb in stroke patients, consensus is still lacking on its additive effects. Therefore, there is a need for determining the possible success of robotic interventions on selected patients, which in turn determine the necessity for new investigating instruments supporting the treatment decision-making process and customization. The objective of the work presented in this preliminary study was to verify that fully robot assistance would not affect the physiological oscillatory cortical activity related to a functional movement in healthy subjects. Further, the clinical results following the robotic treatment of a chronic stroke patient, who positively reacted to the robotic intervention, were analyzed and discussed. First results show that there is no difference in EEG activation pattern between assisted and no-assisted movement in healthy subjects. Even more importantly, the patient's pretreatment EEG activation pattern in no-assisted movement was completely altered, while it recovered to a quasi-physiological one in robot-assisted movement. The functional improvement following treatment was large. Using pretreatment EEG recording during robot-assisted movement might be a valid approach to assess the potential ability of the patient for recovering.

An affordable, adaptable, and hybrid assistive device for upper-limb neurorehabilitation.

The paper presents a multisensory and multimodal device for neuromuscular rehabilitation of the upper limb, designed to enable enriched rehabilitation treatment in both clinical and home environments. Originating from an existing low-cost, variable-stiffness rehabilitation device, it expands its functionalities by integrating additional modules in order to augment application scenarios and applicable clinical techniques. The newly developed system focuses on the integration of a wearable neuromuscular electrical stimulation system, a virtual rehabilitation scenario, a low-cost unobtrusive sensory system and a patient model for adapting training task parameters. It also monitors the user behavior during each single session and its evolution throughout the entire training period. The result is a modular, integrated and affordable rehabilitation device, enabling a biomechanical, neurological, and physiological-based training of patients, including innovative features currently unavailable within off-the-shelf rehabilitation devices.

Normative Data for an Instrumental Assessment of the Upper-Limb Functionality.

Upper-limb movement analysis is important to monitor objectively rehabilitation interventions, contributing to improving the overall treatments outcomes. Simple, fast, easy-to-use, and applicable methods are required to allow routinely functional evaluation of patients with different pathologies and clinical conditions. This paper describes the Reaching and Hand-to-Mouth Evaluation Method, a fast procedure to assess the upper-limb motor control and functional ability, providing a set of normative data from 42 healthy subjects of different ages, evaluated for both the dominant and the nondominant limb motor performance. Sixteen of them were reevaluated after two weeks to perform test-retest reliability analysis. Data were clustered into three subgroups of different ages to test the method sensitivity to motor control differences. Experimental data show notable test-retest reliability in all tasks. Data from older and younger subjects show significant differences in the measures related to the ability for coordination thus showing the high sensitivity of the method to motor control differences. The presented method, provided with control data from healthy subjects, appears to be a suitable and reliable tool for the upper-limb functional assessment in the clinical environment.

Kinect One-based biomechanical assessment of upper-limb performance compared to clinical scales in post-stroke patients.

This paper presents a Kinect One sensor-based protocol for the evaluation of the motor-performances of the upper limb of neurological patients during rehabilitative sessions. The assessment provides evaluations of kinematic, dynamic, motor and postural control variables. A pilot study was conducted on three post-stroke neurological patients, comparing Kinect-One biomechanical assessment with the outcomes of some of the most common clinical scales for the evaluation of the upper-limb functionality. Preliminary results indicate coherency between the clinical and instrumental evaluation. Moreover, the Kinect-One assessment seems to provide some complementary quantitative information, consistently integrating the clinical assessment.

A spherical parallel three degrees-of-freedom robot for ankle-foot neuro-rehabilitation.

The ankle represents a fairly complex bone structure, resulting in kinematics that hinders a flawless robot-assisted recovery of foot motility in impaired subjects. The paper proposes a novel device for ankle-foot neuro-rehabilitation based on a mechatronic redesign of the remarkable Agile Eye spherical robot on the basis of clinical requisites. The kinematic design allows the positioning of the ankle articular center close to the machine rotation center with valuable benefits in term of therapy functions. The prototype, named PKAnkle, Parallel Kinematic machine for Ankle rehabilitation, provides a 6-axes load cell for the measure of subject interaction forces/torques, and it integrates a commercial EMG-acquisition system. Robot control provides active and passive therapeutic exercises.

A new approach to rhythm cueing of cognitive functions: the case of ideomotor apraxia.

Although positive effects of rhythm cueing on motor control in neurologic disorders are known, no studies have yet focused on patients suffering from impaired programming of complex actions. One patient suffering from ideomotor apraxia (a potentially ideal experimental paradigm to test the effect of rhythm on high-level motor control) underwent two rehabilitation training sets differing only for the presence or absence of rhythm cueing. Both sets of training increased the patient's proficiency, but rhythm cueing was significantly more effective, during the training as well as during the post-training uncued test. Ideomotor apraxia represents an effective model to test the effects of rhythm on high-level motor control.

Using kinematic analysis to evaluate constraint-induced movement therapy in chronic stroke patients.

OBJECTIVE: This preliminary study aims to verify if the method of kinematic analysis proposed here may be suitable for evaluating the effects of constraint-induced movement therapy (CIMT) in chronic stroke patients and may be of help in the study of the mechanisms underlying functional improvement following CIMT. METHODS: Clinical and kinematic data were collected from a group of chronic stroke patients and from an age-matched healthy control group. Affected and less affected upper-limb kinematics related to hand-to-mouth and reaching movements were acquired before and immediately after 2 weeks of CIMT. Healthy subjects were submitted to kinematic analysis of the nondominant side and reevaluated after 2 weeks. RESULTS: The clinical results were consistent with those reported in the literature and showed motor function improvement of the hemiparetic limb after CIMT. Kinematic data of the healthy control group showed high test-retest reliability. Statistically significant differences between the affected limb and both the less affected limb and the healthy subjects' nondominant limb were observed. After CIMT, kinematic data showed improvement in the speed of movement and in measures related to the capacity for coordination. CONCLUSIONS: The method of kinematic analysis was sensitive for an assessment of motor recovery induced by CIMT. The kinematic results suggest that the increase in the use of the paretic limb in activities of daily living after the intervention is not only attributable to the patient's increased attention to it and better hand dexterity, but it is also a consequence of the improved speed of movement and better coordination between shoulder and elbow joints.

Instrumental evaluation of gait modifications before and during intrathecal baclofen therapy: a 2-year follow-up case study.

Intrathecal baclofen therapy has been used for several years, despite the fact that long-term gait modifications in ambulatory patients have not been thoroughly investigated. A 31-yr-old male patient affected by hereditary spastic paraparesis was evaluated clinically and by gait analysis. Evaluations were made before and at 6, 12, 16, and 24 mos after implantation. The patient showed a clear improvement in self-selected speed, step and stride length, knee and ankle kinematics, and ankle kinetics. Moreover, the response observed on self-selected speed is consistent with the intrathecal baclofen dose administered. To our knowledge, this is the first report of a long-term instrumental gait analysis assessment of a patient receiving intrathecal baclofen. Gait analysis could be a reliable and feasible assessment tool to evaluate ambulatory patients receiving intrathecal baclofen therapy over time and to help clinicians in determining exact dose requirements.