Elbow Rehabilitation Research Articles

Series elastic actuation of an elbow rehabilitation exoskeleton with axis misalignment adaptation.

Powered exoskeletons can facilitate rehabilitation of patients with upper limb disabilities. Designs using rotary motors usually result in bulky exoskeletons to reduce the problem of moving inertia. This paper presents a new linearly actuated elbow exoskeleton that consists of a slider crank mechanism and a linear motor. The linear motor is placed beside the upper arm and closer to shoulder joint. Thus better inertia properties can be achieved while lightweight and compactness are maintained. A passive joint is introduced to compensate for the exoskeleton-elbow misalignment and intersubject size variation. A linear series elastic actuator (SEA) is proposed to obtain accurate force and impedance control at the exoskeleton-elbow interface. Bidirectional actuation between exoskeleton and forearm is verified, which is required for various rehabilitation processes. We expect this exoskeleton can provide a means of robot-aided elbow rehabilitation.

Mechanical design of EFW Exo II: A hybrid exoskeleton for elbow-forearm-wrist rehabilitation.

The use of rehabilitation exoskeleton has become an important means for the treatment of stroke patients. A hybrid exoskeleton named EFW Exo II is developed for the motor function rehabilitation of elbow, forearm and wrist. The EFW Exo II is based on a parallel 2-URR/RRS mechanism and a serial R mechanism. It could fit both left and right arms for the symmetrical and open structure, and the distance between the elbow and wrist could automatically adjust for different forearm length. Details of the mechanical design are introduced. Brushless DC servo motors with planetary gear reducer are used as the actuators of the exoskeleton. Gear drive and belt drive are used for power transmission. A three dimensional force sensor is mounted in the handle to regulate the interaction between the exoskeleton and patient. The EFW Exo II can realize rehabilitation exercise for each joint and the ranges of motion meet the rehabilitation demands of daily living.

Pneumatic Muscle Actuated Rehabilitation Equipment of the Upper Limb Joints

Rehabilitation equipment of the upper limb joints holds a key role in passive physical therapy. Within this framework, the paper presents two such pieces of equipment developed for the rehabilitation of elbow and of wrist and knuckles, respectively. The presented and discussed equipment is actuated by pneumatic muscles, its benefits being a low cost, simple and robust construction, as well as short response time to commands.

The Design of a Hybrid Exoskeleton for Distal Arm Rehabilitation

An electrical actuated exoskeleton based on a hybrid mechanism is presented for the rehabilitation of elbow, forearm and wrist after fracture or contusion. It is comprised of a parallel 2-URR/RRU mechanism for elbow and wrist and a revolute joint for forearm. Based on screw theory the mobility of 2-URR/RRU is analyzed. The output revolute axes of 2-URR/RRU are perpendicular to each other and the distance between them is adjustable which makes it suitable for different arm length. The inverse kinematics of 2-URR/RRU mechanism are derived for position control. In the aspect of mechanical design, it is actuated by DC steering engines and a three dimensional force sensor is used to regulate the contact forces between patient and robot. Its height and angle are both adjustable by hand to enable the patient have a comfortable posture during the rehabilitation sessions. It can realize rehabilitation exercise for each joint and the ranges of motion meet the rehabilitation demands of daily living.

Development of elbow rehabilitation equipment using pneumatic muscles

Applying continuous passive movements (CPM) to the injured joints represents a viable solution for the rehabilitation of patients with posttraumatic disabilities of the elbow. In order to effectively implement CPM-based rehabilitation procedures, the development of new solutions for high performance equipment serves the interest of both medical facilities and patients. This paper deals with a study of the kinematics, construction and actuation of such new rehabilitation equipment using continuous passive motion. The actuation of this equipment is achieved by two pairs of linear pneumatic muscles.

Comparison between two models of elbow rehabilitation equipment

International studies have revealed that using continuous passive motion (CPM) equipment as part of a rehabilitation program improves the recovery period and also diminishes the rehabilitation costs by about 50%. This explains the need for conceiving elbow joint rehabilitation equipment to help persons suffering from posttraumatic disabilities. In order to create the best model to meet the patients’ requirements this paper presents two constructive solutions of such equipment and a comparison between their designs. Both achieve the desired movements of the elbow joint: flexion-extension and pronation-supination and are actuated by pneumatic muscles, due to the multiple advantages of pneumatic actuation: low cost, compliance and favorable response to commands.

Managing requirements for the development of a novel elbow rehabilitation device

The development of new technologies for healthcare must take into consideration customer requirements from different stakeholders. The Voice of the Customer must be identified, analyzed and organized. This study aims to present a new approach of managing requirements from different product value chain stakeholders for a novel elbow rehabilitation device development. The Customer Value Chain Analysis tool was used to identify the product value chain stakeholders and the Quality Function Deployment tool to analyze and prioritize these requirements. The development is described in accordance with the engineering requirement process adapted to this case: 1) elicitation: the requirements come from the literature; benchmarking; questionnaires applied to all parties identified by Customer Value Chain Analysis application; 2) analyses: requirements were understood, and their overlaps, conflicts and prioritization were done by means of Quality Function Deployment (quality, product and part characteristics matrices); and 3) documentation: the identified construct of requirements were: ergonomics, functions, aesthetics, handling, materials, components/elements. The main parts that must be prioritized were: arm support, forearm support, support shaft, joystick, and support base. The association of these two tools is a novel and successful approach of identify different product value chain stakeholders and prioritize technical requirements for health product development.

Design and prototype of an active assistive exoskeletal robot for rehabilitation of elbow and wrist

Due to the increasing number of people su ering from physical disabilities in the elbow and wrist, developing an assistive wearable robot seems crucial. These disabilities are mostly common in elderly people and people who are su ering from spinal injury or stroke. In this paper, a wearable assistive robot for rehabilitation of the wrist and elbow is developed. The mechanism has 3 Degree of Freedom (DoF); two active DoF for assisting the flexion/extension of the elbow and wrist, and a passive one in order to have unconstrained supination/pronation of the forearm. The motors and sensors were chosen based on kinematic constraints governing the motion of arms and wrists. Finally, with the intention of evaluating the performance of the robot, some preliminary experiments were conducted using a prototype of the designed wearable robot. Experimental results showed that the proposed assistive robot meets its design goals and can assist patient motion in the desired DoF.

Minimally invasive plate osteosynthesis in the treatment of proximal humeral shaft fractures

Introduction The treatment for proximal humeral shaft fracture is still controversial, attributed to the multiplicity of treatment options. The aim of this study was to evaluate the results of minimally invasive plate osteosynthesis (MIPO) in the treatment of proximal humeral shaft fractures. Patients and methods Between February 2007 and November 2011, 20 patients with displaced fracture of the proximal one-third shaft of the humerus were treated using the MIPO technique. The average age of the patients was 45.3 years, and there were 13 male and seven female patients. Eleven (55%) patients had AO (AO Foundation is a medically guided, not-for-profit organization led by an international group of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system) type 12C fractures. The right humerus was fractured in 11 (55%) patients. Falls were the most common cause of fracture in eight (40%) patients. Follow-up was carried out regularly with radiography and measurement of range of movement of the elbow. Results All fractures healed in an average time of 10.35 weeks within an average follow-up of 23.46 months. Surgery was performed on average 1.75 days after injury. Fractures were fixed using dynamic compression plating in 12 cases and locked plating in eight cases. The average range of elbow range of motion was 123 degrees; 12 (60%) patients were able to achieve full elbow extension at last follow-up. The average extension lag was 5.25°. The average range of elbow flexion was 128.25°. Six complications occurred in our cases. There were two cases of shoulder impingement. One patient developed deep infection. Three (15%) patients had postoperative radial nerve injuries. All of them recovered spontaneously. Conclusion Although MIPO is technically demanding, it is a safe and efficient procedure for the treatment of humeral shaft fracture. Adequate healing and low complication rate can be obtained if the appropriate surgical technique is used. Elbow flexion contracture can be regarded as a possible complication that can be avoided by the use of early adequate elbow rehabilitation protocol.

Mechatronic Device for Elbow Rehabilitation

This work proposes a mechatronic device for elbow rehabilitation. The realized therapy is based on continuous passive motion. A prototype was realized and design and dimensioning is here presented. Preliminary tests will be performed on non-pathological subjects to allow clinical experiments.

A haptic device for wrist and elbow rehabilitation

ABSTRACT Interest in the devices for rehabilitation applications has been increasing. And the devices before have proved that they might assist in and quantify the rehabilitation for upper limb disability caused by stroke. This paper is to introduce rehabilitation application of a haptic device based on virtual reality technology, which is compact, portable, and modular. The focus here is a device with force feedback designed to provide five degrees of freedom, which are rotation, opposition, translation, pitch, and yaw. With five degrees of freedom above, the device can help individuals with arm weakness do their exercise and make patients achieve favorable rehabilitation efficacy during their upper limb rehabilitation.

Study, Design and Preliminary Tests of an Automatic Device for Elbow Rehabilitation

The robotic rehabilitation therapy is being used more and more together with conventional rehabilitation because it allows a rapid improvement of the functional abilities of patients. This fact is due, especially in CPM (Continuous Passive Motion), both at a more constant repeatability of the movements performed and to the possibility of using machines for many hours, thanks to their "tireless". The study presented in this article shows the development of elbow rehabilitation device, from design and prototype realization until preliminary tests on patients.

Bimanual elbow exoskeleton: Force based protocol and rehabilitation quantification.

An aging population, along with the increase in cardiovascular disease incidence that accompanies this demographic shift, is likely to increase both the economic and medical burden associated with stroke in western societies. Rehabilitation, the standard treatment for stroke, can be expanded and augmented with state of the art technologies, such as robotic therapy. This paper expands upon a recent work involving a force-feedback master-slave bimanual exoskeleton for elbow rehabilitation, named a Bimanual Wearable Robotic Device (BWRD). Elbow force data acquired during the execution of custom tasks is analyzed to demonstrate the feasibility of tracking patient progress. Two training tasks that focus on applied forces are examined. The first is called "slave arm follow", which uses the absolute angular impulse as a metric; the second is called "conditional arm static", which uses the rise time to target as a metric, both presented here. The outcomes of these metrics are observed over three days.

힘측정기반 팔꿈치 재활로봇 설계 및 힘제어

This paper describes the design of an elbow rehabilitation robot based on force measurement that enables a severe stroke patient confined to their bed to receive elbow rehabilitation exercises. The developed elbow rehabilitation robot was providewitha two-axis force/torque sensor which can detect force Fz and torque Tz, thereby allowing it to measure therotational force (Tz) exerted on the elbow and the signal force Fz which can be used as a safety device. The robot was designed and manufactured for severe stroke patients confined to bed, and the robot program was manufactured to perform flexibility elbow rehabilitation exercises. Asa result of the characteristics test of the developed rehabilitation robot, the device was safely operated while the elbow rehabilitation exercises were performed. Therefore, it is thought that the developed rehabilitation robot can be used for severe stroke patients.

Proof of Concept for Robot-Aided Upper Limb Rehabilitation Using Disturbance Observers

This paper presents a wearable upper body exoskeleton system with a model-based compensation control framework to support robot-aided shoulder–elbow rehabilitation and power assistance tasks. To eliminate the need for EMG and force sensors, we exploit off-the-shelf compensation techniques developed for robot manipulators. Thus, target rehabilitation tasks are addressed by using only encoder readings. A proof-of-concept evaluation was conducted with five able-bodied participants. The patient-active rehabilitation task was realized via observer-based user torque estimation, in which resistive forces were adjusted using virtual impedance. In the patient-passive rehabilitation task, the proposed controller enabled precise joint tracking with a maximum positioning error of 0.25 $^\circ$ . In the power assistance task, the users’ muscular activities were reduced up to 85% while exercising with a 5 kg dumbbell. Therefore, the exoskeleton system was regarded as being useful for the target tasks, indicating that it has a potential to promote robot-aided therapy protocols.

OUR EXPERINCE OF A CASE OF TERRIBLE TRIAD OF ELBOW

AbstractDislocation of the elbow joint in association with fracture of radial head and fracture of coronoid process, is referred to as “terrible triad” of the elbow, the treatment of which provides a challenge to treating surgeon due to its complicated outcomes. The understanding of the elbow kinematics, the usage of various implants and surgical techniques in the recent years has led to the development of standard treatment protocols. The 'terrible triad' of the elbow is a severe injury that is difficult to treat and has a poor prognosis in the medium-tolong term. It is characterised most often by instability of the elbow, development of arthrosis and joint stiffness.A 43 year old lady presented to us after a fall on outstretched dominant hand with severe pain and swelling around elbow. She had sustained a fracture of the radial neck and coronoid process with posterolateral dislocation of elbow. Immediate Closed reduction of the dislocation was performed under GA and elbow was immobilised in a plaster of paris slab for 3 weeks. She underwent operative procedure of open reduction and internal fixation of the radial head with a titanium plate and the coronoid process with a 4mm screw and washer after 10 days.After 3 weeks elbow rehabilitation was begun and at one year post surgery there was signs of fracture healing with full range of motion of the elbow.

An upper-limb power-assist exoskeleton using proportional myoelectric control.

We developed an upper-limb power-assist exoskeleton actuated by pneumatic muscles. The exoskeleton included two metal links: a nylon joint, four size-adjustable carbon fiber bracers, a potentiometer and two pneumatic muscles. The proportional myoelectric control method was proposed to control the exoskeleton according to the user's motion intention in real time. With the feature extraction procedure and the classification (back-propagation neural network), an electromyogram (EMG)-angle model was constructed to be used for pattern recognition. Six healthy subjects performed elbow flexion-extension movements under four experimental conditions: (1) holding a 1-kg load, wearing the exoskeleton, but with no actuation and for different periods (2-s, 4-s and 8-s periods); (2) holding a 1-kg load, without wearing the exoskeleton, for a fixed period; (3) holding a 1-kg load, wearing the exoskeleton, but with no actuation, for a fixed period; (4) holding a 1-kg load, wearing the exoskeleton under proportional myoelectric control, for a fixed period. The EMG signals of the biceps brachii, the brachioradialis, the triceps brachii and the anconeus and the angle of the elbow were collected. The control scheme's reliability and power-assist effectiveness were evaluated in the experiments. The results indicated that the exoskeleton could be controlled by the user's motion intention in real time and that it was useful for augmenting arm performance with neurological signal control, which could be applied to assist in elbow rehabilitation after neurological injury.

Elbow rehabilitation in traumatic pathology

The elbow, intermediate joint of the upper limb, frequently undergoes to pathological events and is especially prone to stiffness. Rehabilitation plays an important role in recovering functional activities. For the rehabilitation team, this goal always represents a challenge, as the treatment has to be continuously modeled and calibrated on the needs of the individual patient, even many times during the same rehabilitation cycle. Containing the effects of immobilization, avoiding to excessively stress the healing tissues, satisfying specific clinical criteria before moving to the next rehabilitation stage, basing the rehabilitation plan on up-to-date clinical and scientific data that can be adapted to each patient and to his/her needs are the basic principles of the rehabilitation plan, which can be chronologically grouped into four rehabilitation stages. After summarizing the general principles of elbow treatment, the specific principles of rehabilitation after elbow fractures and elbow instability are presented, and then the rehabilitative approach to the most frequent and feared pathological conditions of the elbow, namely stiffness, is described.

Mechanism and Control of Continuous-State Coupled Elastic Actuation

Focusing on the physical interaction between people and machines within safety constraints in versatile situations, this paper proposes a new, efficient, coupled elastic actuation (CEA) to provide future human-machine systems with an intrinsically programmable stiffness capacity to shape the output force corresponding to the deviation between human motions and the set positions of the system. As a possible CEA system, a prototype of a two degrees of freedom (2-DOF) continuous-state coupled elastic actuator (CCEA) is designed to provide a compromise between performance and safety. Using a pair of antagonistic four-bar linkages, the inherent stiffness of the system can be adjusted dynamically. In addition, the optimal control in a simple various stiffness model is used to illustrate how to find the optimal stiffness and force trajectories. Using the optimal control results, the shortest distance control is proposed to control the stiffness and force trajectory of the CCEA. Compared to state-of-the-art variable stiffness actuators, the CCEA system is unique in that it can achieve near-zero mechanical stiffness efficiently and the shortest distance control provides an easy way to control various stiffness mechanisms. Finally, a CCEA exoskeleton is built for elbow rehabilitation. Simulations and experiments are conducted to show the desired properties of the proposed CCEA system and the performance of the shortest distance control.

The internal fixation with double steel plate by the olecranon osteotomy approach in the treatment of severe condyle humeral intercondylar splintered fracture

Objective To explore the effect and surgical management of the internal fixation with double steel plate by the olecranon osteotomy approach in the treatment of severe condyle humeral intercondylar splintered fracture. Methods 50 patients with severe condyle humeral intercondylar splintered fractures were treated by double plate internal fixation through oleeranon osteotomy. Results All patients （50 cases） were followed up for 6 months to 2 years. The complications such as bone defect, ossifyingmyositis, tardive ulnar nerve compression, and internal fixation fail were not found. According to Aitken Rorabeck scale,the function of the elbow showed excellent in 35 cases, good in 9 cases, fair in 6 cases,the excellent and good rate was 88%. Conclusion The internal fixation with double steel plate by the olecranon osteotomy approach in the treatment of severe condyle humeral intereondylar splintered fracture was a good approach. Anatomical reduction surgically reconstructed stabilization of the elbow and early active rehabilitation were crucial factors of functional rehabilitation of the elbow. Key words: Severe humeral condyle splintered fracture; Oleeranon osteotomy; Fracture fixation