A robotic system to train activities of daily living in a virtual environment

In the past decade, several arm rehabilitation robots have been developed to assist neurological patients during therapy. Early devices were limited in their number of degrees of freedom and range of motion, whereas newer robots such as the ARMin robot can support the entire arm. Often, these devices are combined with virtual environments to integrate motivating game-like scenarios. Several studies have shown a positive effect of game-playing on therapy outcome by increasing motivation. In addition, we assume that practicing highly functional movements can further enhance therapy outcome by facilitating the transfer of motor abilities acquired in therapy to daily life. Therefore, we present a rehabilitation system that enables the training of activities of daily living (ADL) with the support of an assistive robot. Important ADL tasks have been identified and implemented in a virtual environment. A patient-cooperative control strategy with adaptable freedom in timing and space was developed to assist the patient during the task. The technical feasibility and usability of the system was evaluated with seven healthy subjects and three chronic stroke patients.     

Encoding of movement dynamics by Purkinje cell simple spike activity during fast arm movements under resistive and assistive force fields

It is controversial whether simple-spike activity of cerebellar Purkinje cells during arm movements encodes movement kinematics like velocity or dynamics like muscle activities. To examine this issue, we trained monkeys to flex or extend the elbow by 45 degrees in 400 ms under resistive and assistive force fields but without altering kinematics. During the task movements after training, simple-spike discharges were recorded in the intermediate part of the cerebellum in lobules V-VI, and electromyographic activity was recorded from arm muscles. Velocity profiles (kinematics) in the two force fields were almost identical to each other, whereas not only the electromyographic activities (dynamics) but also simple-spike activities in many Purkinje cells differed distinctly depending on the type of force field. Simple-spike activities encoded much larger mutual information with the type of force field than that with the residual small difference in the height of peak velocity. The difference in simple-spike activities averaged over the recorded Purkinje-cells increased approximately 40 ms before the appearance of the difference in electromyographic activities between the two force fields, suggesting that the difference of simple-spike activities could be the origin of the difference of muscle activities. Simple-spike activity of many Purkinje cells correlated with electromyographic activity with a lead of approximately 80 ms, and these neurons had little overlap with another group of neurons the simple-spike activity of which correlated with velocity profiles. These results show that simple-spike activity of at least a group of Purkinje cells in the intermediate part of cerebellar lobules V-VI encodes movement dynamics.     

Rehabilitation after stroke in older people

Stroke is a leading cause of disability and therefore rehabilitation is a major part of patient care. Most interventions do not target aged patient but there is unequivocal evidence to promote rehabilitation in multidisciplinary stroke units or integrated care of a multidisciplinary team in the community. Most research has focused on the effect of interventions on recovery in different forms of impairment and disability. The most promising options for motor recovery of the arm include constraint-induced movement therapy and robotic-assisted strategies. Interventions to improve postural stability and gait include fitness training, high-intensity therapy, and repetitive-task training. However, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice are underway to test these interventions in the elderly, either alone or in combination with early mobilisation, cardiorespiratory fitness training and physical exercise.     

Robotic guidance benefits the learning of dynamic, but not of spatial movement characteristics

Robotic guidance is an engineered form of haptic-guidance training and intended to enhance motor learning in rehabilitation, surgery, and sports. However, its benefits (and pitfalls) are still debated. Here, we investigate the effects of different presentation modes on the reproduction of a spatiotemporal movement pattern. In three different groups of participants, the movement was demonstrated in three different modalities, namely visual, haptic, and visuo-haptic. After demonstration, participants had to reproduce the movement in two alternating recall conditions: haptic and visuo-haptic. Performance of the three groups during recall was compared with regard to spatial and dynamic movement characteristics. After haptic presentation, participants showed superior dynamic accuracy, whereas after visual presentation, participants performed better with regard to spatial accuracy. Added visual feedback during recall always led to enhanced performance, independent of the movement characteristic and the presentation modality. These findings substantiate the different benefits of different presentation modes for different movement characteristics. In particular, robotic guidance is beneficial for the learning of dynamic, but not of spatial movement characteristics.     

Neural coupling between the upper and lower limbs in humans

The aim of this study was to establish the effects of active sinusoidal ipsilateral and contralateral upper limb flexion, extension, abduction, and adduction with elbows extended on the right soleus H-reflex with subjects seated and standing. Reflex effects were also established when both arms moved synchronously in a reciprocal pattern with elbows flexed in seated and standing subjects. Sinusoidal arm movements were timed to a metronome and performed at 0.2 Hz. Soleus H-reflexes were elicited only once (every 4s) in every movement cycle of the upper limbs. Position of arms, and activity of shoulder muscles were recorded through twin-axis goniometers and surface electromyography (EMG), respectively. We found that in seated subjects, regardless the direction of the active movement or the upper limb being moved, the soleus H-reflex was depressed. In standing subjects, a reflex depression was observed during extension, abduction, and adduction of the ipsilateral and contralateral upper limbs. Muscles were active during arm flexion and abduction in all directions of arm movement with subjects either seated or standing. It is suggested that arm movement might be incorporated in the rehabilitation training of people with a supraspinal or spinal cord lesion, since it can benefit motor recovery by decreasing spinal reflex excitability of the legs in these patients.     

Comparison of error-amplification and haptic-guidance training techniques for learning of a timing-based motor task by healthy individuals

Performance errors drive motor learning for many tasks. Some researchers have suggested that reducing performance errors with haptic guidance can benefit learning by demonstrating correct movements, while others have suggested that artificially increasing errors will force faster and more complete learning. This study compared the effect of these two techniques—haptic guidance and error amplification—as healthy subjects learned to play a computerized pinball-like game. The game required learning to press a button using wrist movement at the correct time to make a flipper hit a falling ball to a randomly positioned target. Errors were decreased or increased using a robotic device that retarded or accelerated wrist movement, based on sensed movement initiation timing errors. After training with either error amplification or haptic guidance, subjects significantly reduced their timing errors and generalized learning to untrained targets. However, for a subset of more skilled subjects, training with amplified errors produced significantly greater learning than training with the reduced errors associated with haptic guidance, while for a subset of less skilled subjects, training with haptic guidance seemed to benefit learning more. These results suggest that both techniques help enhanced performance of a timing task, but learning is optimized if training subjects with the appropriate technique based on their baseline skill level.     

Arm movement maps evoked by cortical magnetic stimulation in a robotic environment

Many neurological diseases result in a severe inability to reach for which there is no proven therapy. Promising new interventions to address reaching rehabilitation using robotic training devices are currently under investigation in clinical trials but the neural mechanisms that underlie these interventions are not understood. Transcranial magnetic stimulation (TMS) may be used to probe such mechanisms quickly and non-invasively, by mapping muscle and movement representations in the primary motor cortex (M1). Here we investigate movement maps in healthy young subjects at rest using TMS in the robotic environment, with the goal of determining the range of TMS accessible movements, as a starting point for the study of cortical plasticity in combination with robotic therapy. We systematically stimulated the left motor cortex of 14 normal volunteers while the right hand and forearm rested in the cradle of a two degree-of-freedom planar rehabilitation robot (IMT). Maps were created by applying 10 stimuli at each of nine locations (3×3 cm² grid) centered on the M1 movement hotspot for each subject, defined as the stimulation location that elicited robot cradle movements of the greatest distance. TMS-evoked movement kinematics were measured by the robotic encoders and ranged in magnitude from 0 to 3 cm. Movement maps varied by subject and by location within a subject. However, movements were very consistent within a single stimulation location for a given subject. Movement vectors remained relatively constant (limited to <90° section of the planar field) within some subjects across the entire map, while others covered a wider range of directions. This may be due to individual differences in cortical physiology or anatomy, resulting in a practical limit to the areas that are TMS-accessible. This study provides a baseline inventory of possible TMS-evoked arm movements in the robotic reaching trainer, and thus may provide a real-time, non-invasive platform for neurophysiology based evaluation and therapy in motor rehabilitation settings.     

Postoperative haptic training facilitates the retrieval of visual-based memories after visual cortex lesions in rats

Two experiments examined the effects of postoperative haptic discrimination training on the relearning of a maze visual discrimination in rats with visual cortex lesions. In the first experiment, rats learned a visual intensity discrimination prior to ablation of the lateral Oc2L cortex. Lesion rats were exposed to either a rough/smooth haptic discrimination training condition, a random training condition, or a no-training condition prior to relearning the visual task. Lesion rats relearned the visual task faster after haptic training than after other postoperative experiences. The second experiment replicated these procedures but with rats in which most of the visual cortex was removed. The lesion-induced relearning deficits in the second experiment were similar to the deficits seen for the smaller Oc2L lesions in the first experiment, supporting the hypothesis that the lateral visual cortex is critical for intensity discrimination. Haptic training also reduced these deficits, but the magnitude of this effect was related to the characteristics of the haptic cue. Postoperative training with haptic cues can produce specific and nonspecific information transfer from the intact somatosensory system to the damaged visual system that can facilitate the visual relearning. Possible implications for neuropsychological rehabilitation are also discussed.     

俯卧式脊柱康复训练仪运动学建模与分析

为了改善现有脊柱康复训练设备的功能单一、结构复杂、训练模式不合理的现状。本研究通过对人体爬行运动进行建模,实现新型智能脊柱康复训练仪的设计。用Denavit-Hartenberg法对爬行训练仪进行运动学建模,得到其正逆运动学方程。使用MATLAB建模软件在预设康复轨迹下进行运动学仿真实验,对运动学求解进行验证。实验结果表明,脊柱康复训练仪能在预定轨迹下按爬行训练的要求运动,验证了脊柱康复训练仪结构设计的合理性。同时,由机械把手位置信息通过逆运动学方程计算得到的各关节的角度误差最大不大于3°,验证了所得运动学方程的有效性。     

基于爬行运动的脊柱康复训练仪的设计

设计出一款多态脊柱康复爬行训练仪。该爬行仪可实现被动形式下的跪撑爬行、攀高爬行、俯式爬行、扭腰摆动等多种爬行训练模式。爬行运动对脊柱有很好的锻炼效果,根据爬行运动设计要实现的动作,利用Solid Works对训练仪整体结构进行三维建模,对训练仪进行运动学和动力学的理论分析,并结合Solid Works Motion进行运动学和动力学仿真。最后通过有限元分析软件ANSYS Workbench对主要受力部件进行静力学分析。通过运动仿真,三维模型可以实现各种预定的运动模式,而且对关键部件进行的强度校核满足强度要求。该训练仪运动模式多样且结构设计合理,选材强度合适,具有一定的可行性。     

反馈技术在运动功能康复治疗中的应用

反馈是执行运动功能过程中的非常重要的信息交换模式，它以体感信息、触觉信息、视觉信息、听觉信息等方式将运动过程的信息传送到中枢神经，调控运动功能执行的时间和空间精度。本文从反馈的作用原理、技术方法和治疗效果等方面，分析和综述了肌电信号反馈、机器人辅助运动康复训练、高级认知过程反馈及三维虚拟技术等几种反馈技术对运动功能康复治疗的作用。     

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。     

髌股疼痛综合征下肢动作模式特征与康复治疗研究进展

髌股疼痛综合征(patellofemoral pain syndrome, PFPS)因其高发病率、低治愈率的现状已在康复治疗领域获得越来越多的关注。研究发现,PFPS患者解剖学异常、疼痛因素导致肌肉活动改变与肌力不足会引起下肢关节产生错误动作模式,这种错误的动作模式会导致病情加重,不利于患者康复。通过运动疗法、贴扎、神经肌肉训练以及关节矫形器可以改善髋、膝、踝动作模式,减轻PFPS的疼痛。对PFPS患者患病后动作模式特征以及相应康复治疗方法进行总结,为PFPS的康复提供参考。     

运动想象结合作业疗法在脑卒中患者康复训练中的研究进展

运动想象(MI)与作业疗法(OT)作为传统的康复治疗手段,已经广泛应用于脑卒中患者的临床康复治疗中。首先简要阐述OT以及MI在脑卒中康复训练中的基本原理,并具体评述OT以及MI针对运动功能、认知功能等不同功能障碍在脑卒中康复临床应用的相关研究进展。其中,MI疗法具有简单易行、成本低廉、可充分调动患者主观能动性等优点,但存在形式单一、过程不易把控等不足,而OT实验范式简单且具有固定模式指导,动作众多且贴合日常生活,其能够为MI增添情景化、任务化的训练模式。最后综述MI结合OT在脑卒中康复训练中的研究进展,研究表明MI与OT结合能够发挥二者优势,有望进一步提升患者康复进程,未来将面向训练方式、神经机制及系统分类性能等层面不断优化和完善。     

老年髋部骨折患者术后功能恢复的长期强化家庭康复训练

文题释义： 家庭康复训练：主要由主管医师、康复医师、康复治疗师及护理人员指导康复训练,主管医师与康复医师共同评估病情并制定康复训练计划,康复治疗师指导训练内容,护理人员协助加强患者管理。出院时向患者及家属发放康复手册,通过文字及视频内容指导患者院外进行长期强化家庭康复训练。每周通过移动电话、网络工具对患者及家属进行线上随访,要求家属定期录制患者康复的视频,并根据实际状态及时调整康复训练处方。建立网络线上交流群,将患者纳入该群,及时向患者解答康复过程中的疑问,防止康复训练不足及康复过度等情况。 日常生活能力量表(Activity of DailyLiving Scale,ADL)：由美国的Lawton和Brody制定于1969年。由躯体生活自理量表(PSMS)和工具性日常生活能力量表组成。共有14项：一是躯体生活自理量表,共6项,包括上厕所、进食、穿衣、梳洗、行走和洗澡;二是工具性日常生活能力量表,共8项,包括打电话、购物、备餐、做家务、洗衣、使用交通工具、服药和自理经济。主要用于评定被试者的日常生活能力。 背景：老年髋部骨折患者术后存在极高的功能致残率,传统康复更多地关注患者住院期间的康复,而忽视院外家庭康复训练。6个月的强化家庭康复训练已被证实为一种确实有效的方法,但更长时间的家庭训练仍有待进一步研究。 目的：探究进行长期强化家庭康复训练法对老年髋部骨折患者术后功能恢复情况的影响。 方法：前瞻性纳入接受手术治疗的老年髋部骨折患者89例,采用随机数字表法分为试验组42例和对照组47例。对照组采用传统康复训练方法,试验组采用长期强化家庭康复训练法,指导功能锻炼并进行规律随访,利用网络工具及时调整康复计划。2组患者均规律随访12个月,分别在术后3,6,12个月进行日常生活能力评分、6分钟步行试验、髋关节Harris评分、功能独立性测量量表评分、SF-36评分,评估患者术后功能改善情况。研究方案的实施符合成都市第六人民医院的相关伦理要求,参与试验的患病个体对试验过程完全知情同意。 结果与结论：①2组患者术后功能逐渐恢复,试验组患者术后3,6,12个月的日常生活能力评分、功能独立性测量量表评分、6分钟步行试验、Harris评分及SF-36评分均优于对照组(P < 0.05);②结果说明,老年髋部骨折患者术后长期强化家庭康复训练法可提高患者日常生活能力,改善患者生活质量,但该康复计划及其疗效仍需要进一步研究。 ORCID: 0000-0002-0570-9065(王可心) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

我国烧伤康复的现状与展望

本文回顾我国烧伤康复的发展历程,理解烧伤康复的现状,分析制约康复治疗的问题所在。比较我国与国外康复治疗的差距,介绍国内开展康复治疗较好的单位的做法和经验。提出了预防为主的康复理念,康复治疗不是始自瘢痕增生后,而是从入院便开始,在烧伤治疗的全过程始终贯穿康复的综合疗法,包括体位摆放、体疗按摩、主动与被动锻炼、加压疗法、瘢痕内注射、可塑夹板、浸浴疗法、涂擦外用药、皮肤护理、心理疏导等,都对减轻瘢痕增生和改善功能发挥了重要作用。近年来我国的烧伤康复取得了明显进展,展望未来仍然任重道远,需要所有医务工作人员为烧伤康复医学的发展继续奋斗。     

Current concepts in the management of patellofemoral pain — The role of alignment

BackgroundPatellofemoral pain is a prevalent and significant clinical problem that is often reported to persist even following evidence based intervention. It is clear therefore that there is much about this complex patient group that is not presently fully understood. This is particularly concerning given the reported links between patellofemoral pain in adolescence and the subsequent development of osteoarthritis and anxiety.AssessmentClinical assessment has historically focussed on biomechanical factors such as altered lower limb kinematics, muscle weakness and late muscle ‘onset or activation’ during activity. However when examined it is clear that study findings from patellofemoral populations are often inconsistent. Reasons for this are discussed and specifically the limitations around current ‘gold standard’ measurement methods, such as motion capture are outlined. A biomechanical approach is applied to demonstrate the importance of ensuring optimal patient alignment during rehabilitation, where optimal is defined as ensuring the most energy efficient muscle or muscles are used by the patient to perform a movement. This in turn ensures that the direction, magnitude and location of load applied to the skeleton during activity is optimal and therefore less likely to lead to injury.TreatmentThe role of alignment in patellofemoral pain and the importance of correcting this during rehabilitation is discussed, and examples provided. Validated, reliable, and reproducible methods of measuring skeletal geometry, muscle geometry, muscle force and direction, and kinematics of activity must be developed as a priority in order for us to further our understanding and improve outcomes in this complex clinical population.     

Functional MRI using robotic MRI compatible devices for monitoring rehabilitation from chronic stroke in the molecular medicine era (Review)

The number of individuals suffering from stroke is increasing daily, and its consequences are a major contributor to invalidity in today's society. Stroke rehabilitation is relatively new, having been hampered from the longstanding view that lost functions were not recoverable. Nowadays, robotic devices, which aid by stimulating brain plasticity, can assist in restoring movement compromised by stroke-induced pathological changes in the brain which can be monitored by MRI. Multiparametric magnetic resonance imaging (MRI) of stroke patients participating in a training program with a novel Magnetic Resonance Compatible Hand-Induced Robotic Device (MR_CHIROD) could yield a promising biomarker that, ultimately, will enhance our ability to advance hand motor recovery following chronic stroke. Using state-of-the art MRI in conjunction with MR_CHIROD-assisted therapy can provide novel biomarkers for stroke patient rehabilitation extracted by a meta-analysis of data. Successful completion of such studies may provide a ground breaking method for the future evaluation of stroke rehabilitation therapies. Their results will attest to the effectiveness of using MR-compatible hand devices with MRI to provide accurate monitoring during rehabilitative therapy. Furthermore, such results may identify biomarkers of brain plasticity that can be monitored during stroke patient rehabilitation. The potential benefit for chronic stroke patients is that rehabilitation may become possible for a longer period of time after stroke than previously thought, unveiling motor skill improvements possible even after six months due to retained brain plasticity.     

Hand-eye coordination for rapid pointing movements. Arm movement direction and distance are specified prior to saccade onset

Visually guided arm movements such as reaching or pointing are accompanied by saccadic eye movements that typically begin prior to motion of the arm. In the past, some degree of coupling between the oculomotor and limb motor systems has been demonstrated by assessing the relative onset times of eye and arm movement, and by the demonstration of a gap effect for arm movement reaction times. However, measures of limb movement onset time based on kinematics are affected by factors such as the relatively high inertia of the limb and neuromechanical delays. The goal of the present study was thus to assess the relative timing of rapid eye and arm movements made to visual targets by examining electromyographic (EMG) activity of limb muscles in conjunction with eye and arm position measures. The observation of a positive correlation between eye and limb EMG onset latencies, and the presence of a gap effect for limb EMG onset times (a reduction in reaction time when a temporal gap is introduced between the disappearance of a central fixation point and the appearance of a new target) both support the idea that eye and arm movement initiation are linked. However, limb EMG onset in most cases precedes saccade onset, and the magnitude of EMG activity prior to eye movement is correlated with both the direction and amplitude of the upcoming arm movement. This suggests that, for the rapid movements studied here, arm movement direction and distance are specified prior to the onset of saccades.     

The effect of cortico-spinal tract damage on primary sensorimotor cortex activation after rehabilitation therapy

Recently, it was shown that patients have different functional activation patterns within affected primary sensorimotor cortex (SMC) after intensive rehabilitation therapy. This individual difference was supposed to depend on the integrity of the cortico-spinal fibres from the primary motor cortex. In this study, we considered whether patients with different fMRI activation patterns after intensive rehabilitation therapy suffered from different cortico-spinal fibre lesions. To comprehend this circumstance a lesion subtraction analysis was used. To verify these results with the use of transcranial magnetic stimulation motor evoked potentials was also derived. Patients were treated after a modified version of constraint-induced movement therapy (modCIMT; 3 h daily for 4 weeks). Increased and decreased SMC activation showed similar individual patterns as described previously. These activation differences depend on the integrity of the cortico-spinal tract, which was measured via lesion subtraction analysis between patient groups, and was supported by affected motor evoked potentials.