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Hand-held augmented reality (AR) offers accessible, interactive rehabilitation options for patients with upper limb motor deficits. Incorporating hand-involved interactions (e.g., tangible and mid-air interactions) into hand-held AR provides patients with intuitive manners to perform rehabilitation exercises mimicking real-world activities. Previous work has shown the importance of user experience and motor performance in rehabilitation systems, but little was known in the literature regarding the impact of hand-involved interactions in hand-held AR on user experience and motor performance in rehabilitation exercises. Hence, this study aims to evaluate user experience and motor performance when using three types of hand-involved interactions in hand-held AR rehabilitation: (1) tangible cube (i.e., a space-multiplexed tangible interaction with a physical cube acting as a real proxy to manipulate a virtual object in the same form); (2) tangible controller (i.e., a time-multiplexed tangible interaction with a physical controller applied to manipulate a virtual object); and (3) hand motion (i.e., a form of mid-air interaction to move a virtual object with hands). Based on the findings from self-report, electroencephalography (EEG), and performance measures, this study reveals the advantages of the tangible cube over the tangible controller, both superior to the hand motion in hand-held AR rehabilitation regarding user experience and motor performance. This study offers new understanding of the advantages and disadvantages of various interaction techniques in hand-held AR rehabilitation, emphasizing crucial design considerations for these systems, with a focus on user experience and motor performance in upper limb rehabilitation. [ABSTRACT FROM AUTHOR]

The Box and Block Test (BBT) is an essential and widely used test in rehabilitation for the assessment of gross unilateral manual dexterity. Although it is a valid, simple, and ecological instrument, it does not provide a quantitative measure of the upper limb trajectories during the test. The study introduces a new motion-capture-based method (using ecological Inertial Measurement Units - IMUs) to evaluate upper body kinematics while performing a targeted version of BBT (tBBT). This observational study compares data from 35 healthy subjects, 35 subjects with Parkinson's disease, and 35 post-stroke individuals to evaluate upper limb kinematics during tBBT quantitatively. Seven IMUs were placed on the trunk, head, and upper limb of each subject. The joint angles and kinematic scores were calculated and analyzed. Motor task execution time and kinematic scores were statistically correlated with clinical assessment measures. Kruskal-Wallis between groups test and Dunn-Bonferroni post-hoc were used. The statistics revealed significant differences (p<0.05) among the three groups. The analyzed joint angles highlight various compensatory strategies in neurological subjects, such as using the trunk to complete a motor task instead of the shoulder and using the wrist instead of the elbow, along with differences in movement fluidity (DimensionLess-Jerk, p<0.05). A positive correlation was found between kinematics and the Fugl-Meyer Assessment-Upper Limb (r=0.7344; p<0.01), and a negative correlation between kinematics and the Unified Parkinson's Disease Rating Scale (r=-0.5286; p<0.01). The quantitative assessments of joint kinematics correlated to clinical assessments could guarantee a new method of assessment of the upper limb in subjects with motor deficits. This would allow to capture new insight into the characteristics of the subject's disability, with implications for the choice of a personalized rehabilitation treatment focused on the motor recovery of the upper limb. • An innovative version of the Box and Block Test can be utilized for an instrumental assessment of upper limb function. • Upper limb kinematics' analysis allows the evaluation of compensatory strategies. • Neurological diseases significantly affect upper extremity motor function patterns. • Kinematics parameters are correlated to the clinical assessment measures. [ABSTRACT FROM AUTHOR]

In the process of the upper limb rehabilitation, the rehabilitation effect is often evaluated from the perspective of the motor function of limbs. However, the state of muscle atrophy is also a noteworthy indicator reflecting the rehabilitation effect. We proposed a wearable solution for the monitoring and grade assessing of local muscle atrophy based on wearable bioimpedance (BioZ) sensors. This work elaborates on the theoretical basis, procedure, and key influencing factors of the proposed solution, and the feasibility and effectiveness have been verified through in vitro and in vivo experiments. A total of 25 phantoms in different CSA (cross-sectional area) and FMR (fat-to-muscle ratio) values were designed to simulate different stages of muscular atrophy, and a linear correlation was observed between BioZ, CSA, and FMR, with an R-squared value of 0.898. The relative impedance difference of 38 patients with unilateral muscle atrophy was 5.231% larger than that of 30 healthy control samples on average (p < 0.05). These results demonstrate the correlation between muscle atrophy and BioZ. As the proof-of-concept for graded assessment, the results analyzed by support vector machines (SVMs) show that the accuracy of three-level classification can reach 94.1% using the five-fold cross-validation. [ABSTRACT FROM AUTHOR]

Brain injuries resulting from spinal cord injuries, strokes, or cerebral palsy are among the traumas most capable of compromising the motor activities of human limbs, hence the necessity for the development of exoskeletons dedicated to the rehabilitation of these organs. This review examines the landscape of actuators essential for the design of cutting-edge upper-limb rehabilitation exoskeletal structures. Beyond merely surveying the current types of actuators available, the paper aims to provide guidelines for selecting actuators that fit optimally with the objectives of upper-limb rehabilitation. The description starts with a brief discussion on the biomechanics of the upper limbs, focusing on the kinematics of pivotal joints (wrist, elbow, shoulder). Subsequently, the existing actuators are systematically reviewed, offering detailed insights into their primary features, operational principles, strengths, weaknesses, and noteworthy applications within the realm of rehabilitation robotics. After the discussion about the actuators, the paper advances by furnishing valuable guidelines for actuators' selection tailored for upper limb rehabilitation. These guidelines discuss crucial factors, such as the forces required and the natural Range Of Motions (ROMs) of upper limb joints. Finally, the manuscript serves as a valuable resource for researchers, engineers, and practitioners involved in the development of innovative upper-limb rehabilitation devices. [ABSTRACT FROM AUTHOR]

Mirror therapy is a commonly used rehabilitation intervention in post stroke upper limb rehabilitation. Despite many potential technological developments, mirror therapy is routinely delivered through the use of a static mirror or mirror box. This review aims to synthesise evidence on the application of immersive virtual reality mirror therapy (IVRMT) in poststroke upper limb rehabilitation. A scoping review was performed on relevant English studies published between 2013 to 2023. Literature search was undertaken on APA PsycInfo, CINAHL, Cochrane Library, MEDLINE, PubMed and Web of Science between August 5 and 17, 2023. Additional studies were included from Google Scholar and reference lists of identified articles. A total of 224 records were identified, of which 8 full-text articles were selected for review. All included studies were published between 2019 and 2023, and from high- and upper-middle-income nations. All the studies were experimental (n = 8). The total sample size in the studies was 259, most of whom were stroke patients with upper limb weakness (n = 184). This review identified three major themes and two sub-themes based on the contents of the studies conducted on the application of IVRMT: IVRMT's technical application, feasibility and impact on clinical outcomes (motor recovery and adverse events). IVRMT was concluded to be a safe and feasible approach to post-stroke upper limb rehabilitation, offering enhanced engagement and motor recovery. However, more methodologically robust studies should be conducted to advance this area of practice, and to include a uniform IVRMT intervention protocol, dose, and use of outcome measure. [ABSTRACT FROM AUTHOR]

Objective: Motor imagery-based brain–computer interface (MI-BCI) is a promising novel mode of stroke rehabilitation. The current study aims to investigate the feasibility of MI-BCI in upper limb rehabilitation of chronic stroke survivors and also to study the early event-related desynchronization after MI-BCI intervention. Methods: Changes in the characteristics of sensorimotor rhythm modulations in response to a short brain–computer interface (BCI) intervention for upper limb rehabilitation of stroke-disabled hand and normal hand were examined. The participants were trained to modulate their brain rhythms through motor imagery or execution during calibration, and they played a virtual marble game during the feedback session, where the movement of the marble was controlled by their sensorimotor rhythm. Results: Ipsilesional and contralesional activities were observed in the brain during the upper limb rehabilitation using BCI intervention. All the participants were able to successfully control the position of the virtual marble using their sensorimotor rhythm. Conclusions: The preliminary results support the feasibility of BCI in upper limb rehabilitation and unveil the capability of MI-BCI as a promising medical intervention. This study provides a strong platform for clinicians to build upon new strategies for stroke rehabilitation by integrating MI-BCI with various therapeutic options to induce neural plasticity and recovery.

Functional electrical stimulation (FES) can support functional restoration of a paretic limb post-stroke. Hebbian plasticity depends on temporally coinciding pre- and post-synaptic activity. A tight temporal relationship between motor cortical (MC) activity associated with attempted movement and FES-generated visuo-proprioceptive feedback is hypothesized to enhance motor recovery. Using a brain–computer interface (BCI) to classify MC spectral power in electroencephalographic (EEG) signals to trigger FES-delivery with detection of movement attempts improved motor outcomes in chronic stroke patients. We hypothesized that heightened neural plasticity earlier post-stroke would further enhance corticomuscular functional connectivity and motor recovery. We compared subcortical non-dominant hemisphere stroke patients in BCI-FES and Random-FES (FES temporally independent of MC movement attempt detection) groups. The primary outcome measure was the Fugl-Meyer Assessment, Upper Extremity (FMA-UE). We recorded high-density EEG and transcranial magnetic stimulation-induced motor evoked potentials before and after treatment. The BCI group showed greater: FMA-UE improvement; motor evoked potential amplitude; beta oscillatory power and long-range temporal correlation reduction over contralateral MC; and corticomuscular coherence with contralateral MC. These changes are consistent with enhanced post-stroke motor improvement when movement is synchronized with MC activity reflecting attempted movement. [ABSTRACT FROM AUTHOR]

Virtual reality has gained more attention in the physical training field, but few studies focus on the effects of VR on older adults. Based on existing study we suggest that VR-based upper limb training might be more effective for older adults and used functional near inferred spectrum and movement analysis to evaluate the effects of VR-based training on older adults. 20 older and 20 youth adults were recruited to perform VR training by extending their upper limb to reaching the objects, and non-VR training as a contrast. Both age-related and task-related differences were found in cortical activation, showing that the VR training has aroused more cortical activation. The older groups have more intensive movement but perform worse in terms of task completion. Both groups performed better in VR, and the difference in the older group was higher. [ABSTRACT FROM AUTHOR]

Robot-assisted rehabilitation is a crucial approach to restoring motor function in the limb. However, the current training trajectory lacks sufficient theoretical or practical support, and the monotony of single-mode training is a concern. Tai Chi Pushing Hands, a beneficial and effective daily exercise, has been shown to improve balance function, psychological state, and motor function of the upper extremities in patients recovering from stroke. To address these issues, we propose a new active rehabilitation training that incorporates Tai Chi Pushing Hands movements and yin-yang balance principles. The training trajectory and direction are encoded by the velocity field and consist of two processes: yang (push) and yin (return). During yang, the limb actively pushes the robot to move, while during yin, the limb actively follows the robot’s movement. To provide necessary assistance, an admittance controller with self-adaptive parameters is designed. In addition, we introduce two indexes, the ‘Intention Angle’ (ϖ) and the time ratio (Γ), to evaluate motion perception performance. Our experiment was conducted on a 4-degree-of-freedom upper limb rehabilitation robot platform, and the subjects were separated into a familiar group and an unfamiliar group. The experiment results show that the training could be completed well no matter whether the subject is familiar with Tai Chi Pushing Hands or not. The parameters and the movement of the robot can be adjusted based on the interactive force to adapt to the ability of the subject.

Objective: Motor imagery-based brain--computer interface (MI-BCI) is a promising novel mode of stroke rehabilitation. The current study aims to investigate the feasibility of MI-BCI in upper limb rehabilitation of chronic stroke survivors and also to study the early event-related desynchronization after MI-BCI intervention. Methods: Changes in the characteristics of sensorimotor rhythm modulations in response to a short brain--computer interface (BCI) intervention for upper limb rehabilitation of stroke-disabled hand and normal hand were examined. The participants were trained to modulate their brain rhythms through motor imagery or execution during calibration, and they played a virtual marble game during the feedback session, where the movement of the marble was controlled by their sensorimotor rhythm. Results: Ipsilesional and contralesional activities were observed in the brain during the upper limb rehabilitation using BCI intervention. All the participants were able to successfully control the position of the virtual marble using their sensorimotor rhythm. Conclusions: The preliminary results support the feasibility of BCI in upper limb rehabilitation and unveil the capability of MI-BCI as a promising medical intervention. This study provides a strong platform for clinicians to build upon new strategies for stroke rehabilitation by integrating MI-BCI with various therapeutic options to induce neural plasticity and recovery. [ABSTRACT FROM AUTHOR]

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AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo understand how the experience of Music Upper Limb Therapy – Integrated (MULT-I) interconnects with the experience of stroke.Thematic analysis of semi-structured interviews and video-recorded MULT-I sessions from a larger mixed-methods study. Thirty adults with post-stroke hemiparesis completed pre-intervention interviews, of whom fifteen participated in MULT-I. Thirteen of the participants in MULT-I completed post-intervention interviews.The experience of stroke was characterized by five themes: (1) sudden loss of functional abilities, (2) disrupted participation, (3) desire for independence, (4) emotional distress and the need for support, and (5) difficulty negotiating changes in sense of self. The experience of MULT-I was characterized by three themes: (1) MULT-I activated movement and empowered personal choice, (2) MULT-I created a safe place to process emotional distress and take on challenges, and (3) MULT-I fostered a sense of belonging and a positive transformation in sense of self. These themes combined create a framework which illustrates the process by which MULT-I addressed each challenge described by survivors of stroke, facilitating a positive transformation in sense of self.MULT-I promotes physical, emotional, and social wellbeing following a stroke. This integrated approach supports a positive transformation in sense of self. These findings have implications for improving psychosocial well-being post stroke.The experience of stroke is characterized by disruptions in physical, emotional, and social well-beingSurvivors of stroke describe difficulty obtaining support for emotional distress and experience negative perceptions of their sense of selfMULT-I addresses functional needs post stroke through motivating physical movement and participation, while also supporting autonomy and providing psychosocial support that facilitates a positive transformation in sense of selfThe experience of stroke is characterized by disruptions in physical, emotional, and social well-beingSurvivors of stroke describe difficulty obtaining support for emotional distress and experience negative perceptions of their sense of selfMULT-I addresses functional needs post stroke through motivating physical movement and participation, while also supporting autonomy and providing psychosocial support that facilitates a positive transformation in sense of self [ABSTRACT FROM AUTHOR]

This paper explores the practicability of bimanual asymmetric interaction and the factors affecting it when manipulating virtual three-dimensional objects through Leap, a novel hand motion capture device. This research has the potential to aid in the rehabilitation of people with upper limb function impairments. The participants were asked to enlarge a virtual three-dimensional box device to a predefined specified scale. Three influencing factors were addressed, i.e., task difficulty, task allocation and interactive mode. The results indicate that all factors have significant effects on movement time. However, analysis of variance tests shows that there are significant effects on the error rate and spatial patterns due to task difficulty and interactive mode, while no significant effects are found for task allocation. Additionally, task allocation is observed to have significant effects on the time of each hand from zooming phase onset to peak velocity. The action of the nondominant hand is coarser than that of the dominant hand. Interestingly, the velocities of both hands synchronized as the task difficulty level increased, even though the limbs moved at quite different speeds in the initial stage. This research provides insights into how one hand coordinates with the other in terms of the temporal aspects of movement kinematics and thus can help in designing rehabilitative devices that interact with the healthy hand. [ABSTRACT FROM AUTHOR]

Most stroke survivors have remaining upper limb impairment six months after stroke and require additional rehabilitation and help from family members to enhance their performance of daily activities. First-person (egocentric) video has been proposed to capture the activities of daily living (ADLs) of stroke survivors in order to assess their hand function at home. This study explored the experiences and expectations of stroke survivors regarding the use of egocentric cameras in daily life for rehabilitation applications. Twenty-one chronic stroke survivors recruited for the study were asked to record three sessions of 1.5 h of video of their ADLs at home over two weeks. Their experiences and expectations after completing the recordings were discussed using a structured questionnaire and a semi-structured interview. The questionnaire and interview data were analysed using descriptive statistics and content analysis, respectively. The results were further integrated using a mixed methods analysis for mutual explanation and elaboration. The themes generated were Camera Usability, Privacy Concerns Related to Home Recordings, Future Use of the Camera in Public, and Information Usefulness. The participants perceived that the camera was easy to use, the information obtained from the recordings was beneficial, and no major concerns about recording at home. A discreet camera and a solution to privacy issues were prerequisites to recording tasks in public. There was high acceptance among stroke survivors regarding the use of wearable cameras for rehabilitation purposes in the future. Concerns to be managed include discomfort, self-consciousness, and the privacy of others. The egocentric camera was easy for the stroke survivors to use at home. However, they expressed a preference for cameras to be less noticeable and lighter in the future to minimize self-consciousness and discomfort. Expectations for future use of an egocentric camera for upper limb rehabilitation at home from the perspectives of stroke survivors included receiving feedback on their hand function in daily life and guidance on how to improve function. Privacy concerns of stroke survivors regarding recording activities of daily living were mostly avoidable by planning in advance. However, some personal hygiene tasks and virtual meetings were recorded by accident. A checklist of common activities that may raise privacy issues can be provided along with the camera to serve as a reminder to avoid these issues. [ABSTRACT FROM AUTHOR]

Electromechanical systems that interact with the user to offer power amplification, assistance, or replacement of motor function are known as exoskeletons for the upper limbs. The upper extremity rehabilitation exoskeletons have garnered increasing attention and impact in the healthcare sector over the past years due to the advancements in the field of robotic control devices and actuation elements. The necessity for assistive supporting and rehabilitation devices that either help improve human strengths or provide assistance in regaining lost motion of a specific limb joint arises as a result of changing trends and a growing population. Age-related bone loss often results in weaker, more fragile bones that make lifting and carrying huge loads more difficult. A stroke can impair mobility and is more likely occurs to the elderly people. Accidental paralysis as well as other health issues including spinal cord injuries, musculoskeletal disorders due to work environment are on the rise resulting in an increased urge for the assistive devices. The motive of this paper is to design a mathematical model of the human upper limb involving DH parameters and forward kinematics alongside with the human joint study to precisely design the model in order to design an upper extremity exo-skeleton for offering limb rehabilitation considering the human joint constraints with respect to the Sagittal, Coronal and Transverse planes. This study is aimed in providing a significant vision in developing the precise rehabilitation devices that can aim in offering the joint specific treatment to the user for human upper arm therapy. [ABSTRACT FROM AUTHOR]

Pneumatic artificial muscle (PAM) has been widely used in rehabilitation and other fields as a flexible and safe actuator. In this paper, a PAM-actuated wearable exoskeleton robot is developed for upper limb rehabilitation. However, accurate modeling and control of the PAM are difficult due to complex hysteresis. To solve this problem, this paper proposes an active neural network method for hysteresis compensation, where a neural network (NN) is utilized as the hysteresis compensator and unscented Kalman filtering is used to estimate the weights and approximation error of the NN in real time. Compared with other inversion-based methods, the NN is directly used as the hysteresis compensator without needing inversion. Additionally, the proposed method does not require pre-training of the NN since the weights can be dynamically updated. To verify the effectiveness and robustness of the proposed method, a series of experiments have been conducted on the self-built exoskeleton robot. Compared with other popular control methods, the proposed method can track the desired trajectory faster, and tracking accuracy is gradually improved through iterative learning and updating.

Brain-computer interface (BCI) based motor imagery (MI) can assist stroke patients in upper limb rehabilitation and help restore motor function to a certain extent. However, the classical MI paradigm distinguishes different limbs and cannot effectively meet the needs of upper limb rehabilitation training for patients. Therefore, this paper designed a new paradigm for three motor imagery actions targeting different joints of the unilateral upper limb, and electroencephalogram (EEG) data from 20 healthy participants were collected for research analysis. A deep neural network model combining an attention mechanism for multiple frequency bands and a deep convolutional network were proposed to adaptively assign weight to the EEG data in different frequency bands. Then feature extraction was performed for each frequency band to learn further and to classify features. This model can obtain an average accuracy of 69.2% for the subject-independent case with the triple classification in the designed fine motor imagery (FMI) dataset, which is better than other controlled methods. Furthermore, ablation experiments were conducted for each module, demonstrating the effectiveness of each module. These results manifest the feasibility of our proposed method and the potential of FMI paradigm for BCI, providing a new training tool for upper limb rehabilitation after stroke.

A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1–Q3)) in (1) UL Fugl–Meyer assessment (1.0 (0.8–3.0), p < 0.001) and action research arm test (2.0 (0.8–2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0–0.3), p < 0.001) and quality of use (0.1 (0.1–0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (−0.45 (−0.81–0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training. [ABSTRACT FROM AUTHOR]

Objective: To identify, map and synthesize the extent and nature of existing studies on the use of home-based digital technology to support post-stroke upper limb rehabilitation. Data sources: A comprehensive literature search was completed between 30 May 2022 and 05 April 2023, from seven online databases (CINAHL, Cochrane Library, PubMed, ScienceDirect, IEEExplore, Web of Science and PEDro), Google Scholar and the reference lists of already identified articles. Methods: A scoping review was conducted according to Arksey and O'Malley (2005), and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. All English-language studies reporting on the use of home-based digital technology to support upper limb post-stroke rehabilitation were eligible for inclusion. Results: The search generated a total of 1895 records, of which 76 articles met the inclusion criteria. Of these, 52 were experimental studies and the rest, qualitative, case series and case studies. Of the overall 2149 participants, 2028 were stroke survivors with upper limb impairment. The majority of studies were aimed at developing, designing and/or assessing the feasibility, acceptability and efficacy of a digital system for poststroke upper limb rehabilitation in home settings. The thematic analysis found six major categories: Tele-rehabilitation (n = 29), games (n = 45), virtual reality (n = 26), sensor (n = 22), mobile technology (n = 22), and robotics (n = 8). Conclusion: The digital technologies used in post-stroke upper limb rehabilitation were multimodal, and system-based comprising telerehabilitation, gamification, virtual reality, mobile technology, sensors and robotics. Furthermore, future research should focus to determine the effectiveness of these modalities. [ABSTRACT FROM AUTHOR]

Introduction: The primary constraint of non-invasive brain-machine interfaces (BMIs) in stroke rehabilitation lies in the poor spatial resolution of motor intention related neural activity capture. To address this limitation, hybrid brain-muscle-machine interfaces (hBMIs) have been suggested as superior alternatives. These hybrid interfaces incorporate supplementary input data from muscle signals to enhance the accuracy, smoothness and dexterity of rehabilitation device control. Nevertheless, determining the distribution of control between the brain and muscles is a complex task, particularly when applied to exoskeletons with multiple degrees of freedom (DoFs). Here we present a feasibility, usability and functionality study of a bio-inspired hybrid brain-muscle machine interface to continuously control an upper limb exoskeleton with 7 DoFs.Methods: The system implements a hierarchical control strategy that follows the biologically natural motor command pathway from the brain to the muscles. Additionally, it employs an innovative mirror myoelectric decoder, offering patients a reference model to assist them in relearning healthy muscle activation patterns during training. Furthermore, the multi-DoF exoskeleton enables the practice of coordinated arm and hand movements, which may facilitate the early use of the affected arm in daily life activities. In this pilot trial six chronic and severely paralyzed patients controlled the multi-DoF exoskeleton using their brain and muscle activity. The intervention consisted of 2 weeks of hBMI training of functional tasks with the system followed by physiotherapy. Patients’ feedback was collected during and after the trial by means of several feedback questionnaires. Assessment sessions comprised clinical scales and neurophysiological measurements, conducted prior to, immediately following the intervention, and at a 2-week follow-up.Results: Patients’ feedback indicates a great adoption of the technology and their confidence in its rehabilitation potential. Half of the patients showed improvements in their arm function and 83% improved their hand function. Furthermore, we found improved patterns of muscle activation as well as increased motor evoked potentials after the intervention.Discussion: This underscores the significant potential of bio-inspired interfaces that engage the entire nervous system, spanning from the brain to the muscles, for the rehabilitation of stroke patients, even those who are severely paralyzed and in the chronic phase.

Rehabilitation systems are devices for rehabilitating the wounded limbs of patients in place of therapies. Innovative needs for new technological applications in areas like healthcare care and rehabilitation have arisen as a result of changes in global population patterns. Recent advancements in robotics for upper-limb rehabilitations have produced a slew of data demonstrating its use as a supplement to traditional physiotherapies. One main attraction of these technologies is their ability to install in-house rehabilitation tools that allow individuals to take control of their therapies more regularly using these technologies. Specialized user interfaces provide patient benefits with workout feedback as well as inputs from healthcare practitioners. These specialized interfaces allow healthcare professionals to view involved patients' exercise routine performance charts. The product includes mechanical parts, sensors and motor drives, databases, and interactive interfaces. The mechanical design of these devices uses 3DPs (3 Dimensional Printing) on key components and implementation controls are obtained by DSPIC30F4011 and stepper motors. Healthcare professionals and patients interface using windows-based apps developed in C# with Visual Studio while patient performance data is stored in SQL (Structured Query Language) Databases and services are completely managed database services that can be deployed in cloud-native applications. [ABSTRACT FROM AUTHOR]

Functional use of the upper extremities (UEs) is a top recovery priority for individuals with cervical spinal cord injury (cSCI), but the inability to monitor recovery at home and limitations in hand function outcome measures impede optimal recovery. We developed a framework using wearable cameras to monitor hand use at home and aimed to identify the best way to report information to clinicians. A dashboard was iteratively developed with clinician (n = 7) input through focus groups and interviews, creating low-fidelity prototypes based on recurring feedback until no new information emerged. Affinity diagramming was used to identify themes and subthemes from interview data. User stories were developed and mapped to specific features to create a high-fidelity prototype. Useful elements identified for a dashboard reporting hand performance included summaries to interpret graphs, a breakdown of hand posture and activity to provide context, video snippets to qualitatively view hand use at home, patient notes to understand patient satisfaction or struggles, and time series graphing of metrics to measure trends over time. Involving end-users in the design process and breaking down user requirements into user stories helped identify necessary interface elements for reporting hand performance metrics to clinicians. Clinicians recognized the dashboard's potential to monitor rehabilitation progress, provide feedback on hand use, and track progress over time. Concerns were raised about the implementation into clinical practice, therefore further inquiry is needed to determine the tool's feasibility and usefulness in clinical practice for individuals with UE impairments. [ABSTRACT FROM AUTHOR]

Hand therapy for individuals who sustained hand injuries is included in the Health Professions Council of South Africa (HPCSA) physiotherapy scope of practice. The training that physiotherapists receive at the undergraduate level lays the foundation for them to deliver hand therapy or hand rehabilitation according to the International Classification of Functioning, Disability and Health domains in a uniquely South African health service context. Further structured formal and informal postgraduate continued education opportunities may put physiotherapists in the ideal position in a multidisciplinary team to deliver optimal hand therapy. The problem is that the physiotherapist’s role in the multidisciplinary team delivering hand therapy in the past two decades has decreased, leaving room for a lack of health professional services in South Africa’s private sector where physiotherapists are often the first consultation in, for example, sports teams, but more pertinently, in the public and rural areas. The International Federation of Societies for Hand Therapy (IFSHT) practice profile and physiotherapy scope of practice, curriculum and education information assist in achieving the aim of this commentary to position physiotherapists in South Africa as primary health practitioners in delivering hand therapy. Clinical implication: The effective management of individuals with hand-related conditions and injuries is pertinent to ensure optimal hand function and quality of life. Equal continued formal education opportunities should thus be created for all multidisciplinary team professions at a postgraduate level.

Passive rehabilitation training in the early poststroke period can promote the reshaping of the nervous system. The trajectory should integrate the physicians' experience and the patient's characteristics. And the training should have high accuracy on the premise of safety. Therefore, trajectory customization, optimization, and tracking control algorithms are conducted based on a new upper limb rehabilitation robot. First, joint friction and initial load were identified and compensated. The admittance algorithm was used to realize the trajectory customization. Second, the improved butterfly optimization algorithm (BOA) was used to optimize the nonuniform rational B-spline fitting curve (NURBS). Then, a variable gain control strategy is designed, which enables the robot to track the trajectory well with small human–robot interaction (HRI) forces and to comply with a large HRI force to ensure safety. Regarding the return motion, an error subdivision method is designed to slow the return movement. The results showed that the customization force is less than 6 N. The trajectory tracking error is within 12 mm without a large HRI force. The control gain starts to decrease in 0.5 s periods while there is a large HRI force, thereby improving safety. With the decrease in HRI force, the real position can return to the desired trajectory slowly, which makes the patient feel comfortable. [ABSTRACT FROM AUTHOR]

To address the fact that the classical motor imagination paradigm has no noticeable effect on the rehabilitation training of upper limbs in patients after stroke and the corresponding feature extraction algorithm is limited to a single domain, this paper describes the design of a unilateral upper-limb fine motor imagination paradigm and the collection of data from 20 healthy people. It presents a feature extraction algorithm for multi-domain fusion and compares the common spatial pattern (CSP), improved multiscale permutation entropy (IMPE) and multi-domain fusion features of all participants through the use of decision tree, linear discriminant analysis, naive Bayes, a support vector machine, k-nearest neighbor and ensemble classification precision algorithms in the ensemble classifier. For the same subject, the average classification accuracy improvement of the same classifier for multi-domain feature extraction relative to CSP feature results went up by 1.52%. The average classification accuracy improvement of the same classifier went up by 32.87% relative to the IMPE feature classification results. This study's unilateral fine motor imagery paradigm and multi-domain feature fusion algorithm provide new ideas for upper limb rehabilitation after stroke.

Cable-driven parallel robots (CDPRs) are still gaining attention thanks to their interesting characteristics compared to serial or classic parallel manipulators. However, the limited range of rotation of their end-effectors reduces their application fields to predominantly translational movements. In this context, the issue of extending the rotational workspace of a CDPR while maintaining a compact robot structure is addressed in this paper. This work is motivated by the need to find the optimal CDPR for upper limb rehabilitation allowing to assist the patient's hand along a set of prescribed tasks. Firstly, a reconfigurable robot, where the motors' locations are movable, is proposed in order to help reaching all the prescribed poses. Although this solution presents promising results compared to classical CDPRs, it involves a sizable robot structure inadequate to rehabilitation application. To improve the obtained solution, another approach is proposed, based on combining the large translational workspace of CDPRs and the large rotational workspace of serial manipulators. The optimal structure of a hybrid robot will be considered for the prototype design. [ABSTRACT FROM AUTHOR]

A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1–Q3)) in (1) UL Fugl–Meyer assessment (1.0 (0.8–3.0), p < 0.001) and action research arm test (2.0 (0.8–2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0–0.3), p < 0.001) and quality of use (0.1 (0.1–0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (−0.45 (−0.81–0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training.

Abstract Background Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has potential to significantly change clinical practice. Bilateral motor priming uses the Exsurgo priming device (Exsurgo Rehabilitation, Auckland, NZ) so that the less affected limb drives the more affected limb in bilateral symmetrical wrist flexion and extension. The aim of this study is to determine the effects of a 5-week protocol of bilateral motor priming in combination with task-specific training on motor impairment of the affected limb, bimanual motor function, and interhemispheric inhibition in moderate to severely impaired people with stroke. Methods Seventy-six participants will be randomized to receive either 15, 2-h sessions, 3 times per week for 5 weeks (30 h of intervention) of bilateral motor priming and task-specific training (experimental group) or the same dose of control priming plus the task-specific training protocol. The experimental group performs bilateral symmetrical arm movements via the Exsurgo priming device which allows both wrists to move in rhythmic, symmetrical wrist flexion and extension for 15 min. The goal is one cycle (wrist flexion and wrist extension) per second. The control priming group receives transcutaneous electrical stimulation below sensory threshold for 15 min prior to the same 45 min of task-specific training. Outcome measures are collected at pre-intervention, post-intervention, and follow-up (8 weeks post-intervention). The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function. The secondary outcome is the Chedoke Arm and Hand Activity Index-Nine, an assessment of bimanual functional tasks. Discussion To date, there are only 6 studies documenting the efficacy of priming using bilateral movements, 4 of which are pilot or feasibility studies. This is the first large-scale clinical trial of bilateral priming plus task-specific training. We have previously completed a feasibility intervention study of bilateral motor priming plus task-specific training and have considerable experience using this protocol. Trial registration ClinicalTrials.gov NCT03517657 . Retrospectively registered on May 7, 2018.

Abstract Dyskinesia of the upper limbs caused by stroke, sports injury, or traffic accidents limits the ability to perform the activities of daily living. Besides the necessary medical treatment, correct and scientific rehabilitation training for the injured joint is an important auxiliary means during the treatment of the effected upper limb. Conventional upper-limb rehabilitation robots have some disadvantages, such as a complex structure, poor compliance, high cost, and poor portability. In this study, a novel soft wearable upper limb rehabilitation robot (SWULRR) with reinforced soft pneumatic actuators (RSPAs) that can withstand high pressure and featuring excellent loading characteristics was developed. Driven by RSPAs, this portable SWULRR can perform rehabilitation training of the wrist and elbow joints. In this study, the kinematics of an SWULRR were analyzed, and the force and motion characteristics of RSPA were studied experimentally. The results provide a reference for the development and application of wearable upper limb rehabilitation robots. An experimental study on the rotation angle of the wrist and the pressure of the RSPA was conducted to test the effect of the rehabilitation training and verify the rationality of the theoretical model. The process of wrist rehabilitation training was tested and evaluated, indicating that SWULRR with RSPAs will enhance the flexibility, comfort, and safety of rehabilitation training. This work is expected to promote the development of wearable upper-limb rehabilitation robots based on modular reinforced soft pneumatic actuators.

The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human–robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30–45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery. [ABSTRACT FROM AUTHOR]

Hand therapy for individuals who sustained hand injuries is included in the Health Professions Council of South Africa (HPCSA) physiotherapy scope of practice. The training that physiotherapists receive at the undergraduate level lays the foundation for them to deliver hand therapy or hand rehabilitation according to the International Classification of Functioning, Disability and Health domains in a uniquely South African health service context. Further structured formal and informal postgraduate continued education opportunities may put physiotherapists in the ideal position in a multidisciplinary team to deliver optimal hand therapy. The problem is that the physiotherapist's role in the multidisciplinary team delivering hand therapy in the past two decades has decreased, leaving room for a lack of health professional services in South Africa's private sector where physiotherapists are often the first consultation in, for example, sports teams, but more pertinently, in the public and rural areas. The International Federation of Societies for Hand Therapy (IFSHT) practice profile and physiotherapy scope of practice, curriculum and education information assist in achieving the aim of this commentary to position physiotherapists in South Africa as primary health practitioners in delivering hand therapy. Clinical implication: The effective management of individuals with hand-related conditions and injuries is pertinent to ensure optimal hand function and quality of life. Equal continued formal education opportunities should thus be created for all multidisciplinary team professions at a postgraduate level. [ABSTRACT FROM AUTHOR]

Most stroke survivors have difficulties completing activities of daily living (ADLs) independently. However, few rehabilitation systems have focused on ADLs-related training for gross and fine motor function together. We propose an ADLs-based serious game rehabilitation system for the training of motor function and coordination of both arm and hand movement where the user performs corresponding ADLs movements to interact with the target in the serious game. A multi-sensor fusion model based on electromyographic (EMG), force myographic (FMG), and inertial sensing was developed to estimate users’ natural upper limb movement. Eight healthy subjects and three stroke patients were recruited in an experiment to validate the system’s effectiveness. The performance of different sensor and classifier configurations on hand gesture classification against the arm position variations were analyzed, and qualitative patient questionnaires were conducted. Results showed that elbow extension/flexion has a more significant negative influence on EMG-based, FMG-based, and EMG+FMG-based hand gesture recognition than shoulder abduction/adduction does. In addition, there was no significant difference in the negative influence of shoulder abduction/adduction and shoulder flexion/extension on hand gesture recognition. However, there was a significant interaction between sensor configurations and algorithm configurations in both offline and real-time recognition accuracy. The EMG+FMG-combined multi-position classifier model had the best performance against arm position change. In addition, all the stroke patients reported their ADLs-related ability could be restored by using the system. These results demonstrate that the multi-sensor fusion model could estimate hand gestures and gross movement accurately, and the proposed training system has the potential to improve patients’ ability to perform ADLs.

Currently, fully automated rehabilitation robots can assist therapists in providing rehabilitation therapy, hence the patients could get hurt. On the other hand, manual treatment may cause less patient injury but it is tiresome, and there are not enough therapists in most countries. Power assist rehabilitation robots can support the therapists in conducting the treatment and may help to alleviate this problem. The goal of this study is to develop a control strategy for the robot to assist the therapist’s movement in a power assist upper limb rehabilitation treatment. The system combines the advantages of robotic and manual rehabilitation therapy. Torque and position sensors fitted on the power assist upper limb rehabilitation robot arm are used for motion intention estimation. The amount of angular velocity necessary to be delivered to the feedback controller will be determined by predicting the therapist‘s motion intention using the impedance control method. The resulting velocity from the motion intention estimator is incorporated into the Sliding Mode Control - Function Approximation Technique (SMC-FAT) based adaptive controller. The SMC-FAT based adaptive controller in the feedback loop, overcomes the uncertain parameters in the combination of the robot and the human arm. The motion intention estimator forecasts the movement of therapists. The proposed controller is used to regulate elbow flexion and extension motion on a power assist upper limb rehabilitation robot with one degree of freedom (DOF). The proposed control system has been tested using MATLAB simulation and hardware experimental tests. The outcomes demonstrate the effectiveness of the proposed controller in directing the rehabilitation robot to follow the desired trajectory based on the therapist's motion intention, with maximum errors of 0.002rad/sec, 0.005rad/sec and 0.02rad/sec for sinusoidal, constant torque values, and hardware experiment respectively. ABSTRAK: Pada masa ini, robot rehabilitasi automatik sepenuhnya dapat membantu ahli terapi dalam menyediakan terapi pemulihan, tetapi pesakit berkemungkinan tercedera. Sebaliknya, rawatan manual berkemungkinan mengurangkan kecederaan pesakit tetapi ia memenatkan, dan terdapat kurang ahli terapi yang mencukupi di kebanyakan negara. Robot pembantu rehabilitasi dapat membantu ahli terapi dalam menjalankan pemulihan dan mengurangkan masalah ini. Sistem ini menggabungkan kelebihan terapi pemulihan robotik dan manual. Alat pengesan tork dan kedudukan diletakkan pada anggota atas lengan robot rahabilitasi yang digunakan bagi mengesan anggaran jarak pergerakan ahli terapi. Anggaran halaju sudut diperlukan bagi kawalan gerak balas dan dapat diketahui melalui anggaran niat gerakan ahli terapi menggunakan kaedah kawalan impedans. Halaju yang terhasil daripada anggaran niat gerakan diadaptasi ke dalam pengawal adaptif berasaskan Kawalan Mod Gelongsor - Teknik Anggaran Fungsi (SMC-FAT). Pengawal penyesuaian berasaskan SMC-FAT dalam gelung maklum balas, mengatasi parameter yang tidak pasti dalam gabungan robot dan lengan manusia. Penganggar niat gerakan meramalkan gerakan ahli terapi. Pengawal yang dicadangkan digunakan bagi mengawal lenturan siku dan gerakan lanjutan pada robot rehabilitasi dengan satu darjah kebebasan (DOF). Sistem kawalan yang dicadangkan telah diuji menggunakan simulasi MATLAB dan ujian eksperimen perkakasan. Dapatan kajian menunjukkan keberkesanan pengawal yang dicadangkan dalam mengarahkan robot rehabilitasi mengikut trajektori yang dikehendaki berdasarkan niat gerakan ahli terapi, dengan ralat maksimum masing-masing 0.002rad/s dan 0.005rad/s bagi sinusoidal, nilai tork malar, dan eksperimen perkakasan masing-masing.

As one of the research hotspots in the field of rehabilitation robotics, the upper limb exoskeleton robot has been widely used in the field of rehabilitation. However, the existing methods cannot comprehensively and accurately reflect the motion state of patients, which may lead to overtraining and secondary injury of patients in the process of rehabilitation training. In this paper, an upper limb exoskeleton control method based on mixed perception model of motion intention and intensity is proposed, which is based on the 6 degree-of-freedom upper limb rehabilitation exoskeleton in the laboratory. First, the kinematic information and heart rate information in the rehabilitation process of patients are collected, corresponding to patients' motion intention and motion intensity, and fused to obtain the mixed perception vector. Second, the motion perception model based on long short-term memory neural network is established to realize the prediction of upper limb motion trajectory of patients and compared with back-propagation neural network to prove its effectiveness. Finally, the control system is built, and both offline and online test of the control method proposed are implemented. The experimental results show that the method can achieve comprehensive motion state perception of patients, realize real-time and accurate prediction trajectory according to human motion intention and intensity. The average prediction accuracy is 95.3%, and predicted joint angle error is less than 5 degrees. Therefore, the control method based on mixed perception model has good robustness and universality, which provides a new method for the active control of upper limb exoskeleton. [ABSTRACT FROM AUTHOR]