Rehabilitation System For Upper Limbs Research Articles

Design and feasibility analysis of magnetorheological flexible joint for upper limb rehabilitation

Traditional upper limb rehabilitation robots have several disadvantageous. For example, they can only conduct rehabilitation training along predetermined trajectories, their safety systems are unreliable, and they lack the ability to adjust or train the affected limb based on the expected torque of the human body. To overcome these limitations, this study proposes a flexible safety system for joint rehabilitation utilising magnetorheological (MR) fluid. MR damper inverters offer significant advantages, including high torque, rapid response, controllable flexibility, and safety assurance. The range of motion trajectories can be adjusted using a four-lever hinge mechanism. The necessary driving force is provided by the motor actuator, and the MR damper imparts flexibility and variable damping characteristics to the output torque. The system uses a force/position impedance safety-control method, and using an internal position closed-loop controller, the MR upper limb rehabilitation flexible joint guides the affected limb to a safe position. A simulation is performed to verify the accuracy of the system’s motion torque and position. Extensive research has been conducted on the safe rehabilitation outcomes of the upper limb rehabilitation system under three working conditions (step, incremental, and equation) involving the interaction moment of the affected limb. Simulation and experimental results demonstrate that the MR damper effectively controls the upper limb rehabilitation system to achieve the desired results, even when subjected to incremental and abrupt interaction forces from the patient. The tracking accuracy error remains within the range of 3%–7% for a certain period, confirming the safety and feasibility of the MR-based upper limb rehabilitation robot design.

Evaluation of Short-Term Clinical Effects of a Novel Repetitive Facilitation Exercise Training Program Using a Hemiplegic Elbow Extension Rehabilitation System

Repetitive Facilitation Exercise (RFE) is known as an effective rehabilitation method that can elicit brain plasticity. In our previous study, we developed a hemiplegic upper limb rehabilitation system that can train the elbow and shoulder based on RFE theory. The system consists of a selective Arm-DoF constrainable mechanism and a multiple facilitative stimulus timing and duration control system. The selective Arm-DoF constrainable mechanism has three DoF, making it possible to selectively restrict a DoF of the shoulder or elbow. The multiple facilitative stimulation timing and duration control system only has an electrical stimulation source and a vibrator and no large actuators to perform the training exercise. In this study, we undertook an evaluation of the short-term clinical effects of a proposed elbow training program using the hemiplegic upper limb rehabilitation system. The training method consists of two sets, each involving 50 repetitions of the elbow extension exercise programmed in our system. We evaluated the short-term training effects through clinical trials for five stroke patients using the above method. In the evaluation, 10 repetitions of pre/post-tests without any facilitative stimulus were performed before and after the two sets of training. As a result, the maximum angular velocities or the average angular velocities of the elbow extensions improved significantly in most subjects. These results indicate that the quickness or the smoothness of elbow extension movements in the hemiplegic limb improved. Therefore, our clinical experiments support the short-term clinical benefits of the proposed method as well as the practicality of quantitative evaluation using our system.

Innovative haptic-based system for upper limb rehabilitation in visually impaired individuals: a multilayer approach

Innovative haptic-based system for upper limb rehabilitation in visually impaired individuals: a multilayer approach

Subject-Independent Estimation of Continuous Movements Using CNN-LSTM for a Home-Based Upper Limb Rehabilitation System

Subject-Independent Estimation of Continuous Movements Using CNN-LSTM for a Home-Based Upper Limb Rehabilitation System

Feasibility of a serious game system including a tangible object for post stroke upper limb rehabilitation: a pilot randomized clinical study.

Serious games can be used to provide intensive rehabilitation through attractive exercises as part of post-stroke rehabilitation. However, currently available commercial and serious games systems primarily train shoulder and elbow movements. These games lack the grasping and displacement components that are essential to improve upper limb function. For this reason, we developed a tabletop device that encompassed a serious game with a tangible object to rehabilitate combined reaching and displacement movements: the Ergotact system. The aim of this pilot study was to assess the feasibility and the short-term effects of a training program using the Ergotact prototype in individuals with chronic stroke. Participants were assigned to one of two groups: a serious game training group (Ergotact) or a control training group (Self). Twenty-eight individuals were included. Upper limb function increased after the Ergotact training program, although not statistically significantly, and the program did not induce pain or fatigue, demonstrating its safety. The Ergotact system for upper limb rehabilitation was well accepted and induced participant satisfaction. It complies with current recommendations for people with stroke to autonomously perform intensive active exercises in a fun context, in addition to conventional rehabilitation sessions with therapists. https://clinicaltrials.gov/ct2/show/NCT03166020?term=NCT03166020&draw=2&rank=1, identifier NCT03166020.

A Motor Recovery Training and Evaluation Method for the Upper Limb Rehabilitation Robotic System

Stroke can cause acute damage to blood vessels in the brain, which often lead to hemiplegia and imbalances in mobility. It is a challenge to develop a motor recovery training and evaluation method with less help of therapists. In this paper, a motor recovery training and evaluation method for upper limb rehabilitation robotic system is proposed. This system has two rehabilitation unit, one is active, the other is passive. The developed rehabilitation robotic system includes exoskeleton rehabilitation robot and PHANTOM1.5. The patients do rehabilitation training with the help of robot in the passive unit, and virtual reality game is designed in active unit. Patients with mild motor impairments observe the virtual reality game interface while manipulating the PHANTOM to do rehabilitation training. Three experiments are proposed in this paper. The fuzzy neural network, spring-damper model, and the method to evaluate the training trajectory are designed and validated. The sEMG signals and grip force during rehabilitation training are collected to set up a fuzzy neural network and achieve evaluation. The accuracy of the network is 0.96 which is calculated in validation set. In chapter IV, the rehabilitation evaluation method is compared with the state of art on rehabilitation evaluation method. The method proposed in this paper can reach high accuracy. It is easy to use and understand for patients even without the help of therapists. The problem of lacking therapists can be solved to some extent by the proposed upper limb rehabilitation system.

Robotic Fingers in Reach-to-Grasp Tasks of Rehabilitation

The REHAROB robotic upper limb rehabilitation system was improved with a custom-designed and developed hand/finger therapy module. The new module extends the scope of the applicable motion therapy from passive to active reach-to-grasp activities of daily living tasks, and the range of treated anatomical joints was also extended to every proximal and distal upper limb anatomical joint. Finger exercising and object grasping are supported with a pair of two degree-of-freedom (DOF) robotic fingers. One of the robotic fingers moves the index/middle/ring fingers together, whereas the other robotic finger moves the thumb. A novel hypothesis was established, analyzed, and tested for setting the orientation of the robotic finger moving the thumb. The robotic thumb is not aligned with the patient's thumb; its orientation is optimized in the patient's hand reference system to maximize the efficiency in the opposite grasping task. While most concurrent systems utilize virtual objects for grasping tasks, the REHAROB system exercises five carefully selected reach-and-grasp type activities of daily living (ADL) with real objects. Actuating the human finger phalanges through custom development finger orthoses is described. An advanced feature of the hand/finger therapy module is the left-right hand side changeover by only alternating the orientation of the robotic fingers and exchanging the finger orthoses.

Game-Based Virtual Reality System for Upper Limb Rehabilitation After Stroke in a Clinical Environment: Systematic Review and Meta-Analysis.

The use of virtual reality (VR) for stroke rehabilitation has been implemented during the last decade. At present, most studies still focus on the effects of VR on upper limb rehabilitation, and few studies have explored VR games, VR system designs, and rehabilitation modes for upper limb rehabilitation. This study aims to (1) evaluate the rehabilitation effect of stroke patients using a game-based VR upper limb rehabilitation system in clinical settings; (2) investigate the impact of custom and commercial VR games on patients in clinical settings; and (3) review VR upper limb rehabilitation modes. The PubMed, ScienceDirect, Scopus, Web of Science, and IEEE Xplore databases were searched, and related literature published through December 2021 was included. A total of 4700 articles were retrieved according to the search strategy. We identified 24 studies, including 793 patients. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of game-based VR upper limb rehabilitation systems. A meta-analysis was conducted to compare the effects of upper limb function, hand dexterity, daily living ability, and cognitive function between the experimental group (EG, using VR for upper limb rehabilitation) and control group (CG, receiving conventional rehabilitation, including physical therapy and occupational therapy). We also conducted an analysis of both custom and commercial games. The results of the meta-analysis proved that game-based VR upper limb rehabilitation therapy for cerebral apoplexy is an effective method of rehabilitation in clinical settings and is more effective than traditional rehabilitation in improving patients' upper limb function and hand mobility. Custom games heal better than commercial games. This study only includes nonimmersive device rehabilitation modes due to research constraints and classified them into four categories. The mode of VR games combined with rehabilitation instruments may solve the problem that patients with severe upper limb dysfunction cannot operate games. Whether the use of immersive VR devices and the fun of games will affect patients' rehabilitation motivation and effect is the direction of future research.

AGREE: an upper-limb robotic platform for personalized rehabilitation, concept and clinical study design.

Rehabilitation exoskeletons can supplement therapist-based training allowing post-stroke patients to perform functional, high-dosage, repetitive exercises. The use of robotic devices allows providing intense rehabilitation sessions and permits clinicians to personalize the therapy according to the patient's need. In this work, we propose an upper-limb rehabilitation system developed within the AGREE project. The platform relies on a four degrees-of-freedom arm exoskeleton, capable of assisting state-of-the-art rehabilitation exercises under different training modalities while behaving transparently to user-generated and therapist-applied forces. The system is provided with a LEDs-matrix mat to guide patients during reaching tasks with visual feedback, an EMG reader to evaluate the patient's involvement during the therapy, and several software tools to help clinicians customize the treatment and monitor the patient's progress. A randomized controlled pilot study aimed at evaluating the usability and the effectiveness of the AGREE rehabilitation platform to improve arm impairment after stroke is currently ongoing.

Manipulability Optimization of a Rehabilitative Collaborative Robotic System

The use of collaborative robots (or cobots) in rehabilitation therapies is aimed at assisting and shortening the patient’s recovery after neurological injuries. Cobots are inherently safe when interacting with humans and can be programmed in different working modalities based on the patient’s needs and the level of the injury. This study presents a design optimization of a robotic system for upper limb rehabilitation based on the manipulability ellipsoid method. The human–robot system is modeled as a closed kinematic chain in which the human hand grasps a handle attached to the robot’s end effector. The manipulability ellipsoids are determined for both the human and the robotic arm and compared by calculating an index that quantifies the alignment of the principal axes. The optimal position of the robot base with respect to the patient is identified by a first global optimization and by a further local refinement, seeking the best alignment of the manipulability ellipsoids in a series of points uniformly distributed within the shared workspace.

Development and user experience of an innovative multi-mode stroke rehabilitation system for the arm and hand for patients with stroke

Many individuals with stroke experience upper-limb motor deficits, and a recent trend is to develop novel devices for enhancing their motor function. This study aimed to develop a new upper-limb rehabilitation system with the integration of two rehabilitation therapies into one system, digital mirror therapy (MT) and action observation therapy (AOT), and to test the usability of this system. In the part I study, the new system was designed to operate in multiple training modes of digital MT (i.e., unilateral and bilateral modes) and AOT (i.e., pre-recorded and self-recorded videos) with self-developed software. In the part II study, 4 certified occupational therapists and 10 stroke patients were recruited for evaluating usability. The System Usability Scale (SUS) (maximum score = 100) and a self-designed questionnaire (maximum score = 50) were used. The mean scores of the SUS were 79.38 and 80.00, and those of the self-designed questionnaire were 41.00 and 42.80, respectively, for the therapists and patients after using this system, which indicated good usability and user experiences. This novel upper-limb rehabilitation system with good usability might be further used to increase the delivery of two emerging rehabilitation therapies, digital AOT and MT, to individuals with stroke.

Design of a virtual reality rehabilitation system for upper limbs that inhibits compensatory movement

Stroke is currently the main cause of death and disability among the elderly in our country. According to medical research, a considerable number of patients with physical disabilities can be recovered through rehabilitation training. However, traditional motor rehabilitation is a continuous, repeated and slow process, and patients tend to feel bored and lose motivation for training.In this paper, we developed a virtual reality rehabilitation system based on Kinect, which is a vision capture sensor, for patients with movement disorders who are at or above Brunnstrom Stage III and have certain motor ability. Through the management platform of the system, physician can obtain the patient's personal information, formulate and adjust the training plan. Patients can control the role in the virtual scene through Kinect sensor, and complete the training action according to the guidance. The system collects the user's motion data in real time and detect the compensation. The system will adaptively evolve to guide the patient to self-correct the compensatory patterns. After the training, the system will evaluate the patients based on the their training performance. Two experiments are also carried out to verify the accuracy of the range of motion and the effectiveness of virtual guidance. It is proved that the virtual reality upper limb rehabilitation training system studied in this paper is reliable, stable, and can guide users to complete the training action and improve the rehabilitation effect.

Upper limb rehabilitation system based on virtual reality for breast cancer patients: Development and usability study.

BackgroundFunctional exercise is crucial for breast cancer patients after surgery, and the use of virtual reality technology to assist patients with postoperative upper limb functional rehabilitation has gradually attracted the attention of researchers. However, the usability of the developed rehabilitation system is still unknown to a large extent. The purpose of this study was to develop a virtual reality upper limb rehabilitation system for patients after breast cancer surgery and to explore its usability.MethodsWe built a multidisciplinary team based on virtual reality and human-computer interaction technology and designed and developed an upper limb function rehabilitation system for breast cancer patients after surgery. Breast cancer patients were recruited from a grade III-a general hospital in Changchun city for the experiment. We used the System Usability Scale to evaluate the system availability, the Presence Questionnaire scale to measure the immersive virtual reality scene, and the Simulator Sickness Questionnaire subjective measurement scale for simulator sickness symptoms.ResultsThis upper limb rehabilitation system hardware consisted of Head-mounted Display, a control handle and notebook computers. The software consisted of rehabilitation exercises and game modules. A total of 15 patients were tested on this system, all of whom were female. The mean age was 54.73±7.78 years, and no patients were excluded from the experiment because of adverse reactions such as dizziness and vomiting. The System Usability Scale score was 90.50±5.69, the Presence Questionnaire score was 113.40±9.58, the Simulator Sickness Questionnaire-nausea score was 0.93±1.16, the Simulator Sickness Questionnaire-oculomotor score was 0.80±1.27, the Simulator Sickness Questionnaire-disorientation score was 0.80±1.27, and the Simulator Sickness Questionnaire total score was 2.53±3.40.ConclusionsThis study fills in the blanks regarding the upper limb rehabilitation of breast cancer patients based on virtual reality technology system usability research. As the starting point of research in the future, we will improve the system’s function and design strictly randomized controlled trials, using larger samples in the promotion, to evaluate its application in breast cancer patients with upper limbs and other physiological functions and the feasibility and effects of rehabilitation.

Gaze-controlled Robot-assisted Painting in Virtual Reality for Upper-limb Rehabilitation.

Stroke is the leading cause of adult disability. Robot-assisted rehabilitation systems show great promise for motor recovery after a stroke. In this work, we present a gazecontrolled robotic system for upper limb rehabilitation. Subjects perform a painting task in virtual reality. We designed a novel and challenging painting task to encourage motivation and engagement, as these are critical factors in treatment efficacy. Because the robotic system can be programmed to provide varying amounts of assistance or resistance to the subject, it can be applied to a wide range of patients at different phases of recovery. We describe here the system configured in two modes: resistive control and hierarchical control. The former is designed for later stages of recovery, where the patient's impaired limb has recovered some function. It can be configured to provide varying degrees of resistance by adjusting the properties of an admittance controller. The latter targets patients in more acute phases, where the impaired limb is less responsive. It provides a combination of assistive and corrective control. We pilot tested our system on 10 able-bodied subjects. Our results show that the system can provide varying degrees of resistive control, and that the integration of high level control modulated by gaze can improve engagement. These results suggest that the system may provide a more engaging environment for a wide range of rehabilitative therapies than currently available.

User-Centered Design and Evaluation of an Upper Limb Rehabilitation System with a Virtual Environment

Virtual environments (VEs) and haptic devices increase patients’ motivation. Furthermore, they observe their performance during rehabilitation. However, some of these technologies present disadvantages because they do not consider therapists’ needs and experience. This research presents the development and usability evaluation of an upper limb rehabilitation system based on a user-centered design approach for patients with moderate or mild stroke that can perform active rehabilitation. The system consists of a virtual environment with four virtual scenarios and a developed haptic device with vibrotactile feedback, and it can be visualized using a monitor or a Head-Mounted Display (HMD). Two evaluations were carried out; in the first one, five therapists evaluated the system’s usability using a monitor through the System Usability Scale, the user experience with the AttrakDiff questionnaire, and the functionality with customized items. As a result of these tests, improvements were made to the system. The second evaluation was carried out by ten volunteers who evaluated the usability, user experience, and performance with a monitor and HMD. A comparison of the therapist and volunteer scores has shown an increase in the usability evaluation (from 78 to >85), the hedonic score rose from 0.6 to 2.23, the pragmatic qualities from 1.25 to 2.20, and the attractiveness from 1.3 to 2.95. Additionally, the haptic device and the VE showed no relevant difference between their performance when using a monitor or HMD. The results show that the proposed system has the characteristics to be a helpful tool for therapists and upper limb rehabilitation.

Clinical Effect of Virtual Reality Technology on Rehabilitation Training of Sports Injury.

In order to make most patients recover most of their limb functions after rehabilitation training, virtual reality technology is an emerging human-computer interaction technology, which uses the computer and the corresponding application software to build the virtual reality environment. Completing the training tasks in the virtual environment attracts the patients to conduct repeated training in the game and task-based training mode and gradually realizes the rehabilitation training goals. For the rehabilitation population with certain exercise ability, the kinematics of human upper limbs is mainly analyzed, and the virtual reality system based on HTC VIVE is developed. The feasibility and work efficiency of the upper limb rehabilitation training system were verified by experiments. Adult volunteers who are healthy and need rehabilitation training to participate in the experiment were recruited, and experimental data were recorded. The virtual reality upper limb rehabilitation system was a questionnaire. By extracting the motion data, the system application effect is analyzed and evaluated by the simulation diagram. Follow-up results of rehabilitation training showed that the average score of healthy subjects was more than 4 points and 3.8 points per question. Therefore, it is feasible to perform upper limb rehabilitation training using the HTC VIVE virtual reality rehabilitation system.

Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation.

Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23–60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.

Research on fNIRS Recognition Method of Upper Limb Movement Intention

This paper aims at realizing upper limb rehabilitation training by using an fNIRS-BCI system. This article mainly focuses on the analysis and research of the cerebral blood oxygen signal in the system, and gradually extends the analysis and recognition method of the movement intention in the cerebral blood oxygen signal to the actual brain-computer interface system. Fifty subjects completed four upper limb movement paradigms: Lifting-up, putting down, pulling back, and pushing forward. Then, their near-infrared data and movement trigger signals were collected. In terms of the recognition algorithm for detecting the initial intention of upper limb movements, gradient boosting tree (GBDT) and random forest (RF) were selected for classification experiments. Finally, RF classifier with better comprehensive indicators was selected as the final classification algorithm. The best offline recognition rate was 94.4% (151/160). The ReliefF algorithm based on distance measurement and the genetic algorithm proposed in the genetic theory were used to select features. In terms of upper limb motion state recognition algorithms, logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and linear discriminant analysis (LDA) were selected for experiments. Kappa coefficient was used as the classification index to evaluate the performance of the classifier. Finally, SVM classification got the best performance, and the four-class recognition accuracy rate was 84.4%. The results show that RF and SVM can achieve high recognition accuracy in motion intentions and the upper limb rehabilitation system designed in this paper has great application significance.

Wireless Motion Capture System for Upper Limb Rehabilitation

This work is devoted to the presentation of a Wireless Sensor System implementation for upper limb rehabilitation to function as a complementary system for a patient’s progress supervision during rehabilitation exercises. A cost effective motion capture sensor node composed by a 9 Degrees-of-Freedom (DoF) Inertial Measurement Unit (IMU) is mounted on the patient’s upper limb segments and sends wirelessly the corresponding measured signals to a base station. The sensor orientation and the upper limb individual segments movement in 3-Dimensional (3D) space are derived by processing the sensors’ raw data. For the latter purpose, a biomechanical model which resembles that of a kinematic model of a robotic arm based on the Denavit-Hartenberg (DH) configuration is used to approximate in real time the upper limb movements. The joint angles of the upper limb model are estimated from the extracted sensor node’s orientation angles. The experimental results of a human performing common rehabilitation exercises using the proposed motion capture sensor node are compared with the ones using an off-the-shelf sensor. This comparison results to very low error rates with the root mean square error (RMSE) being about 0.02 m.

Virtual rehabilitation system for fine motor skills using artificial neural networks

This work presents a rehabilitation system for upper limbs performed by the acquisition of electromyographic signals (EMG) of a patient with movement limitation after stroke. To determine the physical gestures of the arm, the MYO Armband is used, and to increase the default number of movements (4 gestures), a recognition algorithm is performed using artificial neural networks. MATLAB has been used for the extraction of a vector containing the characteristics through probabilistic signals treatment and to determinate the angles of rotation. In addition, an immersive environment is developed in Unity 3D software allowing the user to experience a more motivating therapy. As a peripheral output, HTC VIVE glasses and binaural hearing aids were chosen. To validate this proposal, five users with an age range of 49 to 69 years have made 200 tests in total with the proposed physical gestures (7). In addition, the qualitative validation of the system is done through the SUS usability test and as a result it is obtained (55.25 ± 0.18), demonstrating good acceptance.