Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

I'm sure survivors with spasticity were not included in this testing.

 Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Olivier Lambercy 1,2* , Ludovic Dovat 1 , Hong Yun 3 , Seng Kwee Wee 3 , Christopher WK Kuah 3 , Karen SG Chua 3 , Roger Gassert 2 , Theodore E Milner 4 , Chee Leong Teo 1 and Etienne Burdet 5,1 Abstract 

Background: 

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/ supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. 

Methods: 

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. 

Results: 

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. Conclusions: The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Failure of my medical team to get my boiled eggs salt and peppered

 With absolutely NOTHING done to cure my finger/hand spasticity there is no way to hold a boiled egg without smashing it in the process of getting it into my left hand. Trying to use the left hand to hold the shakers instead does not work, I can't do any arm pronation or supination.  Then there is no ability to shake the shaker.  

Did your stroke medical 'professionals' do any better?

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Did any of these subjects have spasticity? Without that information no one can tell whom this will work for? So, bad research.

 Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

Olivier Lambercy 1,2* , Ludovic Dovat 1 , Hong Yun 3 , Seng Kwee Wee 3 , Christopher WK Kuah 3 , Karen SG Chua 3 , Roger Gassert 2 , Theodore E Milner 4 , Chee Leong Teo 1 and Etienne Burdet 5,1 

Abstract 

Background: 

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/ supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function. 

Methods: 

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up. 

Results: 

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot. 

Conclusions: 

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy. 

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

 Without telling us EXACTLY what the disabilities were, there is no way to determine whom this will work for! Doesn't anyone in stroke know how to run research that get survivors recovered?

15 years ago, this research came out: WHO approved this new one? They should be fired for incompetence in not knowing of previous research!

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

2009, 2009 IEEE International Conference on Rehabilitation Robotics

The latest useless shit here:

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

• Olivier Lambercy,
• Ludovic Dovat,
• Hong Yun,
• Seng Kwee Wee,
• Christopher WK Kuah,
• Karen SG Chua,
• Roger Gassert,
• Theodore E Milner,
• Chee Leong Teo &
• Etienne Burdet 

Journal of NeuroEngineering and Rehabilitation volume 8, Article number: 63 (2011) Cite this article

• 11k Accesses

• 89 Citations

• Metrics details

Abstract

Background

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function.

Methods

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up.

Results

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot.

Conclusions

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Background

Stroke is one of the leading causes of adult disability. While there is strong evidence that physiotherapy promotes recovery, conventional therapy remains suboptimal due to limited financial and human resources, and there are many open questions, e.g. when therapy should be started, how to optimally engage the patient, what is the best dosage, etc. [1–3]. Furthermore, exercise therapy of the upper limb has been shown to be only of limited impact on arm function in stroke patients [4].

Robot-assisted rehabilitation can address these shortcomings and complement traditional rehabilitation strategies. Robots designed to accurately control interaction forces and progressively adapt assistance/resistance to the patients' abilities can record the patient's motion and interaction forces to objectively and precisely quantify motor performance, monitor progress, and automatically adapt therapy to the patient's state.

Studies with robots such as the MIT-Manus, the ARM Guide or the MIME have demonstrated improved proximal arm function after stroke [5–8], although these improvements did not transfer to the distal arm function which is necessary for most Activities of Daily Living (ADL) [9–11]. Robot-assisted training which specifically targets the hand might be required to achieve significant improvements in hand function. Furthermore, several studies indicate a generalization effect of distal arm training, e.g. hand and wrist, on proximal arm function, i.e. elbow and shoulder, which may lead to improved control of the entire arm [10, 12, 13].

We therefore focused on robot-assisted rehabilitation of the hand, adopting a functional approach based on the combined training of grasping and forearm pronation/supination, two critical functions for manipulation. This paper presents the results of a pilot study using the HapticKnob, a portable end-effector based robotic device to train hand opening/closing and forearm rotation. In contrast to robotic devices based on exoskeletons attached to the arm [14], the HapticKnob applies minimal constraints to the different joints of the upper arm, thus corresponding to situations encountered during ADL. The forearm rests on an adjustable padded support, while the shoulder and upper arm are not restrained.

The objectives of this pilot study were to determine the feasibility of training chronic stroke patients with the HapticKnob, and to reduce motor impairment of the upper limb in a safe and acceptable manner. Although a few studies have investigated post-stroke rehabilitation of the hand [12, 13], ours is the first to use robot-assisted training that combines grasp and forearm pronation/supination to perform functional tasks. With this pilot study, we tested the hypothesis that training the hand using this functional approach improves function of the entire arm.

More at link.

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

13 years. Has your stroke hospital incompetently done nothing in that amount of time? How long will you let the board of directors  be ok with such incompetence?

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

2009, 2009 IEEE International Conference on Rehabilitation Robotics

 
Rehabilitation of Grasping and Forearm Pronation/Supination with the
 Haptic Knob
Olivier Lambercy, Ludovic Dovat, Hong Yun, Seng Kwee Wee, Christopher Kuah,Karen Chua, Roger Gassert, Theodore Milner, Teo Chee Leong and Etienne Burdet

 Abstract

—This paper investigates robot-assisted rehabilitation after stroke using the
 Haptic Knob
, a 2 degree-of-freedom end-effector based robotic device to train grasping and wrist pronation/supination. Nine chronic stroke subjects trained over a period of 6 weeks, with 3 one-hour sessions of robot-assisted therapy per week, consisting of two exercises requiring active participation promoted by therapeutic games. Results of standard clinical assessments demonstrate the positive effects of robot-assisted therapy with the Haptic Knob. Subjects improved by a mean of 4.3 points in the Fugl-Meyer assessment scale,together with a decrease in hand impairments such as abnormal muscle tone frequently observed in stroke subjects. Significant improvements were also observed in motor function of the upper arm as a result of the robot-assisted therapy, suggesting homogeneous improvement of upper limb function as a result of distal training.

 

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

With such positive results what has your doctor and stroke hospital done with this in the last 13 years? NOTHING? Then you don't have a functioning stroke doctor or hospital!

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

Olivier Lambercy; Ludovic Dovat; Hong Yun; Seng Kwee Wee; Christopher Kuah; Karen Chua; Roger Gassert; Theodore Milner; Chee Leong Teo; Etienne Burdet

All Authors

---

Abstract

Document Sections

• I.
  INTRODUCTION
• II.
  MATERIALS AND METHODS
• III.
  RESULTS
• IV.
  DISCUSSION
• V.
  CONCLUSION

Abstract:

This paper investigates robot-assisted rehabilitation after stroke using the haptic knob, a 2 degree-of-freedom end-effector based robotic device to train grasping and wrist pronation/supination. Nine chronic stroke subjects trained over a period of 6 weeks, with 3 one-hour sessions of robot-assisted therapy per week, consisting of two exercises requiring active participation promoted by therapeutic games. Results of standard clinical assessments demonstrate the positive effects of robot-assisted therapy with the haptic knob. Subjects improved by a mean of 4.3 points in the Fugl-Meyer assessment scale, together with a decrease in hand impairments such as abnormal muscle tone frequently observed in stroke subjects. Significant improvements were also observed in motor function of the upper arm as a result of the robot-assisted therapy, suggesting homogeneous improvement of upper limb function as a result of distal training.

Published in: 2009 IEEE International Conference on Rehabilitation Robotics

Date of Conference: 23-26 June 2009

Date Added to IEEE Xplore: 21 August 2009

ISBN Information:

ISSN Information:

INSPEC Accession Number: 10838003

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

 

Your doctor with any competence at all should see that using this in acute patients while in the hospital would probably get even better improvements than in chronic patients. But I bet your doctor hasn't done one damn thing with this in the past 13 years. 

Do you prefer your  doctor incompetence NOT KNOWING? OR NOT DOING? Because your doctor is incompetent if nothing has been done, in my opinion.

Rehabilitation of grasping and forearm pronation/supination with the Haptic Knob

2009, 2009 IEEE International Conference on Rehabilitation Robotics
 
Rehabilitation of Grasping and Forearm Pronation/Supinationwith the
 Haptic Knob
Olivier Lambercy, Ludovic Dovat, Hong Yun, Seng Kwee Wee, Christopher Kuah,Karen Chua, Roger Gassert, Theodore Milner, Teo Chee Leong and Etienne Burdet

 Abstract

—This paper investigates robot-assisted rehabilitation after stroke using the Haptic Knob, a 2 degree-of-freedom end-effector based robotic device to train grasping and wrist pronation/supination. Nine chronic stroke subjects trained over a period of 6 weeks, with 3 one-hour sessions of robot-assisted therapy per week, consisting of two exercises requiring active participation promoted by therapeutic games. Results of standard clinical assessments demonstrate the positive effects of robot-assisted therapy with the
 Haptic Knob
. Subjects improved by a mean of 4.3 points in the Fugl-Meyer assessment scale,together with a decrease in hand impairments such as abnormal muscle tone frequently observed in stroke subjects. Significant improvements were also observed in motor function of the upper arm as a result of the robot-assisted therapy, suggesting homogeneous improvement of upper limb function as a result of distal training.

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

With these positive results, has your doctor and hospital brought this in in the past 11 years?  Can they think outside the box and realize that if it works on chronic it probably works much better on acute patients?

Do you prefer your  doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

 

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

• Olivier Lambercy,
• Ludovic Dovat,
• Hong Yun,
• Seng Kwee Wee,
• Christopher WK Kuah,
• Karen SG Chua,
• Roger Gassert,
• Theodore E Milner,
• Chee Leong Teo &
• Etienne Burdet 

Journal of NeuroEngineering and Rehabilitation volume 8, Article number: 63 (2011) Cite this article

• 10k Accesses

• 75 Citations

• Metrics

 

 

Abstract

Background

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function.

Methods

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up.

Results

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot.

Conclusions

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Background

Stroke is one of the leading causes of adult disability. While there is strong evidence that physiotherapy promotes recovery, conventional therapy remains suboptimal due to limited financial and human resources, and there are many open questions, e.g. when therapy should be started, how to optimally engage the patient, what is the best dosage, etc. [1–3].(Because you have never created protocols instead of lazy and incomplete guidelines.) Furthermore, exercise therapy of the upper limb has been shown to be only of limited impact on arm function in stroke patients [4].

Robot-assisted rehabilitation can address these shortcomings and complement traditional rehabilitation strategies. Robots designed to accurately control interaction forces and progressively adapt assistance/resistance to the patients' abilities can record the patient's motion and interaction forces to objectively and precisely quantify motor performance, monitor progress, and automatically adapt therapy to the patient's state.

Studies with robots such as the MIT-Manus, the ARM Guide or the MIME have demonstrated improved proximal arm function after stroke [5–8], although these improvements did not transfer to the distal arm function which is necessary for most Activities of Daily Living (ADL) [9–11]. Robot-assisted training which specifically targets the hand might be required to achieve significant improvements in hand function. Furthermore, several studies indicate a generalization effect of distal arm training, e.g. hand and wrist, on proximal arm function, i.e. elbow and shoulder, which may lead to improved control of the entire arm [10, 12, 13].

We therefore focused on robot-assisted rehabilitation of the hand, adopting a functional approach based on the combined training of grasping and forearm pronation/supination, two critical functions for manipulation. This paper presents the results of a pilot study using the HapticKnob, a portable end-effector based robotic device to train hand opening/closing and forearm rotation. In contrast to robotic devices based on exoskeletons attached to the arm [14], the HapticKnob applies minimal constraints to the different joints of the upper arm, thus corresponding to situations encountered during ADL. The forearm rests on an adjustable padded support, while the shoulder and upper arm are not restrained.

The objectives of this pilot study were to determine the feasibility of training chronic stroke patients with the HapticKnob, and to reduce motor impairment of the upper limb in a safe and acceptable manner. Although a few studies have investigated post-stroke rehabilitation of the hand [12, 13], ours is the first to use robot-assisted training that combines grasp and forearm pronation/supination to perform functional tasks. With this pilot study, we tested the hypothesis that training the hand using this functional approach improves function of the entire arm.

More at link.

A forearm pronation/supination assessment method integrated into Haptic Knob for stroke rehabilitation

A could have really used something like this to try to bring back wrist and hand. But I bet you will need to wait another 30-50 years before this makes it to clinical practice.
http://ieeexplore.ieee.org/xpl/login.jsp?tp=&arnumber=6696171&url=http%3A%2F%2Fieeexplore.ieee.org%2Fxpls%2Fabs_all.jsp%3Farnumber%3D6696171
Zhou, Longjiang ; Institute for Infocomm Research, 1 Fusionopolis Way, 138632, Singapore ; Ang, Kai Keng ; Wang, Chuanchu ; Phua, Kok Soon
more authors
The Haptic Knob (HK) is a robotic device that enables subjects to open or close their hands, or rotate their forearms for stroke rehabilitation. The present HK uses force sensors to measure the force applied by the subject, which provides an indirect force measurement with high development cost. In this paper, we propose a novel method to detect the grasping force applied directly on the haptic knob by measuring the current of the driving motor instead of the rotating torque applied. The same method can also be used to detect the pronation or supination torque applied by the subject by measuring the current of the driving motor. Experiments are performed using weights to apply known torque through a cylindrical disc calibration structure on the haptic knob to establish the relationship between the current of driving motor and the applied torque. The results show a near-linear relationship between the applied torque and the current of the driving motor which demonstrated the feasibility of inferring the applied torque from a subject in performing pronation or supination on the haptic knob from the current of the driving motor. This demonstrated the feasibility of inferring both the applied grasping force of a stroke subject as well as the applied pronation or supination torque on the haptic knob from the current of the driving motor.

Design and control of a 2 degree of freedom upper limb robotic rehabilitation device

Have your doctor see if this is better than the Saeboflex. It seems to include wrist movement also. Another great thesis.
http://iris.lib.neu.edu/cgi/viewcontent.cgi?article=1079&context=mech_eng_theses&sei-redir=1&referer=http%3A%2F%2Fscholar.google.com%2Fscholar_url%3Fhl%3Den%26q%3Dhttp%3A%2F%2Firis.lib.neu.edu%2Fcgi%2Fviewcontent.cgi%253Farticle%253D1079%2526context%253Dmech_eng_theses%26sa%3DX%26scisig%3DAAGBfm1RQ0ouYlphaM6wdOJoLQ0PS8lwGA%26oi%3Dscholaralrt#search=%22http%3A%2F%2Firis.lib.neu.edu%2Fcgi%2Fviewcontent.cgi%3Farticle%3D1079%26context%3Dmech_eng_theses%22

Abstract

Robotic neurorehabilitation is a rapidly growing field in both research and industry. Robotics offer the ability to create less labor-intensive rehabilitation for therapists, while providing an interactive experience for patients. Robotic therapy also provides the advantage of object data

collection for therapists to track patient progress; however, there is still both a clinical and market need for a low-cost, assistive hand rehabilitation

system. Therefore, the comprehensive design, control, and initial testing of an actuated, assistive 2 degree of freedom hand rehabilitation system

with a virtual environment is presented.

The 2 degree of freedom hand rehabilitation system, named the Navigator hand rehabilitation system, can provide assistive or resistive mode exercise for flexion and extension of the fingers, as well as pronation and supination of the wrist. The system incorporates a rack and pinion into a series elastic actuator to provide assistive exercise for flexion and extension of the fingers. A belt drive is used to provide actuation to pronation and

supination of the wrist.

 

The design, implementation of an impedance control system utilizing position and load feedback is also presented. Both automated control results and preliminary pilot data of resistive mode exercises are presented. A virtual environment to interact with the Navigator system was designed and implemented. The virtual environment incorporates both degrees of freedom, allowing the user to combine the motions and associate the movements with virtual tasks. The impedance controller and virtual environment interact via serial communication.

The Navigator device was designed to provide a low cost solution to providing assistive exercisein 2 DOF with an accompanying virtual environment for a home and clinical setting.