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IntroductionStroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients.MethodsSpecifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks.ResultsOur results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks.DiscussionThe present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability.

Rehabilitation robots may help the patient improve their recovery by supporting them to perform repetitive, systematic training sessions. Safety and comfortable feeling of the patients who training with robots is an important issue in not only the steady state but also the transient process. In this research, the trajectory tracking control problems of a two-degrees of freedom (2-DOF) robotic orthosis is discussed. The robotic orthosis is powered by pneumatic artificial muscles (PAMs) in an antagonistic configuration. based on a mathematical model, a modified computed torque control scheme is employed to enhance the tracking performance. The effectiveness of the proposed control strategy is verified by the experiments with the participation of different subjects.

Rehabilitation under water is a viable physical rehabilitation option, but it has some limitations in terms of adapting to needs of each patient. In addition, its facility requirements are relatively high. Simulating the fluid environment using a robotic system would enable therapists adjust various parameters so that the therapy is tailored to the patient's unique state. Also, using a robotic system instead might be less costly and easily reachable. In this study, human lower extremity movement in fluids is modeled. This model is verified by comparing computer simulations with the results of previous experimental studies. Then, the model is used to create a control scheme which is implemented on a robotic gait trainer. Output torques are measured to check the effectiveness of the controller in simulating the fluid environment while compensating for weight and friction of the robotic system. Measurements showed that the desired joint torques were achieved and the controller was able to make the orthosis transparent to the patient. A hip extension exercise used in aquatic therapy was performed with the robotic system while varying drag coefficient, fluid density and flow velocity, and the data collected is presented.

BackgroundThe Lokomat® is a device utilized for gait training in post-stroke patients. Through a systematic review, the objective was to determine whether robot-assisted gait training with the Lokomat® is more effective in enhancing lower extremity rehabilitation in patients with stroke in comparison to conventional physical therapy (CPT).MethodsIn this study, a systematic search was conducted in various databases, including CINAHL, MEDLINE, PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Physiotherapy Evidence Database (PEDro), as well as bibliographies of previous meta-analyses, to identify all randomized controlled trials that investigated the use of Lokomat® devices in adult stroke patients. The study aimed to derive pooled estimates of standardized mean differences for six outcomes, namely, Fugl–Meyer Assessment lower-extremity subscale (FMA-LE), Berg Balance Scale (BBS), gait speed, functional ambulation category scale (FAC), timed up and go (TUG), and functional independence measure (FIM), through random effects meta-analyses.ResultsThe review analyzed 21 studies with a total of 709 participants and found that the use of Lokomat® in stroke patients resulted in favorable outcomes for the recovery of balance as measured by the BBS (mean difference = 2.71, 95% CI 1.39 to 4.03; p < 0.0001). However, the FAC showed that Lokomat® was less effective than the CPT group (mean difference = −0.28, 95% CI −0.45 to 0.11, P = 0.001). There were no significant differences in FMA-LE (mean difference = 1.27, 95% CI −0.88 to 3.42, P = 0.25), gait speed (mean difference = 0.02, 95% CI −0.03 to 0.07, P = 0.44), TUG (mean difference = −0.12, 95% CI −0.71 to 0.46, P = 0.68), or FIM (mean difference = 2.12, 95% CI −2.92 to 7.16, P = 0.41) between the Lokomat® and CPT groups for stroke patients.ConclusionOur results indicate that, with the exception of more notable improvements in balance, robot-assisted gait training utilizing the Lokomat® was not superior to CPT based on the current literature. Considering its ability to reduce therapists' work intensity and burden, the way in which Lokomat® is applied should be strengthened, or future randomized controlled trial studies should use more sensitive assessment criteria.

A new intrinsically compliant robotic orthosis powered by pneumatic muscle actuators (PMA) was developed for treadmill training of neurologically impaired subjects. The robotic orthosis has hip and knee sagittal plane rotations actuated by antagonistic configuration of PMA. The orthosis has passive mechanisms to allow vertical and lateral translations of the trunk and a passive hip abduction/adduction joint. A foot lifter having a passive spring mechanism was used to ensure sufficient foot clearance during swing phase. A trajectory tracking controller was implemented to evaluate the performance of the robotic orthosis on a healthy subject. The results show that the robotic orthosis is able to perform the treadmill training task by providing sufficient torques to achieve physiological gait patterns and a realistic stepping experience. The orthosis is a new addition to the rapidly advancing field of robotic orthoses for treadmill training., (Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.)

Stroke has a considerable incidence in the world population and would cause sequelae in the upper limbs. One way to increase the efficiency in the rehabilitation process of patients with these sequelae is through robot-assisted therapy. The present study developed a portable robotic orthosis called Pinotti Portable Robotic Exoskeleton (PPRE) and validated its functioning in clinical tests. The static and dynamic parts of the device modules are described. Design issues, such as heavyweight and engine positioning, have been optimized. The implementation of control was through a smartphone application that communicates with a microcontroller to perform desired movements. Four individuals with motor impairment of the upper limbs due to stroke performed clinical tests to validate the device. Participants did not mention pain, discomfort, tingling, and paresthesia. The robotic device showed the ability to perform the flexion and extension movements of the fingers and elbow. The PPRE was confirmed to be adequate and functional at different levels of motor impairment assessed. The orthosis presented advantages over the currently existing devices, concerning its biomechanical functioning, portability, comfort, and versatility. Thus, the apparatus has the great innovative potential to become a device for home use, serving as an aid to the therapist and facilitating the rehabilitation of patients after an injury. In a larger sample, future studies are needed to assess the effect of a robotic orthosis on the level of rehabilitation in individuals with upper limb impairment. [ABSTRACT FROM AUTHOR]

Introduction: Stroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients. Methods: Specifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks. Results: Our results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks. Discussion: The present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability. [ABSTRACT FROM AUTHOR]

Highlights: [•] We propose a new anticipatory assistance-as-needed robotic control algorithm. [•] The control algorithm adapts its behavior to the patient dysfunctional profile. [•] The algorithm anticipates to trajectory deviations to encourage neural plasticity. [•] We validated the proposed algorithm throughout a robotic simulator. [ABSTRACT FROM AUTHOR]

Abstract--Recent studies have confirmed that regular treadmill training can improve walking capabilities in incomplete spinal cord-injured subjects. At the beginning of this training the leg movements of the patients have to be assisted by physiotherapists during gait on the moving treadmill. The physical capabilities and the individual experience of the therapists usually limit this training. A driven gait orthosis (DGO) has been developed that can move the legs of a patient in a physiological way on the moving treadmill. The orthosis is adjustable in size so different patients can use it. Actuators at the knee and hip joints are controlled by a position controller. With the DGO the legs of patients with different degrees of paresis and spasticity could be trained for more than half an hour, and physiological gait patterns were obtained. [ABSTRACT FROM AUTHOR]

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Disabilities are a global issue due to the decrease in life quality and mobility of patients, especially people suffering from hand disabilities. This paper presents a review of active hand exoskeleton technologies, over the past decade, for rehabilitation, assistance, augmentation, and haptic devices. Hand exoskeletons are still an active research field due to challenges that engineers face and are trying to solve. Each hand exoskeleton has certain requirements to fulfil to achieve their aims. These requirements have been extracted and categorized into two sections: general and specific, to give a common platform for developing future devices. Since this is still a developing area, the requirements are also shaped according to the advances in the field. Technical challenges, such as size requirements, weight, ergonomics, rehabilitation, actuators, and sensors are all due to the complex anatomy and biomechanics of the hand. The hand is one of the most complex structures in the human body; therefore, to understand certain design approaches, the anatomy and biomechanics of the hand are addressed in this paper. The control of these devices is also an arising challenge due to the implementation of intelligent systems and new rehabilitation techniques. This includes intention detection techniques (electroencephalography (EEG), electromyography (EMG), admittance) and estimating applied assistance. Therefore, this paper summarizes the technology in a systematic approach and reviews the state of the art of active hand exoskeletons with a focus on rehabilitation and assistive devices.

This study developed a robotic orthosis capable of detecting the intention of a wearer to move their fingers, thereafter augmenting their muscle force. This was with the aim of producing a device that can be used in post-stroke hand rehabilitation. The design of the orthosis was based on an existing design, which was modified using BLENDER release 2.78 and printed with ABS plastic. An actuator was mounted at the rear end of the orthosis, to provide actuation to perform full range flexion and extension motion for digits. Force sensors were embedded at the fingertips of the orthosis to detect minute finger movements. For severe cases where stroke survivors are incapable of little finger movements, the study employed a brain-computer interface to detect the intent to move. The robotic orthosis achieved an accuracy of 64.1% and 62% in detecting unclench and clench activities respectively and actuating the orthosis digits in response. The results revealed that the design presented here can help provide effective hand rehabilitation. The study concluded that the design incorporated with BCI systems is capable of performing hand rehabilitation in a clinical setting as it obtains some level of accuracy in detecting patient intent to move and actuating in response. This design is low cost, and hence will lessen the economic burden for stroke survivors in a poor-resource country. [ABSTRACT FROM AUTHOR]

Human hands and fingers are of significant importance in people's capacity to perform daily tasks (touching, feeling, holding, gripping, writing). However, about 1.5 million people around the world are suffering from injuries, muscle and neurological disorders, a loss of hand function, or a few fingers due to stroke. This paper focuses on newly developed finger orthotics, which is thin, adaptable to the length of each finger and low energy costs. The aim of the study is to design and control a new robotic orthosis using for daily rehabilitation therapy. Kinematic and dynamic analysis of orthosis was calculated and the joint regulation of orthosis was obtained. The Lagrange method was used to obtain dynamics, and the Denavit–Hartenberg (D–H) method was used for kinematic analysis of hand. In order to understand its behavior, the robotic finger orthotics model was simulated in MatLab/Simulink. The simulation results show that the efficiency and robustness of proportional integral derivative (PID) controller are appropriate for the use of robotic finger orthotics. [ABSTRACT FROM AUTHOR]

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Study Design: Bibliometric analysis. Objective: The study aims to comprehensively assess the literature related to gait rehabilitation for individuals with spinal cord injury (SCI) to identify significant contributors, and to explore the collaborations and emerging themes in the field. Methods: Original and review articles in English using relevant keywords were searched in the Clarivate Web of Science database. The data from the selected articles were imported into R software. Bibliometric indicators were assessed to determine author contributions, country affiliations, journal sources, and thematic trends. Results: A total of 1313 relevant articles were identified. The USA, followed by Canada and Switzerland were the most prolific countries contributing to gait rehabilitation research in SCI. The most relevant journals were Spinal Cord, Archives of Physical Medicine and Rehabilitation, Journal of Spinal Cord Medicine, Journal of NeuroEngineering, and Journal of Neurotrauma. The highest contributions came from Northwestern University, the University of Miami, and the University of Alberta. The analysis revealed an increase in research interest in gait rehabilitation after 2000, with a focus on interdisciplinary approaches and emerging technologies like robotics, exoskeletons, and neuromodulation. Conclusion: The analysis demonstrates the importance of collaborative and interdisciplinary research in gait rehabilitation. The results indicate a shift in research focus from traditional methods to the integration of technology. The impact of publications from the USA and Europe is a notable finding. The study highlights the growth of articles related to technology-driven approaches and understanding neuroplasticity in gait rehabilitation. [ABSTRACT FROM AUTHOR]

Neurological diseases are observed in approximately 1 billion people worldwide. A further increase is foreseen at the global level as a result of population growth and aging. Individuals with neurological disorders often experience cognitive, motor, sensory, and lower extremity dysfunctions. Thus, the possibility of falling and balance problems arise due to the postural control deficiencies that occur as a result of the deterioration in the integration of multi-sensory information. We propose a novel rehabilitation framework, Integrated Balance Rehabilitation (I-BaR), to improve the effectiveness of the rehabilitation with objective assessment, individualized therapy, convenience with different disability levels and adoption of assist-as-needed paradigm and, with integrated rehabilitation process as whole, that is, ankle-foot preparation, balance, and stepping phases, respectively. Integrated Balance Rehabilitation allows patients to improve their balance ability by providing multi-modal feedback: visual via utilization of virtual reality; vestibular via anteroposterior and mediolateral perturbations with the robotic platform; proprioceptive via haptic feedback. [ABSTRACT FROM AUTHOR]

Patients with motor impairments (e.g., stroke, bone fracture, Parkinson's) are sensitive to the wearing experience of rehabilitation devices, and they often have difficulty accurately positioning them at an accurate position. While solutions involving optical systems or IMUs could potentially help alleviate the issue, they often introduce other challenges such as privacy concerns or discomforting experiences. With the emergence of wearable soft sensors during the last few decades, researchers widely apply soft sensors in rehabilitation to improve the wearing experience. However, these approaches have primarily focused on analyzing the sensor readings to improve accuracy rather than addressing the needs of patients and healthcare providers, and there is a lack of comprehensive design investigation and need assessment based on soft sensor-based rehabilitation systems for motor-impaired patients and their doctors. In this study, we developed an application, RehabFAB, utilizing fabric sensors for rehabilitation purposes. Besides, we evaluated our application and device and investigated the needs of patients and doctors for potential home rehabilitation applications. The investigation was conducted through thematic analysis, correlation analysis and System Usability Scale. The experimental results validated the efficacy, reliability and usability of our approach, with a SUS score of 81.75. In addition, the RehabFAB meets the expectations of motor-impaired patients and medical professionals as a home rehabilitation tool. Our core contributions lie in a thorough evaluation of the needs of motor-impaired patients in order to design a stable and reliable motion-tracking device based on soft sensors for their recovery. [ABSTRACT FROM AUTHOR]

Background: Gait disorder remains a major challenge for individuals with stroke, affecting their quality of life and increasing the risk of secondary complications. Robot-assisted gait training (RAGT) has emerged as a promising approach for improving gait independence in individuals with stroke. This study aimed to evaluate the effect of RAGT in individuals with subacute hemiparetic stroke using a one-leg assisted gait robot called Welwalk WW-1000. Methods: An assessor-blinded, multicenter randomized controlled trial was conducted in the convalescent rehabilitation wards of eight hospitals in Japan. Participants with first-ever hemiparetic stroke who could not walk at pre-intervention assessment were randomized to either the Welwalk group, which underwent RAGT with conventional physical therapy, or the control group, which underwent conventional physical therapy alone. Both groups received 80 min of physical therapy per day, 7 days per week, while the Welwalk group received 40 min of RAGT per day, 6 days per week, as part of their physical therapy. The primary outcome was gait independence, as assessed using the Functional Independence Measure Walk Score. Results: A total of 91 participants were enrolled, 85 of whom completed the intervention. As a result, 91 participants, as a full analysis set, and 85, as a per-protocol set, were analyzed. The primary outcome, the cumulative incidence of gait-independent events, was not significantly different between the groups. Subgroup analysis revealed that the interaction between the intervention group and stroke type did not yield significant differences in either the full analysis or per-protocol set. However, although not statistically significant, a discernible trend toward improvement with Welwalk was observed in cases of cerebral infarction for the full analysis and per-protocol sets (HR 4.167 [95%CI 0.914–18.995], p = 0.065, HR 4.443 [95%CI 0.973–20.279], p = 0.054, respectively). Conclusions: The combination of RAGT using Welwalk and conventional physical therapy was not significantly more effective than conventional physical therapy alone in promoting gait independence in individuals with subacute hemiparetic stroke, although a trend toward earlier gait independence was observed in individuals with cerebral infarction. Trial registration: This study was registered with the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCT 042180078) on March 3, 2019. [ABSTRACT FROM AUTHOR]

Gait and balance have a direct impact on patients' independence and quality of life. Due to a higher life expectancy, the number of patients suffering neurological disorders has increased exponentially, with gait and balance impairments being the main side effects. In this context, the use of rehabilitation robotic devices arises as an effective and complementary tool to recover gait and balance functions. Among rehabilitation devices, end effectors present some advantages and have shown encouraging outcomes. The objective of this study is twofold: to propose a general classification of devices for gait and balance rehabilitation and to provide a review of the existing end effectors for such purposes. We classified the devices into five groups: treadmills, exoskeletons, patient-guided systems, perturbation platforms, and end effectors. Overall, 55 end effectors were identified in the literature, of which 16 were commercialized. We found a disproportionate number of end effectors capable of providing both types of rehabilitation (2/55) and those focused on either balance (21/55) or gait (32/55). The analysis of their features from a mechanical standpoint (degrees of freedom, topology, and training mode) allowed us to identify the potential of parallel manipulators as driving mechanisms of end effector devices and to suggest several future research directions. [ABSTRACT FROM AUTHOR]

Various conditions, including traffic accidents, sports injuries, and neurological disorders, can impair human wrist movements, underscoring the importance of effective rehabilitation methods. Robotic devices play a crucial role in this regard, particularly in wrist rehabilitation, given the complexity of the human wrist joint, which encompasses three degrees of freedom: flexion/extension, pronation/supination, and radial/ulnar deviation. This paper provides a comprehensive review of wrist rehabilitation devices, employing a methodological approach based on primary articles sourced from PubMed, ScienceDirect, Scopus, and IEEE, using the keywords "wrist rehabilitation robot" from 2007 onwards. The findings highlight a diverse array of wrist rehabilitation devices, systematically organized in a tabular format for enhanced comprehension. Serving as a valuable resource for researchers, this paper enables comparative analyses of robotic wrist rehabilitation devices across various attributes, offering insights into future advancements. Particularly noteworthy is the integration of serious games with simplified wrist rehabilitation devices, signaling a promising avenue for enhancing rehabilitation outcomes. These insights lay the groundwork for the development of new robotic wrist rehabilitation devices or to make improvements to existing prototypes incorporating a forward-looking approach to improve rehabilitation outcomes. [ABSTRACT FROM AUTHOR]

We present an overview of the Conference on Transformative Opportunities for Modeling in Neurorehabilitation held in March 2023. It was supported by the Disability and Rehabilitation Engineering (DARE) program from the National Science Foundation's Engineering Biology and Health Cluster. The conference brought together experts and trainees from around the world to discuss critical questions, challenges, and opportunities at the intersection of computational modeling and neurorehabilitation to understand, optimize, and improve clinical translation of neurorehabilitation. We organized the conference around four key, relevant, and promising Focus Areas for modeling: Adaptation & Plasticity, Personalization, Human-Device Interactions, and Modeling 'In-the-Wild'. We identified four common threads across the Focus Areas that, if addressed, can catalyze progress in the short, medium, and long terms. These were: (i) the need to capture and curate appropriate and useful data necessary to develop, validate, and deploy useful computational models (ii) the need to create multi-scale models that span the personalization spectrum from individuals to populations, and from cellular to behavioral levels (iii) the need for algorithms that extract as much information from available data, while requiring as little data as possible from each client (iv) the insistence on leveraging readily available sensors and data systems to push model-driven treatments from the lab, and into the clinic, home, workplace, and community. The conference archive can be found at (dare2023.usc.edu). These topics are also extended by three perspective papers prepared by trainees and junior faculty, clinician researchers, and federal funding agency representatives who attended the conference. [ABSTRACT FROM AUTHOR]