Tackling Post-COVID-19 Rehabilitation Challenges: A Pilot Clinical Trial Investigating the Role of Robotic-Assisted Hand Rehabilitation.

Background: Prolonged hospitalization in severe COVID-19 cases can lead to substantial muscle loss and functional deterioration. While rehabilitation is essential, conventional approaches face capacity challenges. Therefore, evaluating the effectiveness of robotic-assisted rehabilitation for patients with post-COVID-19 fatigue syndrome to enhance both motor function and overall recovery holds paramount significance. Our objective is to assess the effectiveness of rehabilitation in post-COVID-19 patients with upper extremity impairment through the utilization of a hand exoskeleton-based robotic system. Methods: A total of 13 participants experiencing acute or limited functional or strength impairment in an upper extremity due to COVID-19 were enrolled in the study. A structured intervention consisted of 45 min therapy sessions, conducted four times per week over a six-week period, utilizing a hand exoskeleton. The research employed standardized health assessments, motion analysis, and semi-structured interviews for pre-intervention and follow-up evaluations. Paired sample t-tests were employed to statistically analyze the outcomes. Results: The outcomes showed a reduction in overall dependence levels across participants, positive changes in various quality of life-related measurements, and an average increase of 60.4 ± 25.7% and 28.7 ± 11.2% for passive and active flexion, respectively. Conclusions: Our data suggest that hand exoskeleton-based robotic systems hold promise to optimize the rehabilitation outcomes following severe COVID-19. Trial registration: ID NCT06137716 at ClinicalTrials.gov.

Force-based control strategy for a collaborative robotic camera holder in laparoscopic surgery using pivoting motion.

Introduction: Laparoscopic surgery often relies on a fixed Remote Center of Motion (RCM) for robot mobility control, which assumes that the patient's abdominal walls are immobile. However, this assumption is inaccurate, especially in collaborative surgical environments. In this paper, we present a force-based strategy for the mobility of a robotic camera-holder system for laparoscopic surgery based on a pivoting motion. This strategy re-conceptualizes the conventional mobility control paradigm of surgical robotics. Methods: The proposed strategy involves direct control of the Tool Center Point's (TCP) position and orientation without any constraints associated with the spatial position of the incision. It is based on pivoting motions to minimize contact forces between the abdominal walls and the laparoscope. The control directly relates the measured force and angular velocity of the laparoscope, resulting in the reallocation of the trocar, whose position becomes a consequence of the natural accommodation allowed by this pivoting. Results: The effectiveness and safety of the proposed control were evaluated through a series of experiments. The experiments showed that the control was able to minimize an external force of 9 N to ±0.2 N in 0.7 s and reduce it to 2 N in just 0.3 s. Furthermore, the camera was able to track a region of interest by displacing the TCP as desired, leveraging the strategy's property that dynamically constrains its orientation. Discussion: The proposed control strategy has proven to be effective minimizing the risk caused by sudden high forces resulting from accidents and maintaining the field of view despite any movements in the surgical environment, such as physiological movements of the patient or undesired movements of other surgical instruments. This control strategy can be implemented for laparoscopic robots without mechanical RCMs, as well as commercial collaborative robots, thereby improving the safety of surgical interventions in collaborative environments.

Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study.

Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.

Interaction with a Hand Rehabilitation Exoskeleton in EMG-Driven Bilateral Therapy: Influence of Visual Biofeedback on the Users' Performance.

The effectiveness of EMG biofeedback with neurorehabilitation robotic platforms has not been previously addressed. The present work evaluates the influence of an EMG-based visual biofeedback on the user performance when performing EMG-driven bilateral exercises with a robotic hand exoskeleton. Eighteen healthy subjects were asked to perform 1-min randomly generated sequences of hand gestures (rest, open and close) in four different conditions resulting from the combination of using or not (1) EMG-based visual biofeedback and (2) kinesthetic feedback from the exoskeleton movement. The user performance in each test was measured by computing similarity between the target gestures and the recognized user gestures using the L2 distance. Statistically significant differences in the subject performance were found in the type of provided feedback (p-value 0.0124). Pairwise comparisons showed that the L2 distance was statistically significantly lower when only EMG-based visual feedback was present (2.89 ± 0.71) than with the presence of the kinesthetic feedback alone (3.43 ± 0.75, p-value = 0.0412) or the combination of both (3.39 ± 0.70, p-value = 0.0497). Hence, EMG-based visual feedback enables subjects to increase their control over the movement of the robotic platform by assessing their muscle activation in real time. This type of feedback could benefit patients in learning more quickly how to activate robot functions, increasing their motivation towards rehabilitation.

Gauze Detection and Segmentation in Minimally Invasive Surgery Video Using Convolutional Neural Networks.

Medical instruments detection in laparoscopic video has been carried out to increase the autonomy of surgical robots, evaluate skills or index recordings. However, it has not been extended to surgical gauzes. Gauzes can provide valuable information to numerous tasks in the operating room, but the lack of an annotated dataset has hampered its research. In this article, we present a segmentation dataset with 4003 hand-labelled frames from laparoscopic video. To prove the dataset potential, we analyzed several baselines: detection using YOLOv3, coarse segmentation, and segmentation with a U-Net. Our results show that YOLOv3 can be executed in real time but provides a modest recall. Coarse segmentation presents satisfactory results but lacks inference speed. Finally, the U-Net baseline achieves a good speed-quality compromise running above 30 FPS while obtaining an IoU of 0.85. The accuracy reached by U-Net and its execution speed demonstrate that precise and real-time gauze segmentation can be achieved, training convolutional neural networks on the proposed dataset.

Prediction of Cow Calving in Extensive Livestock Using a New Neck-Mounted Sensorized Wearable Device: A Pilot Study.

In this study, new low-cost neck-mounted sensorized wearable device is presented to help farmers detect the onset of calving in extensive livestock farming by continuously monitoring cow data. The device incorporates three sensors: an inertial measurement unit (IMU), a global navigation satellite system (GNSS) receiver, and a thermometer. The hypothesis of this study was that onset calving is detectable through the analyses of the number of transitions between lying and standing of the animal (lying bouts). A new algorithm was developed to detect calving, analysing the frequency and duration of lying and standing postures. An important novelty is that the proposed algorithm has been designed with the aim of being executed in the embedded microcontroller housed in the cow's collar and, therefore, it requires minimal computational resources while allowing for real time data processing. In this preliminary study, six cows were monitored during different stages of gestation (before, during, and after calving), both with the sensorized wearable device and by human observers. It was carried out on an extensive livestock farm in Salamanca (Spain), during the period from August 2020 to July 2021. The preliminary results obtained indicate that lying-standing animal states and transitions may be useful to predict calving. Further research, with data obtained in future calving of cows, is required to refine the algorithm.

Collaborative Robotic Assistant Platform for Endonasal Surgery: Preliminary In-Vitro Trials.

Endonasal surgery is a minimally invasive approach for the removal of pituitary tumors (sarcomas). In this type of procedure, the surgeon has to complete the surgical maneuvers for sarcoma resection with extreme precision, as there are many vital structures in this area. Therefore, the use of robots for this type of intervention could increase the success of the intervention by providing accurate movements. Research has focused on the development of teleoperated robots to handle a surgical instrument, including the use of virtual fixtures to delimit the working area. This paper aims to go a step further with a platform that includes a teleoperated robot and an autonomous robot dedicated to secondary tasks. In this way, the aim is to reduce the surgeon's workload so that he can concentrate on his main task. Thus, the article focuses on the description and implementation of a navigator that coordinates both robots via a force/position control. Finally, both the navigation and control scheme were validated by in-vitro tests.

Automatic gauze tracking in laparoscopic surgery using image texture analysis.

BACKGROUND AND OBJECTIVE: Inadvertent retained surgical gauzes are an infrequent medical error but can have devastating consequences in the patient health and in the surgeon professional reputation. This problem seems easily preventable implementing standardized protocols for counting but due to human errors it still persists in surgery. The omnipresence of gauzes, their small size, and their similar appearance with tissues when they are soaked in blood make this error eradication really complex. In order to reduce the risk of accidental retention of surgical sponges in laparoscopy operations, in this paper we present an image processing system that tracks the gauzes on the video captured by the endoscope. METHODS: The proposed image processing application detects the presence of gauzes in the video images using texture analysis techniques. The process starts dividing the video frames into square blocks and each of these blocks is analyzed to determine whether it is similar to the gauze pattern. The video processing algorithm has been tested in a laparoscopic simulator under different conditions: with clean, slightly stained and soaked in blood gauzes as well as against different biological background tissues. Several methods, including different Local Binary Patterns (LBP) techniques and a convolutional neural network (CNN), have been analyzed in order to achieve a reliable detection in real time. RESULTS: The proposed LBP algorithm classifies the individual blocks in the image with 98% precision and 94% sensitivity which is sufficient to make a robust detection of any gauze that appears in the endoscopic video even if it is stained or soaked in blood. The results provided by the CNN are superior with 100% precision and 97% sensitivity, but due to the high computational demand, real-time video processing is not attainable in this case with standard hardware. CONCLUSIONS: The algorithm presented in this paper is a valuable tool to avoid the retention of surgical gauzes not only because of its reliability but also because it processes the video transparently and unattended, without the need for additional manipulation of special equipment in the operating room.

Application of a Novel Measurement Setup for Characterization of Graphene Microelectrodes and a Comparative Study of Variables Influencing Charge Injection Limits of Implantable Microelectrodes.

Depending on their use, electrodes must have a certain size and design so as not to compromise their electrical characteristics. It is fundamental to be aware of all dependences on external factors that vary the electrochemical characteristics of the electrodes. When using implantable electrodes, the maximum charge injection capacity (CIC) is the total amount of charge that can be injected into the tissue in a reversible way. It is fundamental to know the relations between the characteristics of the microelectrode itself and its maximum CIC in order to develop microelectrodes that will be used in biomedical applications. CIC is a very complex measure that depends on many factors: material, size (geometric and effectiveness area), and shape of the implantable microelectrode and long-term behavior, composition, and temperature of the electrolyte. In this paper, our previously proposed measurement setup and automated calculation method are used to characterize a graphene microelectrode and to measure the behavior of a set of microelectrodes that have been developed in the Fraunhofer Institute for Biomedical Engineering (IBMT) labs. We provide an electrochemical evaluation of CIC for these microelectrodes by examining the role of the following variables: pulse width of the stimulation signal, electrode geometry and size, roughness factor, solution, and long-term behavior. We hope the results presented in this paper will be useful for future studies and for the manufacture of advanced implantable microelectrodes.

A Measurement Setup and Automated Calculation Method to Determine the Charge Injection Capacity of Implantable Microelectrodes.

The design of safe stimulation protocols for functional electrostimulation requires knowledge of the "maximum reversible charge injection capacity" of the implantable microelectrodes. One of the main difficulties encountered in characterizing such microelectrodes is the calculation of the access voltage Va. This paper proposes a method to calculate Va that does not require prior knowledge of the overpotential terms and of the electrolyte (or excitable tissue) resistance, which is an advantage for in vivo electrochemical characterization of microelectrodes. To validate this method, we compare the calculated results with those obtained from conventional methods for characterizing three flexible platinum microelectrodes by cyclic voltammetry and voltage transient measurements. This paper presents the experimental setup, the required instrumentation, and the signal processing.

Improving Challenge/Skill Ratio in a Multimodal Interface by Simultaneously Adapting Game Difficulty and Haptic Assistance through Psychophysiological and Performance Feedback.

In order to harmonize robotic devices with human beings, the robots should be able to perceive important psychosomatic impact triggered by emotional states such as frustration or boredom. This paper presents a new type of biocooperative control architecture, which acts toward improving the challenge/skill relation perceived by the user when interacting with a robotic multimodal interface in a cooperative scenario. In the first part of the paper, open-loop experiments revealed which physiological signals were optimal for inclusion in the feedback loop. These were heart rate, skin conductance level, and skin conductance response frequency. In the second part of the paper, the proposed controller, consisting of a biocooperative architecture with two degrees of freedom, simultaneously modulating game difficulty and haptic assistance through performance and psychophysiological feedback, is presented. With this setup, the perceived challenge can be modulated by means of the game difficulty and the perceived skill by means of the haptic assistance. A new metric (FlowIndex) is proposed to numerically quantify and visualize the challenge/skill relation. The results are contrasted with comparable previously published work and show that the new method afforded a higher FlowIndex (i.e., a superior challenge/skill relation) and an improved balance between augmented performance and user satisfaction (higher level of valence, i.e., a more enjoyable and satisfactory experience).

Capacitive Sensing for Non-Invasive Breathing and Heart Monitoring in Non-Restrained, Non-Sedated Laboratory Mice.

Animal testing plays a vital role in biomedical research. Stress reduction is important for improving research results and increasing the welfare and the quality of life of laboratory animals. To estimate stress we believe it is of great importance to develop non-invasive techniques for monitoring physiological signals during the transport of laboratory animals, thereby allowing the gathering of information on the transport conditions, and, eventually, the improvement of these conditions. Here, we study the suitability of commercially available electric potential integrated circuit (EPIC) sensors, using both contact and contactless techniques, for monitoring the heart rate and breathing rate of non-restrained, non-sedated laboratory mice. The design has been tested under different scenarios with the aim of checking the plausibility of performing contactless capture of mouse heart activity (ideally with an electrocardiogram). First experimental results are shown.