Assistive Arm Research Articles

A phase III randomised trial of trans-abdominal ultrasound in improving application quality and dosimetry of intra-cavitary brachytherapy in locally advanced cervical cancer

IntroductionIntra-cavitary brachytherapy (ICB) remains an integral part of radiotherapy treatment in cervical cancer. Two-dimensional X ray point-based planning remains common and blind insertion leads to uterine perforations and higher toxicity. We conducted a randomised controlled trial of using trans-abdominal ultrasound in performing ICB to reduce perforation and organ at risk doses. Patient and methodsThe present study is a phase III open label randomised controlled trial of ultrasound guided ICB conducted on invasive cervical cancer patients. Patients were randomised by a simple computer-generated randomization chart into Arm A (No Ultrasound guidance) and Arm B (ICB with ultrasound guidance). The uterine perforation rates, tandem length change rates, bladder doses, rectal dose and procedure times were compared. Fischer exact test was used to compare the arms and p value <0.05 considered significant. ResultsA total of 160 patients were randomised. With US assistance, the uterine perforation rate was 1.25% (n = 1). In the non-US assistance arm the perforation rate was 12.5% (n = 10) (p = 0.005). Mean time to complete the entire procedure was significantly shortened from 26 min to 19 min favouring the US arm (p = 0.001). Dosimetric assessment between the two groups showed significant decrease in dose received by the various organs at risk with US assistance. ConclusionThe present study confirms significant improvement in application quality as well as dosimetry with reduction in procedure time. Trans-Abdominal US should be routinely used for ICB procedures, particularly in resource limited settings.

Robotic-Arm Assistance Simplifies Hip Arthrodesis Conversion to Total Hip Arthroplasty

Hip fusion takedown to total hip replacement is a challenging operation. Neck osteotomy and acetabular component placement are technically demanding and often require fluoroscopic guidance. Robotic arm–assisted total hip arthroplasty enhances accuracy of preoperative planning and provides navigated guidance for neck osteotomy and haptic guidance on acetabular reaming and cup implantation. Fluoroscopic guidance is replaced by real-time navigation and on-screen data. This article describes how robotic arm assistance can simplify this complex operation.

Motor performance patterns between unilateral mechanical assistance and bilateral muscle contraction

Motor performance patterns for mechanical assistance on unilateral force control can be affected by simultaneous muscle contraction. This study investigated how muscle activity and motor performance during the cooperation between dominant-arm force control and assistive force are affected by simultaneous non-dominant arm muscle contraction with inertial loading. Eleven participants (age: 24.1 ± 1.7 years) performed trajectory-tracking task based on visual feedback of real-time isometric force control. Their force for dominant-arm elbow flexion was released from reference magnitude of 47 N to magnitude of 23.5 N by providing mechanical assistance of a linear actuator. A 47 N of inertial loading on non-dominant arm elbow flexion was conditionally provided. For four time epochs of the experimental task, we measured responses of the assisted arm in terms of: (1) surface electromyography (EMG) amplitudes of biceps brachii and triceps brachii muscles, (2) peak perturbation, and (3) motor performance of force variability and target overshoot during manual force output. Simultaneous loading on unassisted arm did not affect peak perturbation of assisted arm. However, it caused lower force variability and overshoot ratio during the time epoch of force release and higher EMG amplitudes of biceps brachii muscle during the time epochs after mechanical assistance is provided, compared to the non-loaded condition. Our results indicate that simultaneous muscle contraction affects unilateral force control with mechanical assistance aimed at enhancing motor performance by creating extra agonist muscle activity. These findings can be utilized for improving the performance of human-robot cooperation during manual material handling in many industrial sites.

Role of Ultrasound Guided Tandem Placement in Intracavitary Brachytherapy for Cervical Cancer Management – A Randomized, Open Label Study From an Indian Experience

Tandem placement within the uterine cavity can be a tedious affair in Intracavitary brachytherapy and blind insertion of the tandem may result in suboptimal tandem placement or uterine perforation and reduce the control rate of the tumor locally. Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practiced. Ultrasound (US) is a simple imaging modality that is readily available in most departments and allows real-time visualization of applicators. We present our study with aim to evaluate the role of routine real-time intraoperative trans-abdominal ultrasound guided tandem placement in terms of decreased complication rates, improved implant geometry and increased operator efficiency. A total of 62 patients were randomized and assessed prospectively at our institution who underwent intracavitary brachytherapy for various stages of cervix cancer between October 2019 to March 2020 with 31 patients undergoing US guided tandem placement versus 31 patients who did not undergo the same. A total of 124 applications were analyzed and Cervical dilation, tandem selection and subsequent insertion were guided by trans-abdominal ultrasound with confirmation of the final placement of the applicator on US followed by CT imaging for treatment planning. Thereafter, the perforation rates and the applicator suitability for patient anatomy were assessed. Role of intervention in case of perforation, the time taken for the application, complications following the perforation were also assessed. The rate of perforation in the US assistance arm was 3% applications versus 12% in the non-US assistance arm. The cervical os could be easily identified visually, which was then confirmed with ultrasound guidance. The length of the uterine canal changed in 25 patients during the subsequent brachytherapy application with help of US assistance. Visualization of patient anatomy during the procedure aided the selection of suitable tandem length and angle in 39 of cases and resulted in optimal applicator selection and placement. The average insertion time was 19 minutes versus 27 minutes favoring US assistance (p = 0.012). The need for the assistance from radiology and gynecologic oncology for identification of the uterine cavity was not required in any of the cases suggesting excellent feasibility of US use. The bladder d2cc (EQD2) was 71.4Gy vs 74.8Gy (p = 0.034) and Rectum d2cc was 74.9Gy vs 77.8Gy (p = 0.023) favoring the US assisted arm. The study emphasizes on the routine use of US assistance to improve optimal applicator selection and proper applicator geometry and thereby, reduce the reinsertion and perforation rates. US assistance also helps reduce the procedure time and out-of-department referrals. It is an accurate, fast, easily available, and cost-effective method.

Robotic Arm Assistance System Based on Simple Stereo Matching and Q-Learning Optimization

This study presents a stereo vision robotic arm assistance system, in which five degrees of catching can be performed by the robot arm in a single instance. The algorithm of the control system is built for population-based optimization and specifically aimed to assist people with disabilities. The proposed stereo vision-based robot arm system enables users to manipulate objects based on the robot’s ability to aim at objects by using computer vision. The stereo vision system counts the parameters by focusing on the real-world position of the instance in the coordinate system. A trained deep fully connected network is then adopted to compensate the location measurement errors incurred by the inaccurate parameters measured from the deep learning procedure. Subsequently, the proposed Q-learning-based swarm optimization algorithm is adopted to solve the forward kinematics problem and count the angles of each servo. The performance of the robot arm is compared with several real-life experiments to test its ability to grip a target object in different positions.

The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip

BackgroundTotal hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia. MethodsWe retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained. ResultsSeventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66° to 91°, P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years). ConclusionsRobot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia. Level of EvidenceLevel III, Retrospective

Robotic Surgery in Total Joint Arthroplasty: A Survey of the AAHKS Membership to Understand the Utilization, Motivations, and Perceptions of Total Joint Surgeons

BackgroundIn the past decade, the popularity of robot arm assistance in total joint arthroplasty has outpaced the reporting of long-term data. This study aimed to understand the motivations for use and perceptions of the technology among total joint surgeons. MethodsAn online survey was distributed to the membership of the American Association of Hip and Knee Surgeons. The questions were asked for respondent’s motivations for utilization of the technology, perceptions regarding outcomes and training, and personal characteristics that may have influenced responses. ResultsIncreased precision was the primary reason for users (73.1%) to utilize robot arm assistance in total joint procedures. Nonusers were just as likely to consider adopting the technology because of increase precision and marketing (P = .590). Nonclinical reasons such as marketing, administrative pressure, and peer pressure were primary motivators for 19.7% of users of the technology. Respondents regardless of financial interest and use of the technology felt that robot arm assistance increased operative time (76.5%) and was not more cost-effective than traditional methods (78.7%). Most American Association of Hip and Knee Surgeons members felt that 20-40 surgical cases were needed to become competent with the technique (54.1%). A unique finding of this study is that a larger proportion of orthopedic surgeons considered themselves “innovators” or “early adopters,” based on Roger's diffusion of innovations, than was expected for the general population. ConclusionThis study demonstrates that the decision to adopt robot arm assistance in total joint arthroplasty is multifactorial and may have a significant contribution from nonclinical factors and inherent surgeon characteristics. Continued evaluation of surgeon perceptions will be valuable as new evidence emerges regarding long-term outcomes.

Feedback From Mono-Articular Muscles is Sufficient for Exoskeleton Torque Adaptation.

In this paper, by using a biomechanical model of the human body, we prove that (1) due to the existence of bi-articular muscles and compliant-elements, blind full-torque-compensation at joint level leads to muscles' activity amplification and consequently online adaptation methods are required for exoskeleton torque optimization. Moreover, (2) we state a new hypothesis that "reducing the net torque of two antagonistic mono-articular muscles is sufficient for involved muscles' total effort reduction" and analytically discuss its validity condition. Using this hypothesis, (3) we develop an adaptation rule which optimizes the exoskeleton torque using EMG signals of only two antagonistic mono-articular muscles. Furthermore, (4) the stability, convergence, optimality, and robustness of our adaptation method are proved in the presence of electromyography's intrinsic noisy behavior. Finally, (5) we experimentally validate our EMG-based adaptation method on six healthy subjects. We show that adaptation of the elbow compliance in a 2-DOF semi-active assistive arm in a cyclic task results in significant muscles activity reduction in all our subjects.

Guidance for Treatment of Pelvic Acetabular Injuries with Precise Minimally Invasive Internal Fixation Based on the Orthopaedic Surgery Robot Positioning System.

Pelvic acetabular fracture is a common kind of fracture, mostly caused by high energy injuries. It is associated with high mortality and disability rates. The aim of surgical treatment of pelvic acetabular fractures is to restore the symmetry and stability of the pelvic ring structure and the anatomical structure of acetabular. Open reduction internal fixation is often used for the treatment of such fractures, but open surgery is in cases of serious injury, more bleeding, and high risk of infection. With the development of minimally invasive technology and the concept of the bone channel structure, the percutaneous lag screw technique for the treatment of pelvic and acetabular fractures has been applied in clinical practice and has proven to be effective. However, the anatomical structure of the pelvis and acetabulum is complex, and there are many important nerves and vessels adjacent to it. Traditional fluoroscopy screw placement is prone to screw malposition, and even minor angle changes may lead to screw perforation and damage of nerve vessels. The problem of radiation exposure is also noteworthy. Robotic‐assisted surgery can be used to carry out screw position planning through preoperative imaging, intraoperative real‐time tracking, and mechanical arm assistance to ensure that the screw placement position is consistent with the planning. In this way, robotic‐assisted surgery can be used to accurately insert lag screws, and can reduce surgical risk and radiation exposure. This guide uses the TiRobot system as an example to describe the application of robot surgery in detail, aiming at standardizing the application of robots in orthopaedic surgery.

Self-Collection of Vaginal Swabs Among Adolescent Girls in a School-Setting in East Africa.

Few studies have evaluated the acceptability of self-collected vaginal swabs among young women in sub-Saharan Africa, including in school settings. We evaluated the acceptability of 2 conditions for the self-collection of swabs in secondary schools in Entebbe, Uganda. Assenting girls with parental consent from 3 secondary schools were provided instructions for sampling, and randomly allocated to self-collection of vaginal swabs with or without nurse assistance to help with correct placement of the swab. Swabs were tested for bacterial vaginosis by Gram stain. Participants were followed up after 1 to 2 days and 1 to 2 weeks and invited for a qualitative interview. Overall 96 girls were enrolled (median age, 16 years; interquartile range, 15-17 years). At the first follow-up visit, participants in both arms reported that instructions for sample collection were easy to understand, and they felt comfortable with self-collection. Girls in the nurse assistance arm reported feeling less relaxed (27% vs. 50%, P = 0.02) than those in the arm without nurse assistance, but more confident that they collected the sample correctly (96% vs. 83%, P = 0.04). About half (47%) of participants agreed that self-sampling was painful, but almost all (94%) would participate in a similar study again. Qualitative data showed that participants preferred self-collection without nurse assistance to preserve privacy. Bacterial vaginosis prevalence was 14% (95% confidence interval, 8-22). In this setting, self-collection of vaginal swabs in secondary schools was acceptable and feasible, and girls preferred self-collection without nurse assistance. Self-collection of swabs is an important tool for the detection, treatment and control of reproductive tract infections in girls and young women.

Development of home care assistant robot arm with familiar mechanism

Development of home care assistant robot arm with familiar mechanism

18F-FDG PET/CT-Guided Real-Time Automated Robotic Arm–Assisted Needle Navigation for Percutaneous Biopsy of Hypermetabolic Bone Lesions: Diagnostic Performance and Clinical Impact

The purpose of this study is to establish the feasibility, safety, diagnostic performance, and clinical impact of real-time intraprocedural 18F-FDG PET/CT-guided automated robotic arm-assisted biopsy of hypermetabolic marrow or bone lesions. This prospective study included 73 patients (47 male patients and 26 female patients) who underwent PET/CT-guided biopsy of accessible hypermetabolic marrow or bone lesions. The biopsy needle was inserted into the target lesion with automated robotic arm assistance, and tissue sampling was performed at the site with the highest metabolic activity, after the needle position was confirmed using PET/CT. The results of histopathologic examination and clinical and imaging follow-up examinations were reviewed. The referring physicians were interviewed to assess the clinical impact of interventions on treatment planning. Of the 73 patients assessed, 34 were oncology patients with suspected metastasis or residual disease. The pathologic diagnosis was not known for 38 patients with clinically suspected benign (n = 7) or malignant (n = 31) disease. The remaining patient was suspected of having skeletal sarcoidosis. Thirty-nine marrow lesions and 34 bone lesions were targeted. All procedures were technically successful and safe, and no major complication was observed. Pathologic diagnosis was confirmed for 72 patients, for a diagnostic yield of 98.6%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of malignancy (n = 54) were 98.2%, 100%, 100%, 94.7%, and 98.6%, respectively. The procedure was helpful in determining the treatment plan for 91.7% of patients. Automated robotic arm-assisted FDG PET/CT-guided real-time bone biopsy is a feasible and safe intervention with a very high diagnostic yield. It had a major clinical impact on patients with minimal residual FDG uptake on end-of-treatment PET/CT and isolated suspected metastatic lesions.

Evaluation of Holding Force on Six-D.o.F Surgical Assist Arm with Sphere Joints and Inner-Outer Cables

A new type of surgical instrument developed as substitutes for an abdominal retractor for use during surgery is described. The new instrument can increase the efficiency of retraction during surgery. We develop an assistant mechanism which has a six-D.o.F, as high controllability at the tip of the mechanism. The mechanism consists of a serial three-link manipulator whose each joint is composed of a ball joint. The instrument needs to maintain the shape of the relevant body part while maintaining own posture during surgery.

Classification and characterization of postural transitions using instrumented shoes.

The frequency and quality of sit-to-stand and stand-to-sit postural transitions decrease with age and are highly relevant for fall risk assessment. Accurate classification and characterization of these transitions in daily life of older adults are therefore needed. In this study, we propose to use instrumented shoes for postural transition classification as well as transition duration estimation from insole force signals. In the first part, data were collected with 10 older adults and 10 young participants performing transitions in the laboratory while wearing the instrumented shoes, without arm assistance. A wavelet approach was used to transform the insole force data, and candidate events were selected for transition duration estimation. Transition durations were then validated against a model based on force plate reference. Vertical force estimation was also compared to force plate measurement. In the second part, postural transitions were classified in daily life using the instrumented shoes and validated against a highly accurate wearable system. Transition duration was estimated with an error ranging from 10 to 20% while the error for vertical force estimation was 7%. Postural transition classification was achieved with excellent sensitivity and precision exceeding 90%. In conclusion, the instrumented shoes are suitable for classifying and characterizing postural transitions in daily life conditions of healthy older adults. Graphical abstract "Experimental setup showing instrumented shoes, reference force plate, as well as IMUs used for postural transition classification and duration estimation comparison".

Fast scene analysis using vision and artificial intelligence for object prehension by an assistive robot

Robotic assistance for people affected by motor deficits is a fast growing field. In this context, two major challenges remain in terms of automated scene analysis and automated object prehension. More specifically, the most robust of current segmentation methods are still computationally intensive, preventing the automation of objects prehension from being fast enough to be considered acceptable as an everyday technical-aid. The objective of this study is to develop a fast scene analysis using vision and artificial intelligence for object prehension by an assistive robot.The solution developed in this paper aims at facilitating human-machine interaction by enabling users to easily communicate their needs to the technical aid. To achieve this, this paper proposes several novelties in three interconnected domains: scene segmentation, prehension and recognition of 3D objects. A novel technic, inspired by mechanical probing, is developed for scenes probing to detect objects. A simple, fast and effective decision tree is proposed for object prehension. Finally, the physical characteristics of the 3D objects are directly used in the neural network without using discriminants features descriptors.The results obtained in this paper have shown that scene analysis for robotic object prehension in cooperation with a user can be performed with effective promptness. Indeed, the system requires on average 0.6s to analyze an object in a scene. With the JACO robotic assistance arm, the system can pick up a requested object in 15s while moving at 50mm/s, which may be greatly improved upon using a faster robot. The system performance averages 83% accuracy for object recognition and is able to use a decision tree to select a simple approach path for the robot end-effector towards a desired object. This system, in combination with an assistive robot, has great potential for providing users suffering from musculoskeletal disorders with improved autonomy and independence, and for encouraging sustained usage of this type of technical aids.

A Study of Pneumatic Assist Arm for Physical Load Reduction of Worker

A Study of Pneumatic Assist Arm for Physical Load Reduction of Worker

Robotic Assisted Cannulation of Occluded Retinal Veins.

PurposeTo develop a methodology for cannulating porcine retinal venules using a robotic assistive arm after inducing a retinal vein occlusion using the photosensitizer rose bengal.MethodologyRetinal vein occlusions proximal to the first vascular branch point were induced following intravenous injection of rose bengal by exposure to 532nm laser light delivered by slit-lamp or endolaser probe. Retinal veins were cannulated by positioning a glass catheter tip using a robotically controlled micromanipulator above venules with an outer diameter of 80μm or more and performing a preset piercing maneuver, controlled robotically. The ability of a balanced salt (BSS) solution to remove an occlusion by repeat distention of the retinal vein was also assessed.ResultsCannulation using the preset piercing program was successful in 9 of 9 eyes. Piercing using the micromanipulator under manual control was successful in only 24 of 52 attempts, with several attempts leading to double piercing. The best location for cannulation was directly proximal to the occlusion. Infusion of BSS did not result in the resolution of the occlusion.ConclusionCannulation of venules using a robotic microassistive arm can be achieved with consistency, provided the piercing is robotically driven. The model appears robust enough to allow testing of therapeutic strategies aimed at eliminating a retinal vein thrombus and its evolution over time.

Home Arm Assistance Progression Initiative (HAAPI) Trial: Robotic-Assisted Telerehabilitation for Stroke

Abstract Date Presented 4/18/2015 Stroke survivors in rural areas lack access to the specialized occupational therapy needed for functional gains in the upper extremity (UE). The Home Arm Assistance Progression Initiative (HAAPI) trial demonstrates robotic-assisted telerehabilitation as a viable means to deliver occupational therapy remotely, maintain a client-centered relationship, improve quality of life (QoL), and promote UE neuromotor recovery.

The HAAPI (Home Arm Assistance Progression Initiative) Trial

Background. Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke. Objective. To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved. Methods. In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, or (2) the control group, which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment (UE) were primary and secondary outcome measures, respectively, undertaken before and after the interventions. Results. Both groups demonstrated improvement across all UE outcomes. Conclusions. Robotic + HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time. Additional research is necessary to determine the appropriate dosage of HMP and HEP.

Force-position control of a robotic exoskeleton to provide upper extremity movement assistance

This paper presents an upper extremity (UE) wearable robot, ETS-MARSE and its control strategy to provide movement assistance and active rehabilitation exercises to physically disabled individuals having impaired UE function. The ETS-MARSE was designed to be worn on the lateral side of UE and is able to assist arm movements at the level of shoulder, elbow, forearm and wrist joint movements. Considering the dynamic modelling of the robot system and the UE motion which are non-linear in nature, a non-linear sliding mode control with exponential reaching law was used to manoeuvre the ETS-MARSE and to provide both passive and assisted arm movement therapy. To provide passive arm movement therapy, pre-programmed trajectories corresponding to recommended passive rehabilitation exercises were used to manoeuvre the ETS-MARSE, whereas in case of assisted rehabilitation therapy user interaction wrist force sensor signals were used to steer the ETS-MARSE in assisting the UE movements. Experiments involving healthy human subjects were performed with the developed ETS-MARSE to evaluate the controller’s performance and that of the ETS-MARSE in regards to providing the therapeutic exercises. Experimental results indicate that with the proposed control strategy, ETS-MARSE can effectively deliver rehabilitation exercises.