This research was supported by the Swiss National Science Foundation, the Betty and David Koetser Foundation for Brain Research and the ETH Foundation.

The experiments presented here were approved by the Veterinary Office of the Canton of Zurich, Switzerland and were carried out according to national and institutional regulations.
1. Feeding Conditions
NOTE: All training sessions are performed under a scheduled feeding protocol.
<ol>
	<li>Feed the rats 50 g/kg of standard chow once per day, after training is completed. This amount of food is sufficient to prevent major weight loss (body weight is &#62;90% of free-feeding weight), but small enough to ensure reproducible behavioral conditioning. Weigh the rats daily to ensure their body weight remains stable. 
	NOTE:&#160;Additional overnight (10-12 h) food deprivation may be useful prior to the first reward-touch session (step 2.3).</li>
</ol>
2. Training Procedure for a Reach-and-pull Task
<ol>
	<li>Preparation: Allow the rats to habituate to their new home cages for at least a week after arrival in the animal facility. Handle the rats regularly during this time and give dustless precision pellets in the home cage to habituate the rats to the new food. These pellets will be used as rewards throughout the training protocol.</li>
	<li>Habituation: Place the rats in the testing cage for 30-45 min and provide 30-50 pellets in the feeding bowl, mixed with powdered chow. Open and close the cage window and run the pellet dispenser occasionally to habituate the rats to their sound.
	<ol>
		<li>Repeat this for 2-3 days.</li>
	</ol>
	</li>
	<li>Reward-touch: Train the rats to touch the spherical handle through the cage window and to then move to the opposite side of the cage to retrieve a food reward.
	<ol>
		<li>Adjust the software settings so that the handle is located just outside the testing cage window at the start of each trial and align the handle with the center of the cage window. When the trials are successful, i.e., as soon as a light touch on the handle (0.25 mm displacement in any direction) has been detected, a tone sounds and a reward is dispensed. Classify trials as failed when no touch has been detected for 180 s after the window opens.</li>
		<li>Put the rat in the training cage. Prompt the rat to reach out by letting it grab at a pellet held near the handle. Direct the rat&#39;s attention to the handle and food bowl by tapping on the cage.</li>
		<li>Stop prompting when the rat independently reaches through the cage window and retrieves the food pellet.</li>
		<li>Continue until 100 trials (touches) are completed or until 60 min have passed, whichever comes first.</li>
		<li>Continue training for 3-4 days and begin the next stage of training (step 2.4) when rats achieve 100 trials within 30 min on 2 consecutive days. 
		NOTE: Do not over-train this step. The goal of reward-touch is to achieve reliable interaction between the rat and robot, so that this behavior can be shaped in subsequent training.</li>
	</ol>
	</li>
	<li>Free pull (FP): Train the rats to reach out and pull the robot&#39;s handle.
	<ol>
		<li>Adjust the software settings so that the handle is located 18 mm from the window at the start of each trial, and must be pulled for at least 10 mm without interruption for a successful trial. There are no lateral restrictions on the pulling movement in this stage.
		<ol>
			<li>Classify a trial as failed when the handle has not been moved for 180 s after the window opens, when the handle is moved outside of the reachable workspace (more than 12 mm from midline), or when the rat has pulled less than 10 mm within 5 s after the first touch has been detected.</li>
		</ol>
		</li>
		<li>Take note of the number of times the left and right paw are used during the first 20 trials of the first FP session. The paw that is used in at least 80% of the trials is considered the preferred paw. 
		NOTE: Paw preference may already be clear in reward-touch sessions.</li>
		<li>Move the handle laterally until it is aligned with the edge of the window to facilitate pulling with the preferred paw (i.e. move the robot 5 mm to the left side of the window for right-handed rats and vice-versa). 
		NOTE: Place the handle in this exact same position relative to the cage for all following training sessions for this rat. Assure exact placement by marks on the cage wall and on the robot.</li>
		<li>Put the rat in the training cage and train until 100 trials are completed or until 60 min have passed, whichever comes first. 
		NOTE: If the rat does not reach out far enough, prompt it by letting it grab at a pellet held near the handle. Rats may stop trying to pull after repeated failed attempts. Tap on the cage, let them grab for pellets held with a pair of forceps or dispense a pellet to restore their motivation.</li>
		<li>For experiments involving only FP training, continue training as described in 2.4. 
		NOTE: Typically, 1-2 FP sessions are needed to help transition from reward touch to SP(Straight Pull) training. The goal of these FP sessions is to habituate rats to reach out, grab and pull the handle, rather than to only touch it. As with reward-touch training, it is important not to over-train if the goal is to transition to a next training step.</li>
	</ol>
	</li>
	<li>Straight pull (SP): Train the rats to pull the handle without deviating more than 2 mm from midline. 
	NOTE: The midline is defined relative to the start position of the robot, not to the midpoint of the cage window. Thus, a pulling attempt ending at the midpoint of the cage window will result in a pulling trajectory that deviates more than 2 mm from midline.
	<ol>
		<li>Adjust the software settings so that only trials where the pulling movement does not deviate more than 2 mm from midline on either side are rewarded by a tone and a pellet. Keep all other parameters as described in step 2.4.</li>
		<li>Put the rat in the training cage and train until 100 trials are completed or until 60 min have passed, whichever comes first. 
		NOTE: Rats may become extremely agitated and stop trying to pull after repeated failed attempts. Tap on the cage to redirect their attention to the reaching task, let them grab for pellets held with a pair of forceps or dispense a pellet to restore their motivation.</li>
		<li>Continue training until the rats reach plateau performance, or adapt the training period according to the goal of an experiment.</li>
	</ol>
	</li>
</ol>

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The authors have nothing to disclose

Skilled reaching tasks are commonly used to study motor skill acquisition as well as impairment of motor function under pathological conditions6. Reliable and unambiguous analysis of reaching behavior is essential for the study of cellular mechanisms underlying motor skill acquisition, as well as neurophysiological processes involved in loss and subsequent recovery of function in animal models of neurological disease. The results presented here show how spatial and temporal aspects of the pulling ...

Motor tasks are widely used to assess behavioral and neural changes related to motor learning or to alterations in motor function in neurological or pharmacological animal models. Fine motor function can be difficult to quantify in rodents, however. Tasks requiring manual dexterity, such as manipulation of cereal1, pasta2, or sunflower seeds3 are sensitive and do not require extensive training of the animal. Their main drawback is that these tasks yield mostly qualitative results and can be difficult to score unambiguously.
Skilled reaching tasks, such as variations of the single pellet reaching task are more straightforward to quantify4,5. However, kinematic factors that underlie successful execution of these tasks can only be inferred to a limited extent and require labor-intensive frame-by-frame video analysis.
Robotic devices have gained popularity as means of quantifying aspects of forelimb function and motor skill. Several automated reaching tasks are available. The majority focus on a single aspect of a forelimb movement, such as pulling of a handle along a linear guide6,7, simple distal limb movements8, or pronation and supination of the paw9. While these devices show promise for the analysis of motor function in, they only reflect the complex motor actions executed during single pellet reaching to a limited extend.
Here, we demonstrate the use of a three-degree-of-freedom robotic device, ETH Pattus, developed for training and assessment of various motor tasks in rats10,11. It records planar and rotational movement of rat forelimb movements in reach, grasp, and pulling tasks carried out in the horizontal plane. Rats interact with the robot via a 6 mm-diameter spherical handle that can be reached through a window in the testing cage (width: 15 cm, length: 40 cm, height: 45 cm) and moved in the horizontal plane (pushing and pulling movements) and rotated (pronation-supination movements). Thus, it enables the rat to carry out movements that approximate those executed during conventional single pellet reaching tasks. The window is 10 mm wide and located 50 mm above the cage floor. The handle is located 55 mm above the floor. A sliding door blocks access to the handle between reaching trials and opens when the robot reaches its start position and closes after a trial is completed. After a correctly executed movement, rats receive a food reward on the opposite side of the testing cage.
The robot is controlled via software and records output from 3 rotary encoders at 1000 Hz, resulting in information about the position of the handle in the horizontal plane, as well as its rotation angle (for details, see reference11). The conditions required for successful task execution are defined in the software prior to each training session (e.g. minimum required pulling distance and maximum deviation from midline in a reach-and-pull task). An initial standardized reference position of the handle is recorded with a fixed holder at the start of each training session. This reference is used for all trials within a session, assuring a constant start position of the handle for each trial. Constant positioning of the handle relative to the cage window is assured by alignment of marks on the cage and robot (Figure 1).
Video recordings of the reaching movements are recorded using a small high speed camera (120 frames/s, 640 x 480 resolution). A small display in the camera&#39;s view shows the rat&#39;s identification number, training session, trial number and trial result (success or failed). These videos are used to verify recorded results and to assess the effects of reaching movements that precede the touching, pulling or rotation of the handle.
Here, we demonstrate the use of this robotic platform in variations of a reach-and-pull task. This task can be trained within a period of time that is comparable to other skilled reaching paradigms and yields reproducible results. We describe a typical training protocol, as well as some of the main output parameters. Moreover, we show how minor changes in the used training protocol can result in altered time courses of behavioral outcomes that may represent independent subprocesses within the motor skill learning process.

<table><tbody><tr><td>ETH Pattus</td><td></td><td></td><td>ETH Pattus was made by the Rehabilitation Engineering Laboratory of Prof. Gassert at ETH Zurich.&amp;nbsp;</td></tr><tr><td>Training cage&amp;nbsp;</td><td></td><td></td><td>The plexiglass training cage was made in-house.&amp;nbsp;</td></tr><tr><td>Pellet dispenser</td><td>Campden Instruments</td><td>80209</td><td></td></tr><tr><td>45-mg dustless precision pellets</td><td>Bio-Serv</td><td>F0021-J</td><td></td></tr><tr><td>GoPro Hero 3+ Silver Edition&amp;nbsp;</td><td>digitec.ch</td><td>284528</td><td>Small highspeed camera&amp;nbsp;</td></tr><tr><td>Small display</td><td>Adafruit Industries</td><td>#50, #661</td><td>128 x 32 SPI OLED display controlled via an Arduino Uno microcontroller and Labview software</td></tr><tr><td>LabVIEW 2012</td><td>National Instruments</td><td>776678-3513</td><td>ETH Pattus is compatible with more recent Labview versions.&amp;nbsp;</td></tr><tr><td>Matlab 2014b</td><td>The Mathworks</td><td>MLALL</td><td></td></tr></tbody></table>

investigating motor skill learning processes with a robotic manipulandum

Skilled reaching tasks are commonly used in studies of motor skill learning and motor function under healthy and pathological conditions, but can be time-intensive and ambiguous to quantify beyond simple success rates. Here, we describe the training procedure for reach-and-pull tasks with ETH Pattus, a robotic platform for automated forelimb reaching training that records pulling and hand rotation movements in rats. Kinematic quantification of the performed pulling attempts reveals the presence of distinct temporal profiles of movement parameters such as pulling velocity, spatial variability of the pulling trajectory, deviation from midline, as well as pulling success. We show how minor adjustments in the training paradigm result in alterations in these parameters, revealing their relation to task difficulty, general motor function or skilled task execution. Combined with electrophysiological, pharmacological and optogenetic techniques, this paradigm can be used to explore the mechanisms underlying motor learning and memory formation, as well as loss and recovery of function (e.g. after stroke).

Here, we show 3 variations of a reach-and pull task using male Long-Evans rats (10-12 weeks old). In the free-pull (FP) group (N = 6), rats were trained to pull the robot&#39;s handle for a 22 day period without lateral restrictions. Animals in the straight-pull 1 (SP1) group (N = 12) were trained to pull the handle without deviating more than 2 mm from midline. These animals transitioned directly from reward-touch (step 2.3) to straight-pull training (step 2.5). For both FP and SP1 anima...

Watch this Scientific Journal Video about Investigating Motor Skill Learning Processes with a Robotic Manipulandum at JoVE.com

Investigating Motor Skill Learning Processes with a Robotic Manipulandum

A paradigm is presented for training and analysis of an automated skilled reaching task in rats. Analysis of pulling attempts reveals distinct subprocesses of motor learning.

Skilled reaching tasks are commonly used in studies of motor skill learning and motor function under healthy and pathological conditions, but can be ...

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8.7K Views.  University Hospital Zurich. A paradigm is presented for training and analysis of an automated skilled reaching task in rats. Analysis of pulling attempts reveals distinct subprocesses of motor learning.

Video: Investigating Motor Skill Learning Processes with a Robotic Manipulandum

Study Motor Skill Learning by Single-pellet Reaching Tasks in Mice

Reaching for and retrieving objects require precise and coordinated motor movements in the forelimb. When mice are repeatedly trained to grasp and retrieve food rewards positioned at a specific location, their motor performance (defined as accuracy and speed) improves progressively over time, and plateaus after persistent training. Once such reaching skill is mastered, its further maintenance does not require constant practice. Here we introduce a single-pellet reaching task to study the acquisition and maintenance of skilled forelimb movements in mice. In this video, we first describe the behaviors of mice that are commonly encountered in this learning and memory paradigm, and then discuss how to categorize these behaviors and quantify the observed results. Combined with mouse genetics, this paradigm can be utilized as a behavioral platform to explore the anatomical underpinnings, physiological properties, and molecular mechanisms of learning and memory.

Persistent practice improves the precision of coordinated movements.&#160;Here we introduce a single-pellet reaching task, which is designed to assess the learning and memory of forelimb skill in mice.&#160;

Reaching for and retrieving objects require precise and coordinated motor movements in the forelimb. When mice are repeatedly trained to grasp and ...

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

Advances in robotic systems have resulted in prostheses for the upper limb that can produce multifunctional movements. However, these sophisticated systems require upper limb amputees to learn complex control schemes. Humans have the ability to learn new movements through imitation and other learning strategies. This protocol describes a structured rehabilitation method, which includes imitation, repetition, and reinforcement learning, and aims to assess if this method can improve multifunctional prosthetic control. A left below elbow amputee, with 4 years of experience in prosthetic use, took part in this case study. The prosthesis used was a Michelangelo hand with wrist rotation, and the added features of wrist flexion and extension, which allowed more combinations of hand movements. The participant&#8217;s Southampton Hand Assessment Procedure score improved from 58 to 71 following structured training. This suggests that a structured training protocol of imitation, repetition and reinforcement may have a role in learning to control a new prosthetic hand. A larger clinical study is however required to support these findings.

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.

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

Acquisition of a High-precision Skilled Forelimb Reaching Task in Rats

Movements are the main measurable output of central nervous system function. Developing behavioral paradigms that allow detailed analysis of motor learning and execution is of critical importance in order to understand the principles and processes that underlie motor function. Here we present a paradigm to study movement acquisition within a daily session of training (within-session) representing the fast learning component and primary acquisition as well as skilled motor learning over several training sessions (between-session) representing the slow learning component and consolidation of the learned task. This behavioral paradigm increases the degree of difficulty and complexity of the motor skill task due to two features: First, the animal realigns its body prior to each pellet retrieval forcing renewed orientation and preventing movement execution from the same angle. Second, pellets are grasped from a vertical post that matches the diameter of the pellet and is placed in front of the cage. This requires a precise grasp for successful pellet retrieval and thus prevents simple pulling of the pellet towards the animal. In combination with novel genetics, imaging and electrophysiological technologies, this behavioral method will aid to understand the morphological, anatomical and molecular underpinnings of motor learning and memory.

A paradigm is presented to analyze the acquisition of a high-precision skilled forelimb reaching task in rats.

Movements are the main measurable output of central nervous system function. Developing behavioral paradigms that allow detailed analysis of motor ...

Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee&#39;s hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.

We describe a novel virtual-reality based setup which exploits voluntary control of one hand to improve motor-skill performance in the other (non-trained) hand. This is achieved by providing real-time movement-based sensory feedback as if the non-trained hand is moving. This new approach may be used to enhance rehabilitation of patients with unilateral hemiparesis.

As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by ...

Design and Implementation of a Bespoke Robotic Manipulator for Extra-corporeal Ultrasound

With the potential for high precision, dexterity, and repeatability, a self-tracked robotic system can be employed to assist the acquisition of real-time ultrasound. However, limited numbers of robots designed for extra-corporeal ultrasound have been successfully translated into clinical use. In this study, we aim to build a bespoke robotic manipulator for extra-corporeal ultrasound examination, which is lightweight and has a small footprint. The robot is formed by five specially shaped links and custom-made joint mechanisms for probe manipulation, to cover the necessary range of motion with redundant degrees of freedom to ensure the patient&#39;s safety. The mechanical safety is emphasized with a clutch mechanism, to limit the force applied to patients. As a result of the design, the total weight of the manipulator is less than 2 kg and the length of the manipulator is about 25 cm. The design has been implemented, and simulation, phantom, and volunteer studies have been performed, to validate the range of motion, the ability to make fine adjustments, mechanical reliability, and the safe operation of the clutch. This paper details the design and implementation of the bespoke robotic ultrasound manipulator, with the design and assembly methods illustrated. Testing results to demonstrate the design features and clinical experience of using the system are presented. It is concluded that the current proposed robotic manipulator meets the requirements as a bespoke system for extra-corporeal ultrasound examination and has great potential to be translated into clinical use.

This paper introduces the design and implementation of a bespoke robotic manipulator for extra-corporeal ultrasound examination. The system has five degrees of freedom with lightweight joints made by 3D printing and a mechanical clutch for safety management.

With the potential for high precision, dexterity, and repeatability, a self-tracked robotic system can be employed to assist the acquisition of real-time ...

Engineering

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

Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has been shown to be limited in inter-rater reliability. One factor in this poor inter-rater reliability is the variability of passive motion while measuring the angle of catch (AoC) measurements. Therefore, an isokinetic device has been proposed to standardize the manual joint motion; however, the benefits of isokinetic motion for AoC measurements has not been tested in a standardized manner. This protocol investigates whether isokinetic motion itself can improve inter-rater reliability for AoC measurements. For this purpose, a robotic isokinetic device was developed that is combined with surface electromyography (EMG). Two conditions, manual and isokinetic motions, are compared with the standardized method to measure the angle and subjective feeling of catch. It is shown that in 17 stroke patients with mild elbow flexor spasticity, isokinetic motion improved the intraclass correlation coefficient (ICC) for inter-rater reliability of AoC measurements to 0.890 [95% confidence interval (CI): 0.685&#8211;0.961] by the EMG criteria, and 0.931 (95% CI: 0.791&#8211;0.978) by the torque criteria, from 0.788 (95% CI: 0.493&#8211;0.920) by manual motion. In conclusion, isokinetic motion itself can improve inter-rater reliability of AoC measurements in stroke patients with mild spasticity. Given that this system may provide greater standardized angle measurements and catch of feeling, it may be a good option for the evaluation of spasticity in a clinical setting.

Using a robotic isokinetic device with electromyography (EMG) measurements, this protocol illustrates that isokinetic motion itself can improve inter-rater reliability for the angle of catch measurements in stroke patients with mild elbow flexor spasticity.

Measuring spasticity is important in treatment planning and determining efficacy after treatment. However, the current tool used in clinical settings has ...

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 ...

Medicine

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

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.

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.

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