Name: enhancing upper limb function and motor skills post-stroke through an upper limb rehabilitation robot
Uploaded: 2024-09-06T13:50:00.000+00:00
Duration: 4 min 49 s
Description: Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

We are also thankful to the healthcare professionals and staff members at the First Affiliated Hospital of Zhejiang University for their support and cooperation throughout the research process.

This study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University, China, and all research protocols were formulated in compliance with the principles of the Declaration of Helsinki. All patients provided written informed consent to participate in this study. The study recruited 24 patients with upper limb hemiplegia who were admitted to the rehabilitation ward of the First Affiliated Hospital of Zhejiang University from January 2023 to June 2023. Inclusion criteria were: first ischemic or hemorrhagic stroke confirmed by neuroimaging (CT or MRI), aged 45 to 75 years, within 6 months of onset, upper limb motor function impairment and unilateral hemiplegia (Fugl-Meyer Assessment for Upper Extremity, FMA-UE &#8804;40)12,13, modified Ashworth Scale &#8804;214, Mini-Mental State Examination (MMSE) &#62;20 (indicating adequate cognitive function)15, and a clinically stable condition with underlying diseases well controlled, and signed informed consent. Exclusion criteria were: unstable intracranial condition, cognitive and language impairment, shoulder subluxation, shoulder/elbow/wrist mobility impairment, severe spasticity (Ashworth 3-4), and visual impairment. The details of the robot and the software used in this study are listed in the Table of Materials.
1. Study design
<ol>
	<li>Generate a random number using SAS software to split all patients into two groups: experimental and control, each containing 12 patients.</li>
	<li>Conduct initial assessments of upper limb motor function and self-care ability using FMA-UE12, Brunnstrom score (BRS)16, and modified Barthel index (MBI)17 by a blinded rehabilitation therapist.</li>
	<li>Administer basic drug therapy to all patients throughout the trial, focusing on blood pressure control, blood glucose management, blood lipid regulation, seizure prevention, etc.</li>
	<li>Provide the control group with 30 min of routine upper limb rehabilitation training daily, including active and passive joint training, muscle strengthening, and finger movement exercises18.
	<ol>
		<li>Additionally, include 30 min of sanding board training daily19. Offer specialized therapy for lower limb dysfunction, aphasia, dysphagia, and other functional disorders as needed by professional therapists, administered five times a week for eight weeks.</li>
	</ol>
	</li>
	<li>Offer the experimental group the same 30 min routine upper limb rehabilitation therapy as the control group daily, supplemented with 30 min of upper limb rehabilitation robot training daily. Provide equivalent therapy for other functional disorders as provided to the control group.</li>
</ol>
2. Specific operation steps for the upper limb rehabilitation robot
<ol>
	<li>Evaluation of joint range of motion and motor control ability
	<ol>
		<li>Ask the patient to sit in front of the robot, keeping the chest one punch away from the platform (Figure 1).</li>
		<li>Place the affected hand on the end processor of the robot, and use gloves and binders to secure the wrist and hand to prevent slip-off during exercise.</li>
		<li>Ask the patient to move the upper arm to the maximum and extend it as far as possible. 
		NOTE: The instrument will automatically record the patient&#39;s hand movement trajectory to determine the patient&#39;s active joint movement range.</li>
		<li>Put the healthy hand on the affected hand and maximally move the affected upper arm with the assistance of the healthy side. 
		NOTE: The instrument recorded the patient&#39;s hand movement trajectory and obtained the passive joint range of motion. Passive range of motion measurements may be assisted by the therapist if the patient has bilateral mobility impairment.</li>
		<li>Set the motor control evaluation parameters, including target repetition times, single exercise time, and single relaxation time. 
		NOTE: The motor control evaluation parameters were set by the therapist according to the patient&#39;s FMA-UE score12and weekly evaluations using the robot&#39;s built-in assessment system, such as increasing the difficulty for participants with better upper limb strength, increasing the number of repetitions and reducing the rest time, to more accurately assess the patient&#39;s motor control.</li>
		<li>Control the target point to move in different directions according to the motion path and direction displayed on the screen. 
		NOTE: The instrument will evaluate the patient&#39;s motor control ability according to the patient&#39;s motor performance.</li>
	</ol>
	</li>
	<li>Selection of training mode
	<ol>
		<li>Select the isokinetic passive training mode if the upper limb muscles of the patient cannot contract at all or only have a small amount of contraction (BRS 1-2). 
		NOTE: The robot provides complete help to drive the affected upper limb for the passive movement training exercise task.</li>
		<li>Select the auxiliary movement training mode if the patient&#39;s upper limb can perform partial joint movement, but the movement is very slight, and the voluntary movement ability is poor (BRS 3). 
		NOTE: The system can provide the corresponding auxiliary force in real-time according to the actual force degree of the patient and induce the active participation of the patient&#39;s upper limb to the greatest extent during the whole training process to form the correct movement mode.</li>
		<li>Select the active training mode if the patient&#39;s upper limb muscle strength can produce large force or partial resistance (BRS 4). 
		NOTE: The robot can further strengthen the main movement ability of the patient&#39;s upper limb.</li>
		<li>Select the resistance training mode to further improve the accuracy and aiming control of the patient&#39;s upper limb if the patient&#39;s upper limb strength is already strong and can resist greater resistance (BRS 5-6).</li>
	</ol>
	</li>
	<li>Selection of training procedures
	<ol>
		<li>Choose the training procedure, noting that the system provides more than 10 interesting game programs so that patients can experience different VR scenes and interactive experiences, which greatly improves the training enthusiasm of patients (Figure 2).</li>
	</ol>
	</li>
	<li>Setting game parameters
	<ol>
		<li>Set the training time according to the physical condition of the patient, which can be about 10-20 min in general. 
		NOTE: If the patient&#39;s upper limb strength is good, increase the single training time to improve the patient&#39;s exercise tolerance. If the patient&#39;s upper limb strength is poor, select a shorter single training time and allow the patient to complete the training program in multiple sessions.</li>
		<li>Set the range of motion according to the evaluated range of motion of the joint, selecting from full range, medium range, or small range of motion.</li>
		<li>Set the activity trajectory according to the characteristics of the patient&#39;s upper arm muscle strength, choosing the appropriate activity path to target and strengthen weak muscles.</li>
		<li>Set the power assist or resistance value according to the muscle strength of the patient. 
		NOTE: During the training process, the instrument can also automatically adjust the power assist and friction force according to the actual force feedback of the patient.</li>
		<li>Set the protection threshold using mechanical feedback technology to detect when the patient&#39;s strength reaches the threshold, indicating spasms (manifested as discomfort, a sudden increase in muscle tone, or abnormal joint stiffness and locking). The device will issue an alarm and stop immediately to ensure the safety of the patient&#39;s training.</li>
	</ol>
	</li>
	<li>Specific training process 
	NOTE: Patients are trained with 2-3 game items per day, and different game items can be changed regularly.
	<ol>
		<li>Engage in the vegetable farm: In the virtual farm, ask the patient to control the small hands to grab fruits and vegetables and collect as many stars as possible. 
		NOTE: This activity primarily targets the range of motion in elbow and wrist flexion and extension.</li>
		<li>Participate in defend the base: In the scene of the virtual military base, ask the patient to accurately control the bullseye to shoot all the eliminated monsters. 
		NOTE: This exercise aims to enhance muscle control in the elbow and wrist, improving the accuracy of shooting actions.</li>
		<li>Play color dodgeball: On different roads and obstacles, ask the patient to control the ball to avoid obstacles of different colors to obtain gold coins. 
		NOTE: This exercise involves shoulder, elbow, and wrist movements to improve muscle strength and joint mobility.</li>
		<li>Navigate Star Wars: In the virtual space environment, ask the patient to control the position of the aircraft to shoot to destroy the virus while avoiding movement and enemy attacks, training muscle endurance and reaction force. 
		NOTE: This training boosts upper limb endurance, reaction speed, and accuracy, and improves elbow and shoulder coordination and strength.</li>
		<li>Participate in quality ball: Ask the patient to control the ball to reach and stay in the bull &#39;s-eye; the closer the ball is to the bull &#39;s-eye, the higher the score is. 
		NOTE: This activity exercises elbow flexion, extension, shoulder adduction, abduction, and activates the biceps and triceps for precise control.</li>
		<li>Play super ping-pong: In the virtual ball environment, ask the patient to control the ping-pong board to hit the ball and play table tennis with the opponent. The difficulty is advanced and upgraded, and the reaction and hand-eye coordination abilities are trained.</li>
		<li>Engage in block world: Ask the patient to control bullseye shooting to destroy blocks, watch out for enemy attacks and collect as many coins as possible, train thinking strategy and hand-eye coordination.</li>
		<li>Play ball: Ask the patient to control the ball to touch the target; the ball is scored, watch out for enemy attacks, and collect as many coins as possible.</li>
		<li>Participate in legendary gunner: Ask the patient to hold the handle and continuously exert force in the direction of the arrow. The muscle groups of the upper limbs are isometric contraction, and the force is stored to fire to destroy the target.</li>
	</ol>
	</li>
</ol>
3. Follow-up procedure
<ol>
	<li>Evaluate all patients for FMA, BRS, and MBI again after 8 weeks of training by the same rehabilitation therapist.</li>
	<li>Enter all data into the software for statistical analysis. Use a paired sample t-test for intra-group comparison and two independent sample t-tests for inter-group comparison. Consider P &#60; 0.05 as statistically significant.</li>
</ol>

Integrated Robotic and Conventional Therapy for Post-Stroke Upper Limb Recovery

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The authors declare no conflicts of interest or financial disclosures related to this study.

Building upon previous research20, this study adopts an integrated approach by combining robotic training for upper limb rehabilitation with conventional therapeutic methods for post-stroke recovery. The current findings suggest that this integration substantially enhances upper limb motor function and improves the ability to perform activities of daily living (ADLs), surpassing the outcomes achieved with traditional rehabilitation techniques alone.
This investigation e...

Stroke, identified as an acute neurological event caused by the blockage or rupture of cerebral vessels, interrupts brain circulation1, ranking as the second leading cause of death and a major contributor to long-term disability worldwide. On the initial day following a stroke, up to 80% of survivors experience upper limb dysfunction, with 30%-66% still facing challenges six months later2. After one year, those with upper limb impairments report heightened anxiety, diminished quality of life, and reduced happiness3. Moreover, by 16 months post-stroke, only about 60% of hemiplegic individuals requiring hospital rehabilitation attain functional independence in basic daily activities, with those suffering from sensory, motor, and visual impairments being significantly more reliant on caregiver support4. Additionally, upper limb dysfunction impedes hand utility, particularly noted by increased muscle tension among weakened flexors and extensors during physical tasks5.
Despite various rehabilitation efforts, effectively addressing upper limb injuries in stroke survivors presents a formidable challenge6. High-intensity, repetitive task training has shown optimal outcomes but demands considerable therapist involvement, leading to high costs and logistical burdens7. Therefore, low-cost interventions are needed that do not increase therapists' workload while increasing patient interest in training. The upper limb rehabilitation robot can serve as an alternative treatment to promote high-intensity exercise and reduce dependence on therapists1. It is a newly developed upper limb intelligent feedback rehabilitation robot system (see Table of Materials). The device can output objective metrics (such as speed, torque, range of motion, position, etc.) to assess and monitor patients' improvements and customize treatment according to varying degrees of motor impairment. It has high consistency and reproducibility for widespread use. Additionally, strong evidence supports high-intensity, high-repetitiveness, and task-oriented training in facilitating post-stroke motor recovery8.
On the other hand, rehabilitation robots are a relatively novel assistive treatment approach with advantages like high safety and durability9. The American Stroke Association recently released guidelines reporting that robot-assisted motor training can help patients improve post-stroke motor function and mobility in addition to conventional therapy10. A 2018 article in the Journal of Rehabilitation Medicine reported that combining robot-assisted training with conventional rehabilitation can significantly improve upper limb motor function in stroke patients, warranting clinical promotion11. The system includes four training modes: constant speed training, power-assisted training, active training, and resistance training, and can conduct assessments of joint range of motion. A review of robot-assisted rehabilitation for subacute stroke patients indicated that robotic interventions significantly improved upper extremity functions, particularly in shoulder, elbow, and forearm performance, as assessed by the Functional Independence Measure and Fugl-Meyer Assessment Scale. These interventions also enhanced daily living activities, improving the quality of life10.
This study aims to evaluate the effectiveness of an intelligent feedback rehabilitation robot in rehabilitating upper limb motor functions in patients with early post-stroke hemiplegia, providing a scientific basis for rehabilitation strategies for stroke patients with hemiplegia.

<table><tbody><tr><td>Upper Limb Rehabilitation Robot[Fourier M2]</td><td>Shanghai Fourier Intelligence, China</td><td>ArmMotus M2</td><td>The upper limb intelligent force feedback motion control training system [M2] is a new generation of upper limb intelligent force feedback rehabilitation robot training system independently developed by Shanghai Fourier Intelligence. Based on core technologies such as force feedback, this training system can sense the patient&#039;s force and whether there is any spasticity when the patient completes the predetermined action, and then change the power assist or resistance of the device itself, so as to improve the upper limb motor dysfunction. Through goal-oriented training, M2 endows games with training, increases the enthusiasm of patients, and more effectively exercises the gross motor function and cognitive function of patients&#039; upper limbs.</td></tr><tr><td>SAS software</td><td>SAS Institute</td><td></td><td>https://www.sas.com/en_in/home.html</td></tr><tr><td>SPSS software</td><td>IBM</td><td>version 26</td><td>https://www.ibm.com/products/spss-statistics</td></tr></tbody></table>

enhancing upper limb function and motor skills post-stroke through an upper limb rehabilitation robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

A total of 24 patients were enrolled and randomly assigned to either the control or experimental group (Table 1). There was no statistically significant difference between the two groups for sex, age, disease duration, or stroke type (P &#62; 0.05). After 8 weeks of upper limb training, the Fugl-Meyer Assessment for Upper Extremity (FMA-UE)12 was used to evaluate upper limb motor function, while the Brunnstrom Recovery Stage for Arm (BRS-Arm)16 and...

Author Spotlight: Enhancing Post-Stroke Upper Limb Rehabilitation with Robotic Technologies for Improved Motor Recovery and Functional Outcomes

This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

enhancing-upper-limb-function-motor-skills-post-stroke-through-an

Research

JoVE Journal

Medicine

598 Views.  Zhejiang University. Dit onderzoek richt zich op het verbeteren van revalidatie van de bovenste ledematen na een beroerte met behulp van robottechnologieën, met als doel het motorisch herstel en de functionele resultaten te verbeteren. Ons protocol biedt real-time aanpassing en gepersonaliseerde feedback, wat leidt tot een effectievere en boeiendere revalidatie. Ons toekomstige onderzoek zal zich richten op het verbeteren van robottherapie en het combineren ervan met virtual rea...

Video: Auteur in de schijnwerpers: Verbetering van de revalidatie van de bovenste ledematen na een beroerte met robottechnologieën voor verbeterd motorisch herstel en functionele resultaten

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

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.

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 ...

Bioengineering

Remote Limb Ischemic Preconditioning:  A Neuroprotective Technique in Rodents

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. Sublethal ischemia has also been shown to upregulate protective mechanisms in remote tissues. A brief period of ischemia (5-10 min) in the hind limb of mammals induces self-protective responses in the brain, lung, heart and retina. The effect is known as remote ischemic preconditioning (RIP). It is a therapeutically promising way of protecting vital organs, and is already under clinical trials for heart and brain injuries. This publication demonstrates a controlled, minimally invasive method of making a limb &#8211; specifically the hind limb of a rat &#8211; ischemic. A blood pressure cuff developed for use in human neonates is connected to a manual sphygmomanometer and used to apply 160 mmHg pressure around the upper part of the hind limb. A probe designed to detect skin temperature is used to verify the ischemia, by recording the drop in skin temperature caused by pressure-induced occlusion of the leg arteries, and the rise in temperature which follows release of the cuff. This method of RIP affords protection to the rat retina against bright light-induced damage and degeneration.

Remote ischemic preconditioning (RIP) is a method of conditioning tissues against damaging stress. We have established a method of remote ischemia at the hind limb, by inflating a sphygmomanometer cuff for 5-10 min. The neuroprotective capabilities of RIP have been demonstrated in a model of retinal degeneration in rodents.

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. ...

Revolutionizing Stroke Rehabilitation with Enhanced Grasping and Finger Recovery

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.

Author Spotlight: Enhancing Grasping Abilities for Hemiplegic Patients with Flexible Robotic Limbs 

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.

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

Engineering

The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of daily activities due to lower and upper limb impairments. Intensive physical and occupational therapy are still considered main treatments, but new adjunct therapies to standard rehabilitation that may optimize functional outcomes are being studied.
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that polarizes underlying brain regions through the application of weak direct currents through electrodes on the scalp, modulating cortical excitability. Increased interest in this technique can be attributed to its low cost, ease of use, and effects on human neural plasticity. Recent research has been performed to determine the clinical potential of tDCS in diverse conditions such as depression, Parkinson&#39;s disease, and motor rehabilitation after stroke. tDCS helps enhance brain plasticity and seems to be a promising technique in rehabilitation programs.
A number of robotic devices have been developed to assist in the rehabilitation of upper limb function after stroke. The rehabilitation of motor deficits is often a long process requiring multidisciplinary approaches for a patient to achieve maximum independence. These devices do not intend to replace manual rehabilitation therapy; instead, they were designed as an additional tool to rehabilitation programs, allowing immediate perception of results and tracking of improvements, thus helping patients to stay motivated.
Both tDSC and robot-assisted therapy are promising add-ons to stroke rehabilitation and target the modulation of brain plasticity, with several reports describing their use to be associated with conventional therapy and the improvement of therapeutic outcomes. However, more recently, some small clinical trials have been developed that describe the associated use of tDCS and robot-assisted therapy in stroke rehabilitation. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

The combined use of transcranial direct current stimulation and robotic therapy as an add-on for conventional rehabilitation therapy may result in improved therapeutic outcomes due to modulation of brain plasticity. In this article, we describe the combined methods used in our institute for improving motor performance after stroke.

Neurologic disorders such as stroke and cerebral palsy are leading causes of long-term disability and can lead to severe incapacity and restriction of ...

Neuroscience

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.

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 ...

Evaluating Brain Activation by fNIRS During a Lower Limb Robotic Therapy Session

An Experiment Using Functional Near-Infrared Spectroscopy and Robot-Assisted Multi-Joint Pointing Movements of the Lower Limb

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise in helping stroke patients regain lost motor functions. One potential avenue for increasing the understanding of how motor recovery occurs is to study brain activation during the movements that are targeted by therapy in healthy individuals. Functional Near-Infrared Spectroscopy (fNIRS) has emerged as a promising neuroimaging technique for examining neural underpinnings of motor function. This study aimed to investigate fNIRS neural correlates of complex lower limb movements in healthy subjects. Participants were asked to perform cycles of rest and movement for 6 min using a robotic device for motor rehabilitation. The task required coordinated knee and ankle joint movements to point to targets displayed on a computer screen. Two experimental conditions with different levels of movement assistance provided by the robot were explored. The results showed that the fNIRS protocol effectively detected brain regions associated with motor control during the task. Notably, all subjects exhibited greater activation in the contralateral premotor area during the no-assistance condition compared to the assisted condition. In conclusion, fNIRS appears to be a valuable approach for detecting changes in oxyhemoglobin concentration associated with multi-joint pointing movements of the lower limb. This research might contribute to the understanding of stroke motor recovery mechanisms and might pave the way for improved rehabilitation treatments for stroke patients. However, further research is needed to fully elucidate the potential of fNIRS in studying motor function and its applications in clinical settings.

Author Spotlight: Assessing Brain Activity in Robotic-Assisted Lower Limb Rehabilitation Using fNIRS

It is estimated that 1 in 6 individuals worldwide will have a stroke in their lifetime, causing long-term disability, whose rehabilitation mechanisms are still poorly understood. This study proposes a protocol to evaluate brain activation by functional near-infrared spectroscopy (fNIRS) during a lower limb robotic therapy session.

Stroke affects approximately 17 million individuals worldwide each year and is a leading cause of long-term disability. Robotic therapy has shown promise ...

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the potential to meet these demands by providing engaging and motivating therapy options. The digital occupational training system is a VR application that utilizes cutting-edge technologies, including multi-touch screens, virtual reality, and human-computer interaction, to offer diverse training techniques for advanced cognitive capacity and hand-eye coordination abilities. The objective of this study was to assess the effectiveness of this program in enhancing cognitive function and upper extremity rehabilitation in stroke patients. The training and assessment consist of five cognitive modules covering perception, attention, memory, logical reasoning, and calculation, along with hand-eye coordination training. This research indicates that after eight weeks of training, the digital occupational training system can significantly improve cognitive function, daily living skills, attention, and self-care abilities in stroke patients. This software can be employed as a time-saving and clinically effective rehabilitation aid to complement traditional one-on-one occupational therapy sessions. In summary, the digital occupational training system shows promise and offers potential financial benefits as a tool to support the functional recovery of stroke patients.

Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System

The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

Dual Upper Limb Robotic Training in Stroke Rehabilitation

Application of a Dual Upper Limb Task-Oriented Robotic System for the Functional Recovery of the Upper Limb in Stroke Patients

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm training can help stroke survivors regain their upper limb function and improve their daily activities. The dual upper limb task-oriented robotic system is designed to assist the healthy side of the stroke patient in driving the affected side to perform bilateral arm training through the use of a robotic device. It can also guide the patient in carrying out dual upper limb coordinated movements and engage them in a task-oriented virtual game using force feedback and human-computer interaction technology. This study aimed to assess the efficacy of the system in enhancing upper limb function and activities of daily living in stroke patients. The assessment methods used included motor evoked potential (MEP), functional test for the hemiplegic upper extremity-Hong Kong (FTHUE-HK), Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), and modified Barthel index (MBI). The results of the study indicate that the dual upper limb task-oriented robotic system can significantly improve the corticospinal pathway, upper limb function, and activities of daily living in stroke patients after 6 weeks of treatment. This system can serve as an effective adjunct to upper limb functional rehabilitation in stroke survivors, reducing the dependence on rehabilitation therapists. In conclusion, the dual upper limb task-oriented robotic system provides a new strategy for post-stroke limb functional rehabilitation and holds great potential for application, as it offers certain social and financial benefits.

Author Spotlight: Enhancing Upper Limb Rehabilitation in Stroke Patients Through Advanced Robotic and Neuromodulation Technologies

This experimental protocol outlines the use of a dual upper limb task-oriented robotic system for stroke patients with upper limb dysfunction. The findings indicate that this system can significantly improve stroke patients' upper limb function and daily living activities.

Highly repetitive and task-oriented training has been shown to promote the recovery of limb function in stroke patients. Additionally, bilateral arm ...

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

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