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Soft pneumatic actuators for pushing fingers into extension. 用于推动手指伸展的软气动执行器。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-30 DOI: 10.1186/s12984-024-01444-4
James V McCall, Gregory D Buckner, Derek G Kamper

Background: Compliant pneumatic actuators possess many characteristics that are desirable for wearable robotic systems. These actuators can be lightweight, integrated with clothing, and accommodate uncontrolled degrees of freedom. These attributes are especially desirable for hand exoskeletons, where the soft actuator can conform to the highly variable digit shape. In particular, locating the pneumatic actuator on the palmar side of the digit may have benefits for assisting finger extension and resisting unwanted finger flexion, but this configuration requires suppleness to allow digit flexion while retaining sufficient stiffness to assist extension.

Methods: To meet these needs, we designed an actuator consisting of a hollow chamber long enough to span the joints of each digit while sufficiently narrow not to inhibit finger adduction. We explored the geometrical design parameter space for this chamber in terms of shape, dimensions, and wall thickness. After fabricating an elastomer-based prototype for each actuator design, we measured active extension force and passive resistance to bending for each chamber using a mechanical jig. We also created a finite element model for each chamber to enable estimation of the impact of chamber deformation, caused by joint rotation, on airflow through the chamber. Finally, we created a prototype hand exoskeleton with the chamber parameters yielding the best outcomes.

Results: A rectangular cross-sectional area was preferable to a semi-obround shape for the chamber; wall thickness also impacted performance. Extension joint torque reached 0.33 N-m at a low chamber pressure of 48.3 kPa. The finite element model confirmed that airflow for the rectangular chamber remained high despite deformation resulting from joint rotation. The hand exoskeleton created with the rectangular chambers enabled rapid movement, with a cycle time of 1.1 s for voluntary flexion followed by actuated extension.

Conclusions: The developed soft actuators are feasible for use in promoting finger extension from the palmar side of the hand. This placement utilizes pushing rather than pulling for digit extension, which is more comfortable and safer. The small chamber volumes allow rapid filling and evacuation to facilitate relatively high frequency finger movements.

背景:顺应性气动执行器具有许多可穿戴机器人系统所需要的特性。这些致动器重量轻,可与服装集成,并能适应不受控制的自由度。对于手部外骨骼来说,这些特性尤为理想,因为在手部外骨骼中,柔软的致动器可以适应高度可变的数字形状。特别是,将气动致动器安装在手指的掌侧可能有利于帮助手指伸展并防止不必要的手指弯曲,但这种配置需要柔软度以允许手指弯曲,同时保留足够的硬度以帮助手指伸展:为了满足这些需求,我们设计了一种由空腔组成的致动器,空腔的长度足以跨越每个手指的关节,同时又足够狭窄,不会抑制手指的内收。我们从形状、尺寸和壁厚等方面探索了空腔的几何设计参数空间。在为每种致动器设计制作了基于弹性体的原型后,我们使用机械夹具测量了每个腔体的主动伸展力和被动抗弯强度。我们还为每个腔体创建了一个有限元模型,以便估算关节旋转造成的腔体变形对通过腔体的气流的影响。最后,我们创建了一个手部外骨骼原型,其腔室参数产生了最佳效果:结果:长方形横截面积比半圆形的腔室更可取;壁厚也会影响性能。在 48.3 kPa 的低腔室压力下,伸展关节扭矩达到 0.33 N-m。有限元模型证实,尽管关节旋转会导致变形,但矩形腔室的气流仍然很高。用矩形腔体制作的手部外骨骼能够快速运动,自主屈伸和驱动伸展的周期时间为 1.1 秒:结论:开发的软促动器可用于从手掌侧促进手指伸展。这种装置利用推力而不是拉力来实现手指伸展,更加舒适和安全。小腔容积允许快速填充和排空,以促进相对高频率的手指运动。
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引用次数: 0
Pilot study of using transcranial temporal interfering theta-burst stimulation for modulating motor excitability in rat. 利用经颅瞬时干扰θ-脉冲刺激调节大鼠运动兴奋性的试验性研究
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-30 DOI: 10.1186/s12984-024-01451-5
Chun-Wei Wu, Bor-Shing Lin, Zhao Zhang, Tsung-Hsun Hsieh, Jian-Chiun Liou, Wei-Lun Lo, Yu-Ting Li, Shao-Chu Chiu, Chih-Wei Peng

Transcranial temporal interference stimulation (tTIS) is a promising brain stimulation method that can target deep brain regions by delivering an interfering current from surface electrodes. Most instances of tTIS stimulate the brain with a single-frequency sinusoidal waveform generated by wave interference. Theta burst stimulation is an effective stimulation scheme that can modulate neuroplasticity by generating long-term potentiation- or depression-like effects. To broaden tTIS application, we developed a theta burst protocol using tTIS technique to modulate neuroplasticity in rats. Two cannula electrodes were unilaterally implanted into the intact skull over the primary motor cortex. Electrical field of temporal interference envelopes generated by tTIS through cannula electrodes were recorded from primary motor cortex. Theta burst schemes were characterized, and motor activation induced by the stimulation was also evaluated simultaneously by observing electromyographic signals from the corresponding brachioradialis muscle. After validating the stimulation scheme, we further tested the modulatory effects of theta burst stimulation delivered by tTIS and by conventional transcranial electrical stimulation on primary motor cortex excitability. Changes in the amplitude of motor evoked potentials, elicited when the primary motor cortex was activated by electrical pulses, were measured before and after theta burst stimulation by both techniques. Significant potentiation and suppression were found at 15 to 30 min after the intermittent and continuous theta burst stimulation delivered using tTIS, respectively. However, comparing to theta burst stimulations delivered using conventional form of transcranial electrical stimulation, using tTIS expressed no significant difference in modulating motor evoked potential amplitudes. Sham treatment from both methods had no effect on changing the motor evoked potential amplitude. The present study demonstrated the feasibility of using tTIS to achieve a theta burst stimulation scheme for motor cortical neuromodulation. These findings also indicated the future potential of using tTIS to carry out theta burst stimulation protocols in deep-brain networks for modulating neuroplasticity.

经颅颞部干扰刺激(tTIS)是一种很有前途的脑刺激方法,它可以通过从表面电极发出干扰电流来刺激大脑深部区域。大多数经颅颞部干扰刺激都是通过波干扰产生的单频正弦波来刺激大脑。Theta 突发性刺激是一种有效的刺激方案,可通过产生类似长期延时或抑制的效果来调节神经可塑性。为了扩大 tTIS 的应用范围,我们开发了一种使用 tTIS 技术调节大鼠神经可塑性的 Theta 脉冲串方案。我们将两个插管电极单侧植入完整头骨的初级运动皮层。通过插管电极从初级运动皮层记录 tTIS 产生的时间干扰包络电场。对θ猝发方案进行了表征,并通过观察相应肱肌的肌电信号同时评估了刺激引起的运动激活。在验证了刺激方案后,我们进一步测试了 tTIS 和传统经颅电刺激对初级运动皮层兴奋性的调节作用。通过这两种技术测量了θ脉冲刺激前后初级运动皮层被电脉冲激活时运动诱发电位振幅的变化。在使用 tTIS 进行间歇性和持续性θ脉冲串刺激后 15 至 30 分钟,分别发现了显著的增强和抑制作用。不过,与传统的经颅电刺激相比,tTIS 在调节运动诱发电位振幅方面没有显著差异。两种方法的假治疗对运动诱发电位振幅的改变均无影响。本研究证明了使用 tTIS 实现用于运动皮层神经调控的θ突发性刺激方案的可行性。这些研究结果还表明,使用 tTIS 在深脑网络中实施θ 脉冲串刺激方案以调节神经可塑性的未来潜力。
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引用次数: 0
Healthy older adults generate transverse-plane momenta required for 90° turns while walking during the same phases of gait as used in straight-line gait. 健康的老年人在行走时产生 90° 转弯所需的横向平面力矩,其步态阶段与直线步态相同。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-23 DOI: 10.1186/s12984-024-01437-3
Mitchell Tillman, Jun Ming Liu, Zahava M Hirsch, Janine Molino, Antonia M Zaferiou

Background: Generation and regulation (control) of linear and angular momentum is a challenge during turning while walking which may be exacerbated by age-related changes. In healthy older adults, little is known about how momentum is controlled during turns, especially within each phase of gait. Each phase of gait affords unique mechanical contexts to control momenta and regulate balance. In healthy young adults, we found that the transverse-plane linear and angular momenta generation strategies observed within specific phases of gait during straight-line gait were also used during turns. Therefore, in this study, we investigated whether healthy older adults shared similar momentum control strategies specific to each gait phase during straight-line gait and turns.

Methods: Nine healthy older adults completed straight-line gait and 90° leftward walking turns. We compared the change in transverse-plane whole-body linear and angular momentum across gait phases (left and right single and double support). We also compared the average leftward force and transverse-plane moment across gait phases.

Results: We found that leftward linear momentum was generated most during right single support in straight-line gait and leftward turns. However, in contrast to straight-line gait, during leftward turns, average leftward force was applied across gait phases, with left single support generating significantly less leftward average force than other gait phases. Leftward angular momentum generation and average moment were greatest during left double support in both tasks. We observed some within-participant results that diverged from the group statistical findings, illustrating that although they are common, these momenta control strategies are not necessary.

Conclusions: Older adults generated transverse-plane linear and angular momentum during consistent phases of gait during straight-line gait and 90° turns, potentially indicating a shared control strategy. Understanding momentum control within each phase of gait can help design more specific targets in gait and balance training interventions.

背景:线性和角度动量的产生和调节(控制)是步行转弯过程中的一项挑战,而与年龄有关的变化可能会加剧这一挑战。在健康的老年人中,人们对转弯时如何控制动量知之甚少,尤其是在步态的每个阶段。步态的每个阶段都提供了控制动量和调节平衡的独特机械环境。在健康的青壮年身上,我们发现在直线步态的特定步态阶段中观察到的横向平面线性和角动量产生策略在转弯时也同样适用。因此,在本研究中,我们调查了健康的老年人在直线步态和转弯时是否共享类似的各步态阶段特有的动量控制策略:方法:9 名健康的老年人完成了直线步态和 90° 左转行走。我们比较了不同步态阶段(左右单支撑和双支撑)横向平面全身线性动量和角动量的变化。我们还比较了不同步态阶段的平均左向力和横向平面力矩:结果:我们发现,在直线步态和向左转弯时,右单支撑产生的左向线动量最大。然而,与直线步态不同的是,在向左转弯时,各步态阶段都施加了平均向左力,左单支撑产生的平均向左力明显小于其他步态阶段。在这两项任务中,左双支撑时产生的向左角动量和平均力矩最大。我们观察到一些参与者内部的结果与群体统计结果不一致,这说明尽管它们很常见,但这些力矩控制策略并非必要:结论:老年人在直线步态和 90° 转体时会在步态的一致阶段产生横向平面线性动量和角度动量,这可能表明存在一种共同的控制策略。了解步态各阶段的动量控制有助于在步态和平衡训练干预中设计更具体的目标。
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引用次数: 0
Robotic assessment of bilateral and unilateral upper limb functions in adults with cerebral palsy. 用机器人评估脑瘫成人的双侧和单侧上肢功能。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-22 DOI: 10.1186/s12984-024-01415-9
I Poitras, S P Dukelow, A Campeau-Lecours, C Mercier

Background: Children with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study's aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP.

Methods: Nineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks.

Results: The majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (rs = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories).

Conclusions: Adults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.

背景:单侧脑瘫(CP)患儿主要表现为身体一侧的运动障碍,同时也有同侧和双侧障碍。众所周知,这些障碍会持续到成年,但其程度尚未在成年 CP 患者中得到描述。本研究的目的是描述成年脊髓灰质炎患者双侧和单侧上肢障碍的特征:19名患有CP的成年人(34.3岁±11.5)在Kinarm外骨骼实验室进行了三项机器人评估,包括两项双侧任务(物体撞击[非对称独立目标任务]和球在横杆上[对称共同目标任务])和一项单侧任务(视觉引导下的伸手,用受影响较大的手臂[MA]和受影响较小的手臂[LA]完成)。将个人结果与性别、年龄和惯用手相匹配的常模数据进行比较,描述参与者在每个任务特定变量(如手速)、每个表现类别(如前馈控制)和整体任务表现中表现出障碍的比例。使用斯皮尔曼相关系数评估以下各项之间的关联:1:单侧任务中每个肢体的 MA 和 LA 的结果;2:单侧与双侧任务中每个肢体的结果:大多数参与者在双侧任务中表现出障碍(84%)。大多数受试者的双侧表现类别(即双人)都存在双侧协调障碍(物体击中:57.8%;球击中横杆:31.6%)。大多数受试者在使用 MA 手臂(63%)执行单侧任务时出现协调障碍,使用 LA 手臂(31%)的受试者比例较小。前馈控制是受试者受损比例最高的单侧表现类别,同时显示出 MA 臂和 LA 臂受损之间的关系最密切(rs = 0.93)。反馈控制是最常与双侧任务障碍相关的单侧表现类别(8 个表现类别中的 6 个):结论:患有脊髓灰质炎的成人在完成双侧任务时会出现更多的障碍,但在单侧任务中仍有很大的障碍。他们经常出现前馈控制障碍,同时在双侧和单侧任务中更依赖于反馈控制,从而导致运动表现较差。
{"title":"Robotic assessment of bilateral and unilateral upper limb functions in adults with cerebral palsy.","authors":"I Poitras, S P Dukelow, A Campeau-Lecours, C Mercier","doi":"10.1186/s12984-024-01415-9","DOIUrl":"10.1186/s12984-024-01415-9","url":null,"abstract":"<p><strong>Background: </strong>Children with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study's aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP.</p><p><strong>Methods: </strong>Nineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks.</p><p><strong>Results: </strong>The majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (r<sub>s</sub> = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories).</p><p><strong>Conclusions: </strong>Adults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"21 1","pages":"144"},"PeriodicalIF":5.2,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A compact solution for vibrotactile proprioceptive feedback of wrist rotation and hand aperture. 用于手腕旋转和手部孔径振动本体感觉反馈的紧凑型解决方案。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-13 DOI: 10.1186/s12984-024-01420-y
Andrea Marinelli, Nicolò Boccardo, Michele Canepa, Dario Di Domenico, Emanuele Gruppioni, Matteo Laffranchi, Lorenzo De Michieli, Michela Chiappalone, Marianna Semprini, Strahinja Dosen

Background: Closing the control loop between users and their prostheses by providing artificial sensory feedback is a fundamental step toward the full restoration of lost sensory-motor functions.

Methods: We propose a novel approach to provide artificial proprioceptive feedback about two degrees of freedom using a single array of 8 vibration motors (compact solution). The performance afforded by the novel method during an online closed-loop control task was compared to that achieved using the conventional approach, in which the same information was conveyed using two arrays of 8 and 4 vibromotors (one array per degree of freedom), respectively. The new method employed Gaussian interpolation to modulate the intensity profile across a single array of vibration motors (compact feedback) to convey wrist rotation and hand aperture by adjusting the mean and standard deviation of the Gaussian, respectively. Ten able-bodied participants and four transradial amputees performed a target achievement control test by utilizing pattern recognition with compact and conventional vibrotactile feedback to control the Hannes prosthetic hand (test conditions). A second group of ten able-bodied participants performed the same experiment in control conditions with visual and auditory feedback as well as no-feedback.

Results: Conventional and compact approaches resulted in similar positioning accuracy, time and path efficiency, and total trial time. The comparison with control condition revealed that vibrational feedback was intuitive and useful, but also underlined the power of incidental feedback sources. Notably, amputee participants achieved similar performance to that of able-bodied participants.

Conclusions: The study therefore shows that the novel feedback strategy conveys useful information about prosthesis movements while reducing the number of motors without compromising performance. This is an important step toward the full integration of such an interface into a prosthesis socket for clinical use.

背景:通过提供人工感觉反馈来闭合用户与假肢之间的控制环,是完全恢复失去的感觉运动功能的基本步骤:我们提出了一种新方法,利用由 8 个振动电机组成的单一阵列(紧凑型解决方案)提供两个自由度的人工本体感觉反馈。在一项在线闭环控制任务中,新方法所提供的性能与传统方法所提供的性能进行了比较。在传统方法中,同样的信息分别通过两个由 8 个和 4 个振动电机组成的阵列(每个自由度一个阵列)来传递。新方法采用高斯插值法来调节单个振动电机阵列(紧凑反馈)的强度曲线,通过调整高斯的平均值和标准偏差来分别传递手腕旋转和手部开度的信息。十名健全参与者和四名经桡骨截肢者利用模式识别与紧凑型和传统型振动反馈来控制汉内斯假手(测试条件),进行了目标实现控制测试。第二组由 10 名健全参与者组成,他们在控制条件下进行了同样的实验,包括视觉和听觉反馈以及无反馈:结果:传统方法和紧凑方法的定位精度、时间和路径效率以及总试验时间相似。与对照条件的比较显示,振动反馈直观而有用,但也凸显了偶然反馈源的力量。值得注意的是,截肢者的表现与健全者相似:因此,这项研究表明,新颖的反馈策略可以传递有关假肢运动的有用信息,同时减少电机数量,而不会影响性能。这是将这种界面完全集成到临床使用的假肢插座中的重要一步。
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引用次数: 0
The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial. 支架对因中风导致上肢偏瘫的患者参加以游戏为基础、缺乏监督的家庭康复计划的内在动机和自主坚持的影响。随机对照试验。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-13 DOI: 10.1186/s12984-024-01441-7
Gerard Fluet, Qinyin Qiu, Amanda Gross, Holly Gorin, Jigna Patel, Alma Merians, Sergei Adamovich

Background: This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.

Methods: 33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients.

Results: There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training.

Conclusions: Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living.

Trial registration: Clinical Trials.gov-NCT03985761, Registered June 14, 2019.

研究背景这项平行随机对照试验考察了两组受试者的内在动机、坚持性和运动功能改善情况,这两组受试者都参加了为期 12 周的家庭上肢康复计划。17 名受试者进行了支架式游戏,游戏难度从 8 到 12 级不等,难度不断增加。方法:使用随机数字生成器将 33 名年龄在 20-80 岁、中风后至少 6 个月、患有中度至轻度偏瘫的人随机分为两组。他们在训练前后分别接受了行动研究手臂测试、上肢 Fugl Meyer 评估、中风影响量表和内在动机量表的测试。使用游戏系统生成的时间戳对坚持情况进行测量。受试者家中安装了家庭虚拟康复系统(Qiu,发表于《神经康复》杂志17:1-10,2020年),并学习如何使用该系统进行康复游戏。研究人员要求受试者每天进行二十分钟的训练,但受试者也可以自行选择训练时间。受试者在没有预约的情况下接受了 12 周的训练,并得到了研究人员的间歇性支持。采用方差分析对各组结果进行比较。使用皮尔逊相关系数评估受试者人口统计学特征与坚持情况以及运动结果之间的相关性:结果:共有 5 人辍学,无不良事件发生。在五项临床结果测量中,时间对其中四项的主效应具有统计学意义。培训组与时间之间没有明显的交互作用。各组间的依从性测量没有明显差异。综合组的 UEFMA 评分平均提高了 5.85 分(95% CI 4.73-6.98)。两组中均有 21 名受试者的 UEFMA 分数至少提高了 5 分,超过了 4.25 的最小临床重要性差异。IMI评分在训练前和训练后保持稳定:结论:与通过算法控制游戏难度相比,在基于游戏的康复训练过程中进行脚手架挑战并不能提高坚持率。两种在家中进行的游戏式治疗方案都受到了稀少的监督,但都足以在运动功能和日常生活活动方面取得具有统计学意义和临床意义的改善:临床试验.gov-NCT03985761,2019年6月14日注册。
{"title":"The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, sparsely supervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.","authors":"Gerard Fluet, Qinyin Qiu, Amanda Gross, Holly Gorin, Jigna Patel, Alma Merians, Sergei Adamovich","doi":"10.1186/s12984-024-01441-7","DOIUrl":"10.1186/s12984-024-01441-7","url":null,"abstract":"<p><strong>Background: </strong>This parallel, randomized controlled trial examined intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a 12-week, home-based upper extremity rehabilitation program. Seventeen subjects played scaffolded games, presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally.</p><p><strong>Methods: </strong>33 persons 20-80 years of age, at least 6 months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the gaming system. Subjects had the Home Virtual Rehabilitation System (Qiu in J Neuroeng Rehabil 17: 1-10, 2020) placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for 12 weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients.</p><p><strong>Results: </strong>There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ significantly between groups. The combined groups improved their UEFMA scores on average by 5.85 (95% CI 4.73-6.98). 21 subjects from both groups demonstrating improvements in UEFMA scores of at least 5 points, exceeding the minimal clinically important difference of 4.25. IMI scores were stable pre to post training.</p><p><strong>Conclusions: </strong>Scaffolding challenges during game based rehabilitation did not elicit higher levels of adherence when compared to algorithm control of game difficulty. Both sparsely supervised programs of game-based treatment in the home were sufficient to elicit statistically significant, clinically meaningful improvements in motor function and activities of daily living.</p><p><strong>Trial registration: </strong>Clinical Trials.gov-NCT03985761, Registered June 14, 2019.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"21 1","pages":"143"},"PeriodicalIF":5.2,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11321133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feedback control of heart rate during robotics-assisted tilt table exercise in patients after stroke: a clinical feasibility study 中风后患者在机器人辅助倾斜台运动中的心率反馈控制:一项临床可行性研究
IF 5.1 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-12 DOI: 10.1186/s12984-024-01440-8
Lars Brockmann, Jittima Saengsuwan, Corina Schuster-Amft, Kenneth J. Hunt
Patients with neurological disorders including stroke use rehabilitation to improve cognitive abilities, to regain motor function and to reduce the risk of further complications. Robotics-assisted tilt table technology has been developed to provide early mobilisation and to automate therapy involving the lower limbs. The aim of this study was to evaluate the feasibility of employing a feedback control system for heart rate (HR) during robotics-assisted tilt table exercise in patients after a stroke. This feasibility study was designed as a case series with 12 patients ( $$n = 12$$ ) with no restriction on the time post-stroke or on the degree of post-stroke impairment severity. A robotics-assisted tilt table was augmented with force sensors, a work rate estimation algorithm, and a biofeedback screen that facilitated volitional control of a target work rate. Dynamic models of HR response to changes in target work rate were estimated in system identification tests; nominal models were used to calculate the parameters of feedback controllers designed to give a specified closed-loop bandwidth; and the accuracy of HR control was assessed quantitatively in feedback control tests. Feedback control tests were successfully conducted in all 12 patients. Dynamic models of heart rate response to imposed work rate were estimated with a mean root-mean-square (RMS) model error of 2.16 beats per minute (bpm), while highly accurate feedback control of heart rate was achieved with a mean RMS tracking error (RMSE) of 2.00 bpm. Control accuracy, i.e. RMSE, was found to be strongly correlated with the magnitude of heart rate variability (HRV): patients with a low magnitude of HRV had low RMSE, i.e. more accurate HR control performance, and vice versa. Feedback control of heart rate during robotics-assisted tilt table exercise was found to be feasible. Future work should investigate robustness aspects of the feedback control system. Modifications to the exercise modality, or alternative modalities, should be explored that allow higher levels of work rate and heart rate intensity to be achieved.
包括中风在内的神经系统疾病患者通过康复治疗来提高认知能力、恢复运动功能并降低进一步并发症的风险。目前已开发出机器人辅助倾斜台技术,以提供早期移动和涉及下肢的自动化治疗。本研究旨在评估中风后患者在机器人辅助倾斜台运动期间采用心率(HR)反馈控制系统的可行性。这项可行性研究以病例系列的形式进行,共有 12 名患者参与($$n = 12$$),对中风后的时间或中风后功能障碍的严重程度没有限制。在机器人辅助倾斜台上安装了力传感器、工作率估算算法和生物反馈屏幕,以方便患者自愿控制目标工作率。在系统识别测试中估算了心率对目标工作率变化的动态响应模型;使用标称模型计算了反馈控制器的参数,该控制器旨在提供指定的闭环带宽;在反馈控制测试中对心率控制的准确性进行了定量评估。所有 12 名患者都成功进行了反馈控制测试。估算出的心率对施加的工作率的动态响应模型的平均均方根(RMS)误差为 2.16 次/分(bpm),而实现的高精度心率反馈控制的平均均方根跟踪误差(RMSE)为 2.00 次/分(bpm)。研究发现,控制精度(即 RMSE)与心率变异幅度(HRV)密切相关:心率变异幅度低的患者 RMSE 低,即心率控制性能更准确,反之亦然。研究发现,在机器人辅助的倾斜台运动中对心率进行反馈控制是可行的。未来的工作应研究反馈控制系统的稳健性。此外,还应该对运动方式或替代方式进行改进,以实现更高水平的工作率和心率强度。
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引用次数: 0
Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke. 基于混合现实技术的手部和手指康复训练对中风患者手指运动追踪的效果。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-10 DOI: 10.1186/s12984-024-01418-6
Yeajin Ham, Dong-Seok Yang, Younggeun Choi, Joon-Ho Shin

Background: Mixed reality (MR) is helpful in hand training for patients with stroke, allowing them to fully submerge in a virtual space while interacting with real objects. The recognition of individual finger movements is required for MR rehabilitation. This study aimed to assess the effectiveness of updated MR-board 2, adding finger training for patients with stroke.

Methods: Twenty-one participants with hemiplegic stroke (10 with left hemiplegia and 11 with right hemiplegia; nine female patients; 56.7 ± 14.2 years of age; and onset of stroke 32.7 ± 34.8 months) participated in this study. MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions involving 30-min training using MR-board 2. The outcome measurements for upper extremity function were the Fugl-Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), the thumb opposition test (TOT), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). One-way repeated measures analysis of variance and the post hoc test were applied for the measurements. MR-board 2 recorded the fingers' active range of motion (AROM) and Dunnett's test was used for pairwise comparisons.

Results: Except for the FMA-proximal score (p = 0.617) and TOT (p = 0.005), other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery improved significantly (p < 0.001) during MR-board 2 training and were maintained until follow-up. All AROM values of the finger joints changed significantly during training (p < 0.001).

Conclusions: MR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.

Trial registration number: This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

背景:混合现实(MR)有助于中风患者的手部训练,使他们能够完全沉浸在虚拟空间中,同时与真实物体互动。混合现实康复训练需要识别个别手指动作。本研究旨在评估更新版 MR-board 2 的效果,增加对中风患者的手指训练:21名中风偏瘫患者(左侧偏瘫10人,右侧偏瘫11人;女性9人;年龄(56.7±14.2)岁;中风发病时间(32.7±34.8)个月)参加了本研究。MR-board 2 由一块板、一个深度摄像头、塑料状物体、一个显示器、一个掌上摄像头和七个游戏化训练程序组成。所有参与者均使用 MR-board 2 进行了 20 次自我训练,每次 30 分钟。上肢功能的结果测量包括福格尔-迈耶评估(FMA)上肢评分、手指屈伸重复次数(Repeat-FE)、拇指对抗测试(TOT)、箱形和块形测试评分(BBT)、沃尔夫运动功能测试评分(WMFT)和卒中影响量表(SIS)。测量采用单因素重复测量方差分析和事后检验。MR-board 2记录了手指的主动运动范围(AROM),并采用邓尼特检验进行配对比较:结果:除 FMA 近端评分(p = 0.617)和 TOT(p = 0.005)外,其他 FMA 评分、BBT 评分、Repeat-FE、WMFT 评分和 SIS 中风恢复情况均有显著改善(p 结论:MR-board 2 的自我训练效果显著:MR-board 2 自我训练包括使用有形用户界面和手指实时跟踪进行人与计算机之间的自然互动,可改善上肢功能障碍、活动和参与。MR-board 2可作为中风患者的自我训练工具,提高他们的生活质量:本研究已在临床研究信息服务机构注册(CRIS:KCT0004167)。
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引用次数: 0
Correction: Hybrid approaches to allied health services for children and young people: a scoping review. 更正:为儿童和青少年提供联合医疗服务的混合方法:范围综述。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-10 DOI: 10.1186/s12984-024-01434-6
Tal Krasovsky, Patrice L Weiss, Liat Gafni-Lachter, Rachel Kizony, Naomi Gefen
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引用次数: 0
Perspectives on the comparative benefits of body-powered and myoelectric upper limb prostheses. 身体供电型上肢假肢和肌电型上肢假肢的优势对比透视。
IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Pub Date : 2024-08-08 DOI: 10.1186/s12984-024-01436-4
Susannah M Engdahl, Michael A Gonzalez, Christina Lee, Deanna H Gates

Background: Patient access to body-powered and myoelectric upper limb prostheses in the United States is often restricted by a healthcare system that prioritizes prosthesis prescription based on cost and perceived value. Although this system operates on an underlying assumption that design differences between these prostheses leads to relative advantages and disadvantages of each device, there is limited empirical evidence to support this view.

Main text: This commentary article will review a series of studies conducted by our research team with the goal of differentiating how prosthesis design might impact user performance on a variety of interrelated domains. Our central hypothesis is that the design and actuation method of body-powered and myoelectric prostheses might affect users' ability to access sensory feedback and account for device properties when planning movements. Accordingly, other domains that depend on these abilities may also be affected. While our work demonstrated some differences in availability of sensory feedback based on prosthesis design, this did not result in consistent differences in prosthesis embodiment, movement accuracy, movement quality, and overall kinematic patterns.

Conclusion: Collectively, our findings suggest that performance may not necessarily depend on prosthesis design, allowing users to be successful with either device type depending on the circumstances. Prescription practices should rely more on individual needs and preferences than cost or prosthesis design. However, we acknowledge that there remains a dearth of evidence to inform decision-making and that an expanded research focus in this area will be beneficial.

背景:在美国,患者在使用体外动力和肌电上肢假肢时往往受到医疗保健系统的限制,该系统根据成本和感知价值确定假肢处方的优先次序。虽然这一体系的基本假设是,这些假肢之间的设计差异会导致每种假肢的相对优缺点,但支持这一观点的经验证据却很有限:这篇评论文章将回顾我们的研究团队进行的一系列研究,目的是区分假肢设计如何影响用户在各种相互关联领域的表现。我们的核心假设是,身体供电假肢和肌电假肢的设计和驱动方法可能会影响使用者在计划动作时获取感觉反馈和考虑设备特性的能力。因此,依赖于这些能力的其他领域也可能受到影响。虽然我们的研究表明,根据假肢设计,感觉反馈的可用性存在一些差异,但这并没有导致假肢体现、运动准确性、运动质量和整体运动模式的一致差异:总之,我们的研究结果表明,使用者的表现并不一定取决于假肢的设计,使用者可以根据具体情况成功使用任何一种假肢。处方实践应更多地考虑个人需求和偏好,而不是成本或假体设计。不过,我们也承认,目前仍缺乏可供决策参考的证据,扩大该领域的研究重点将大有裨益。
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引用次数: 0
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