Journal of NeuroEngineering and Rehabilitation

Journal: Journal of NeuroEngineering and Rehabilitation

Abbreviation

J. Neuroeng. Rehabilitat.

Publisher

BioMed Central

ISSN

1743-0003

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Publications 1 - 10 of 106

Robot-supported assessment of balance in standing and walking
Shirota, Camila; van Asseldonk, Edwin H.F.; Matjačić, Zlatko; et al. (2017)
Journal of NeuroEngineering and Rehabilitation
Clinically useful and efficient assessment of balance during standing and walking is especially challenging in patients with neurological disorders. However, rehabilitation robots could facilitate assessment procedures and improve their clinical value. We present a short overview of balance assessment in clinical practice and in posturography. Based on this overview, we evaluate the potential use of robotic tools for such assessment. The novelty and assumed main benefits of using robots for assessment are their ability to assess ‘severely affected’ patients by providing assistance-as-needed, as well as to provide consistent perturbations during standing and walking while measuring the patient’s reactions. We provide a classification of robotic devices on three aspects relevant to their potential application for balance assessment: 1) how the device interacts with the body, 2) in what sense the device is mobile, and 3) on what surface the person stands or walks when using the device. As examples, nine types of robotic devices are described, classified and evaluated for their suitability for balance assessment. Two example cases of robotic assessments based on perturbations during walking are presented. We conclude that robotic devices are promising and can become useful and relevant tools for assessment of balance in patients with neurological disorders, both in research and in clinical use. Robotic assessment holds the promise to provide increasingly detailed assessment that allows to individually tailor rehabilitation training, which may eventually improve training effectiveness.
Need for mechanically and ergonomically enhanced tremor-suppression orthoses for the upper limb: a systematic review
Fromme, Nicolas P.; Camenzind, Martin; Riener, Robert; et al. (2019)
Journal of NeuroEngineering and Rehabilitation
Introduction Tremor is the most common movement disorder, affecting 5.6% of the population with Parkinson’s disease or essential tremor over the age of 65. Conventionally, tremor diseases like Parkinson’s are treated with medication. An alternative non-invasive symptom treatment is the mechanical suppression of the oscillation movement. The purpose of this review is to identify the weaknesses of past wearable tremor-suppression orthoses for the upper limb and identify the need for further research and developments. Method A systematic literature search was conducted by performing a keyword combination search of the title, abstract and keyword sections in the four databases Web of Science, MedLine, Scopus, and ProQuest. Initially, the retrieved articles were selected by title and abstract using selection criteria. The same criteria were then applied to the full publication text. After the selection process, relevant information on the retrieved orthoses was isolated, sorted and analysed systematically. Results Forty-six papers, representing 21 orthoses, were identified and analysed according to the mechanical and ergonomic properties. The identified orthoses can be divided into 5 concepts and 16 functional prototypes, then subdivided further based upon their use of passive, semi-active, or active suppression mechanisms. Most of the orthoses concentrate on the wrist and elbow flexion and extension. They mainly rely on rigid structures and actuators while having tremor-suppression efficacies for tremorous subjects from 30 to 98% using power spectral density or other methods. Conclusion The comparison of tremor-suppression orthoses considered and mapped their various mechanical and ergonomic properties, including the degrees of freedom, weight, suppression characteristics, and efficacies. This review shows that most of the orthoses are bulky and heavy, with a non-adapted human-machine interface which can cause rejection by the user. The main challenge of the design of an effective, minimally intrusive and portable tremor-suppressing orthosis is the integration of compact, powerful, lightweight, and non-cumbersome suppression mechanisms. None of the existing prototypes combine all the desired characteristics. Future research should focus on novel suppression orthoses and mechanisms with compact dimensions and light weight in order to be less cumbersome while giving a good tremor-suppression performance.
Concurrent validity and test-retest reliability of the Virtual Peg Insertion Test to quantify upper limb function in patients with chronic stroke
Tobler-Ammann, Bernadette C.; de Bruin, Eling; Fluet, Marie-Christine; et al. (2016)
Journal of NeuroEngineering and Rehabilitation
Background Measuring arm and hand function of the affected side is vital in stroke rehabilitation. Therefore, the Virtual Peg Insertion Test (VPIT), an assessment combining virtual reality and haptic feedback during a goal-oriented task derived from the Nine Hole Peg Test (NHPT), was developed. This study aimed to evaluate (1) the concurrent validity of key outcome measures of the VPIT, namely the execution time and the number of dropped pegs, with the NHPT and Box and Block Test (BBT), and (2) the test-retest-reliability of these parameters together with the VPIT’s additional kinetic and kinematic parameters in patients with chronic stroke. The three tests were administered on 31 chronic patients with stroke in one session (concurrent validity), and the VPIT was retested in a second session 3–7 days later (test-retest reliability). Spearman rank correlation coefficients (ρ) were calculated for assessing concurrent validity, and intraclass correlation coefficients (ICCs) were used to determine relative reliability. Bland-Altman plots were drawn and the smallest detectable difference (SDD) was calculated to examine absolute reliability. Results For the 31 included patients, 11 were able to perform the VPIT solely via use of their affected arm, whereas 20 patients also had to utilize support from their unaffected arm. For n = 31, the VPIT showed low correlations with the NHPT (ρ = 0.31 for time (Tex[s]); ρ = 0.21 for number of dropped pegs (Ndp)) and BBT (ρ = −0.23 for number of transported cubes (Ntc); ρ = −0.12 for number of dropped cubes (Ndc)). The test-retest reliability for the parameters Tex[s], mean grasping force (Fggo[N]), number of zero-crossings (Nzc[1/sgo/return) and mean collision force (Fcmean[N]) were good to high, with ICCs ranging from 0.83 to 0.94. Fair reliability could be found for Fgreturn (ICC = 0.75) and trajectory error (Etrajgo[cm]) (0.70). Poor reliability was measured for Etrajreturn[cm] (0.67) and Ndp (0.58). The SDDs were: Tex = 70.2 s, Ndp = 0.4 pegs; Fggo/return = 3.5/1.2 Newton; Nzc[1/s]go/return = 0.2/1.8 zero-crossings; Etrajgo/return = 0.5/0.8 cm; Fcmean = 0.7 Newton. Conclusions The VPIT is a promising upper limb function assessment for patients with stroke requiring other components of upper limb motor performance than the NHPT and BBT. The high intra-subject variation indicated that it is a demanding test for this stroke sample, which necessitates a thorough introduction to this assessment. Once familiar, the VPIT provides more objective and comprehensive measurements of upper limb function than conventional, non-computerized hand assessments.
Evaluation of upper extremity neurorehabilitation using technology: a European Delphi consensus study within the EU COST Action Network on Robotics for Neurorehabilitation
Hughes, Ann-Marie; Barbosa Bouças, Sofia; Burridge, Jane H.; et al. (2016)
Journal of NeuroEngineering and Rehabilitation
Background The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of meta-analyses of trials. In this paper we report the consensus reached on assessment protocols and outcome measures for evaluation of the upper extremity in neurorehabilitation using technology. The outcomes of this research will be part of the development of European guidelines. Methods A rigorous, systematic and comprehensive modified Delphi study incorporated questions and statements generation, design and piloting of consensus questionnaire and five consensus experts groups consisting of clinicians, clinical researchers, non-clinical researchers, and engineers, all with working experience of neurological assessments or technologies. For data analysis, two major groups were created: i) clinicians (e.g., practicing therapists and medical doctors) and ii) researchers (clinical and non-clinical researchers (e.g. movement scientists, technology developers and engineers). Results Fifteen questions or statements were identified during an initial ideas generation round, following which the questionnaire was designed and piloted. Subsequently, questions and statements went through five consensus rounds over 20 months in four European countries. Two hundred eight participants: 60 clinicians (29 %), 35 clinical researchers (17 %), 77 non-clinical researchers (37 %) and 35 engineers (17 %) contributed. At each round questions and statements were added and others removed. Consensus (≥69 %) was obtained for 22 statements on i) the perceived importance of recommendations; ii) the purpose of measurement; iii) use of a minimum set of measures; iv) minimum number, timing and duration of assessments; v) use of technology-generated assessments and the restriction of clinical assessments to validated outcome measures except in certain circumstances for research. Conclusions Consensus was reached by a large international multidisciplinary expert panel on measures and protocols for assessment of the upper limb in research and clinical practice. Our results will inform the development of best practice for upper extremity assessment using technologies, and the formulation of evidence-based guidelines for the evaluation of upper extremity neurorehabilitation.
Leg surface electromyography patterns in children with neuro-orthopedic disorders walking on a treadmill unassisted and assisted by a robot with and without encouragement
Aurich-Schuler, Tabea; Müller, Roland; van Hedel, Hubertus J.A. (2013)
Journal of NeuroEngineering and Rehabilitation
Background Robot-assisted gait training and treadmill training can complement conventional physical therapy in children with neuro-orthopedic movement disorders. The aim of this study was to investigate surface electromyography (sEMG) activity patterns during robot-assisted gait training (with and without motivating instructions from a therapist) and unassisted treadmill walking and to compare these with physiological sEMG patterns. Methods Nine children with motor impairments and eight healthy children walked in various conditions: (a) on a treadmill in the driven gait orthosis Lokomat®, (b) same condition, with additional motivational instructions from a therapist, and (c) on the treadmill without assistance. sEMG recordings were made of the tibialis anterior, gastrocnemius lateralis, vastus medialis, and biceps femoris muscles. Differences in sEMG amplitudes between the three conditions were analyzed for the duration of stance and swing phase (for each group and muscle separately) using non-parametric tests. Spearman’s correlation coefficients illustrated similarity of muscle activation patterns between conditions, between groups, and with published reference trajectories. Results The relative duration of stance and swing phase differed between patients and controls, and between driven gait orthosis conditions and treadmill walking. While sEMG amplitudes were higher when being encouraged by a therapist compared to robot-assisted gait training without instructions (0.008 ≤ p-value ≤ 0.015), muscle activation patterns were highly comparable (0.648 ≤ Spearman correlation coefficients ≤ 0.969). In general, comparisons of the sEMG patterns with published reference data of over-ground walking revealed that walking in the driven gait orthosis could induce more physiological muscle activation patterns compared to unsupported treadmill walking. Conclusions Our results suggest that robotic-assisted gait training with therapeutic encouragement could appropriately increase muscle activity. Robotic-assisted gait training in general could induce physiological muscle activation patterns, which might indicate that this training exploits restorative rather than compensatory mechanisms.
The Cybathlon promotes the development of assistive technology for people with physical disabilities
Riener, Robert (2016)
Journal of NeuroEngineering and Rehabilitation
Background The Cybathlon is a new kind of championship, where people with physical disabilities compete against each other at tasks of daily life, with the aid of advanced assistive devices including robotic technologies. The first championship will take place at the Swiss Arena Kloten, Zurich, on 8 October 2016. The idea Six disciplines are part of the competition comprising races with powered leg prostheses, powered arm prostheses, functional electrical stimulation driven bikes, powered wheelchairs, powered exoskeletons and brain-computer interfaces. This commentary describes the six disciplines and explains the current technological deficiencies that have to be addressed by the competing teams. These deficiencies at present often lead to disappointment or even rejection of some of the related technologies in daily applications. Conclusion The Cybathlon aims to promote the development of useful technologies that facilitate the lives of people with disabilities. In the long run, the developed devices should become affordable and functional for all relevant activities in daily life.
A survey on the influence of CYBATHLON on the development and acceptance of advanced assistive technologies
Meyer, Jan T.; Weber, Selina; Jäger, Lukas; et al. (2022)
Journal of NeuroEngineering and Rehabilitation
Background Advanced assistive technologies (AAT) aim to exploit the vast potential of technological developments made in the past decades to improve the quality of life of people with disabilities. Combining complex robotic technologies with the unique needs of people with disabilities requires a strong focus on user-centered design to ensure that the AAT appropriately addresses the daily life struggles of target users. The CYBATHLON aims to promote this mindset by empowering the AAT target users (“pilots”) to compete on race tracks that represent approximations of daily life obstacles. The objective of this work was to investigate the AAT technology development, usability, and user involvement (i.e., application of user-centered design) in the context of the CYBATHLON. Methods With an online survey targeting the pilots and technical leads of teams preparing for the CYBATHLON 2020 Global Edition, we investigated to what extent the pilots were involved in device development and how this influences the perceived usability of the showcased AAT. Furthermore, the effects of user-centered design variables on the individual race performances were analyzed. Results A total of 81 responses from 35 pilots and 46 technical leads were collected in the two weeks prior to the event. Of all teams partaking in the included disciplines of the CYBATHLON 2020 Global Edition, 81.8% (36 of 44) were included in the study. User-centered design appeared to be a prevalent practice among the teams, as 85.7% of all pilots reported a certain level of involvement. However, only 25.5% of the pilots reported daily life usage, despite QUEST usability scores of both respondent groups showing moderate to high satisfaction with the respected AAT across all investigated disciplines. An explorative linear mixed model indicated that daily life usage (p < 0.05) and prolonged user involvement (e.g., more than 2 years, p < 0.001) have a significant positive effect on the race performance at the competition. Conclusions We conclude that the CYBATHLON positively fulfills its conceptual goals of promoting active participation and inclusion of people with disabilities in the design and evaluation of AAT, thereby stimulating the development of promising novel technological solutions. Also, our data could underline the value of the competition as a benchmark, highlighting remaining usability limitations or technology adoption hurdles.
Test-retest reliability of fMRI experiments during robot-assisted active and passive stepping
Jaeger, Lukas; Marchal-Crespo, Laura; Wolf, Peter; et al. (2015)
Journal of NeuroEngineering and Rehabilitation
Background Brain activity has been shown to undergo cortical and sub-cortical functional reorganisation over the course of gait rehabilitation in patients suffering from a spinal cord injury or a stroke. These changes however, have not been completely elucidated by neuroimaging to date, mainly due to the scarcity of long-term, follow-up investigations. The magnetic resonance imaging (MRI) compatible stepper MARCOS was specifically developed to enable the investigation of the supraspinal adaptations in paretic patients undergoing gait-rehabilitation in a controlled and repeatable manner. In view of future clinical research, the present study aims at examining the test-retest reliability of functional MRI (fMRI) experiments using MARCOS. Methods The effect of repeated active and passive stepping movements on brain activity was investigated in 16 healthy participants from fMRI data collected in two separate imaging sessions six weeks apart. Root mean square errors (RMSE) were calculated for the metrics of motor performance. Regional overlap of brain activation between sessions, as well as an intra-class correlation coefficient (ICC) was computed from the single-subject and group activation maps for five regions of interest (ROI). Results Data from eight participants had to be excluded due to excessive head motion. Reliability of motor performance was higher during passive than active movements, as seen in 4.5- to 13-fold lower RMSE for passive movements. In contrast, ICC ranged from 0.48 to 0.72 during passive movements and from 0.77 to 0.85 during active movements. Regional overlap of activations was also higher during active than during passive movements. Conclusion These findings imply that an increased variability of motor performance during active movements of healthy participants may be associated with a stable neuronal activation pattern across repeated measurements. In contrast, a stable motor performance during passive movements may be accompanied by a confined reliability of brain activation across repeated measurements.
The FreeD module for the Lokomat facilitates a physiological movement pattern in healthy people – a proof of concept study
Aurich-Schuler, Tabea; Gut, Anja; Labruyere, Rob (2019)
Journal of NeuroEngineering and Rehabilitation
Background A contralateral pelvic drop, a transverse rotation and a lateral translation of the pelvis are essential features of normal human gait. These motions are often restricted in robot-assisted gait devices. The optional FreeD module of the driven gait orthosis Lokomat (Hocoma AG, Switzerland) incorporates guided lateral translation and transverse rotation of the pelvis. It consequently should support weight shifting during walking. This study aimed to investigate the influence of the FreeD module on trunk kinematics and hip and trunk muscle activity. Methods Thirty- one healthy adults participated. A video analysis of their trunk movements was performed to investigate the lateral chest and pelvis displacement within the Lokomat (with and without FreeD), and this was compared to treadmill walking. Furthermore, surface electromyography (sEMG) signals from eight muscles were collected during walking in the Lokomat (with and without FreeD), on the treadmill, and overground. To compare the similarity of the sEMG patterns, Spearman’s correlation analyses were applied. Results Walking with FreeD elicited a significantly higher lateral pelvis displacement and a lower lateral chest displacement (relative to the pelvis) compared to walking with a fixated pelvis. No significant differences in the sEMG patterns were found for the Lokomat conditions (with and without FreeD) when comparing it to treadmill or overground walking. Conclusions The differences in pelvis displacement act as a proof of concept of the FreeD module. The reduction of relative lateral chest movement corresponds to a decrease in compensatory trunk movements and has its origin in allowing weight shifting through the FreeD module. Both Lokomat conditions showed very similar muscle activity patterns of the trunk and hip compared to overground and treadmill walking. This indicates that the Lokomat allows a physiological muscle activity of the trunk and hip during gait.
Sensitivity to temporal parameters of intraneural tactile sensory feedback
Valle, Giacomo; Strauss, Ivo; D'Anna, Edoardo; et al. (2020)
Journal of NeuroEngineering and Rehabilitation
Background Recent studies have shown that neural stimulation can be used to provide artificial sensory feedback to amputees eliciting sensations referred on the amputated hand. The temporal properties of the neural stimulation modulate aspects of evoked sensations that can be exploited in a bidirectional hand prosthesis. Methods We previously collected evidence that the derivative of the amplitude of the stimulation (intra-digit temporal dynamics) allows subjects to recognize object compliance and that the time delay among stimuli injected through electrodes implanted in different nerves (inter-digit temporal distance) allows to recognize object shapes. Nevertheless, a detailed characterization of the subjects’ sensitivity to variations of intra-digit temporal dynamic and inter-digit temporal distance of the intraneural tactile feedback has not been executed. An exhaustive understanding of the overall potentials and limits of intraneural stimulation to deliver sensory feedback is of paramount importance to bring this approach closer and closer to the natural situation. To this aim, here we asked two trans-radial amputees to identify stimuli with different temporal characteristics delivered to the same active site (intra-digit temporal Dynamic Recognition (DR)) or between two active sites (inter-digit Temporal distance Recognition (TR)). Finally, we compared the results achieved for (simulated) TR with conceptually similar experiments with real objects with one subject. Results We found that the subjects were able to identify stimuli with temporal differences (perceptual thresholds) larger than 0.25 s for DR and larger than 0.125 s for TR, respectively. Moreover, we also found no statistically significant differences when the subjects were asked to identify three objects during simulated ‘open-loop’ TR experiments or real ‘closed-loop’ tests while controlling robotic hand. Conclusions This study is a new step towards a more detailed analysis of the overall potentials and limits of intraneural sensory feedback. A full characterization is necessary to develop more advanced prostheses capable of restoring all lost functions and of being perceived more as a natural limb by users.

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Journal: Journal of NeuroEngineering and Rehabilitation

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