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Bimanual Elbow Robotic Orthoses: Preliminary Investigations on an Impairment Force-Feedback Rehabilitation Method

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Bimanual Elbow Robotic Orthoses: Preliminary Investigations on an Impairment Force-Feedback Rehabilitation Method

Gil Herrnstadt et al. Front Hum Neurosci.

Abstract

Modern rehabilitation practices have begun integrating robots, recognizing their significant role in recovery. New and alternative stroke rehabilitation treatments are essential to enhance efficacy and mitigate associated health costs. Today's robotic interventions can play a significant role in advancing rehabilitation. In addition, robots have an inherent ability to perform tasks accurately and reliably and are typically well suited to measure and quantify performance. Most rehabilitation strategies predominantly target activation of the paretic arm. However, bimanual upper-limb rehabilitation research suggests potential in enhancing functional recovery. Moreover, studies suggest that limb coordination and synchronization can improve treatment efficacy. In this preliminary study, we aimed to investigate and validate our user-driven bimanual system in a reduced intensity rehab practice. A bimanual wearable robotic device (BWRD) with a Master-Slave configuration for the elbow joint was developed to carry out the investigation. The BWRD incorporates position and force sensors for which respective control loops are implemented, and offers varying modes of operation ranging from passive to active training. The proposed system enables the perception of the movements, as well as the forces applied by the hemiparetic arm, with the non-hemiparetic arm. Eight participants with chronic unilateral stroke were recruited to participate in a total of three 1-h sessions per participant, delivered in a week. Participants underwent pre- and post-training functional assessments along with proprioceptive measures. The post-assessment was performed at the end of the last training session. The protocol was designed to engage the user in an assortment of static and dynamic arm matching and opposing tasks. The training incorporates force-feedback movements, force-feedback positioning, and force matching tasks with same and opposite direction movements. We are able to suggest identification of impairment patterns in the position-force plot results. In addition, we performed a proprioception evaluation with the system. We set out to design innovative and user immersive training tasks that utilize the BWRD capabilities, and we demonstrate that the subjects were able to cooperate and accomplish the protocol. We found that the Fugl-Meyer and Wolf Motor Function Test (pre to post) measured improvements (15 and 19%, respectively). Recognizing the brevity of the training, we focus our report primarily on the proprioception testing (32% significant improvement, p prop = 0.033) and protocol distinctive features and results. This paper presents the electromechanical features and performance of the BWRD, the testing protocol, and the assessments utilized. Outcome measures and results are presented and demonstrate the successful application and operation of the system.

Keywords: bimanual; cerebrovascular accident; exoskeleton; hemiparesis; neurorehabilitation; rehabilitation robot; stroke; upper limb.

Figures

Figure 1
Figure 1
BWRD system in use, and devices top view.
Figure 2
Figure 2
Master device view of the electromechanical components and structural assembly.
Figure 3
Figure 3
Slave device view of the electromechanical components and structural assembly.
Figure 4
Figure 4
(A) BWRD system connectivity. (B) The PC–FC is a parallel position and force controller used in tasks #1 through #3 and #5. (C) The PEFC, used in task #4, generates a resistance force on the Master orthosis based on the position error between the Master and the Slave arms. (D) The FPVC, used in task #6, generates a movement of the Slave device with a velocity proportional to the forces applied against the Master and/or Slave devices.
Figure 5
Figure 5
Tasks #1, 2, and 3 intended performance is shown in (A–C), respectively. Deficient performance of tasks #1 through #3 is shown in (D–F), respectively. In task #1 (A), the paretic arm is intended to be relaxed, in task #2 (B), the paretic arm is intended to be active in the same direction with the intact arm motion, and in task #3 (C), the paretic arm is intended to be active but opposing the motion of the intact arm.
Figure 6
Figure 6
Task #4. In line (A), angular error and torque are jointly reducing. In line (B), no angular error results in zero torque. In line (C), angular error is increased triggering an increase in torque. In line (D), the subject has reached his target estimate.
Figure 7
Figure 7
Task #5. In gaps (A) and (C), the subject is successfully applying equal forces with both arms resulting in a low resistance (duty cycle) and a parallel movement. In gap (B), the forces between the arms diverge resulting in higher resistance and reduced motion.
Figure 8
Figure 8
Task #6. Subfigures (A,B) refer to a 2 and 4 lb cases, respectively. A Master force drift can be observed in (B).
Figure 9
Figure 9
Robot proprioception change for all participants. Horizontal lines indicate mean and ±1 SD.
Figure 10
Figure 10
Participants’ proprioception test mean daily errors per assessment angle.
Figure 11
Figure 11
Participants’ proprioception test directional errors per angle pre- (day 1) and post- (day 3) training.

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