作者要感谢主席汉斯Oppel和他的假肢奥托博克保健品有限公司的技术人员制造在这项研究中所用的参与者插座。这项研究是由财务欧洲研究委员会（ERC）通过ERC高级资助DEMOVE（267888号），奥地利议会研究和技术开发，和奥地利联邦科学，研究和经济支持。

这项研究进行了按照赫尔辛基宣言，作为经当地研究伦理委员会。该研究在全面详细解释，以参与者启动前，让参与者权衡决定自愿参加研究，证实了他的参与知情，同意书的时间。 注:一个人，年龄27年来，在研究中的一部分。参与者有正常视力，被左低于肘部截肢者，并且是一位经验丰富的用户（4年共假体的使用）。在此之前开始这项研究，他用每天的假体是一个4通道肌电假手与转动手腕，每天12-15小时为15个月。参与者的右手此前被重建手术，但没有其他物理或神经系统受损。 1.研究设计<ol><li>拆分研究了两会:NA39;已经使用，并使用下面的系统培训。 注:这是为了让前，后分别训练检体内的比较。 </li><li>确保这两个会话是至少三个月分开，以便被视为彼此独立。 </li><li>在这两届会议的开始，适合定制的插座和假体的参与者。确保假肢的硬件和控制算法匹配在这个协议中的材料部分详述。确保参与者不能够使用定制的假体在会话之间的间隔时间。 </li><li>根据训练中的朴素会议和本协议的结构化培训会议部分所述的步骤病人。在每届会议开始时，校准假肢的硬件。使用收集的校准数据进行实时控制假肢。 </li><li>一旦朴素会议及结构性培训课程完成后，评估PArticipant的表现用南安普敦手评估程序（SHAP）的测量结果。23用比较参与者的标准假体（无论是培训课程之前获得）的SHAP分数的基准指标。 </li></ol> 2.材料<ol><li>适合用定制插座的参与者。根据制造商的说明将市面上购买假体。装备假手与原型组件，使促动腕关节屈曲，后伸和旋转。这使得参与者，以控制手3.5自由度（自由度）（ 表1）。 注意:在这个实验中一个米开朗基罗手（见材料清单）中的使用。能够转动手腕，屈伸其它终端装置，连同标准握功能也将是适当的。 </li><li>使用八个等距周围放置树桩原始信号电极记录EMG信号，和一个板上解码系统在1000赫兹的采样速率和数字化的10位深度。根据供应商的规格电极本身内执行的初始滤波和放大。使用个人计算机（PC）来进行主处理，它与采集硬件通信，并控制通过无线连接的假体。 注:在本研究中的表面肌电信号电极和车载使用的解码系统（AxonBus）来自奥托博克。类似设备的其他制造商也将是适当的。无线连接是通过蓝牙，同样其他方式可以适用。 </li></ol> 3.控制算法<ol><li>使用的控制算法，提供了在多个自由度的同时和比例控制假肢21在本研究中使用的算法是一个两阶段的决策模式，使得依赖于上下文的运动估计是可能的。 </li><li>经系统培训，其中包含了所有的控制单自由度的运动，记录来电肌电图（EMG）。 </li><li>在第一阶段中，评估基于从训练数据中的马哈拉诺比斯距离的新计算出的肌电特征向量的预期运动的固有维信息。作出决定用户的意图是否是执行罚款1自由度或粗糙的同时2自由度的运动。 注:一个特征向量 x类的马氏距离我带班的意思是我和协方差矩阵Σi的计算公式为载体μ: <img alt="式（1）" src="/files/ftp_upload/52968/52968eq1.jpg" /> 如在Amsuess 等人所描述的，新计算出的特征向量被映射到高维空间和马哈拉诺比斯距离的变换点的任何经训练类点被取为量度新颖性。21所述的经验确定的阈值，以该距离给出了新颖性（2自由度，否则为1自由度）的决定。 </li><li>在第二阶段，基于前决定，使用两个平行的估计1 - 1处理顺序的动作（序列-E）和其它处理同时运动（SIM-E） - 提供假体的控制信号。 注意:SEQ-E是在本质比例估计（即，肌肉收缩的强度），基于共同的空间模式（CSP）21，而SIM-E是一个线性回归，其同时操纵2自由度的手腕。 </li></ol> 4.软件框架注意:在此研究中允许假肢硬件和嵌入式控制算法之间的通信的处理中所使用的软件框架。它还提供了所需的最大化学员培训在视觉上支持性的培训工具。 <ol><li>显示均方根电子的平方（RMS）MG信号从8等距地置于电极的肌电振幅的极坐标图作为电极位置的功能的形式收集。这种视觉反馈可轻松监控肌电图在前臂的横向平面的空间分布。使用这样的设置中，每个用户的运动的可由此引起明显的图案 22中的极坐标图，然后可以被保存并用于训练为特定手势的重复性。 注:该框架允许的肌电图数据集合中的标准模式识别方法23对于每个肌电图通道的RMS超过40毫秒的计算方法。 <img alt="公式（2）" src="/files/ftp_upload/52968/52968eq2.jpg" /> 导致观测每个合奏窗口。 </li><li>对于初始校准收集的最大的长期随意收缩（MLVC）每个值拟提出的动议。通过示威的手进行提示参与者同时也让声音和视觉指示，持续5秒所需的运动。 </li><li>校准后，目前的参与者与一组梯形线索。这些力配置文件包含高原定在30％，60％和90％的校准的最大的。 </li><li>在每次试验中，指导参与者通过调节提示运动（ 图1）的力量水平，督导红色指针沿着线索。指针的垂直位置对应于在所有八个通道的求和的RMS值。与高原区间对应的中间3秒设定审判的持续时间5秒。 </li></ol> 5.朴素会议注:在天真的训练结束后，参与者曾在这项研究中所用的假体控制方案中没有现成的经验。 <ol><li>不给参加者的任何正式临床训练，但仅指示该残肢，其中一个是静止状态的8动作，将允许在计算机屏幕上的视觉目标的控制。这些任务类似于在经典模式识别用于接近假体控制23，以及用于这些方法在本研究参与者有大约60小时的以往的经验。 </li><li>在屏幕上显示所要求的运动的文本和静态图象而言以下的视觉提示（图1），同时。 </li><li>显示参与者他的肌电图的激活模式，其对应于八种特定和独特极坐标图（ 图2）。 </li><li>使用可听指令，鼓励参与者遵循视觉线索。如果用在结构化的培训课程，这些可听指令必须相同。 </li><li>重复任务的三次不同的手臂部位（放松，达到在前面，到达对面），以增强系统的培训。请记住，有8种不同的动作和三个力水平，一旦所有的手臂位置都包括在内，系统训练输入总计为72个体样本的总和。 </li><li>一旦完成，让参与者有机会练习之前完成SHAP结局评估的实时控制。 </li><li>确保参与者不具有访问定制的假体和控制算法超出天真会议结束。 </li></ol> 6.结构化培训课程<ol><li>天真会议三个月后，进行系统的培训会议。 </li><li>结构在下面的顺序步骤（图3）的会话: <ol><li>对于模仿，指导参与者直接模仿所需的8行动的示威者在实时进行（ 表1）。 3秒执行每个动作。 </li><li>对于重复，要求与会者重申，一直被模仿10次的动作，所以30秒执行每个动作。 </li><li>为了增强与计算机SYS统的培训，要求参加者到现在用电脑的视觉反馈搞，这是完全一样的设置为天真的会话。确保在这两个部分之间没有区别。 </li><li>对于假体的控制，要求参与者在完成成果的评估之前练习定制假体的实时控制。 </li></ol></li><li>在模仿，座位的参加者从示威者45°角，并与示威者的手参与者患侧匹配过程中的所有操作（ 图4）充分和一览无遗提供。从计算机屏幕没有视觉线索应提供给参与者在这个时候。 </li><li>用于重复，在与会者的动作，具有示范观察对应EMG活动如由极座标图的每个运动（图4）表示。一旦验证机已确定该participant也会产生独特的和可重复的肌电激活模式的每一个动作，要求参与者重复30秒的动作没有任何视觉线索。 注:总共有8个独特的行动 - 他们中的七个（腕旋前/旋后，腕屈/伸，手开，重点抓地力和细捏），需要肌肉活化，和第八是没有行动代表一个稳定宽松的状态。 </li><li>经过加固和计算机系统的训练，目前的参与者与视觉的他的八个动作反馈，正是因为主要出现在天真会议上，对应于八个不同的和具体的极坐标图在计算机屏幕上（ 图3）。为了优化性能，要求参与者在观看与录制的动态覆盖实时极坐标图来加强学习，一般2-4尝试每个动作之间执行的操作。一旦有信心，参与者就可以完成那名PERF完全相同的任务<html> ormed在天真会议。 </li></ol> 7.人工控制<ol><li>使用从每个会话的训练数据集来校准和调整假体的实时控制。 </li><li>最初，只有允许参与者通过顺序比例控制， 即，一运动的时间，与设备成比例肌肉收缩的水平的速度，以控制假肢。 </li><li>一旦每个八个操作以可重复和可靠的方式执行的，切换控制方案，以比例和同时控制，允许在一时间手腕的一个以上的运动。 </li><li>有参与者实践简单的任务，如拾取瓶子并铺设在其一侧（2次尝试就足够了）。允许一段时间的休息进行成果评估前。在这项研究中，2小时的休息天真的会议，和24小时的休息结构化会议的情况。 </li></ol>书名"&gt; 8。结果测<ol><li>评估不仅是使用SHAP，它监视手和上肢功能密切相关的日常生活（一项ADLs）活动的天真和结构化的培训课程全球上肢功能。在SHAP执行的任务包括操纵轻和重的物体，以及ADL的任务，如切削的对象，用小刀或撤消按钮。该SHAP已被证实为病理和假肢手部功能评估。24 注:此测量被选为这项研究的参与者已经定期随访，用他的临床团队这一结果的措施。 </li></ol>

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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Adaptive+representation+of+dynamics+during+learning+of+a+motor+task.">Adaptive representation of dynamics during learning of a motor task.</a> The Journal of Neuroscience the Official Journal of the Society for Neuroscience. 14 (5 Pt 2), (1994).</li><li>Hogervorst, T., Brand, R. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanoreceptors+in+joint+function.">Mechanoreceptors in joint function.</a> The Journal of Bone and Joint Surgery. American Volume. 80 (9), 1365-1378 (1998).</li><li>Bosco, G., Poppele, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proprioception+from+a+spinocerebellar+perspective.">Proprioception from a spinocerebellar perspective.</a> Physiological Reviews. 81 (2), 539-568 (2001).</li><li>Iacoboni, M., Molnar-Szakacs, I., Gallese, V., Buccino, G., Mazziotta, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grasping+the+intentions+of+others+with+one&#8217;s+own+mirror+neuron+system.">Grasping the intentions of others with one&#8217;s own mirror neuron system.</a> PLoS Biology. 3 (3), 0529-0535 (2005).</li><li>Williams, J. H. G., Whiten, A., Waiter, G. D., Pechey, S., Perrett, D. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+and+subcortical+mechanisms+at+the+core+of+imitation.">Cortical and subcortical mechanisms at the core of imitation.</a> Social Neuroscience. 2 (1), 66-78 (2007).</li><li>Allison, T., Puce, A., McCarthy, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Social+perception+from+visual+cues:+Role+of+the+STS+region.">Social perception from visual cues: Role of the STS region.</a> Trends in Cognitive Sciences. 4 (7), 267-278 (2000).</li><li>Thompson, J. C., Hardee, J. E., Panayiotou, A., Crewther, D., Puce, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Common+and+distinct+brain+activation+to+viewing+dynamic+sequences+of+face+and+hand+movements.">Common and distinct brain activation to viewing dynamic sequences of face and hand movements.</a> NeuroImage. 37 (3), 966-973 (2007).</li><li>Binkofski, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+fronto-parietal+circuit+for+object+manipulation+in+man:+Evidence+from+an+fMRI-study.">A fronto-parietal circuit for object manipulation in man: Evidence from an fMRI-study.</a> European Journal of Neuroscience. 11 (9), 3276-3286 (1999).</li><li>Iacoboni, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cortical+Mechanisms+of+Human+Imitation.">Cortical Mechanisms of Human Imitation.</a> Science. 286 (5449), 2526-2528 (1999).</li></ol>

作者宣称没有竞争的经济利益。

我们的研究结果表明了参与这一研究，系统的训练帮助一个单独的会话中改进的多功能假手控制。此处所用的结构化的方案是仿，重复和手部动作的加强件的组合，参与者无法完成与他的传统假手。 虽然参与者的得分更高，他的传统假体在SHAP测试，值得一提的是，他通常穿的设备每天12至15小时之间历时15个月。记录在案的基线SHAP得分，很显然，他已经学会并经过一个很长的...

在截肢者更换手功能是一个艰巨的任务。协调高度熟练的手部动作是不是一种与生俱来的能力，并采取人多年的学习开发的1-5手的创伤性丧失之后，复制这种能力通过人工手段不是一个简单的任务，可能需要一段持续的学习。 假肢的设计和对它们的控制接口的方法都受到快速的技术革新，随着多功能控制以自然的方式的目的。6的这些控制系统的复杂性增加了基本上为截肢者提供更多的功能。为了确保这些系统的精确控制，并减少遗弃的新技术，充分的培训需要建立。这可能是比较成功的，如果它是基于截肢者固有的学习策略。 视力可以勒期间发挥重要作用arning手部动作。行为研究表明，通过观察他人7的动作或使用视觉提示8，身强力壮的人学习，并协调新的动作。通过观察，理解和执行观察到行动的过程中，个人能够模仿他人的行为。具体皮质网络，其可包括一个反射镜-神经元系统（MNS），被认为是背后这种能力，并且可以具有在控制假肢的作用。9-11 仿的作用可能不只是被实际上限制为执行该已看到的动作，但连同MNS，允许尚未被观察到，但由观察者的马达repetoire外推运动的执行。12，模仿可能不一定是一种与生俱来的能力，但运动技能随着时间的推移accruement导致有经验的和复杂的行动。13届观察行动，在只是简单想象他们的rength，已被证明是提高学习新的任务。14因此，模仿可能是一个务实的态度来训练截肢者，有证据表明它的目标指向15的方法，用在康复设定目标对实现有用的假手功能。 康复研究已分别显示视觉线索，如一个假手虚拟模拟中，鼓励被截肢者在康复训练。16此外，当使用时在被锁定的范例进行重复已被证明使上肢假体的快速学习控制。17虽然虚拟模拟已经被证明是同样有效的假肢手使体健，体用户控制肌电设备实时控制，使用标准化成果的措施截肢者18它们的作用尚不明确。最后，如​​果上肢AMPU协议塔季翁培训存在的，仿的假体控制学习中的作用没有明确讨论。19,20 本研究旨在理解，如果使用仿制的，在重复和强化相结合，对多功能假肢控制的学习产生积极的影响作为一个系统的培训计划的一部分。 这里介绍的是谁被训练使用的多功能假手一经桡动脉截肢的病例报告。参与者此前曾习惯于传统经营肌电假肢。利用视觉线索，无论是在模仿一个健康的示威者，并为简单的计算机视觉反馈的形式，截肢者提高很快处理了他的新设备。

<table><tbody><tr><td>Michelangelo Hand</td><td>Otto Bock Healthcare Products GmbH, A</td><td>8E500=L-M</td><td></td></tr><tr><td>AxonRotation</td><td>Otto Bock Healthcare Products GmbH, A</td><td>9S503</td><td></td></tr><tr><td>Wrist Flexor</td><td>Otto Bock Healthcare Products GmbH, A</td><td></td><td>prototype unit</td></tr><tr><td>AxonMaster</td><td>Otto Bock Healthcare Products GmbH, A</td><td>13E500</td><td></td></tr><tr><td>Electrode</td><td>Otto Bock Healthcare Products GmbH, A</td><td>13E200=50AC</td><td></td></tr><tr><td>ScissorFenceElectrodeCarrier</td><td>Otto Bock Healthcare Products GmbH, A</td><td></td><td>prototype unit</td></tr><tr><td>Acquisition Software</td><td>Otto Bock Healthcare Products GmbH, A</td><td></td><td>prototype unit</td></tr><tr><td>Carbon shaft</td><td>Otto Bock Healthcare Products GmbH, A</td><td></td><td>prototype unit</td></tr></tbody></table>

a structured rehabilitation protocol for improved multifunctional prosthetic control: a case study

在机器人系统的进步已导致在假肢可以制作多功能运动的上肢。然而，这些复杂的系统，需要上肢截肢者学习复杂的控制方案。人类必须学会通过模仿等学习策略的新的运动的能力。本协议描述的结构化的康复方法，其中包括模仿，重复和强化学习，其目的在于评估，如果这种方法可以提高多功能假肢控制。阿左肘关节以下被截肢，用4年的假体的使用体验，在这种情况下，研究的一部分。所使用的假体是米开朗基罗手转动手腕，及腕屈伸的附加功能，这让手部动作的更多的组合。来自58个参与者的南安普敦手工评估程序得分提高到71以下的系统培训。这表明，IMIT的结构化培训协议通货膨胀，重复和强化可能在学习控制新假手的作用。然而，一个更大的临床研究需要支持这些发现。

经临床人员8人个月前开始测试时，测得他每天假肢参与者的基线SHAP表现为81。 100一SHAP分数代表身强力壮的手部功能。24与会者的天真会拥有较先进的假肢控制系统中打进了58的整体SHAP得分。然而，3个月后，用与新系统没有进一步交互，除了从结构化训练，参与者达到71 SHAP得分用相同的先进系统 ​​（ 表2）。 当整体SHAP比分被细分为功能配置文件评估?...

Watch this Scientific Journal Video about A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study at JoVE.com

A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

As prosthetic development moves towards the goal of natural control, harnessing amputees&#8217; inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.

结构化的康复协议改进的多功能假肢控制:一个案例研究

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated ...

a-structured-rehabilitation-protocol-for-improved-multifunctional

Research

JoVE Journal

Behavior

9.4K 次观看.  Christian Doppler Laboratory for Restoration of Extremity Function. As prosthetic development moves towards the goal of natural control, harnessing amputees’ inherent ability to learn new motor skills may enable proficiency. This manuscript describes a structured rehabilitation protocol, which includes imitation, repetition, and reinforcement learning strategies, for improved multifunctional prosthetic control.

视频: A Structured Rehabilitation Protocol for Improved Multifunctional Prosthetic Control: A Case Study

Oscillation and Reaction Board Techniques for Estimating Inertial Properties of a Below-knee Prosthesis

The purpose of this study was two-fold: 1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee prosthesis, and 2) contrast the effects of the proposed technique and that of using intact limb inertial properties on joint kinetic estimates during walking in unilateral, transtibial amputees. An oscillation and reaction board system was validated and shown to be reliable when measuring inertial properties of known geometrical solids. When direct measurements of inertial properties of the prosthesis were used in inverse dynamics modeling of the lower extremity compared with inertial estimates based on an intact shank and foot, joint kinetics at the hip and knee were significantly lower during the swing phase of walking. Differences in joint kinetics during stance, however, were smaller than those observed during swing. Therefore, researchers focusing on the swing phase of walking should consider the impact of prosthesis inertia property estimates on study outcomes. For stance, either one of the two inertial models investigated in our study would likely lead to similar outcomes with an inverse dynamics assessment.

Body segmental inertial properties are required for inverse dynamics modeling. Using an oscillation and reaction board technique, inertial properties of below-knee prostheses were measured. Using direct measures of prosthesis inertia in the inverse dynamics model of the prosthetic leg resulted in lower magnitudes of resultant joint forces and moments.

对于膝下义肢的估算惯性振荡性质与反应板技术

The purpose of this study was two-fold: 1) demonstrate a technique that can be used to directly estimate the inertial properties of a below-knee ...

科研

生物工程

Engineering Platform and Experimental Protocol for Design and Evaluation of a Neurally-controlled Powered Transfemoral Prosthesis

To enable intuitive operation of powered artificial legs, an interface between user and prosthesis that can recognize the user's movement intent is desired. A novel neural-machine interface (NMI) based on neuromuscular-mechanical fusion developed in our previous study has demonstrated a great potential to accurately identify the intended movement of transfemoral amputees. However, this interface has not yet been integrated with a powered prosthetic leg for true neural control. This study aimed to report (1) a flexible platform to implement and optimize neural control of powered lower limb prosthesis and (2) an experimental setup and protocol to evaluate neural prosthesis control on patients with lower limb amputations. First a platform based on a PC and a visual programming environment were developed to implement the prosthesis control algorithms, including NMI training algorithm, NMI online testing algorithm, and intrinsic control algorithm. To demonstrate the function of this platform, in this study the NMI based on neuromuscular-mechanical fusion was hierarchically integrated with intrinsic control of a prototypical transfemoral prosthesis. One patient with a unilateral transfemoral amputation was recruited to evaluate our implemented neural controller when performing activities, such as standing, level-ground walking, ramp ascent, and ramp descent continuously in the laboratory. A novel experimental setup and protocol were developed in order to test the new prosthesis control safely and efficiently. The presented proof-of-concept platform and experimental setup and protocol could aid the future development and application of neurally-controlled powered artificial legs.

Neural-machine interfaces (NMI) have been developed to identify the user's locomotion mode. These NMIs are potentially useful for neural control of powered artificial legs, but have not been fully demonstrated. This paper presented (1) our designed engineering platform for easy implementation and development of neural control for powered lower limb prostheses and (2) an experimental setup and protocol in a laboratory environment to evaluate neurally-controlled artificial legs on patients with lower limb amputations safely and efficiently.

工程平台和设计一个Neurally控制供电采用经假体与评价实验方案

To enable intuitive operation of powered artificial legs, an interface between user and prosthesis that can recognize the user's movement intent is ...

A Human-machine-interface Integrating Low-cost Sensors with a Neuromuscular Electrical Stimulation System for Post-stroke Balance Rehabilitation

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to reorganize its structure, function and connections as a response to intrinsic or extrinsic stimuli is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with non-invasive electrotherapy, such as neuromuscular electrical stimulation (NMES) and sensory electrical stimulation (SES). NMES involves coordinated electrical stimulation of motor nerves and muscles to activate them with continuous short pulses of electrical current while SES involves stimulation of sensory nerves with electrical current resulting in sensations that vary from barely perceivable to highly unpleasant. Here, active cortical participation in rehabilitation procedures may be facilitated by driving the non-invasive electrotherapy with biosignals (electromyogram (EMG), electroencephalogram (EEG), electrooculogram (EOG)) that represent simultaneous active perception and volitional effort. To achieve this in a resource-poor setting, e.g., in low- and middle-income countries, we present a low-cost human-machine-interface (HMI) by leveraging recent advances in off-the-shelf video game sensor technology. In this paper, we discuss the open-source software interface that integrates low-cost off-the-shelf sensors for visual-auditory biofeedback with non-invasive electrotherapy to assist postural control during balance rehabilitation. We demonstrate the proof-of-concept on healthy volunteers.

A novel low-cost human-machine interface for interactive post-stroke balance rehabilitation system is presented in this article. The system integrates off-the-shelf low-cost sensors towards volitionally driven electrotherapy paradigm. The proof-of-concept software interface is demonstrated on healthy volunteers.

人机界面集成的低成本传感器，具有神经肌肉电刺激系统中风后康复平衡

A stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow to brain thereby preventing ...

神经科学

通过增强抓握和手指恢复来彻底改变中风康复

A Flexible Wearable Supernumerary Robotic Limb for Chronic Stroke Patients

In this study, we present a flexible wearable supernumerary robotic limb that helps chronic stroke patients with finger rehabilitation and grasping movements. The design of this innovative limb draws inspiration from bending pneumatic muscles and the unique characteristics of an elephant's trunk tip. It places a strong emphasis on crucial factors such as lightweight construction, safety, compliance, waterproofing, and achieving a high output-to-weight/pressure ratio. The proposed structure enables the robotic limb to perform both envelope and fingertip grasping. Human-robot interaction is facilitated through a flexible bending sensor, detecting the wearer's finger movements and connecting them to motion control via a threshold segmentation method. Additionally, the system is portable for versatile daily use. To validate the effectiveness of this innovation, real-world experiments involving six chronic stroke patients and three healthy volunteers were conducted. The feedback received through questionnaires indicates that the designed mechanism holds immense promise in assisting chronic stroke patients with their daily grasping activities, potentially improving their quality of life and rehabilitation outcomes.

作者聚焦：使用灵活的机器人肢体增强偏瘫患者的抓握能力 

This protocol introduces a flexible wearable supernumerary robotic limb tailored to assist in finger rehabilitation for stroke patients. The design incorporates a bending sensor to facilitate seamless human-robot interaction. Validation through experiments involving both healthy volunteers and stroke patients underscores the efficacy and dependability of the proposed study.

一种用于慢性脑卒中患者的柔性可穿戴编外机器人肢体

In this study, we present a flexible wearable supernumerary robotic limb that helps chronic stroke patients with finger rehabilitation and grasping ...

工程学

Surface Electromyographic Biofeedback as a Rehabilitation Tool for Patients with Global Brachial Plexus Injury Receiving Bionic Reconstruction

In patients with global brachial plexus injury and lack of biological treatment alternatives, bionic reconstruction, including the elective amputation of the functionless hand and its replacement with a prosthesis, has recently been described. Optimal prosthetic function depends on a structured rehabilitation protocol, as residual muscle activity in a patient&#8217;s arm is later translated into prosthetic function. Surface electromyographic (sEMG) biofeedback has been used during rehabilitation after stroke, but has so far not been used in patients with complex peripheral nerve injuries. Here, we present our rehabilitation protocol implemented in patients with global brachial plexus injuries suitable for bionic reconstruction, starting from identification of sEMG signals to final prosthetic training. This structured rehabilitation program facilitates motor relearning, which may be a cognitively debilitating process after complex nerve root avulsion injuries, aberrant re-innervation and extra-anatomical reconstruction (as is the case with nerve transfer surgery). The rehabilitation protocol using sEMG biofeedback aids in the establishment of new motor patterns as patients are being made aware of the advancing re-innervation process of target muscles. Additionally, faint signals may also be trained and improved using sEMG biofeedback, rendering a clinically &#34;useless&#34;&#160;muscle (exhibiting muscle strength M1 on the British Medical Research Council [BMRC] scale) eligible for dexterous prosthetic hand control. Furthermore, functional outcome scores after successful bionic reconstruction are presented in this article.

Optimal functional outcomes after bionic reconstruction in patients with global brachial plexus injury depend on a structured rehabilitation protocol. Surface electromyographic guided training may improve the amplitude, separation and consistency of EMG signals, which - after elective amputation of a functionless hand - control and drive a prosthetic hand.

表面肌电图生物反馈作为全球胸腺丛损伤患者接受仿生重建的康复工具

In patients with global brachial plexus injury and lack of biological treatment alternatives, bionic reconstruction, including the elective amputation of ...

Development of a Novel Task-oriented Rehabilitation Program using a Bimanual Exoskeleton Robotic Hand

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton&#160;hand that is fitted to the subject&#8217;s affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.

This study reports the development of a novel robot-assisted task-oriented program for hand rehabilitation. The developmental process consists of experiments using both healthy subjects and subjects who have had a stroke and suffered from subsequent motor control dysfunction.

使用双骨外骨骼机器人手开发面向任务的新康复计划

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor ...

医学

Therapy Interventions for Upper Limb Amputees Undergoing Selective Nerve Transfers

Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective activation of muscle units is made possible by surgically re-routing nerves, yielding a high number of independent myoelectric control signals. However, this intervention requires careful patient selection and specific rehabilitation therapy. Here a rehabilitation protocol is presented for high-level upper limb amputees undergoing TMR, based on an expert Delphi study. Interventions before surgery include detailed patient assessment and general measures for pain control, muscle endurance and strength, balance, and range of motion of the remaining joints. After surgery, additional therapeutic interventions focus on edema control and scar treatment and the selective activation of cortical areas responsible for upper limb control. Following successful&#160;reinnervation of target muscles, surface electromyographic (sEMG) biofeedback is used to train the activation of the novel muscular units. Later on, a table-top prosthesis may provide the first experience of prosthetic control. After fitting the actual prosthesis, training includes repetitive drills without objects, object manipulation, and finally, activities of daily living. Ultimately, regular patient appointments and functional assessments allow tracking prosthetic function and enabling early interventions if malfunctioning.

This work presents a protocol to enhance prosthetic function after selective nerve transfer surgery. Rehabilitation interventions include patient information and selection, support of wound healing, cortical re-activation of sensory-motor areas of the upper limb, training of selective muscle activation, prosthetic handling in daily life, and regular follow-up assessments.

接受选择性神经转移的上肢截肢者的治疗干预

Targeted Muscle Reinnervation (TMR) improves the biological control interface for myoelectric prostheses after above-elbow amputation. Selective ...

Use of a Foot-Induced Digitally Controlled Resistance Device for Functional Magnetic Resonance Imaging Evaluation in Patients with Foot Paresis

Neurological deficits from a stroke can result in long-term motor disabilities, including those that affect walking gait. However, extensive rehabilitation following stroke is typically time limited. Establishing predictive biomarkers to identify patients who may meaningfully benefit from additional physical therapy and demonstrate improvement is important to improve the patients&#39; quality of life. Detection of neuroplastic remodeling of the affected region and changes in the activity patterns excited while performing suitable motor tasks could have valuable implications for chronic stroke recovery. This protocol describes the use of a digitally controlled, magnetic resonance-compatible foot-induced robotic device (MR_COFID) to present a personalized foot-motor task involving trajectory following to stroke-affected subjects with gait impairment during functional magnetic resonance imaging (fMRI). In the task, foot flexion is performed against bi-directional resistive forces, which are tuned to the subject&#39;s strength in both the dorsiflexion and plantar flexion directions, while following a visual metronome. fMRI non-invasively uses endogenous deoxyhemoglobin as a contrast agent to detect blood oxygenation level-dependent (BOLD) changes between the active and resting periods during testing. Repeated periodic testing can detect therapy-related changes in excitation patterns during task performance. The use of this technique provides data to identify and measure biomarkers that may indicate the likelihood of an individual benefitting from rehabilitation beyond that which is currently provided to stroke patients.

Chronic stroke patients' insured rehabilitation is generally time limited. Imaging-based study of brain activity from walking-related motor tasks can lead to establishing biomarkers to measure improved outcomes and justify extending tailored therapy. A novel, magnetic resonance-compatible, variable-resistance foot motion device and a protocol for use during functional magnetic resonance imaging are presented.

结构化的康复协议改进的多功能假肢控制:一个案例研究

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Use of a Foot-Induced Digitally Controlled Resistance Device for Functional Magnetic Resonance Imaging Evaluation in Patients with Foot Paresis