Name: robotic mirror therapy system for functional recovery of hemiplegic arms
Uploaded: 2016-08-15T15:00:00
Description: Watch this Scientific Journal Video about Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms at JoVE.com

This work was supported by the Brain Fusion Program of Seoul National University (800-20120444) and the Interdisciplinary Research Initiatives Program from College of Engineering and College of Medicine, Seoul National University (800-20150090).

&#160;All of the procedures were reviewed and approved by the Institutional Review Board of Seoul National University Hospital.
1. Mirror Therapy Tasks
<ol>
	<li>Examples of 2-dimensional mirror therapy tasks (Figure 3)
	<ol>
		<li>Freely move the healthy arm while looking in the mirror about 5 min for warm-up exercise. 
		NOTE: One may utilize a metronome so that the patient can exercise the motion of the healthy arm in a rhythmic manner.</li>
		<li>On healthy side, dribble and place a sma...

<ol>
	<li>Hamzei, 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=Functional+plasticity+induced+by+mirror+training:+the+mirror+as+the+element+connecting+both+hands+to+one+hemisphere.">Functional plasticity induced by mirror training: the mirror as the element connecting both hands to one hemisphere.</a> Neurorehabil Neural Repair. 26 (5), 484-496 (2012).</li><li>Thieme, H., Mehrholz, J., Pohl, M., Behrens, J., Dohle, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mirror+therapy+for+improving+motor+function+after+stroke.">Mirror therapy for improving motor function after stroke.</a> Cochrane Database Syst Rev. 3, CD008449 (2012).</li><li>Dohle, C., 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=Mirror+therapy+promotes+recovery+from+severe+hemiparesis:+a+randomized+controlled+trial.">Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial.</a> Neurorehabil Neural Repair. 23 (3), 209-217 (2009).</li><li>Pervane Vural, S., Nakipoglu Yuzer, G. F., Sezgin Ozcan, D., Demir Ozbudak, S., Ozgirgin, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Mirror+Therapy+in+Stroke+Patients+With+Complex+Regional+Pain+Syndrome+Type+1:+A+Randomized+Controlled+Study.">Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study.</a> Arch Phys Med Rehabil. 97 (4), 575-581 (2016).</li><li>De Santis, D., 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=Robot-assisted+training+of+the+kinesthetic+sense:+enhancing+proprioception+after+stroke.">Robot-assisted training of the kinesthetic sense: enhancing proprioception after stroke.</a> Front Hum Neurosci. 8, 1037 (2015).</li><li>Smorenburg, A. R., Ledebt, A., Deconinck, F. J., Savelsbergh, G. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practicing+a+matching+movement+with+a+mirror+in+individuals+with+spastic+hemiplegia.">Practicing a matching movement with a mirror in individuals with spastic hemiplegia.</a> Res Dev Disabil. 34 (9), 2507-2513 (2013).</li><li>Semrau, J. A., Herter, T. M., Scott, S. H., Dukelow, S. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robotic+identification+of+kinesthetic+deficits+after+stroke.">Robotic identification of kinesthetic deficits after stroke.</a> Stroke. 44 (12), 3414-3421 (2013).</li><li>Niku, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chapter+4,+Dynamic+Analysis+and+Forces.">Chapter 4, Dynamic Analysis and Forces.</a> Introduction to Robotics: Analysis, Systems, Applications. , (2001).</li><li>Sanford, J., Moreland, J., Swanson, L. R., Stratford, P. W., Gowland, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+the+Fugl-Meyer+assessment+for+testing+motor+performance+in+patients+following+stroke.">Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.</a> Phys Ther. 73 (7), 447-454 (1993).</li><li>Bohannon, R. W., Smith, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interrater+reliability+of+a+modified+Ashworth+scale+of+muscle+spasticity.">Interrater reliability of a modified Ashworth scale of muscle spasticity.</a> Phys Ther. 67 (2), 206-207 (1987).</li><li>Shah, S., Vanclay, F., Cooper, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Improving+the+sensitivity+of+the+Barthel+Index+for+stroke+rehabilitation.">Improving the sensitivity of the Barthel Index for stroke rehabilitation.</a> J Clin Epidemiol. 42 (8), 703-709 (1989).</li><li>Lo, A. C., 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=Robot-assisted+therapy+for+long-term+upper-limb+impairment+after+stroke.">Robot-assisted therapy for long-term upper-limb impairment after stroke.</a> N Engl J Med. 362 (19), 1772-1783 (2010).</li><li>Ho, N. S., 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=An+EMG-driven+exoskeleton+hand+robotic+training+device+on+chronic+stroke+subjects:+task+training+system+for+stroke+rehabilitation.">An EMG-driven exoskeleton hand robotic training device on chronic stroke subjects: task training system for stroke rehabilitation.</a> IEEE Int Conf Rehabil Robot. , 5975340 (2011).</li><li>Hesse, S., Schulte-Tigges, G., Konrad, M., Bardeleben, A., Werner, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+arm+trainer+for+the+passive+and+active+practice+of+bilateral+forearm+and+wrist+movements+in+hemiparetic+subjects.">Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects.</a> Arch Phys Med Rehabil. 84 (6), 915-920 (2003).</li><li>Lum, P. S., 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=MIME+robotic+device+for+upper-limb+neurorehabilitation+in+subacute+stroke+subjects:+A+follow-up+study.">MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study.</a> J Rehabil Res Dev. 43 (5), 631-642 (2006).</li><li>Yang, C. L., Lin, K. C., Chen, H. C., Wu, C. Y., Chen, C. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pilot+comparative+study+of+unilateral+and+bilateral+robot-assisted+training+on+upper-extremity+performance+in+patients+with+stroke.">Pilot comparative study of unilateral and bilateral robot-assisted training on upper-extremity performance in patients with stroke.</a> Am J Occup Ther. 66 (2), 198-206 (2012).</li><li>Nef, T., Mihelj, M., Riener, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ARMin:+a+robot+for+patient-cooperative+arm+therapy.">ARMin: a robot for patient-cooperative arm therapy.</a> Med Biol Eng Comput. 45 (9), 887-900 (2007).</li><li>Ozkul, F., Barkana, D. E., Demirbas, S. B., Inal, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+proprioceptive+sense+of+the+elbow+joint+with+RehabRoby.">Evaluation of proprioceptive sense of the elbow joint with RehabRoby.</a> IEEE Int Conf Rehabil Robot. , 5975466 (2011).</li><li>Pehlivan, A. U., Celik, O., O'Malley, M. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+design+of+a+distal+arm+exoskeleton+for+stroke+and+spinal+cord+injury+rehabilitation.">Mechanical design of a distal arm exoskeleton for stroke and spinal cord injury rehabilitation.</a> IEEE Int Conf Rehabil Robot. , 5975428 (2011).</li><li>Zhang, H., 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=Feasibility+studies+of+robot-assisted+stroke+rehabilitation+at+clinic+and+home+settings+using+RUPERT.">Feasibility studies of robot-assisted stroke rehabilitation at clinic and home settings using RUPERT.</a> IEEE Int Conf Rehabil Robot. , 5975440 (2011).</li></ol>

The primary purpose of this study was to develop a real-time mirror robot system for functional recovery of a hemiplegic arm using an automatic control algorithm. The effect of robot-assisted therapy on long-term recovery of upper-limb impairment after stroke was proven beneficial in previous studies12, and various kinds of arm robots have been introduced13-20. However, previous studies of upper extremity robots that realized bilateral arm movement applied mechanical connections without using a mirr...

For patients with stroke, dysfunction of a hemiplegic arm has debilitating effect. The ability to perform bimanual activities is essential for daily life, but functional deficit of a hemiplegic arm often remains even a few years after stroke onset. Among various training programs in the hospital, an exercise to increase the range of motion or passive repetition of simple tasks have little effect on functional recovery of a hemiplegic arm. For this reason, training of meaningful tasks related to activities of daily living (ADLs) has been applied to occupational therapy in hospitals.
The effects of mirror therapy were proven by previous studies in neurorehabilitation1-4. Mirror therapy is conducted by eliciting an illusion through use of a mirror as if the hemiplegic arm is moving in real-time while moving the healthy arm. It can facilitate brain neuroplasticity by activation of the sensorimotor cortex1. Thus, motor power and function of the hemiplegic arm can be improved. However, conventional mirror therapy has a critical limitation in that the hemiplegic arm is not actually moving.
Therefore, we developed a real-time 2-axis mirror robot system as a simple add-on module to conventional mirror therapy, using closed feedback mechanism. This may convey proprioceptive input to the sensory cortex, which is considered important in neuroplasticity and functional recovery of a hemiplegic arm (Figures 1 and 2)5-7.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>LabVIEW</td>
			<td>National Instruments</td>
			<td></td>
			<td>System design software</td>
		</tr>
		<tr>
			<td>24V power supply</td>
			<td>XP Power</td>
			<td>MHP1000PS24 24V</td>
			<td>Any 24V power supply should do</td>
		</tr>
		<tr>
			<td>AHRS sensor receiver</td>
			<td>E2box</td>
			<td>EBRF24GRCV</td>
			<td></td>
		</tr>
		<tr>
			<td>AHRS sensors</td>
			<td>E2box</td>
			<td>EBIMU-9DOFV2</td>
			<td>You will need total 3 sensors. Any AHRS sensors will do</td>
		</tr>
		<tr>
			<td>EC90 flat motor module</td>
			<td>Maxon</td>
			<td>323772 + 223094 + 453231</td>
			<td>Any geared motor with higher than 30Nm should do. (For our custom machined parts, you will need these particular flat motor and gear module, but the gear ratio and encoder may vary)&#160;</td>
		</tr>
		<tr>
			<td>EC45 flat motor module</td>
			<td>Maxon</td>
			<td>397172</td>
			<td>Any geared motor with higher than 10Nm should do (For our custom machined parts, you should use the same gear module but the gear ratio, motor, and encoder may vary)</td>
		</tr>
		<tr>
			<td>EPOS2 70/10 controller</td>
			<td>Maxon</td>
			<td>375711</td>
			<td>This can be replaced with EPOS 24/5 controller</td>
		</tr>
		<tr>
			<td>EPOS2 24/5 controller</td>
			<td>Maxon</td>
			<td>367676</td>
			<td></td>
		</tr>
		<tr>
			<td>Connector and cable set</td>
			<td>Maxon</td>
			<td>381405 + 384915 + 275934 + 354045</td>
			<td>You can also make these cables. Connectors and corresponding wire info can be found in &#34;300583-Hardware-Reference-En.pdf&#34; and &#34;300583-Cable-Starting-Set-En.pdf&#34;</td>
		</tr>
		<tr>
			<td>Coupling- Oldham, Set Screw Type</td>
			<td>Misumi</td>
			<td>MCORK30-10-12</td>
			<td>Type may vary</td>
		</tr>
		<tr>
			<td>Coupling- High Rigidity, Oldham, 
			Set Screw Type</td>
			<td>Misumi</td>
			<td>MCOGRK34-12-12</td>
			<td>Type may vary</td>
		</tr>
		<tr>
			<td>Shaft Collars</td>
			<td>Misumi</td>
			<td>SCWDM10-B &#160;</td>
			<td>You will need 4 sets</td>
		</tr>
		<tr>
			<td>Shaft Collars</td>
			<td>Misumi</td>
			<td>SDBJ10-8</td>
			<td>You will need 2 sets</td>
		</tr>
		<tr>
			<td>Precision Linear Shaft</td>
			<td>Misumi</td>
			<td>&#160;PSSFG10-200</td>
			<td>Any straight 10mm diameter shaft with at least 200mm length should do&#160;</td>
		</tr>
		<tr>
			<td>Bearings with housings</td>
			<td>Misumi</td>
			<td>BGRAB6801ZZ</td>
			<td></td>
		</tr>
		<tr>
			<td>Elbow motor force dispersion shaft&#160;</td>
			<td>custom machined</td>
			<td>3D CAD&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Lower elbow support</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Elbow rooftop frame</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Support wall</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td>You will need 2 frames.</td>
		</tr>
		<tr>
			<td>Elbow coupling hollow cylinder cover&#160;</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Wrist motor force dispersion shaft</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Wrist rooftop frame</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Upper wrist coupling hollow cylinder cover</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Lower wrist coupling hollow cylinder cover</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Joint movement limiter</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Handle</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Upper elbow support</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Friction reduction ring</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Acrylic mirror</td>
			<td>custom laser cutting</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Task table</td>
			<td>custom machined</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Silicone sponge</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>DOF limiter</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>DOF limiter lid</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Healthyarm handle</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Ball rollers - Press fit</td>
			<td>Misumi</td>
			<td>BCHA18</td>
			<td></td>
		</tr>
		<tr>
			<td>Goalpost</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Circle trace</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
		<tr>
			<td>Angled assist</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td>Optional</td>
		</tr>
		<tr>
			<td>Curved assist</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td>Optional</td>
		</tr>
		<tr>
			<td>Plain assist</td>
			<td>3D printed</td>
			<td>Part Drawings</td>
			<td>Optional</td>
		</tr>
		<tr>
			<td>Task board</td>
			<td>custom laser cutting</td>
			<td>Part Drawings</td>
			<td></td>
		</tr>
	</tbody>
</table>

robotic mirror therapy system for functional recovery of hemiplegic arms

Mirror therapy has been performed as effective occupational therapy in a clinical setting for functional recovery of a hemiplegic arm after stroke. It is conducted by eliciting an illusion through use of a mirror as if the hemiplegic arm is moving in real-time while moving the healthy arm. It can facilitate brain neuroplasticity through activation of the sensorimotor cortex. However, conventional mirror therapy has a critical limitation in that the hemiplegic arm is not actually moving. Thus, we developed a real-time 2-axis mirror robot system as a simple add-on module for conventional mirror therapy using a closed feedback mechanism, which enables real-time movement of the hemiplegic arm. We used 3 Attitude and Heading Reference System sensors, 2 brushless DC motors for elbow and wrist joints, and exoskeletal frames. In a feasibility study on 6 healthy subjects, robotic mirror therapy was safe and feasible. We further selected tasks useful for activities of daily living training through feedback from rehabilitation doctors. A chronic stroke patient showed improvement in the Fugl-Meyer assessment scale and elbow flexor spasticity after a 2-week application of the mirror robot system. Robotic mirror therapy may enhance proprioceptive input to the sensory cortex, which is considered to be important in neuroplasticity and functional recovery of hemiplegic arms. The mirror robot system presented herein can be easily developed and utilized effectively to advance occupational therapy.

Six healthy subjects conducted a &#39;pen marking task&#39; (touching the two small boards alternately with a pen attached on the healthy hand as shown in Figure 17) 10 times which took on average 106 sec per subject. No adverse event was observed, and robotic mirror therapy was proven to be feasible.
In addition, a clinical study on rehabilitation doctors was conducted. We requested expert opinions to determine...

Watch this Scientific Journal Video about Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms at JoVE.com

Robotic Mirror Therapy System for Functional Recovery of Hemiplegic Arms

We developed a real-time mirror robot system for functional recovery of hemiplegic arms using automatic control technology, conducted a clinical study on healthy subjects, and determined tasks through feedback from rehabilitation doctors. This simple mirror robot can be applied effectively to occupational therapy in stroke patients with a hemiplegic arm.

Mirror therapy has been performed as effective occupational therapy in a clinical setting for functional recovery of a hemiplegic arm after stroke. It is ...

The overall goal of this procedure is to introduce a real-time robotic mirror therapy system for functional recovery of hemiplegic arms. This method can help answer key questions in translationary neurorehab biomedical engineering research by showing that functional recovery of hemiplegic arms with advanced occupational therapy is achievable. The main advantage of this robotic mirror therapy is that it can enhance proprioceptive input to the sensory cortex, which is very important in brain neuroplasticity for stroke patients.Individuals new to this method may struggle, as it was complicated to develop the software protocol, and assemble frames and motors. We first had the idea for this method when we observed conventional neurotherapy, which was limited in that the hemiplegic arm was not actually moving. Visual demonstration of this method is critical, as the sensor settings, assembly, and setup for robotic mirror therapy are difficult to learn.Begin by obtaining a three attitude and heading reference system, or AHRS sensors, and connect them to a computer, one at a time, with a USB connector. Use communications software to configure the general sensor settings on the computer. Set each sensor to RS 232.And select the COM port. Then, set the baud rate to 115, 200 bits per second. Data bits to eight.Parity to none. Stop bits to one. And the flow control to none.To check the COM port, click the home button on the bottom-left corner. Right-click on the computer, select properties, device manager, and click on the port tab to expand it. Once the communication has been established, the hyperterminal will display sensor readings.Then, set the channels and assign different IDs for each sensor. Repeat the configuration, COM port check, and channel and ID assignment for each sensor. Finally, set the output format as quaternions.And set the sensors to display the battery reserve. Begin assembling the elbow-joint motor by putting one of the coupling bodies with a keyway on the motor shaft. And securing it using an M5 hex-socket screw.Secure the elbow coupling hollow cylinder cover to the elbow motor by using four 10 millimeter M5 socket-head screws. And place a second buffer coupling body on top of the first coupling body. Then, plug the ball bearing into the elbow rooftop frame, and secure it with four eight millimeter M4 socket-head screws.Next, plug the elbow motor force dispersion shaft into the lower elbow support, and secure it with four six millimeter M3 socket-head screws. Then, place the upper elbow support on top of the lower elbow support and secure it using eight 12 millimeter M3 socket-head screws. Place part C on top, part B in the middle, and another coupling body at the bottom.Join them together and secure the coupling body with one 10 millimeter M5 hex-socket screw. Then, attach part A to the bottom of this assembly with four 15 millimeter M5 socket-head screws. Next, secure a lower-wrist coupling hollow cylinder cover with the wrist motor, using four 10 millimeter M4 socket-head screws.Then, place a coupling body on the motor shaft. Secure it with one M4 hex-socket screw, and follow that with a buffer coupling body on top. Attach a friction-reduction ring on top of the wrist rooftop frame with double-sided tape.Then, plug the wrist motor force dispersion shaft into the handle, and secure it using four M2.5 socket-head screws. Join part F on top, part E in the middle, and a coupling body on the bottom. Fix the coupling body with a 10 millimeter M4 hex-socket screw.Add an upper-wrist coupling hollow cylinder cover to the bottom of this assembly, using four 10 millimeter M3 socket-head screws. Then, secure part D to the bottom of the upper-wrist coupling hollow cylinder cover using four 15 millimeter socket-head screws. Next, secure two join-movement limiters, wrapped with sponges for safety reasons, and two shaft collars with levers, using four 15 millimeter M4 socket-head screws.Then, slide the shaft collars in part G into the shafts, and use two normal shaft collars to secure the shafts and the wrist rooftop frame together, using eight eight millimeter M3 socket-head screws. Secure additional shaft collars with the lower-elbow support using four 15 millimeter M4 socket-head screws. Then, join the two parts and secure with a lever.Finally, attach a support wall to the assembly using six 15 millimeter M4 socket-head screws, and secure a table stand using six 15 millimeter M6 socket-head screws. Begin by placing the AHRS sensors on the handle, the wrist frame, and the edge of the platform on the participant's healthy side, making sure to align them in parallel with the robot's orientation. Then, start the therapy software on the computer.Choose the hemiplegic side by clicking the patient side switch button. Set the following joint angle limits:Elbow flexion at less than 50 degrees, elbow extension at more than minus 70 degrees, wrist flexion at less than 80 degrees, and wrist extension at more than minus 60 degrees. Then, set the velocity value between zero and 22.5 RPM for the elbow motor.Use a velocity value between zero and 33 RPM for the wrist motor, and set the maximum acceleration and deceleration values as well. Next, turn on all the AHRS sensors. Then, run the program by clicking the arrow button in the upper-left corner of the program.When the Save As"prompt pops up, write the file name for the results data and press OK.Finally, while the robot and healthy arm are at the initial position, where both hands are away from the body and parallel to each other, press the calibration button to initiate sensor values to zero. Begin by informing the participant that they will use their healthy arm to complete a set of mirror therapy tasks. The ball in holes, soccer game, dots tracing, and moving a cup task.For the ball in holes task, place a small ball into the chosen hole, similar to the game of billiards. Likewise, for the soccer game, dribble and place a small ball into a goal, much like in a real game of soccer. Next, for the dots tracing task, use numbered stickers placed on a table as a guide to repeatedly move a handle in numerical order.And then return it in the reverse direction. Finally, for the moving a cup task, take a cup with the handle and push it to a chosen location. Repeat until five minutes have elapsed.Here, results are shown from a patient who suffered a right basal ganglia hemorrhage 19 months ago and received robotic mirror therapy for two weeks. The Fugl-Meyer assessment of the hemiplegic arm improved from 12 to 17 after ten sessions. Furthermore, the modified Ashworth scale of elbow flexors, measuring spasticity, was reduced from grade two, to one plus.And the left-lateral pinch power was increased from zero to three pounds. Once mastered, the robotic mirror therapy can be completed in 40 minutes, if it is performed properly. While performing this procedure, it's important to know that the illusion of sychronicity between both arms is essential for the mirror therapy.After its development, this procedure will pave the way for the research in the field of neuro-rehabilitation to explore the effects of advanced occupational therapy to enhance proprioception in patients with brain legions, such as stroke. After watching this video, you should have a good understanding of how to make and conduct a real-time robotic mirror therapy system for functional recovery of hemiplegic arms.

Research

JoVE Journal

Bioengineering

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