Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study

Journal of NeuroEngineering and Rehabilitation, Oct 2017

Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients’ reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system. Retrospective trial registration in ISRCTN Register with study ID ISRCTN12843006 .

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Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study

Resquín et al. Journal of NeuroEngineering and Rehabilitation Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study F. Resquín 0 J. Gonzalez-Vargas 0 J. Ibáñez 0 3 F. Brunetti 2 I. Dimbwadyo 1 L. Carrasco 5 S. Alves 4 C. Gonzalez-Alted 4 A. Gomez-Blanco 4 J. L. Pons 0 0 Neural Rehabilitation Group, Cajal Institute of the Spanish National Research Council (CSIC) , Avda. Doctor Arce, 37, 28002 Madrid , Spain 1 Occupational Therapy Department. Occupational Thinks Research Group. Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid , Madrid , Spain 2 Catholic University of Asunción , Asunción , Paraguay 3 Sobell Department of Motor Neuroscience and Movement 4 Centro de Referencia Estatal de Atención al Daño Cerebral (CEADAC) , Madrid , Spain 5 Occupational Thinks Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid , Madrid , Spain Background: Brain injury survivors often present upper-limb motor impairment affecting the execution of functional activities such as reaching. A currently active research line seeking to maximize upper-limb motor recovery after a brain injury, deals with the combined use of functional electrical stimulation (FES) and mechanical supporting devices, in what has been previously termed hybrid robotic systems. This study evaluates from the technical and clinical perspectives the usability of an integrated hybrid robotic system for the rehabilitation of upper-limb reaching movements after a brain lesion affecting the motor function. Methods: The presented system is comprised of four main components. The hybrid assistance is given by a passive exoskeleton to support the arm weight against gravity and a functional electrical stimulation device to assist the execution of the reaching task. The feedback error learning (FEL) controller was implemented to adjust the intensity of the electrical stimuli delivered on target muscles according to the performance of the users. This control strategy is based on a proportional-integral-derivative feedback controller and an artificial neural network as the feedforward controller. Two experiments were carried out in this evaluation. First, the technical viability and the performance of the implemented FEL controller was evaluated in healthy subjects (N = 12). Second, a small cohort of patients with a brain injury (N = 4) participated in two experimental session to evaluate the system performance. Also, the overall satisfaction and emotional response of the users after they used the system was assessed. Results: In the experiment with healthy subjects, a significant reduction of the tracking error was found during the execution of reaching movements. In the experiment with patients, a decreasing trend of the error trajectory was found together with an increasing trend in the task performance as the movement was repeated. Brain injury patients expressed a great acceptance in using the system as a rehabilitation tool. Conclusions: The study demonstrates the technical feasibility of using the hybrid robotic system for reaching rehabilitation. Patients' reports on the received intervention reveal a great satisfaction and acceptance of the hybrid robotic system. Trial registration: Retrospective trial registration in ISRCTN Register with study ID ISRCTN12843006. Hybrid robotic systems; Upper limb rehabilitation; Stroke rehabilitation; Functional electrical stimulation; Feedback error learning Background Upper limb hemiparesis is one of the most common consequences after a brain injury accident [ 1 ]. This motor impairment has an adverse impact on the quality of life of survivors since it hinders the execution of activities of daily living. From the rehabilitation perspective, it is widely accepted that high-intensity and repetitive task-specific practice is the most effective principle to promote motor recovery after a brain injury [ 1, 2 ]. However, traditional rehabilitation treatment offers a dose of movement repetition that is in most cases insufficient to facilitate neural reorganization [3]. In response to these current clinical shortcomings, there is a clear interest in alternative rehabilitation methods that improve the arm motor functionality of brain injury survivors. Hybrid robotic systems for motor rehabilitation are a promising approach that combine the advantages of robotic support or assistive devices and functional electrical stimulation (FES) technologies to overcome their individual limitations and to offer more robust rehabilitation interventions [ 4 ]. Despite the potential benefits of using hybrid robotic systems for arm rehabilitation, a recent published review shows that only a few hybrid systems presented in the literature were tested with stroke patients [ 4 ]. Possible reasons could be the difficulties arising from the (...truncated)


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F. Resquín, J. Gonzalez-Vargas, J. Ibáñez, F. Brunetti, I. Dimbwadyo, L. Carrasco, S. Alves, C. Gonzalez-Alted, A. Gomez-Blanco, J. L. Pons. Adaptive hybrid robotic system for rehabilitation of reaching movement after a brain injury: a usability study, Journal of NeuroEngineering and Rehabilitation, 2017, pp. 104, DOI: 10.1186/s12984-017-0312-4