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Objective To investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years. Case An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment. Results The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4. Discussion The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.

Robotic and advanced technology rehabilitation is useful for people with difficulties and deficits in arm and hand movements, walking problems and balance disorders. Robotic technologies are being introduced in the rehabilitation field to support the activity of specialists, doctors and physiotherapists; the future and the challenge of rehabilitation lies precisely in the development of robotics. Robot assists the therapist in administering the most appropriate motor therapy with precision and repeatability modulates the difficulty of the exercise. It allows repetitive task-oriented activities with augmentative feedback capable of inducing brain plasticity. It acquires quantitative information on movement and evaluates the services performed he first, “Arm and Hand”, is used to help the opening and closing movements of the hand. After entering it by hand and forearm, gently guides the patient's shoulder and elbow movements to reach and grasp objects. “Wrist”, on the other hand, interacts with the movements of the wrist and integrates functionally with the “Hand” module.

Introduction The hybrid assistive limb (HAL) is a wearable exoskeleton cyborg that assists walking and lower limb movements via real-time actuator control by detecting the wearer's bioelectric signals on the surface of their skin. Purpose The purpose of this study was to report the improvement in walking ability following HAL gait training in a patient with tetraplegia after incomplete cervical spinal cord injury (SCI). Patient and methods A 47-year-old man with traumatic cervical SCI for six months after fall had incomplete tetraplegic SCI grade C as classified according to the American Spinal Cord Injury Association impairment scale and was unable to walk in conventional rehabilitation. Results The HAL gait training was received 2 or 3 times per week for 13 sessions. Improvement was observed in gait speed (baseline: 0.12; after training: 0.45 m/sec), step length (baseline: 0.30; after training: 0.45 m), and cadence (baseline: 23.1; after training: 59.6 steps/min) based on a 10-meter walking test; International Standards for Neurological and functional Classification of Spinal Cord Injury (ISNCSCI) motor score (baseline: 59; after training: 76); and walking index for spinal cord injury (WISCI) II score (baseline: 1; after training: 6). Conclusion We report the recovery of walking ability in a patient with chronic severe incomplete tetraplegic SCI following the HAL training.

Robotic rehabilitation states as the restorative therapy for the which act as the augmented tool for the health care workers. The methodology was to collect the articles from various scholar sites and where the scrutinization for 180 articles were done. Where the need of the study was to create review upon the robotic technology in the health care. They act as the rehabilitative tool for the upper and lower limb which is further classified into endoskeletons and exoskeletons which is having which is having different mechanism of play and different outcome. The need of rehabilitation technology with robots is inclusive of accurate monitoring, surgery, medicine and rehabilitation. There is a history of robotics in health care as begin in 1960’s for surgery and in 1990’s for rehabilitation and now have expanded in various accessible new technologies that are affordable, having multiple control system with various degrees of freedom and different approach to work. Some of them are highly versatile even can work without any supervision. The need of robotics will increase so as to assist not to remove and gain satisfaction at every end of patient and health worker. The past to present to the future have been very challenging but are present with great outcomes.

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on “Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin” (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.

Upper limb dysfunction after stroke is one of the most serious functional disorders, and adequate functional recovery is often not expected. Although various studies have been conducted on effective rehabilitation for upper limb dysfunction, active rehabilitation such as repetitive training of upper limb elevation has not been sufficiently conducted yet because the shoulder joint is highly unstable and the appearance of pain is easily observed. In this study, we performed right shoulder joint elevation training in a seated position using a single-joint hybrid assistive limb (HAL) in a 54-year-old female with right hemiplegia after a stroke. Her right upper limb function improved as follows: passive and active range of motion (ROM) of shoulder flexion, from 105° to 115° and from 65° to 105°, respectively; manual muscle test (MMT), from 2 to 4; box and block test of the right hand, from 1 to 8; right grip strength, from less than 5 to 7.4 kg; and action research arm test (ARAT) total scores, from 10 to 20. No adverse events including shoulder pain were seen. According to the result of the pilot study, HAL may be an effective rehabilitation tool for upper limb dysfunction after stroke.

Analysis of kinematic features related to clinical assessment scales may qualitatively improve the evaluation of upper extremity movements of stroke patients. We aimed to investigate kinematic features that could correlate the change in the Fugl-Meyer Assessment (FMA) score of stroke survivors through upper extremity robotic rehabilitation. We also analyzed whether changes in kinematic features by active and active-assisted robotic rehabilitation correlated differently with changes in FMA scores. Fifteen stroke patients participated in the upper extremity robotic rehabilitation program, and nine kinematic features were calculated from reach tasks for assessment. Simple and multiple linear regression analyses were used to characterize correlations. Features representing movement speed were associated with changes in FMA scores for the group that used an active rehabilitation robot. In contrast, in the group that used an active-assisted rehabilitation robot, features representing movement smoothness were associated with changes in the FMA score. These estimates can be an important basis for kinematic analysis to complement clinical scales.

The relationship between clinical assessments and the patient’s motor characteristics can be an important part of knowing the patient's rehabilitation progress. In this study, we investigate the relationship between the clinical assessment and kinematic features of upper arm movements in stroke patients. We evaluated the Fugl-Meyer Assessment score (FMA score) and calculated the kinematic features by observing the patients who were performing reaching tasks. Multiple-linear-regression analysis was performed to investigate the correlation between the FMA score and the kinematic features. Different kinematic features of active and active-assistive robotic rehabilitation were found to correlate with the FMA score.

[Purpose] Recent studies have reported the effectiveness of robotic rehabilitation of paralyzed upper limbs in stroke patients. For example, the Single-Joint Hybrid Assistive Limb has been shown to improve upper limb impairments. However, limited data are available on the effectiveness of robotic rehabilitation of the upper limb with regards to daily living. In this case study, an accelerometer was adopted to examine whether rehabilitation using the Single-Joint Hybrid Assistive Limb improved upper limb activity during daily living in a stroke patient. [Participant and Methods] The participant was a 69-year-old male diagnosed with stroke and left hemiparesis. The Single-Joint Hybrid Assistive Limb was applied to the participant's elbow on the paralyzed side. The participant wore an accelerometer on each wrist to measure the activities of the upper limbs. Clinical tests of the paralyzed upper limb were also performed. [Results] The activity of the paralytic limb was significantly higher after Single-Joint Hybrid Assistive Limb intervention than before the intervention. On the other hand, none of the results of the clinical tests changed beyond a clinically important difference. [Conclusion] The Single-Joint Hybrid Assistive Limb could be useful for promoting active use of a paralyzed upper limb in daily living. In addition, an accelerometer could be especially useful for evaluating the effects of robotic rehabilitation.

Background: This study aims to evaluate the effectiveness of the robotic device used in lower limb rehabilitation to reduce motor impairment and improve motor performance in patients with traumatic spinal injury. Methods: The data were obtained by retrospective analysis of patients who underwent lower extremity rehabilitation after traumatic spinal injury by robot-assisted rehabilitation in the hospital between December 2017 and December 2019. The results were statistically analyzed and shown as mean ± SD (min-max). Results: A total of 51 patients with mean age of 59.51 ± 8.2 (38 - 72) were admitted to the clinic. Mean ages of thirty-one male patients and twenty females patients were 58.74 ± 8.88 (38 - 77) and 60.7 ± 7.09 (44 - 72), respectively. Comparing ages in terms of gender, it was not statistically significant (p = 0.441). Body mass indexes of male patients were 32.84 ± 6.52 (20 - 48) and 31.4 ± 7.73 (18 - 48) for females. Body mass index of patients was not statistically significant in terms of their gender (p = 0.478). Oswestry disability index scores were 32.04 ± 10.74 (16 - 58) before treatment and 30.69 ± 10.31 (15 - 55) after treatment. Oswestry disability index values before and after robotic rehabilitation were statistically significant (p Conclusions: The motor function gains obtained during the robot-assisted treatment of traumatic spinal injury patients showed robotic device was useful in the training program. Robotic rehabilitation was effective in the improvement of the lower extremities during motor examination.

The article considers changes in the basic hemodynamic parameters in patients undergoing active kinesiotherapy using the ExoLiteMS robotic rehabilitation system. Standard clinical methods of functional evaluation were used to assess the changes in the hemodynamics in patients at rest and under physical load.

The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p 0.001) and a greater rebalance between the SAI of both the hemispheres (p 0.001).These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

Objective:To determine the effects of robot-assisted movement training on daily life activities and hopelessness levels in neurorehabilitation patients. Material and methods: The study is a randomized controlled trial. The study was conducted on 48 patients. Of these 48 patients, 8 were excluded because they did not meet the inclusion criteria. Patients who had acute internal diseases, had received botulinum toxin within 6 months before the treatment, or were unable to cooperate enough to participate in the assessments were excluded. The patients were randomly assigned to two groups: Group I consisted of 21 patients who applied gait training with a robotic device in addition to the routine neurorehabilitation programme; Group II included 19 patients in the routine neurorehabilitation programme. Hopelessness levels and daily living activities were assesed before and after treatment .Assessments were made by Beck Hopelessness Scale (BHS), and Barthel Index before and after the treatment. The IBM SPSS Statistics for Windows version 22.0 (IBM, Armonk, NY, USA) was used in the analysis of the data, andp< 0.05 was considered to be significant. Results:There was a statistically significant difference between the pre-treatment and post-treatment hopelessness levels of the patients included in robotic rehabilitation program (p=0.001), while no significant difference was found between the hopelessness levels of the cases included in routine neurorehabilitation program (p= 0.07). No statistical difference was found within and between the groups in terms of both pre- and post-treatment Barthel Index scores. An increase was found in the Barthel Index scores when compared with pre-treatment, although the increase was not found to be significant. Conclusion:Robotic rehabilitation plays an active role in providing help to therapist, fulfilling motor learning principles and conducting high intensity and long-term movements. Robotic systems also have a positive effect on patients’ mood and coping strategies. According to the results of our study, robotic rehabilitation in neurorehabilitation patients will provide additional advantages.

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.

Background In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation. Methods After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones. Results Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p Conclusions This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists’ effort, increase repeatability and accuracy of assessments, and promote subject’s engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644.

The use of robotic systems in physical rehabilitation protocols has become increasingly attractive and has been given more focus in the last decade as a result of the high prevalence of motor deficits in the population, which is linked to an overburdened healthcare system. In accordance with current trends, three robotic devices have been designed, called ParReEx Elbow, ParReEx Wrist, and ASPIRE, which were designed to improve upper-limb medical recovery (shoulder, elbow, forearm, and wrist). The three automated systems were tested in a hospital setting with 23 patients (12 men and 11 women) suffering from motor deficits caused by various neurological diseases such as stroke, Parkinson’s disease, and amyotrophic lateral sclerosis (ALS). The patients were divided into three groups based on their pathology (vascular, extrapyramidal, and neuromuscular). Objective clinical measures, such as the Medical Research Council (MRC) scale, goniometry, and dynamometry, were used to compare pre- and post-rehabilitation assessments for both robotic-aided and manual physical rehabilitation therapy. The results of these tests showed that, with the exception of a few minor differences in muscular strength recovery, the robotic-assisted rehabilitation methods performed equally as well as the manual techniques, though only minor improvements were validated during short-term rehabilitation. The greatest achievements were obtained in the goniometric analysis where some rehabilitation amplitudes increased by over 40% in the vascular group, but the same analysis returned regressions in the neuromuscular group. The MRC scale analysis returned no significant differences, with most regressions occurring in the neuromuscular group. The dynamometric analysis mostly returned improvements, but the highest value evolution was 19.07%, which also in the vascular group. While the results were encouraging, more research is needed with a larger sample size and a longer study period in order to provide more information regarding the efficacy of both rehabilitation methods in neurological illnesses.

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient’s level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode. This work was funded by the Conselleria d’Educacio, Cultura i Esport of Generalitat Valenciana by the European Social Fund—Investing in your Future, through the grant ACIF 2018/214, PEJ2018-002684-A and PEJ2018-002670-A, and by the Spanish Ministry of Science and Innovation through the project PID2019-108310RB-I00.

Currently, there is a lack of easy-to-use hand rehabilitation devices which not only retrain motor functions, but also include somatosensory information of the interaction with tangible virtual objects to also regain sensory function. To overcome these shortcomings, we are developing a novel haptic rehabilitation device that focuses on usability, enforces physiological movements and provides haptic rendering capabilities.

Cerebral palsy includes several posture and movement disorders which produce limitations in functional activities such as gait. In recent years robotics have been used as a complement of the treatment of neurological pathologies. The exoskeleton Ekso bionics enables professionals to perform treatments to improve gait in patients with cerebral palsy. After 24 sessions many spatiotemporal and kinematic parameters were improved in one patient with cerebral palsy.

Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Ministry of Health (MOH) Nanyang Technological University National Medical Research Council (NMRC) Published version This work was supported by the National Medical Research Council (NMRC, NMRCB2b0006c) Singapore and the H-Man project (NMRC/BnB/0006b/2013), Ministry of Health, Singapore; Ageing Research Institute for Society and Education (ARISE), Singapore: M4082063 and Interdisciplinary Graduate School, Nanyang Technological University, Singapore. Grant support duration: 2013–2018.

A study on mice shows that drugs and mechatronic devices could be combined to regain movement after a stroke A study on mice shows that drugs and mechatronic devices could be combined to regain movement after a stroke

The coronavirus disease (COVID-19) outbreak requires rapid reshaping of rehabilitation services to include patients recovering from severe COVID-19 with post-intensive care syndromes, which results in physical deconditioning and cognitive impairments, patients with comorbid conditions, and other patients requiring physical therapy during the outbreak with no or limited access to hospital and rehabilitation centers. Considering the access barriers to quality rehabilitation settings and services imposed by social distancing and stay-at-home orders, these patients can be benefited from providing access to affordable and good quality care through home-based rehabilitation. The success of such treatment will depend highly on the intensity of the therapy and effort invested by the patient. Monitoring patients' compliance and designing a home-based rehabilitation that can mentally engage them are the critical elements in home-based therapy's success. Hence, we study the state-of-the-art telerehabilitation frameworks and robotic devices, and comment about a hybrid model that can use existing telerehabilitation framework and home-based robotic devices for treatment and simultaneously assess patient's progress remotely. Second, we comment on the patients' social support and engagement, which is critical for the success of telerehabilitation service. As the therapists are not physically present to guide the patients, we also discuss the adaptability requirement of home-based telerehabilitation. Finally, we suggest that the reformed rehabilitation services should consider both home-based solutions for enhancing the activities of daily living and an on-demand ambulatory rehabilitation unit for extensive training where we can monitor both cognitive and motor performance of the patients remotely.

Coupled with sensors, robotic devices for Stroke rehabilitation describe the motor behavior of patients as kinematic and kinetic data, which are underexplored in the data science and machine learning context, due to the time-consuming task of pursuing enough data volume. Moreover, the definition of biomarkers for a quantitative and deterministic assessment of patient progress remains an open problem in the literature. Four different studies were carried out aiming to address such an issue. We also propose a modular framework for organizing pieces of software for data analysis with the calculations of more than twenty robot-based metrics implemented. Our first study concerns a clinically-naive method for defining a region in the data space, alluding to a state of rehabilitation, based on the uncertainty in the classification of hemiparetic sides of chronic stroke patients. Our second study raised evidences that anodal tDCS may have a detrimental or maladaptive interaction with the affected hemisphere in patients with very severe upper-extremity impairments. Our third study correlates the implemented robot-based metrics with traditional clinical scales, so trained machine learning models can play the same role on a quantitative and deterministic way, eliminating the subjective nature from traditional evaluation methods. We found that having a model to estimate clinical scales only from one kind of robot (shoulder/elbow or wrist) is as good as combining data from both. We found in our fourth study evidences from a clinical perspective on the prediction of clinical outcomes of patients at early stages of the treatment. Our results indicate the possibility of improving the decision-making process by alerting, at the end of the second therapy session, when patients will potentially not present a significant response. The four projects here described enabled to push the state of the art towards the development of biomarkers to evaluate and track patients progress on rehabilitation robotics treatments; proposing standards for simplifying the data sharing; simplifying clinical studies with traditional statistical tools and our framework API and optimize the clinicians decision-making process towards impacting patients budget on rehabilitation treatments for optimizing quality of life. Acoplados a sensores, robôs para reabilitação de AVC descrevem o comportamento motor de pacientes como grandezas cinemáticas e dinâmicas, pouco exploradas no contexto de ciência de dados, devido à custosa tarefa de obter um volume significativo de dados. Além disso, a definição de biomarcadores para uma avaliação mais confiável da evolução do paciente permanece um problema aberto na literatura. Quatro estudos diferentes foram conduzidos com o objetivo de abordar tal questão. É proposta também uma ferramenta modular para organizar programas para análise de dados, com cálculos de mais de vinte métricas implementadas. O primeiro estudo consiste em um método puramente baseado em dados para definir uma região no espaço de dados, aludindo a um estado de reabilitação, baseado na incerteza da classificação de lados hemiparéticos de pacientes com AVC crônico. Nosso segundo estudo levantou evidências de que a tDCS anódica pode ter uma interação desvantajosa com o hemisfério afetado em pacientes com déficis muito severos dos membros superiores. O terceiro estudo correlaciona as métricas implementadas com escalas clínicas tradicionais, de forma que os modelos de aprendizado de máquina treinados possam desempenhar o mesmo papel de forma quantitativa e determinística, eliminando a natureza subjetiva dos métodos tradicionais de avaliação. Descobrimos que utilizar o modelo treinado com dados de apenas de um tipo de robô (ombro/cotovelo ou pulso) para estimar escalas clínicas é tão eficiente quanto combinar dados de ambos. Encontramos no quarto estudo evidências, sob uma perspectiva clínica, de um potencial de previsão de resultados clínicos de pacientes em estágios iniciais do tratamento. Nossos resultados indicam a possibilidade de melhorar o processo de tomada de decisão alertando, ao final da segunda sessão, se o paciente potencialmente não apresentará uma resposta significativa à terapia. Os projetos aqui descritos avançam o estado da arte no desenvolvimento de biomarcadores para avaliar e acompanhar o progresso do paciente em terapia robótica; propõem padrões a fim de simplificar o compartilhamento de dados; simplificam os estudos clínicos com amparo estatístico, bem como a ferramenta proposta, e otimizam a tomada de decisão clínica, impactando o orçamento em tratamentos de reabilitação e otimizando recursos do paciente para uma melhor qualidade de vida.

Featured ApplicationThe proposed technology is useful for the estimation of human biomarkers in rehabilitation processes or for any application that needs human pose estimation.AbstractAssistance and rehabilitation robotic platforms must have precise sensory systems for human–robot interaction. Therefore, human pose estimation is a current topic of research, especially for the safety of human–robot collaboration and the evaluation of human biomarkers. Within this field of research, the evaluation of the low-cost marker-less human pose estimators of OpenPose and Detectron 2 has received much attention for their diversity of applications, such as surveillance, sports, videogames, and assessment in human motor rehabilitation. This work aimed to evaluate and compare the angles in the elbow and shoulder joints estimated by OpenPose and Detectron 2 during four typical upper-limb rehabilitation exercises: elbow side flexion, elbow flexion, shoulder extension, and shoulder abduction. A setup of two Kinect 2 RGBD cameras was used to obtain the ground truth of the joint and skeleton estimations during the different exercises. Finally, we provided a numerical comparison (RMSE and MAE) among the angle measurements obtained with OpenPose, Detectron 2, and the ground truth. The results showed how OpenPose outperforms Detectron 2 in these types of applications.

Robot-aided gait training (RAGT) has been implemented to provide patients with spinal cord injury (SCI) with a physiological limb activation during gait, cognitive engagement, and an appropriate stimulation of peripheral receptors, which are essential to entrain neuroplasticity mechanisms supporting functional recovery. We aimed at assessing whether RAGT by means of an end-effector device equipped with body weight support could improve functional ambulation in patients with subacute, motor incomplete SCI. In this pilot study, 15 patients were provided with six RAGT sessions per week for eight consecutive weeks. The outcome measures were muscle strength, ambulation, going upstairs, and disease burden. Furthermore, we estimated the activation patterns of lower limb muscles during RAGT by means of surface electromyography and the resting state networks' functional connectivity (RSN-FC) before and after RAGT. Patients achieved a clinically significant improvement in the clinical outcome measures substantially up to six months post-treatment. These data were paralleled by an improvement in the stair-climbing cycle and a potentiating of frequency-specific and area-specific RSN-FC patterns. Therefore, RAGT, by means of an end-effector device equipped with body weight support, is promising in improving gait in patients with subacute, motor incomplete SCI, and it could produce additive benefit for the neuromuscular reeducation to gait in SCI when combined with conventional physiotherapy.

With the development of robotics-based technologies for human healthcare, human–machine interaction is gaining increasing importance, bringing with it ethical considerations, including the impairment of patients and potential risks to their integrity. This study investigates the Cybernics approach to the robotic rehabilitation system HAL (Hybrid Assistive Limb) as a socio-technological conception of human–machine relations. Contrary to common individualistic conceptions, this heterarchic approach to empowerment technologies (ET) builds on an intrinsic relation between human and machine, in which machines are primarily regarded as a supplement and not a threat to impaired humans. This leads to the question of how ET are constructed and legitimized in Japan, and what relationship between humans and machines is envisioned in the context of healthcare. In referencing Society 5.0 as the developmental framework for ET in Japan, the Cybernics approach to ET as employed at the University of Tsukuba and a case study of the HAL system as enabling an interactive unity of human and machine show that the socio-technological conception proposes a capability-oriented approach with built-in ethics, offering a complementary view to prevailing accounts of human–machine relations.

Introduction Stroke is the third leading cause of adult disability world-wide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. Evidence acquisition We systematically reviewed stroke rehabilitation guideline recommendations between January 1st, 2010 and October 31th, 2020. We explored electronic databases (n=4), guideline repositories and professional rehabilitation networks (n=12). Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. Evidence synthesis From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. Robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. Unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. Conclusions Our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. However, robot assisted gait training (RAGT) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

Robotics can be used to describe wrist kinematics and assess sensorimotor impairments, while the implementation of training algorithms can be aimed at improving neuromuscular control. The purpose of this study was to use a robotic device to develop an adaptive and individualized training program of the distal upper extremity for individuals with multiple sclerosis (MS). This approach included an online assessment of performance aimed at changing the level of assistance/resistance provided during the task. Participants (N = 7) completed a robotic training program that occurred 3 times weekly for 4 weeks. The training protocol consisted of tracking a target moving along a figure by grasping the end-effector of the robotic device and moving it along the trajectory. Outcome measures were assessed pre- and post-intervention. Improvements in performance were quantified by average tracking (p = 0.028) and figural error (p = 0.028), which was significantly reduced by 26% and 43%, respectively. Isometric wrist strength significantly improved post-intervention (flexion: p = 0.043, radial and ulnar deviation: p = 0.028). The results of this work demonstrate that 4-weeks of adaptive robotic training is a feasible rehabilitative program that has the potential to improve distal upper extremity motor accuracy and muscular strength in a MS population.

Central pontine myelinolysis (CPM) is a solitary, symmetric, demyelination in the central pons. This case study aimed to report the effects of an intensive robotic gait training with Lokomat-Pro on mobility and quality of life in a case of CPM.A 33-year-old female patient with tetraparesis and gait disturbance due to CPM was hospitalized to undergo intensive rehabilitation training for about 2 months. Daily session of Lokomat-Pro and psychotherapy by telemedicine were performed, besides nursing care and occupational and physical therapy. Motor evaluation and quality of life were assessed by using standardized scales.The multidisciplinary therapy led to significant improvements both in functional motor outcomes (as per 10-Meter Walk Test, Berg Balance and Tinetti scale) and quality of life.Innovation technology, including robotics and telemedicine, may be a valuable tool to improve functional outcomes in patients with severe motor impairment due to chronic CPM.IMPLICATIONS FOR REHABILITATIONA multidisciplinary approach involving robotics plus virtual reality is mandatory to reduce medical and bedridden complications in patients affected by CPM.

The use of robotics in the field of rehabilitation became a modern request of the continuing developing society. The aim of this paper is to present an ankle rehabilitation solution by using a commercial off-the–shelf robotic system equipped with a special designed rehabilitation device, able to constrain the position of the leg of the patient and at the same time to perform the rehabilitation motions requested by the medical protocol of the rehabilitation. The robotic system equipped with the rehabilitation device is presented along with the functional validation of the system using in-lab tests.

Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).

CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico FAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas Gerais Introdução: A doença de Parkinson (DP) é uma doença crônica e progressiva que apresenta sinais e sintomas motores característicos. A rigidez muscular é um dos principais sinais / sintomas motores da DP e pode se manifestar em diferentes áreas do corpo, sendo mais comum nos membros superiores, o que dificulta a realização de atividades que envolvam o uso das mãos. Diante disso, a reabilitação fisioterapêutica é essencial na manutenção da funcionalidade dos membros afetados pelos sinais / sintomas motores da DP, influenciando na qualidade de vida dos indivíduos acometidos pela doença. Nesse sentido, o uso de dispositivos robóticos na reabilitação dos sinais / sintomas motores da doença de Parkinson é uma área em crescente expansão. Objetivo: Avaliar a influência de uma órtese ativa de punho (OAP) na atividade eletromiográfica dos flexores e extensores do carpo e na amplitude de movimento da articulação do punho em indivíduos com a doença de Parkinson. Métodos: A atividade muscular dos flexores e extensores do carpo foi estimada por meio de eletromiografia. Para estimar a amplitude de movimento (ADM), um modelo biomecânico da parte superior do corpo foi desenvolvido no software Visual3D e a ADM da flexão e extensão do punho foi estimada. Ambas as características, EMG e ADM, foram avaliadas com e sem o uso da órtese ativa de punho e posteriormente comparadas utilizando métodos estatísticos para verificar a influência da órtese ativa de punho na atividade muscular e amplitude de movimento durante a flexão e extensão do punho. Resultados: Os resultados mostram que o uso da órtese influencia principalmente a extensão de punho. Para o movimento de extensão do punho foi observado um aumento médio de 22% na atividade muscular do extensor radial longo do carpo e uma redução média de 9º na amplitude de movimento da extensão do punho ao usar a órtese. Conclusão: As alterações da atividade eletromiográfica e amplitude de movimento causadas pelo uso da órtese ativa de punho avaliada não são expressivas no sentido de que o dispositivo não impõe uma limitação significativa da amplitude articular em uma aplicação clínica, e o aumento da atividade muscular não dificulta ou interfere na realização das tarefas propostas no protocolo experimental, confirmando o design ergonômico da órtese e o potencial para ser utilizada na reabilitação do punho de indivíduos acometidos pela doença de Parkinson em ambiente clínico. Introduction: Parkinson's disease (PD) is a chronic and progressive disease that presents characteristic motor symptoms. Rigidity is one of the main motor symptoms of PD and can manifest itself in different areas of the body, being more common in the upper limbs, which makes it difficult to perform activities that involve the use of hands. Therefore, physical therapy rehabilitation is extremely important for maintaining the functionality of the limbs affected by PD motor symptoms, influencing the quality of life of individuals affected by the disease. In this sense, the use of robotic devices in the rehabilitation of motor symptoms of Parkinson's disease is an area in increasing expansion. Objective: To evaluate the ergonomics of an active wrist orthosis developed for the rehabilitation of symptoms of rigidity in individuals with PD. Methods: The muscle activity of the carpal flexors and extensors was estimated using electromyography. To estimate the motion amplitude (MA), a biomechanical model of the upper body was developed in the Visual3D software and the MA of wrist flexion and extension was estimated. Both characteristics, EMG and MA, were evaluated with and without the use of the active wrist orthosis and later compared using statistical methods to verify the influence of the active wrist orthosis. Results: The results show that the use of the orthosis mainly influences the wrist extension. For the wrist extension movement, it was observed an average increase of 22% in the muscular activity of the long radial carpal extensor and an average decrease of 9º in the motion amplitude of the wrist extension when using the orthosis. Conclusion: The changes in electromyographic activity and motion amplitude caused by the use of the evaluated active wrist orthosis are not significant in the sense that the device does not impose a significant limitation of joint amplitude in a clinical application, and the increase in muscle activity does not interfere in performing the tasks proposed in the experimental protocol, confirming the ergonomic design of the orthosis and the potential to be used in the rehabilitation of the wrist of individuals affected by Parkinson's disease in a clinical setting. Dissertação (Mestrado)

Recent advancements in ICT have sped up the development of new services in healthcare. In this context, remote patient monitoring and rehabilitation activities can take place either in satellite hospital centers or directly in patients’ homes. Specifically, using a combination of Cloud/Edge computing, Internet of Things (IoT) and Machine Learning (ML) technologies, patients with motor disabilities can be remotely assisted avoiding stressful waiting times and overcoming geographical barriers. This is possible by applying the Tele-Rehabilitation as a Service (TRaaS) concept. The objective of this paper is twofold: i) studying how Machine Learning can improve the TRaaS, and ii) demonstrating how a NoSQL graph database approach can enhance the performance because it works directly at the database layer instead of at application one. In particular, the K-Nearest Neighbors (K-NN) algorithm is studied in order to identify the best therapy, i.e., rehabilitation training, for a new remote patient with motor impairment. Experiments compare two system prototypes, that are respectively based on Python and Neo4j, showing that the latter presents better performance in terms of processing time guaranteeing the same accuracy.

Background Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. Methods Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. Results Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. Conclusions The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. Trial registration: ClinicalTrials.gov, NCT04201613, Registered 17 December 2019—Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613.

Objective Robotic gait training presents a promising training modality. Nevertheless, evidence supporting the efficacy of such therapy in children with cerebral palsy remains insufficient. This study aimed to assess the effect of robotic gait training in children/adolescents with cerebral palsy. Methods Twenty-four children/adolescents with bilateral cerebral palsy (12 female, 10.1 ± 3.1 years, Gross Motor Function Classification System II to IV) took part in this study. They received two 30−45 min sessions/week of Lokomat training for 12-weeks. Muscle strengths, 6-min walk exercise and gait parameters were evaluated pre- and post-training and at 6-months-follow-up. Training effect according to the level of impairment severity (moderate vs severe) was analyzed using a change from the baseline procedure. Results A significant increase in muscle strength was observed after training (p ≤ 0.01). Hip flexors and knee extensors strength changes were maintained or improved at follow-up (p

Stroke survivors show greater postural oscillations and altered muscular activation compared to healthy controls. This results in difficulties in walking and standing, and in an increased risk of falls. A proper control of the trunk is related to a stable walk and to a lower falling risk; to this extent, rehabilitative protocols are currently working on core stability. The main objective of this work was to evaluate the effectiveness of trunk and balance training performed with a new robotic device designed for evaluation and training of balance and core stability, in improving the recovery of chronic stroke patients compared with a traditional physical therapy program. Thirty chronic stroke patients, randomly divided in two groups, either underwent a traditional rehabilitative protocol, or a robot-based program. Each patient was assessed before and after the rehabilitation and at 3-months follow-up with clinical and robot-based evaluation exercises focused on static and dynamic balance and trunk control. Results from clinical scores showed an improvement in both groups in balance and trunk control. Robot-based indices analysis indicated that the experimental group showed greater improvements in proprioceptive control, reactive balance and postural control in unstable conditions, compared to the control group, showing an improved trunk control with reduced compensatory strategies at the end of the training. Moreover, the experimental group had an increased retention of the benefits obtained with training at 3 months follow up. These results support the idea that such robotic device is a promising tool for stroke rehabilitation.

Background Parkinson’s disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson’s disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson’s disease, designed to improve the gait and to reduce the risk of falling. Methods This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale – International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. Discussion The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. Trial registration NCT04087031, registration date September 12, 2019.

In this paper, we present MyoTrack, a realtime classification procedure that identifies levels of subject participation during robot-assisted rehabilitation using a wearable surface electromyography (sEMG) Myo armband. We hypothesize, test, and prove that high sEMG correlates with high participation and vice versa. We then use Myo's inertial measurement unit to extract the subject's hand trajectory during the rehabilitation task. Comparing this hand trajectory with the ground-truth robot trajectory enables us to identify whether any high muscle activity corresponds to the active participation of the subject in robotic therapy or not (random gestures and motions). Since the robotic assistance implemented in this paper can autonomously complete the therapy task without any subject participation; it is crucial to identify the patient's participation level in realtime and develop a suitable intervention strategy. Using 15 healthy subjects, we demonstrate that the proposed methodology of combining sEMG activation and robot-hand trajectory matching is a reliable indicator of subject participation with a realtime accuracy of 91.45%. We also present a realtime application that uses MyoTrack in the back-end to identify the realtime participation of a subject and intervene accordingly.

Background: Robot-assisted rehabilitation is an appealing strategy for patients after stroke, as it generates repetitive movements in a consistent, precise, and automated manner.Objective: To ident...

This paper develops a robotic cognitive rehabilitation therapy (CRT) system to assist patients with mild cognitive impairment (MCI) in block design test (BDT) rehabilitation training. This system bridges the treatment gap that occurs when one physician has several patients to attend to. One physician can setup the BDT training task and simultaneously monitor the training progress of several patients with MCI, which forms an effective one-to-many rehabilitation model. A target information acquisition method is designed to realize target detection and position extraction in automatic rehabilitation. Two graphic user interfaces (GUIs) are developed to provide intuitive control and immediate visual feedback. Different BDTs are selected from the benchmark by the physician in an integrated GUI (I-GUI) and are assigned to several patient GUIs (P-GUIs), respectively. During training, automatic visual assistance can be triggered by the help button and the patients can be guided in finding the target block. Additionally, a robotic arm could be engaged to further help with teaching so that patients can follow the instructions given by the P-GUI and imitate the demonstration given by the robot arm to finish the training task. This system converts traditional MCI rehabilitation into an automatic process, creating an effective model of BDT training for MCI rehabilitation.

Objective:The aim of this study was to investigate the effects of robotic rehabilitation (RR) on spasticity and motor functions of children with varying types and functional levels of cerebral palsy (CP).Materials and Methods:A total of 28 children were evaluated aged 6-16 years, with level 2-4 CP according to the Gross Motor Function Classification System (GMFCS) who were planned to undergo 30 sessions of RR. Motor functions were evaluated before and after RR using the Gross Motor Function scale-66 (GMFS-66) B, C, D and E dimensions, gastrosoleus spasticity with the Modified Ashworth scale (MAS) and a target was defined for each patient with a Goal Attainment scale (GAS). Following the RR treatment, the efficacy was evaluated by grouping the patients according to the GMFCS level and the type of CP.Results:11% of the patients were at level 2, 36% were at level 3, and 54% were at level 4.61% of them were identified as bilateral spastic, 21% unilateral spastic and 14% mixed type. The patients comprised 50% male and 50% female children with a mean age of 10.8±2.7 years. Mean participation in the RR program was 23±9.6 sessions. A statistically significant improvement was determined in the D dimension of the GMFS in the children at level 2 and 3 of GMFCS (p0.05). No differences were determined between the type of CP groups in respect of GMFS, MAS and GAS. Conclusion:It was concluded that the application of RR was of benefit for the children with CP at the level 2 and 3 of GMFCS in respect of the development of standing activities.

[Purpose] This study aimed to assess whether robotic rehabilitation can improve upper limb function, activities of daily living performance, and kinematic performance of chronic stroke survivors. [Subjects and Methods] Participants were 21 chronic stroke survivors (19 men; 60.8 years; Mini-Mental State Examination score: 28; onset duration: 10.2 years). Training exercises were performed with a Whole Arm Manipulator and a 120-inch projective display to provide visual and auditory feedback. Once the training began, red and grey balls appeared on the projective display, and participants performed reaching movements, in the assist-as-needed mode, toward 6 directional targets in a 3-dimensional space. All participants received training for 40 minutes per day, thrice per week, for 6 weeks. Main outcome measures were upper limb function (Fugl-Meyer Assessment, Action Research Arm Test, and Box and Blocks Test scores), activities of daily living performance (Modified Barthel Index), and kinematic performance (movement velocity) in 6 directions. [Results] After 6 weeks, significant improvement was observed in upper limb function, activities of daily living performance, and kinematic performance. [Conclusion] This study demonstrated the positive effects of robotic rehabilitation on upper limb function, activities of daily living performance, and kinematic performance in chronic stroke survivors.

Despite concerted efforts over the last three decades, upper-extremity robotic rehabilitation has yet to reach its full potential. We assert that assuming the goal of robotic rehabilitation is to automate conventional therapy may have led to overly narrow research directions and to mixed results from clinical studies. Recontextualizing this assumption opens promising research avenues for roboticists. Breaking the robotic device design loop and instead seeking out ‘big data’ opportunities has the potential to identify promising robot-mediated interventions. This will require a shift in roboticists' attitudes toward participating in neuroscience and clinical research. By expanding assessment beyond kinematics, robotic devices can provide clinicians with a more complete picture of impairment and recovery. We discuss the current assumptions in greater detail and point toward promising research in these revised directions.

As the medical field continues to evolve, the average life expectancy of the people increases. However, due to natural deterioration, the average muscle force of the arm decreases in respect to age. So, there are some needs for the people to exercise his/her body as he/she is getting older. There are many researches about the robotic rehabilitation of the upper limb for patients. However, only a few focus on the system of the upper limb muscle exercise for normal people. So, in this study, an electromyography (EMG)-based variable impedance control method is developed for elbow exercise in normal people. Four EMG sensors were attached to the designated right arm and their average EMG level was controlled by the proposed algorithm during an elbow flexion-extension exercise. A total of twenty nine experiments with 15 subjects were performed to verify the proposed control algorithm with NCCEES, an elbow exercise system developed by the authors for the elbow exercise. The experimental results showed th...

Objective Non-invasive neuromuscular characterization aims to provide greater insight into the effectiveness of existing and emerging rehabilitation therapies by quantifying neuromuscular characteristics relating to force production, muscle viscoelasticity and voluntary neural activation. In this paper, we propose a novel approach to evaluate neuromuscular characteristics, such as muscle fiber stiffness and viscosity, by combining robotic and HD-sEMG measurements with computational musculoskeletal modeling. This pilot study investigates the efficacy of this approach on a healthy population and provides new insight on potential limitations of conventional musculoskeletal models for this application. Methods Subject-specific neuromuscular characteristics of the biceps and triceps brachii were evaluated using robot-measured kinetics, kinematics and EMG activity as inputs to a musculoskeletal model. Results Repeatability experiments in five participants revealed large variability within each subjects evaluated characteristics, with almost all experiencing variation greater than 50% of full scale when repeating the same task. Conclusion The use of robotics and HD-sEMG, in conjunction with musculoskeletal modeling, to quantify neuromuscular characteristics has been explored. Despite the ability to predict joint kinematics with relatively high accuracy, parameter characterization was inconsistent i.e. many parameter combinations gave rise to minimal kinematic error. Significance: The proposed technique is a novel approach for in vivo neuromuscular characterization and is a step towards the realization of objective in-home robot-assisted rehabilitation. Importantly, the results have confirmed the technical (robot and HD-sEMG) feasibility while highlighting the need to develop new musculoskeletal models and optimization techniques capable of achieving consistent results across a range of dynamic tasks.

Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program. Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed. Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject’s upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.