Somehow you think there is a chance that stroke hospitals will buy expensive rehab like this?
Current status of robotic stroke rehabilitation and opportunities for a cyber-physically assisted upper limb stroke rehabilitation
Proceedings
of TMCE 2014,
May 19-23, 2014, Budapest, Hungary, Edited by I. Horváth, Z. Rusák
Organizing Committee of TMCE 2014, ISBN 978-94-6186-177-1
Chong Li
Faculty of Industrial Design Engineering Delft University of Technology & The State Key Laboratory of Tribology Tsinghua University C.Li-1@tudelft.nl
Zoltán Rusák Imre Horváth
Faculty of Industrial Design Engineering Delft University of Technology { Z.Rusak, I.Horvath }@tudelft.nl
Linhong Ji Yuemin Hou
The State Key Laboratory of Tribology Tsinghua University jilh@tsinghua.edu.cn, hym01@mails.tsinghua.edu.cn
ABSTRACT
In the last two decades, robotics-assisted stroke reha-bilitation has been wide-spread, in particular for movement rehabilitation of upper limbs. Several studies have reported on the clinical effectiveness of this kind of therapy. The results of these studies show that robot assisted therapy can be more effective in recovering motor control abilities than conventional therapy. On the other hand, studies found no signifi-cant improvement on motor function abilities of pa-tients. These contradictory results stimulated our re-search to survey current status of robotics-assisted rehabilitation and to look for advancement opportuni-ties. We developed a reasoning model that help us conduct the study systematically and to consider the four most important aspects, namely (i) the post-stroke pathophysiological status of patients, (ii) the nature of the rehabilitation therapies, (iii) the versatil-ity of the robotic rehabilitation instruments, and (iv) the kind of stimulation provided for patients. Our major finding is that there are strong evidences that the efficacy of robotics-assisted rehabilitation can be increased by motivation and engagement. We con-cluded that by exploiting the opportunities offered by cyber-physical systems and gamification, a signifi-cant improvement of context sensitive engagement can be realized. Our follow-up research will study various implementation opportunities, the affordabilities of various cyber-physical solutions, and influence on patients.
KEYWORDS
Stroke rehabilitation, robotic rehabilitation, rehabili-tation program, motivation and engagement, cyber physical system
1. INTRODUCTION TO THE PROBLEM
Stroke is a serious disabling health-care problem ob-servable all round the world [1]. Approximately 16 million people experience a stroke worldwide per year, of which about two-thirds survive [2]. Some 85 percent of stroke survivors recover partially [3], and about 35 percent of them suffer from a major disabil-ity [4] [5]. The most common impairment caused by stroke is motor impairment, which can be regarded as a loss of muscle function control, or limitations in limb movements or mobility [6]. Therefore, problem of stroke rehabilitation has got to the focus of both academic research and practical therapy. In their practical work of physiotherapists and occupational therapists are concentrating on the recovery of im-paired movement capabilities and the associated functions, especially in the case of patients with the impaired upper extremity. The simple reason is that the lack or limitation of arm-movement heavily in-fluences the activities of daily activities of post-stroke patients, their abilities to take care of them- selves, and thus their well-being and social inde-pendence [7] [8]. In the context of treatment and rehabilitation, robot-ic-assisted rehabilitation represents the state of the art in the practice. It was introduced twenty years ago in the developed countries and has been proliferating all over the world, in particular for movement rehabilita-tion of upper limbs [9]. Numerous rehabilitation ro-bots have been developed and applied in rehabilita-tion processes. By now, a lot of knowledge and expe-rience has been aggregated concerning their clinical effectiveness [9] [10]. Certain studies argue that less improvement of the functional abilities was achieved after lengthy train-ing processes than expected [9]. This entails that only limited improvements were achieved in the activities of daily living (ADL) of patients. For example, the results obtained by applying the Fugl-Meyer assess-ment model show that robot assisted therapy is much more effective in recovering motor control abilities, such as motor power, than conventional therapy [9]. On the other hand, studies that used function inde-pendence measurement and the Wolf functional abil-ity test found no significant improvement on motor function abilities of patients [11] [12] [13]. In some cases conventional therapy even had greater gains in motor function abilities than robot assisted therapy [11]. These contradictory results can partially be ex-plained by the limitations of movement patterns in the motor exercises offered by the robotic systems compared to exercises involving daily activities. Fur-thermore, recent findings suggest that maintaining attention and engagement during the learning of new motor skills or the re-learning of forgotten skills are important for inducing cerebral plasticity after neuro-logical impairments [14] [15]. Current robotics-assisted therapies do not place the patients in an im-mersive training environment, which would be able
to motivate the patients’ initiative so that their
poten-tials to recover could be developed to their fullest. Though movement rehabilitation of upper limbs has been in the center of developments and applications, the results achieved so far are only sub-optimal. The objective of this paper is to cast light on the af-fordances and the limitations of the current rehabili-tation instrumentation and approaches, to propose a more effective version of robotics-assisted rehabilita-tion as a possible solution for eliminating a number of limitations and offering new opportunities for in-volving patients in the facilitation of their own reha-bilitation processes. Section 2 introduces our reason-ing model that was applied in the survey of the cur-rent state of the art. Both a patient-centered and a rehabilitation-centered classification have been con-sidered in order to be able to end up with a compre-hensive and consistent analysis. Four categories of rehabilitation robotics have been identified and used in the analysis of the advantages and the limitations in the context of various stroke patient categories. Section 3, 4, 5 and 6 present the results of the anal-yses of the identified four categories of rehabilitation robotics and applications. Section 7 and 8 summarize the limitations of the current rehabilitation approach-es and identify the opportunities of the cyber-physical solution for rehabilitation, respectively.
2. THE REASONING MODEL USED IN THE SURVEY
To frame our explorative research, we considered a reasoning model that interconnects four main fields of interest. The first one is pathophysiological status of the patients, which focuses on introducing stages of recovery process of the patients and which kind of therapy should be used in each stage. The second one is the nature of rehabilitation therapies, which is from a therapy-centered view introducing different kinds of therapies being used in current clinical rehabilita-tion process. The third one is versatility of robotic instruments which focuses on the robotic instruments and their programs. Last but not least, there is an as-pect focusing on the kind of stimulation provided for the patients , which is an influencing factor of stroke rehabilitation that have not been fully addressed by current robotic rehabilitation. This model is graph-ically represented in Figure 1. Each of the indicated
Figure 1
The reasoning model used in this study
of TMCE 2014,
May 19-23, 2014, Budapest, Hungary, Edited by I. Horváth, Z. Rusák
Organizing Committee of TMCE 2014, ISBN 978-94-6186-177-1
Chong Li
Faculty of Industrial Design Engineering Delft University of Technology & The State Key Laboratory of Tribology Tsinghua University C.Li-1@tudelft.nl
Zoltán Rusák Imre Horváth
Faculty of Industrial Design Engineering Delft University of Technology { Z.Rusak, I.Horvath }@tudelft.nl
Linhong Ji Yuemin Hou
The State Key Laboratory of Tribology Tsinghua University jilh@tsinghua.edu.cn, hym01@mails.tsinghua.edu.cn
ABSTRACT
In the last two decades, robotics-assisted stroke reha-bilitation has been wide-spread, in particular for movement rehabilitation of upper limbs. Several studies have reported on the clinical effectiveness of this kind of therapy. The results of these studies show that robot assisted therapy can be more effective in recovering motor control abilities than conventional therapy. On the other hand, studies found no signifi-cant improvement on motor function abilities of pa-tients. These contradictory results stimulated our re-search to survey current status of robotics-assisted rehabilitation and to look for advancement opportuni-ties. We developed a reasoning model that help us conduct the study systematically and to consider the four most important aspects, namely (i) the post-stroke pathophysiological status of patients, (ii) the nature of the rehabilitation therapies, (iii) the versatil-ity of the robotic rehabilitation instruments, and (iv) the kind of stimulation provided for patients. Our major finding is that there are strong evidences that the efficacy of robotics-assisted rehabilitation can be increased by motivation and engagement. We con-cluded that by exploiting the opportunities offered by cyber-physical systems and gamification, a signifi-cant improvement of context sensitive engagement can be realized. Our follow-up research will study various implementation opportunities, the affordabilities of various cyber-physical solutions, and influence on patients.
KEYWORDS
Stroke rehabilitation, robotic rehabilitation, rehabili-tation program, motivation and engagement, cyber physical system
1. INTRODUCTION TO THE PROBLEM
Stroke is a serious disabling health-care problem ob-servable all round the world [1]. Approximately 16 million people experience a stroke worldwide per year, of which about two-thirds survive [2]. Some 85 percent of stroke survivors recover partially [3], and about 35 percent of them suffer from a major disabil-ity [4] [5]. The most common impairment caused by stroke is motor impairment, which can be regarded as a loss of muscle function control, or limitations in limb movements or mobility [6]. Therefore, problem of stroke rehabilitation has got to the focus of both academic research and practical therapy. In their practical work of physiotherapists and occupational therapists are concentrating on the recovery of im-paired movement capabilities and the associated functions, especially in the case of patients with the impaired upper extremity. The simple reason is that the lack or limitation of arm-movement heavily in-fluences the activities of daily activities of post-stroke patients, their abilities to take care of them- selves, and thus their well-being and social inde-pendence [7] [8]. In the context of treatment and rehabilitation, robot-ic-assisted rehabilitation represents the state of the art in the practice. It was introduced twenty years ago in the developed countries and has been proliferating all over the world, in particular for movement rehabilita-tion of upper limbs [9]. Numerous rehabilitation ro-bots have been developed and applied in rehabilita-tion processes. By now, a lot of knowledge and expe-rience has been aggregated concerning their clinical effectiveness [9] [10]. Certain studies argue that less improvement of the functional abilities was achieved after lengthy train-ing processes than expected [9]. This entails that only limited improvements were achieved in the activities of daily living (ADL) of patients. For example, the results obtained by applying the Fugl-Meyer assess-ment model show that robot assisted therapy is much more effective in recovering motor control abilities, such as motor power, than conventional therapy [9]. On the other hand, studies that used function inde-pendence measurement and the Wolf functional abil-ity test found no significant improvement on motor function abilities of patients [11] [12] [13]. In some cases conventional therapy even had greater gains in motor function abilities than robot assisted therapy [11]. These contradictory results can partially be ex-plained by the limitations of movement patterns in the motor exercises offered by the robotic systems compared to exercises involving daily activities. Fur-thermore, recent findings suggest that maintaining attention and engagement during the learning of new motor skills or the re-learning of forgotten skills are important for inducing cerebral plasticity after neuro-logical impairments [14] [15]. Current robotics-assisted therapies do not place the patients in an im-mersive training environment, which would be able
to motivate the patients’ initiative so that their
poten-tials to recover could be developed to their fullest. Though movement rehabilitation of upper limbs has been in the center of developments and applications, the results achieved so far are only sub-optimal. The objective of this paper is to cast light on the af-fordances and the limitations of the current rehabili-tation instrumentation and approaches, to propose a more effective version of robotics-assisted rehabilita-tion as a possible solution for eliminating a number of limitations and offering new opportunities for in-volving patients in the facilitation of their own reha-bilitation processes. Section 2 introduces our reason-ing model that was applied in the survey of the cur-rent state of the art. Both a patient-centered and a rehabilitation-centered classification have been con-sidered in order to be able to end up with a compre-hensive and consistent analysis. Four categories of rehabilitation robotics have been identified and used in the analysis of the advantages and the limitations in the context of various stroke patient categories. Section 3, 4, 5 and 6 present the results of the anal-yses of the identified four categories of rehabilitation robotics and applications. Section 7 and 8 summarize the limitations of the current rehabilitation approach-es and identify the opportunities of the cyber-physical solution for rehabilitation, respectively.
2. THE REASONING MODEL USED IN THE SURVEY
To frame our explorative research, we considered a reasoning model that interconnects four main fields of interest. The first one is pathophysiological status of the patients, which focuses on introducing stages of recovery process of the patients and which kind of therapy should be used in each stage. The second one is the nature of rehabilitation therapies, which is from a therapy-centered view introducing different kinds of therapies being used in current clinical rehabilita-tion process. The third one is versatility of robotic instruments which focuses on the robotic instruments and their programs. Last but not least, there is an as-pect focusing on the kind of stimulation provided for the patients , which is an influencing factor of stroke rehabilitation that have not been fully addressed by current robotic rehabilitation. This model is graph-ically represented in Figure 1. Each of the indicated
Figure 1
The reasoning model used in this study
No comments:
Post a Comment