Rehabilitation Platform Research Articles

Evaluation of a Game Based Tele Rehabilitation Platform for In-Home Therapy of Hand-Arm Function Post Stroke: Feasibility Study.

There is a need for innovation to improve compliance and accessibility of rehabilitation programs for individuals with acquired brain injuries. A computer game-assisted tele-rehabilitation platform (GTP) has been developed to address this need. With the novel application of a miniature inertial computer mouse and taking advantage of the wide variety of computer games, the GTP can provide engaging exercises for rehabilitation of upper extremity motor skills. To determine the feasibility and acceptability of the game-assisted home exercise program for upper extremity rehabilitation for people with stroke. The treatment effect was also measured after 16 weeks of intervention. A feasibility study. College of Rehabilitation Science, University of Manitoba. Ten stroke clients. Participants received three to four initial clinically supervised therapy sessions for training with the game assisted therapy program. Once trained, participants continued the program at the home for 16 weeks, four times per week. Feasibility was evaluated based on retention rate and compliance. Semistructured interviews after the completion of the program were done to assess acceptability of the program. Quantitative analysis included (1) the Wolf Motor Function Test A and B and (2) a computerized performance-based assessment of specific object manipulation tasks that required a combination of finger, wrist, elbow and shoulder motion. Findings demonstrated the feasibility and acceptability of the home tele-rehab program. Eight of the 10 participants fully complied with the 16-week exercise program. Two participants had difficulty with computer operations and did not complete the program. For the eight participants who completed the program, there was a substantial improvement from pre- to postintervention. Although some difficulties with the technology were reported, the findings demonstrate feasible trial procedures, acceptable game-assisted task-oriented home training with a high compliance rate and positive outcomes. These findings and the theoretical evidence direct the next phase of a full-scale randomized controlled trial.

Design of a 3D Platform for Immersive Neurocognitive Rehabilitation

In recent years, advancements in human–computer interaction (HCI) have enabled the development of versatile immersive devices, including Head-Mounted Displays (HMDs). These devices are usually used for entertainment activities as video-gaming or augmented/virtual reality applications for tourist or learning purposes. Actually, HMDs, together with the design of ad-hoc exercises, can also be used to support rehabilitation tasks, including neurocognitive rehabilitation due to strokes, traumatic brain injuries, or brain surgeries. In this paper, a tool for immersive neurocognitive rehabilitation is presented. The tool allows therapists to create and set 3D rooms to simulate home environments in which patients can perform tasks of their everyday life (e.g., find a key, set a table, do numerical exercises). The tool allows therapists to implement the different exercises on the basis of a random mechanism by which different parameters (e.g., objects position, task complexity) can change over time, thus stimulating the problem-solving skills of patients. The latter aspect plays a key role in neurocognitive rehabilitation. Experiments obtained on 35 real patients and comparative evaluations, conducted by five therapists, of the proposed tool with respect to the traditional neurocognitive rehabilitation methods highlight remarkable results in terms of motivation, acceptance, and usability as well as recovery of lost skills.

An Omnidirectional Assistive Platform Integrated With Functional Electrical Stimulation for Gait Rehabilitation: A Case Study.

This paper presents a novel omnidirectional platform for gait rehabilitation of people with hemiparesis after stroke. The mobile platform, henceforth the "walker", allows unobstructed pelvic motion during walking, helps the user maintain balance and prevents falls. The system aids mobility actively by combining three types of therapeutic intervention: forward propulsion of the pelvis, controlled body weight support, and functional electrical stimulation (FES) for compensation of deficits in angular motion of the joints. FES is controlled using gait data extracted from a set of inertial measurement units (IMUs) worn by the user. The resulting closed-loop FES system synchronizes stimulation with the gait cycle phases and automatically adapts to the variations in muscle activation caused by changes in residual muscle activity and spasticity. A pilot study was conducted to determine the potential outcomes of the different interventions. One chronic stroke survivor underwent five sessions of gait training, each one involving a total of 30 minutes using the walker and FES system. The patient initially exhibited severe anomalies in joint angle trajectories on both the paretic and the non-paretic side. With training, the patient showed progressive increase in cadence and self-selected gait speed, along with consistent decrease in double-support time. FES helped correct the paretic foot angle during swing phase, and likely was a factor in observed improvements in temporal gait symmetry. Although the experiments showed favorable changes in the paretic trajectories, they also highlighted the need for intervention on the non-paretic side.

Serious Game Platform with Haptic Feedback and EMG Monitoring for Upper Limb Rehabilitation and Smoothness Quantification on Spinal Cord Injury Patients

Cervical Spinal Cord injury (SCI) is a neurological disease that produces, as a consequence, impairments of the upper limb function. This paper illustrates a virtual reality platform based on three serious games for upper limb rehabilitation with electromyography monitoring, providing force feedback to the patient. In the rehabilitation process proposed, haptic feedback was provided to the patients to strength the arm muscles by means of the Novint Falcon device. This end-effector device was used to manipulate the serious games. During the therapy performance, the system recorded electromyography signals from the patient’s arm muscles, which may be used to monitor muscle contraction. The work presented a virtual reality system developed for spinal cord-injured patients. Each virtual reality environment could be modified in strength and duration according to the patients’ needs and was implemented for recording quantitative data about the motor performance. The platform was validated as a proof of concept in cervical spinal cord-injured patients. Results showed that this rehabilitation platform could be used for obtaining objective information in relation to motor control characteristics.

Development of a three-channel automatic climbing training system for rat rehabilitation after ischemic stroke.

This paper reports the development of a three-channel automatic speed-matching climbing training system that could train three rats at the same time for rehabilitation after an ischemic stroke. An infrared (IR) remote sensor was installed at the end of each channel to monitor the real-time position of a climbing rat. This research was carried out in five stages: i) system design; ii) hardware circuit; iii) running speed control; iv) functional testing; and v) verification using an animal model of cerebral stroke. The rehabilitated group significantly outperformed the middle cerebral artery occlusion (MCAo) sedentary group in the rota-rod and inclined plate tests 21 days after a stroke. The rehabilitated group also had a cerebral infarction volume of 28.34±19.4%, far below 56.81±18.12% of the MCAo group 28 days after the stroke, validating the effectiveness of this training platform for stroke rehabilitation. The running speed of the climbing rehabilitation training platform was designed to adapt to the physical conditions of subjects, and overtraining injuries can be completely prevented accordingly.

An interactive and innovative application for hand rehabilitation through virtual reality

Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients' motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients' wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.

An interactive and innovative application for hand rehabilitation through virtual reality

Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients' motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients' wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.

Markovian robust filtering and control applied to rehabilitation robotics

In this article, we deal with rehabilitation robot robust control in order to obtain best performance in the human-robot interaction. This class of system is subject to abrupt changes due to exogenous inputs and parameter variations caused, mainly, by the human dynamic behavior. In this context, Markovian jump linear systems offer suitable tools to model and control of this class of interactions. We propose force and impedance controllers based on robust recursive Markovian versions of the standard Kalman filter and the linear quadratic regulator. Different levels of the individual's actuation during the interaction with the robot define the Markov states. The measurement of electromyographic signals is used as jump parameter among Markov states. Also, a serious game is used to generate visual feedback, to promote active user participation, and to guide his movement routine. We compare our proposal with two other Markovian-based approaches and show the effectiveness our method through experiments with an ankle rehabilitation platform.

Voice analysis rehabilitation platform based on LSTM algorithm

Voice analysis rehabilitation platform based on LSTM algorithm

Hand Rehabilitation and Telemonitoring through Smart Toys.

We describe here a platform for autonomous hand rehabilitation and telemonitoring of young patients. A toy embedding the electronics required to sense fingers pressure in different grasping modalities is the core element of this platform. The system has been realized following the user-centered design methodology taking into account stakeholder needs from start: clinicians require reliable measurements and the ability to get a picture remotely on rehabilitation progression; children have asked to interact with a pleasant and comfortable object that is easy to use, safe, and rewarding. These requirements are not antithetic, and considering both since the design phase has allowed the realization of a platform reliable to clinicians and keen to be used by young children.

Design of Virtual Reality-Enabled Surface Electromyogram-Triggered Grip Exercise Platform.

Adequate grip ability is important for effective execution of daily living activities. Neurological disorders like stroke that result in muscle weakness, limited strength and poor control often lead to reduced grip ability in the affected limb. Conventional rehabilitation for grip training is often monotonous and subjective. Technology-assisted Virtual Reality (VR)-based rehabilitation offers a motivating environment to the participants for rehabilitation. However, the existing systems need specialized set-up architecture, thereby limiting their accessibility. Furthermore, these systems quantify the functional grip ability based on task performance, and do not explore physiological basis of grip ability. In this work, we develop a VR-based rehabilitation platform integrated with physiology-sensitive biofeedback. The developed platform, Gripx makes use of features extracted from sEMG data collected from upper limb muscles to adaptively provide audio-visual biofeedback through a VR environment. We compare task based performance, physiological indices and clinical measures to evaluate the potential of Gripx. The results of our study with 8 healthy and 12 post-stroke participants show the potential of Gripx to contribute to grip rehabilitation over multiple exposures. This approach of integrating VR-based task design with physiology-sensitive biofeedback helps patients to better assess their physiological responses and enhance the efficacy of rehabilitation.

Remarkable cell recovery from cerebral ischemia in rats using an adaptive escalator-based rehabilitation mechanism.

Currently, many ischemic stroke patients worldwide suffer from physical and mental impairments, and thus have a low quality of life. However, although rehabilitation is acknowledged as an effective way to recover patients’ health, there does not exist yet an adaptive training platform for animal tests so far. For this sake, this paper aims to develop an adaptive escalator (AE) for rehabilitation of rats with cerebral ischemia. Rats were observed to climb upward spontaneously, and a motor-driven escalator, equipped with a position detection feature and an acceleration/deceleration mechanism, was constructed accordingly as an adaptive training platform. The rehabilitation performance was subsequently rated using an incline test, a rotarod test, the infarction volume, the lesion volume, the number of MAP2 positive cells and the level of cortisol. This paper is presented in 3 parts as follows. Part 1 refers to the escalator mechanism design, part 2 describes the adaptive ladder-climbing rehabilitation mechanism, and part 3 discusses the validation of an ischemic stroke model. As it turned out, a rehabilitated group using this training platform, designated as the AE group, significantly outperformed a control counterpart in terms of a rotarod test. After the sacrifice of the rats, the AE group gave an average infarction volume of (34.36 ± 3.8)%, while the control group gave (66.41 ± 3.1)%, validating the outperformance of the escalator-based rehabilitation platform in a sense. An obvious difference between the presented training platform and conventional counterparts is the platform mechanism, and for the first time in the literature rats can be well and voluntarily rehabilitated at full capacity using an adaptive escalator. Taking into account the physical diversity among rats, the training strength provided was made adaptive as a reliable way to eliminate workout or secondary injury. Accordingly, more convincing arguments can be made using this mental stress-free training platform.

Visual vs vibrotactile feedback for posture assessment during upper-limb robot-aided rehabilitation

Repetitive and intensive exercises during robot-aided rehabilitation may expose patients to inappropriate and unsafe postures. The introduction of a sensory feedback can help the subject to perform the rehabilitation task with an ergonomic posture. In this work, the introduction of visual and vibrotactile feedback in a robotic platform for upper limb rehabilitation has been proposed to ensure ergonomic posture during rehabilitation. The two feedback modalities have been used to provide information about incorrect neck and trunk posture. Ten healthy subjects have been involved in this study. Each of them performed 3D reaching movements with the aid of the robotic platform in three different conditions, i.e. without feedback, with visual feedback and with vibrotactile feedback, and a comparative analysis has been carried out to evaluate feedback effectiveness, acceptance and performance. Experimental results show that in case of no feedback the subjects reach and maintain configurations that can lead to incorrect neck and trunk configurations and therefore, if repeated, to musculoskeletal disorders. Conversely, with visual or vibrotactile feedback, the subjects tend to correct inappropriate posture with both trunk and head during task performing.

International feasibility trial on the use of an interactive mobile health platform for cardiac rehabilitation: protocol of the Diversity 1 study

IntroductionThe implementation of home-based cardiac rehabilitation has demonstrated potential to increase patient participation, but the content and the delivering of the programmes varies across countries. The objective of this study...

A one-degree-of freedom ankle rehabilitation platform

The ankle structure holds one of the most important role in the human biomechanics. Due to complexity of everyday activities this joint is the most prone to be injured part of the lower limb. For a complete recovery of the locomotor function, recovery exercises are mandatory. The existent ankle rehabilitation equipments allow only simple rehabilitation exercises, which cannot be used safely without the aid of a therapist. The introduction of robotic physical recovery systems represents a modern alternative to traditional recovery. Actuated devices are advantageous because they allow many types of exercises on same device, and also they accurate measure forces and angular motions. The purpose of this two paper is to propose a simple rehabilitation device, based on a one-degree-of-freedom mechanisms. Some structural, kinematic and designing aspects of this new ankle rehabilitation device are presented.

Visuomotor control of ankle joint using position vs. force.

Ankle joint plays a critical role in daily activities involving interactions with environment using force and position control. Neuromechanical dysfunctions (e.g., due to stroke or brain injury), therefore, have a major impact on individuals' quality of life. The effective design of neuro-rehabilitation protocols for robotic rehabilitation platforms relies on understanding the control characteristics of the ankle joint in interaction with external environment using force and position, as the findings in upper limb may not be generalizable to the lower limb. This study aimed to characterize the skilled performance of ankle joint in visuomotor position and force control. A two-degree-of-freedom (DOF) robotic footplate was used to measure individuals' force and position. Healthy individuals (n=27) used ankle force or position for point-to-point and tracking control tasks in 1-DOF and 2-DOF virtual game environments. Subjects' performance was quantified as a function of accuracy and completion time. In contrastto comparable performance in 1-DOF control tasks, theperformance in 2-DOF tasks was different and hadcharacteristicpatterns in the position and force conditions, with a significantly better performance for position. Subjective questionnaires on the perceived difficulty matched the objective experimental results, suggesting that the poor performance in force control was not due to experimental set-up or fatigue but can be attributed to the different levels of challenge needed in neural control. It is inferred that in visuomotor coordination, the neuromuscular specialization of ankle provides better control over position rather than force. These findings can inform the design of neuro-rehabilitation platforms, selection of effective tasks and therapeutic protocols.

High mobility control of an omnidirectional platform for gait rehabilitation after stroke.

We present a novel control method for an omnidirectional robotic platform for gait training. This mobile platform or "walker" provides trunk support and allows unrestricted motion of the pelvis simultaneously. In addition to helping the user maintain balance and preventing falls, the walker combines two types of therapeutic intervention: forward propulsion of the trunk and partial body weight support (BWS). The core of the walker's control is an admittance controller that maximizes the platform's horizontal mobility by optimizing the virtual mass of the admittance model. Said mass represents the best tradeoff between a low-frequency oscillation mode that becomes more damped as the virtual mass decreases, and a high-frequency mode that becomes less damped simultaneously and hence could destabilize the system. Forward propulsion of the trunk is aided by a horizontal force that is modulated with the patient's gait speed and turning rate to ensure easy adaptation. BWS is provided by a second, independent admittance controller that generates a spring-like upward force. In an initial study, a stroke patient was able to walk stably in the platform, as evidenced by the absence of oscillations associated with an excessively low virtual mass. A progressive increase in the patient's self-selected speed, along with greater uniformity in the instantaneous velocity, suggest that forward propulsion was effective in compensating the patient's own propulsion deficit.

A Socially Assistive Robotic Platform for Upper-Limb Rehabilitation: A Longitudinal Study With Pediatric Patients

In motor rehabilitation therapies, especially with pediatric patients, there is often a loss of interest and motivation due to the lack of variety in exercises and therapeutic activities. NAOTherapist (NT) is a socially assistive robotics (SAR) platform designed to support hands-off rehabilitation sessions through two interactive games: mirror and Simon. It integrates a cognitive architecture with an NAO humanoid robot that acts as a coach, as well as a red-green-blue-depth (RGB-D) sensor that eases body capture. This work aims to deploy and evaluate the developed technology for a long-term experience.

A Robotic Platform for 3D Forelimb Rehabilitation with Rats.

In an attempt to promote greater functional recovery after spinal cord injury, researchers have begun exploring combinatorial treatments, such as robotic rehabilitation combined with stem cell transplantation. Since these treatment methods are in their nascent stages, rodent models have been proposed for initial investigations. Robots have been built for locomotion rehabilitation and planar forelimb reach and grasp assessment with rodents; however, a robotic platform suitable for three-dimensional movement rehabilitation of the rodent forelimb has not yet been developed. In this paper, a novel three degree of freedom robotic manipulator for automated forelimb rehabilitation combined with stem cell transplantation after cervical spinal cord injury with rats is proposed. The robot interfaces with a rat in an end-effector manner, measuring and interacting with the forelimb in the 3D Cartesian space. In this work, we trained two rats through behavioral shaping to actively interact with the device during two robot control modes. This work provides preliminary investigations into the feasibility of 3D forelimb rehabilitation with rats, which could be translated as a paradigm for combinatorial treatments after spinal cord injury in a controlled manner.

An obstetric brachial plexus lesion rehabilitation platform

Purpose Obstetric brachial plexus lesions (OBPL) are caused by the lesion or rupture of the cervical and thoracic nerves during birth. Physical therapy, based on ludic activities, can be useful to improve the OBPL treatment in children. This paper proposes a rehabilitation platform with a ludic interface (lights and sounds), using the magnitude motion gain of a user to aid in the OBPL treatment.