Emergence of flexible technology in developing advanced systems for post-stroke rehabilitation: a comprehensive review

So wearable technology.

Emergence of flexible technology in developing advanced systems for post-stroke rehabilitation: a comprehensive review

Muhammad Ahmed Khan1, *, Matteo Saibene1 , Rig Das1 , Iris Brunner2 , and Sadasivan Puthusserypady1 1 Department of Health Technology, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark 2 Hammel Neurocenter, Department of Clinical Medicine, University of Aarhus, 8450 Hammel, Denmark *Authors to whom any correspondence should be addressed. Email: mahkh@dtu.dk 

Abstract 

Objective. 

 

Stroke is one of the most common neural disorders, which causes physical disabilities and motor impairments among its survivors. Several technologies have been developed for providing stroke rehabilitation and to assist the survivors in performing their daily life activities. Currently, the use of flexible technology (FT) for stroke rehabilitation systems is on a rise that allows the development of more compact and lightweight wearable systems, which stroke survivors can easily use for long-term activities. 

 

Approach. 

 

For stroke applications, FT mainly includes the “flexible/stretchable electronics”, “e-textile (electronic textile)” and “soft robotics”. Thus, a thorough literature review has been performed to report the practical implementation of FT for post-stroke application. 

 

Main results. 

 

In this review, the highlights of the advancement of FT in stroke rehabilitation systems are dealt with. Such systems mainly involve the “biosignal acquisition unit”, “rehabilitation devices” and “assistive systems”. In terms of biosignals acquisition, electroencephalography (EEG) and electromyography (EMG) are comprehensively described. For rehabilitation/assistive systems, the application of functional electrical stimulation (FES) and robotics units (exoskeleton, orthosis, etc.) have been explained. Significance. This is the first review article that compiles the different studies regarding flexible technology based post-stroke systems. Furthermore, the technological advantages, limitations, and possible future implications are also discussed to help improve and advance the flexible systems for the betterment of the stroke community. 

Keywords: Stroke, flexible technology, assistive and rehabilitation systems, flexible/stretchable electronics, e-textile, soft robotics, biosignals acquisition, functional electrical stimulation. 

1. Introduction 

Stroke is a neurological disorder in which the brain is unable to receive an adequate amount of oxygen due to obstruction in blood flow to the brain cells. It is a life-changing event that can affect the subject's cognitive and emotional state as much as their physical functions. Studies show that individuals recovering from a stroke often experience helplessness, frustration, and social isolation, which is linked to increased depression and decreased ability to manage their daily activities [1, 2]. According to a study conducted in 2015, there are about 25.7 million stroke survivors worldwide [3]. One recent study indicates that there are approximately 116.4 million DALYs (disability-adjusted life-years) and 5.5 million deaths due to stroke [4]. Mainly there are five post-stroke phases that comprise hyper-acute (0-24 hours), acute (1-7 days), early subacute (7 days to 3 months), late subacute (3-6 months), and chronic (> 6 months) [5, 6]. Among the stroke survivors, around 50% suffer from upper limb paresis, i.e., weakness or inability to move the upper limb [7]. Thus, the primary aim of post-stroke care is to assist the patients in their everyday life activities and rehabilitate them for effective recovery of lost functions.  

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