What is your competent? doctors' EXACT PROTOCOL TO GET YOUR UPPER LIMB RECOVERED TO 100%. Doesn't have one I bet, So incompetence personified! Your doctor has known since medical school that stroke is a shitshow and has DONE NOTHING to fix that!
Structure, sensing and control of pneumatic upper limb rehabilitation system: Review and prospect
Introduction
Stroke, a prevalent chronic cerebrovascular disorder often termed cerebrovascular accident [1], manifests as persistent neurological deficits from acute cerebral vascular events, with 85 % of cases resulting in hemiplegia, particularly among elderly populations [2]. According to ⟪World Stroke Organization (WSO): Global Stroke Fact Sheet 2025 Report⟫, among non-communicable disorders (NCDs), stroke remains the second-leading cause of death and the third-leading cause of death and disability combined (as expressed by disability-adjusted life-years lost - DALYs) in the world [3]. From 1990 to 2021, the burden (in terms of the absolute number of cases) increased substantially (70.0 % increase in incident strokes, 44.0 % deaths from stroke, 86.0 % prevalent strokes, and 32 % DALYs) [4]. Fig. 1. (a), Fig. 1. (b) [4]shows the global age-standardized stroke prevalence (per 100 000 population) (a) and mortality (b) for both sexes in 2021. The most recent Global Burden of Disease stroke burden project has estimated an almost doubling of disability-adjusted life-years (DALYs), deaths, and cost due to stroke from 2020 to 2050 [5]. Globally, the age-standardised prevalence of cardiovascular disease (including stroke) risk factors (including hypertension, overweight, and diabetes) are also increasing [6]. Especially in China, it constitutes the foremost cause of adult mortality and disability, characterized by quintuple high parameters: incidence, recurrence, disability, fatality rates, and socioeconomic burden [7]. A trend towards increasing incidence and prevalence rate of cardiovascular diseases (including stroke) in people aged 15–39 years globally [8]. Epidemiological data from China reveal 12.42 million stroke patients aged ≥40, exhibiting progressive younger-onset trends, as detailed in Fig. 2(a)(b) illustrating prevalence and crude mortality of stroke patients in China. Accelerated urbanization and demographic aging have exacerbated cerebrovascular risk factor exposure, intensifying disease burden trajectories [9].
Most stroke patients are accompanied by different sequelae of movement disorders, of which 75 % manifest as upper limb movement disorders, and only 20 % recover within six months after surgery. Therefore, upper limb dysfunction is a common and most serious functional disorder in stroke patients [10]. As the core of the patient's recovery of movement, timely upper limb rehabilitation training is of great significance to improving the patient's quality of life and reducing the family and social economic burden [11]. Traditional sports rehabilitation training relies on the rehabilitator's techniques and guidance of training movements. The patient is in a passive training state, and the rehabilitation effect is limited by the rehabilitator's level and training intensity. There are currently problems such as doctor-patient communication difficulties, shortage of rehabilitation teachers and long training cycles, making it difficult to achieve high-quality personalized services [12]. With the development of medical and industrial integration technology, robot rehabilitation systems have gradually replaced manual labor and provide efficient active and passive rehabilitation training [13]. Passive training is completed through external force assistance in the early stage of recovery; active regulation can be achieved based on electromyography/EEG signals in the later stage of recovery, and additional load-intensive training intensity can be enhanced [14]. Studies have shown that the effect of rehabilitation training for stroke patients using rehabilitation institutions is significant, which can greatly promote the improvement of patients' limb function [15].
For the included studies, the authors searched extensive literature in different digital databases, such as PubMed, the Institute of Electrical and Electronics Engineers (IEEE), Science Direct, and CNKI. As shown in Fig. 3 (Flow chart of systematic evaluation and screening), the selection is carried out through four stages: identification of relevant papers; Further screening based on title and abstract: Qualification is determined according to a specific set of criteria; Firstly, by searching "Pneumatic artificial muscle", "Hysteresis", "Rehabilitation", "Upper limb control strategy", "Sensor", and "Sensor signal" Keywords such as "fusion" were initially screened to identify these works; Secondly, we set up time filtering conditions (mainly in the last ten years), AND manually filter by using Boolean logic combination keywords (such as "and", "OR", "NOT") to improve the search accuracy. Therefore, 33 500 publications related to stroke rehabilitation system and evaluation were found. The following criteria apply to the first screening: Articles must be published in a peer-reviewed journal or conference and be considered relevant to this review based on the title and abstract. After an initial screening, the number of papers was reduced to 1320. The next step is eligibility, considering the overall quality of the article, including qualitative and/or quantitative analysis. This resulted in the eventual inclusion of only 118 publications that fit this study. It included 15 articles on stroke-related data and characteristics, 60 articles on the overall structure of the upper limb rehabilitation system, and 43 articles on control strategies applied to the upper limb rehabilitation system.
In addition, Fig. 4 shows the proportion of Chinese and English references, in which Chinese accounts for 21.43 % and English accounts for 78.57 %. This reflects the large international focus of this study, which greatly enhances the global applicability of this study. Fig. 5 shows the proportion of references in different time periods, among which 1900–2000 accounted for 1.3 %, 2001–2014 accounted for 19.48 % and 2015–2025 accounted for 79.22 %. Most of the articles in the first two periods are the basic content of the original theory, and this study mainly focuses on the international research achievements in the past ten years, which reflects the timeliness and cutting-edge of this study.
Therefore, in recent years, the research interest in the field of upper limb rehabilitation training has grown exponentially, due to the demand for higher quality, more compatible and interactive human-machine systems and the problems to be solved. This study systematically reviews the upper limb rehabilitation robots of pneumatic drive systems, and analyses the potential future development directions based on existing research, providing readers with scientific references and research directions. This paper is divided into four main chapters. The first chapter introduces the existing upper limb rehabilitation apparatus in detail, including electric upper limb rehabilitation systems and upper limb rehabilitation systems driven by pneumatic artificial muscles. The second chapter mainly introduces various types of sensor devices used in upper limb rehabilitation apparatus and their applications. The third chapter mainly discusses the control strategies in upper limb rehabilitation apparatus, covering control strategies based on kinematics and dynamics, as well as control strategies for pneumatic artificial muscle characteristics and control strategies based on sensor signal fusion. The fourth chapter mainly discusses the problems existing in the current upper limb rehabilitation apparatus and the direction of future research and development. Finally, the main work of the full paper is summarized and the general laws of structural modelling, sensor fusion and control strategies of pneumatic upper limb rehabilitation systems are summarized.
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