基于多传感器信息的新型穿戴式上肢外骨骼康复机器人

目的 设计基于多传感器信息的新型穿戴式上肢外骨骼康复机器人,以解决上肢外骨骼康复机器人便携性不佳、患者参与度较低、训练模式自适应不足等问题,并探究受试者穿戴外骨骼时肌肉激活程度、肌电信号预测关节角度的准确性以及实现上肢康复训练的可行性.方法 该设备机械结构包括肘关节和腕关节,采用模块化设计并结合3D打印技术;控制系统包括肌电采集、应力采集、姿态采集等单元,并设计主动、被动和助动三种训练模式.受试者穿戴外骨骼机器人后进行屈-伸肘实验,对比有、无辅助力时手臂肌肉激活程度;分析肘关节角度,并对比肌电信号预测的关节运动角度;验证机器人运行性能与应力检测效果.结果 受试者穿戴外骨骼康复机器人安全可靠地完成了屈-伸肘动作,受试者肱二头肌、肱三头肌肌肉激活程度在有、无辅助力时分别减弱约32％、11％,肌电信号预测关节角度准确度约95％,应力测量值误差均低于5％.结论 上肢外骨骼机器人可以给人体提供辅助力、预测关节角度,机器人通过肌电、应力以及位置信息辅助患者实现上肢康复训练具有可行性.     

基于PCI-1240运动控制卡的肢体康复训练控制系统的实现与软件设计EI北大核心CSCD

本研究开发了一种基于坐姿的下肢康复运动控制系统,该系统包括下肢外骨骼机构、电机驱动控制电路、运动控制程序等。通过6个电机为髋、膝、踝关节转动提供动力,采用PCI-1240运动控制卡作为控制核心,实现了下肢各关节重复性转动训练和步态康复训练的速度、角度和运动时间的精确控制和调节。本文试验结果表明,该运动控制系统能很好地满足下肢功能障碍患者重复性康复训练运动的需求。本文为康复训练机器人中运动控制系统提供了更多的方法数据,可促进工业自动化设备向医疗领域转变,有利于康复机器人的更进一步研究。     

具备力传感监测的上肢外骨骼康复系统的设计与实现

目的 近年来,外骨骼机器人正逐渐走入临床康复实践,自由度、运动模式和力反馈评价是影响外骨骼机器人康复效果的重要因素,实验设计并实现了多抗阻训练模式的上肢外骨骼康复系统,该系统具备6个自由度并可全程跟踪用户与外骨骼间的接触力。方法 通过人体上肢运动学分析,对上肢外骨骼康复系统的关节和自由度进行设计,主要由配重箱体、升降台、横梁、外骨骼机械臂组成;考虑不同体型患者要求,配置可调节长度导轨;硬件系统采用主控板、节点板的分层控制方法;软件系统使用模块化设计。在上肢外骨骼康复系统与人体接触处设置多个三维力传感器。使用角度和力传感器对上肢外骨骼康复系统的运动角度空间、疲劳测试下控制稳定度及主、被动模式下的接触力分布进行分析。最终征募17例受试者进行肩关节的伸展运动,采集不同阻抗等级下的力传感器数据,并进行主观体验问卷调查。结果 上肢外骨骼康复系统工作空间角度幅值与设计要求相同,误差小于5%;连续工作4 h情况下,运动角速度变化率不超过1%。主动运动模式下,17例受试者人机接触力男性测量值（23.63±5.26） N,女性（21.54±5.16） N;人机接触力较小,其中15例受试者给出了舒适度较高...     

基于PCI-1240运动控制卡的肢体康复训练控制系统的实现与软件设计

本研究开发了一种基于坐姿的下肢康复运动控制系统,该系统包括下肢外骨骼机构、电机驱动控制电路、运动控制程序等。通过6个电机为髋、膝、踝关节转动提供动力,采用PCI-1240运动控制卡作为控制核心,实现了下肢各关节重复性转动训练和步态康复训练的速度、角度和运动时间的精确控制和调节。本文试验结果表明,该运动控制系统能很好地满足下肢功能障碍患者重复性康复训练运动的需求。本文为康复训练机器人中运动控制系统提供了更多的方法数据,可促进工业自动化设备向医疗领域转变,有利于康复机器人的更进一步研究。     

功能电刺激腕关节运动的自适应控制技术研究

针对功能电刺激(FES)康复技术中肌肉的时变和高度非线性的特点,提出一种实时调整FES系统输出,实现康复患者自适应训练的方法。考虑到患者间和康复各阶段肌肉对电刺激响应能力的差异,利用神经网络良好的非线性逼近能力,采用神经网络辨识器辨识相关运动肌肉的FES模型,并在此基础上,利用神经网络控制器在线调节控制策略及刺激参数,提高FES系统的自适应能力。通过人体腕关节运动控制的FES实验,验证该方法具有较高的轨迹跟踪控制精度和较强的自适应能力。     

基于交互力模糊识别的上肢康复机器人模式调整控制策略研究

在上肢康复机器人辅助训练过程中,对于软瘫期脑卒中患者通常采用被动训练策略。为了激发患者的主动康复意愿,对于逐渐具备主动发力能力的患者,康复治疗师会采用机器人助动训练策略。本文针对末端牵引式上肢康复机器人,提出一种基于交互力模糊判别的人体上肢运动功能评估方法以及按需辅助的人机交互控制策略。首先设计了基于计算力矩控制器的被动训练和结合势能场的助动训练模式,然后将训练过程中三维力传感器采集的交互力信息引入至模糊推理系统中,提出了主动参与度σ,并设计相应的辅助策略算法实现两种训练模式的自适应调整。最后通过试验证明了主动参与度σ与表面肌电信号之间的相关性。并且,相较于仅通过交互力大小进行模式调整的控制策略,该方法具有更快的响应速度,使机器人在训练过程中更具安全性。     

下肢外骨骼康复机器人的研究与进展

背景：如何提高脑血管疾病所致中枢神经系统损伤患者的日常活动能力是康复医学亟待解决的问题,而外骨骼康复机器人的发展为解决这一问题提供了可能。 目的：回顾下肢外骨骼康复机器人的研究进展,对下肢外骨骼康复机器人的设计与开发提出新的展望。 方法：由第一作者检索1990/2008 PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)及万方数据库(http://www.wanfangdata.com.cn)有关医用下肢外骨骼康复机器人的文献,英文检索词为“exoskeletons robot,central nerve damage,passive rehabilitation training,the man-machine integration interaction interface”,中文检索词为“外骨骼机器人,中枢神经损伤,主被动康复训练,人机一体化交互接口”。排除重复性研究。 结果与结论：共纳入26篇文献归纳总结。外骨骼康复机器人研究报道较多,但如能解决体积小、轻便、低功耗、大功率输出等问题,同时具有响应快、低惯性、高精度和高安全性等性能,必将使神经损伤患者下肢功能最大化地恢复成为可能。     

下肢外骨骼康复机器人在膝关节活动受限康复治疗中的应用*

背景：下肢外骨骼康复机器人以持续主被动活动联合为理论基础,通过模拟人体运动,刺激机体的自然复原力,发挥组织代偿作用。 目的：动态观察并了解下肢外骨骼康复机器人在膝关节活动受限患者功能锻炼中的康复作用。 方法：将20例术后早期膝关节活动受限患者随机等分为实验组与对照组,实验组采用下肢外骨骼康复机器人行肢体功能锻炼,对照组采用被动训练装置CPM机行功能锻炼,治疗间隙2组均采用心理疏导、低频脉冲电疗和红外线等物理治疗。 结果与结论：治疗2个月后,实验组与对照组患者膝关节后屈、前伸活动度均较治疗前明显改善(P < 0.01),同时实验组股四头肌肌力较治疗前明显改善(P < 0.01)。2个月后的后续治疗,实验组患者膝关节后屈、前伸活动度有了进一步的改善(P < 0.05),对照组上述指标无明显改善。说明早期采用下肢外骨骼康复机器人或CPM机配合心理疏导、低频脉冲电疗和红外线等治疗均能明显提高膝关节活动受限患者膝关节活动度,同时下肢外骨骼康复机器人具有恢复患者股四头肌肌力的作用。     

基于实时步态分析的行走辅助外骨骼机器人系统

面向因病痛或自然衰老等原因腿部运动功能受到轻度影响的患者或老年人,本文提出了一种可穿戴外骨骼机器人系统,通过体重支撑的方式减轻双腿在行走过程中对髋、膝、踝关节和腿部肌肉的负载,以实现行走辅助的功能。考虑到使用人群的心理诉求和病症特点,有别于固定式或跟随式康复机器人上配有的减重系统,本文提出的外骨骼机器人结构美观,轻巧便携。系统通过足底压力传感器实时对使用者的步态进行分析,通过步态相的划分,针对各步态相提出不同的控制策略。通过座椅上的压力传感器实时监测外骨骼提供支撑力度的大小,且驱动控制使用比例-积分-微分(PID)控制技术进行力矩控制。机器人系统总重12.5 kg,站立时平均辅助支撑约10 kg,行走中平均辅助支撑约3 kg,起到了一定的体重支撑效果,减轻了行走和站立时对下肢的压力。     

下肢外骨骼康复机器人关节运动轨迹分析与步态测试研究

本研究针对一款下肢外骨骼康复机器人(lower limb exoskeleton rehabilitation robot,LLERR)进行了关节运动轨迹分析与步态测试研究.分别通过D-H法和拉格朗日法对外骨骼机器人单侧下肢进行运动学和动力学建模分析,得出各运动关节间运动学与动力学关系.通过虚拟样机仿真验证提出的外骨骼...     

Hybrid robotic systems for upper limb rehabilitation after stroke: A review

In recent years the combined use of functional electrical stimulation (FES) and robotic devices, called hybrid robotic rehabilitation systems, has emerged as a promising approach for rehabilitation of lower and upper limb motor functions. This paper presents a review of the state of the art of current hybrid robotic solutions for upper limb rehabilitation after stroke. For this aim, studies have been selected through a search using web databases: IEEE-Xplore, Scopus and PubMed. A total of 10 different hybrid robotic systems were identified, and they are presented in this paper. Selected systems are critically compared considering their technological components and aspects that form part of the hybrid robotic solution, the proposed control strategies that have been implemented, as well as the current technological challenges in this topic. Additionally, we will present and discuss the corresponding evidences on the effectiveness of these hybrid robotic therapies. The review also discusses the future trends in this field.     

Control strategies for effective robot assisted gait rehabilitation: The state of art and future prospects

A large number of gait rehabilitation robots, together with a variety of control strategies, have been developed and evaluated during the last decade. Initially, control strategies applied to rehabilitation robots were adapted from those applied to traditional industrial robots. However, these strategies cannot optimise effectiveness of gait rehabilitation. As a result, researchers have been investigating control strategies tailored for the needs of rehabilitation. Among these control strategies, assisted-as-needed (AAN) control is one of the most popular research topics in this field. AAN training strategies have gained the theoretical and practical evidence based backup from motor learning principles and clinical studies. Various approaches to AAN training have been proposed and investigated by research groups all around the world. This article presents a review on control algorithms of gait rehabilitation robots to summarise related knowledge and investigate potential trends of development.There are existing review papers on control strategies of rehabilitation robots. The review by Marchal-Crespo and Reinkensmeyer (2009) had a broad cover of control strategies of all kinds of rehabilitation robots. Hussain et al. (2011) had specifically focused on treadmill gait training robots and covered a limited number of control implementations on them. This review article encompasses more detailed information on control strategies for robot assisted gait rehabilitation, but is not limited to treadmill based training. It also investigates the potential to further develop assist-as-needed gait training based on assessments of patients’ ability.In this paper, control strategies are generally divided into the trajectory tracking control and AAN control. The review covers these two basic categories, as well as other control algorithm and technologies derived from them, such as biofeedback control. Assessments on human gait ability are also included to investigate how to further develop implementations based on assist-as-needed concept. For the consideration of effectiveness, clinical studies on robotic gait rehabilitation are reviewed and analysed from the viewpoint of control algorithm.     

Cardiac patient teaching: application to patients undergoing coronary angioplasty and their partners

Education is accepted as a key component of cardiac rehabilitation for patients following myocardial infarction and bypass graft surgery. Recently, there has been a call for rehabilitation to be uniformly offered to partners and families of cardiac patients, and for the expanding boundaries of rehabilitation to include patients who undergo coronary angioplasty. This paper aims to highlight patient education strategies for cardiac patients and partners with a focus on assessment of their educational needs. The unique needs of patients undergoing coronary angioplasty and their partners will then be discussed with existing cardiac educational strategies expanded to encompass this group of patients.     

Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation

In cardiac rehabilitation programs, patients learn how to adopt a healthier lifestyle, including regular, strenuous physical activity. Long-term success is only modest despite good intentions. To improve exercise adherence, a 3-group experiment was designed that included innovative psychological interventions. All 3 groups underwent a standard care rehabilitation program. Patients in the 2 treatment groups were instructed not only to produce detailed action plans but also to develop barrier-focused mental strategies. On top of this, in 1 of these groups a weekly diary was kept for 6 weeks to increase a sense of action control. At the end of a standard cardiac rehabilitation program, 240 patients were randomly assigned to these treatment groups plus a standard care control group. Treatments resulted in more physical activity at follow-up and better adherence to recommended levels of exercise intensity. Moreover, self-regulatory skills such as planning and action control were improved by the treatments. Follow-up analyses demonstrated the mediating mechanisms of self-regulatory skills in the process of physical exercise maintenance. Findings imply that interventions targeting self-regulatory skills can enable postrehabilitation patients to reduce behavioral risk factors and facilitate intended lifestyle changes.     

Brain–computer interface technology as a tool to augment plasticity and outcomes for neurological rehabilitation

Brain–computer interfaces (BCIs) are a rehabilitation tool for tetraplegic patients that aim to improve quality of life by augmenting communication, control of the environment, and self-care. The neurobiology of both rehabilitation and BCI control depends upon learning to modify the efficacy of spared neural ensembles that represent movement, sensation and cognition through progressive practice with feedback and reward. To serve patients, BCI systems must become safe, reliable, cosmetically acceptable, quickly mastered with minimal ongoing technical support, and highly accurate even in the face of mental distractions and the uncontrolled environment beyond a laboratory. BCI technologies may raise ethical concerns if their availability affects the decisions of patients who become locked-in with brain stem stroke or amyotrophic lateral sclerosis to be sustained with ventilator support. If BCI technology becomes flexible and affordable, volitional control of cortical signals could be employed for the rehabilitation of motor and cognitive impairments in hemiplegic or paraplegic patients by offering on-line feedback about cortical activity associated with mental practice, motor intention, and other neural recruitment strategies during progressive task-oriented practice. Clinical trials with measures of quality of life will be necessary to demonstrate the value of near-term and future BCI applications.     

Neurorehabilitation with new functional electrical stimulation for hemiparetic upper extremity in stroke patients.

In recent years, our understanding of motor learning, neuroplasticity, and functional recovery after the occurrence of brain lesion has grown significantly. New findings in basic neuroscience have stimulated research in motor rehabilitation. Repeated motor practice and motor activity in a real-world environment have been identified in several prospective studies as favorable for motor recovery in stroke patients. Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following stroke. In this paper, an overview of current research into clinical and therapeutic applications of functional electrical stimulation (FES) is presented. In particular, electromyography (EMG)-initiated electrical muscle stimulation--but not electrical muscle stimulation alone--improves the motor function of the hemiparetic arm and hand. Triggered electrical stimulation is reported to be more effective than untriggered electrical stimulation in facilitating upper extremity motor recovery following stroke. Power-assisted FES induces greater muscle contraction by electrical stimulation in proportion to the voluntary integrated EMG signal picked up, which is regulated by a closed-loop control system. Power-assisted FES and motor point block for antagonist muscles have been applied with good results as a new hybrid FES therapy in an outpatient rehabilitation clinic for patients with stroke. Furthermore, a daily home program therapy with power-assisted FES using new equipment has been able to effectively improve wrist and finger extension and shoulder flexion. Proprioceptive sensory feedback might play an important role in power-assisted FES therapy. Although many physiotherapeutic modalities have been established, conclusive proof of their benefit and physiological models of their effects on neuronal structures and processes are still missing. A multichannel near-infrared spectroscopy study to noninvasively and dynamically measure hemoglobin levels in the brain during functional activity has shown that cerebral blood flow in the sensory-motor cortex on the injured side is higher during a power-assisted FES session than during simple active movement or simple electrical stimulation. Nevertheless, evidence-based strategies for motor rehabilitation are more easily available, particularly for patients with hemiparesis.     

Psychiatric rehabilitation and staff development: Educational and organizational models

Despite their demonstrated success in several research studies, the social learning strategies that comprise psychiatric rehabilitation have not been widely used to care for severely mentally ill patients in real-world settings. One way this deficiency has been addressed is by educating staff on how to use these strategies. Staff members who participate in educational approaches to staff development — based on principles of operant and vicarious learning — quickly acquire the rehabilitation skills and are able to perform them competently. However, follow-up research suggests that organizational barriers impede the subsequent introduction and maintenance of newly acquired skills at the home program. Organizational development strategies attempt to overcome barriers like staff burnout and insufficient collegial support by helping the line-level treatment team develop a user-friendly rehabilitation program that meets the team's perceptions of appropriate intervention. The purpose of this review is to compare and contrast the educational and organizational models of staff development. This comparison will outline directions for future efforts at developing effective rehabilitation programs.     

早期康复护理干预与急性脑梗塞患者NIHSS评分及C反应蛋白的关系

目的 探讨早期康复护理和脑卒中患者神经功能NIHSS评分以及C反应蛋白的关系.方法 选取2012年1月至2014年12月在我院住院的急性脑梗死患者150例,包括73例男性和77例女性.随机分为早期康复护理干预组和对照组.早期康复护理组和对照组均接受神经内科常规治疗及常规护理.康复护理组除接受神经内科常规治疗及常规护理外,再分阶段由神经科医师、康复医师和护士进行早期康复护理,分别于治疗前、治疗第14天和第30天对患者的神经功能缺损程度采用NIHSS评分及C反应蛋白含量的测定.结果 与对照组相比较,康复护理组干预前两者NIHSS评分无统计学差异(P＞0.05),康复护理组第14天和第30天NIHSS评分均显著降低(P＜0.05).且对照组和康复护理组两组第14天和第30天与干预前比较,均显著降低(P＜0.05).与对照组相比较,康复护理组干预前两者C反应蛋白含量无统计学差异(P＞0.05),康复护理组第14天和第30天C反应蛋白含量均显著降低(P＜0.05).且对照组和康复护理组两组第14天和第30天与干预前比较,均显著降低(P＜0.05).结论 早期康复护理可显著降低急性脑梗死患者NIHSS评分及C反应蛋白的含量,为急性脑梗死患者的临床护理提供理论依据.     

Autoimmune diseases and rehabilitation

This review gives an overview of the rehabilitation of autoimmune diseases. After general remarks on rehabilitation, the effects of acute and chronic exercises on inflammatory markers are summarized. Most of the available literature deals with rheumatoid arthritis (RA) and multiple sclerosis (MS), and therefore, rehabilitation of these diseases is described in more detail. Exercise is the main component in the rehabilitation of patients with RA and aims at increasing physical capacity, muscle strength, aerobic endurance, cardiovascular fitness and functional abilities, and helps to prevent secondary deconditioning due to reduced activity levels. Since MS causes a wide range of symptoms, the rehabilitation of these patients requires a multidisciplinary approach and encompasses physiotherapy, exercise therapy, hippotherapy, cognitive rehabilitation, psychological therapy, strategies to improve fatigue and coping programs. The ultimate goal of rehabilitation is to enable patients with chronic conditions to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels, and to attain independence and self-determination as far as possible.     

Rehearsal strategy use in Alzheimer's disease

Memory strategy usage and awareness of memory performance are both crucial for memory rehabilitation. We explored Alzheimer's patients' ability to apply and control learning strategies and also their ability to predict the effect of these strategies on subsequent performance. In a rehearsal condition, participants were explicitly asked to overtly rehearse words and were given as long as they liked at study. In a control condition, participants read the words passively at a fixed presentation rate. In all groups, recall was superior in the rehearsal condition than in the reading condition. Alzheimer's patients showed different strategy usage. Overall, people with Alzheimer's disease spend longer studying to-be-remembered words under unpaced conditions, but they do not use this time to rehearse to the same extent as controls. We hypothesize that this failure to rehearse could be based on the inability to use effortful executive mechanisms involved during study.