Abstract
Upper limb exoskeletons have drawn significant attention in neurorehabilitation because of the anthropomorphic mechanical structure analogous to human anatomy. Whereas, the training movements are typically unorganized because most exoskeletons ignore the natural movement characteristic of human upper limbs, particularly inter-joint postural synergy. This paper introduces a newly developed exoskeleton (Armule) for upper limb rehabilitation with a postural synergy design concept, which can reproduce activities of daily living (ADL) motion with the characteristics of human natural movements. The semitransparent active control strategy with the interactive force guidance and visual feedback ensured the active participation of users. Eight participants with hemiplegia due to a first-ever, unilateral stroke were recruited and included. They participated in exoskeleton therapy sessions for 4 weeks, with passive/active training under trajectories and postures with the characteristics of human natural movements. The primary outcome was the Fugl-Meyer Assessment for Upper Extremities (FMA-UE). The secondary outcomes were the Action Research Arm Test(ARAT), modified Barthel Index (mBI), and metric measured with the exoskeleton After the 4-weeks intervention, all subjects showed significant improvements in the following clinical measures: the FMA-UE (difference, 11.50 points, p = 0.002), the ARAT (difference, 7.75 points ), and the mBI (difference, 17.50 points, p = 0.003 ) score. Besides, all subjects showed significant improvements in kinematic and interaction force metrics measured with the exoskeleton. These preliminary results demonstrate that the Armule exoskeleton could improve individuals' motor control and ADL function after stroke, which might be associated with kinematic and interaction force optimization and postural synergy modification during functional tasks.
Highlights
STROKE is the leading cause of adult mortality and disability worldwide[1], and more than two-thirds of stroke survivors arrive at the hospital with motor impairments and function in the upper limbs characterized by muscle weakness, spasms, loss of coordination, and pathological synergies
At 4 weeks, the patients trained showed significant reductions in motor impairment and significant improvements in motor capacity, as measured by the FMA-UE, the minimal clinically important difference (MCID) for FMA-UE is 4 points in acute to subacute stroke and 5.25points in chronic stroke
The ARAT the MCID for the ARAT in stroke individuals is 10% of its range (5.7 points)
Summary
STROKE is the leading cause of adult mortality and disability worldwide[1], and more than two-thirds of stroke survivors arrive at the hospital with motor impairments and function in the upper limbs characterized by muscle weakness, spasms, loss of coordination, and pathological synergies. Robot-assisted training is an innovative exercise-based therapy that involves the principles of motor learning It lightens the burden on the therapist and can provide highly intensive, adaptive, and task-specific training as well as feedback and motivation for enhancing neuroplasticity, more importantly, it introduces a standardized quantitative evaluation method for the rehabilitation training process. Exoskeleton robots provide a rich range of functional movements, the curse of dimensionality caused by the mechanical structure with a high DOF brings serious challenges to the control strategy[20]. Such a structure means high manufacturing and use costs, making it less cost-effective, which is not conducive to the promotion of rehabilitation robots.
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