Browsing by Keyword "Rehabilitation"
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Item Analysis of the movements generated by a multi-field functional electrical stimulation device for upper extremity rehabilitation(2022-10) Martín-Odriozola, Aitor; Rodríguez-de-Pablo, Cristina; Caceres-Salegi, Ane; García-Calleja, Andrea; Marín-Ojea, Juan Ignacio; Hernández, Erik; Imatz-Ojanguren, Eukene; Keller, Thierry; Zabaleta-Rekondo, Haritz; Martín‐Odriozola, Aitor; Rodríguez‐de‐Pablo, Cristina; Caceres‐Salegi, Ane; García‐Calleja, Andrea; Marín‐Ojea, Juan Ignacio; Imatz‐Ojanguren, Eukene; Zabaleta‐Rekondo, Haritz; Medical Technologies; Tecnalia Research & InnovationBackground: The most common chronic sequela after stroke is the loss of arm function, and functional electrical stimulation (FES) applied to the forearm muscles is one of the options to treat it. Surface multi-field electrodes have emerged, showing a great potential to improve the selectivity of the stimulation, delay muscle fatigue, and provide easier donning and doffing. The muscular selectivity takes on special relevance in the rehabilitation of the upper extremity as hand dexterity requires a wide diversity of specific muscle actions. Methods: This pilot study analyses the movements generated in the wrist and fingers using a commercial multi-field technology-based FES device (Fesia Grasp). The study included five patients with hemiplegic subacute stroke, in which scanning of all cathodes of the electrode was carried out daily for 5 days, in two different forearm positions, with the resulting movements being labeled by experienced therapists. Results: The aim of this pilot study was to determine if there were differences between subjects and between forearm positions in terms of produced movements. Movements of the wrist (two movements) and the fingers (six movements) could be achieved in two different forearm positions. Conclusions: The multi-field electrode of Fesia Grasp enables to generate a wide range of movements of the hand in different positions. This fact could allow to produce more physiological movement patterns during the rehabilitation process with FES, which could have a beneficial effect on the recovery of patients with neurological diseases.Item Brain-machine interfaces for rehabilitation in stroke: A review: A review(2018-07) López-Larraz, E.; Sarasola-Sanz, A.; Irastorza-Landa, N.; Birbaumer, N.; Ramos-Murguialday, A.; Medical TechnologiesBACKGROUND: Motor paralysis after stroke has devastating consequences for the patients, families and caregivers. Although therapies have improved in the recent years, traditional rehabilitation still fails in patients with severe paralysis. Brain-machine interfaces (BMI) have emerged as a promising tool to guide motor rehabilitation interventions as they can be applied to patients with no residual movement. OBJECTIVE: This paper reviews the efficiency of BMI technologies to facilitate neuroplasticity and motor recovery after stroke. METHODS: We provide an overview of the existing rehabilitation therapies for stroke, the rationale behind the use of BMIs for motor rehabilitation, the current state of the art and the results achieved so far with BMI-based interventions, as well as the future perspectives of neural-machine interfaces. RESULTS: Since the first pilot study by Buch and colleagues in 2008, several controlled clinical studies have been conducted, demonstrating the efficacy of BMIs to facilitate functional recovery in completely paralyzed stroke patients with noninvasive technologies such as the electroencephalogram (EEG). CONCLUSIONS: Despite encouraging results, motor rehabilitation based on BMIs is still in a preliminary stage, and further improvements are required to boost its efficacy. Invasive and hybrid approaches are promising and might set the stage for the next generation of stroke rehabilitation therapies.Item Clinical validation of a novel postural support device for hospitalized sub-acute post stroke wheelchair users(2016-04-07) Veneman, Jan F.; Jung, Je Hyung; Manterola Del Puerto, Iraitz; Seco Rodríguez, Maria Luz; Camiruaga Zalbidea, Iñaki; Cardoso Martin, Sergio; Mendoza Arteche, Lorea; Alemany Herrera, Jorge; Tecnalia Research & Innovation; Medical TechnologiesPurpose: We present a novel wheelchair posture support device (WPSD) and its clinical validation. The device was developed in order to assure correct sitting posture and to reduce the time spent by caregivers for re-positioning of hospitalized, wheelchair-bound, post-acute stroke patients. Method: The device was validated with 16 subjects during a period of 5 days in which use of the device was compared with regular care practice. Results: The device was used for the five consecutive days in 69% of patients, while for 6% it was not suitable; 25% did not complete the 5 days for reasons unrelated to the device. Caregivers needed to re-position the patients that used the device for the full 5 days (n=11) on an average 52% less often when using the device, as compared to regular practice. Furthermore, the device was rated as usable and functional by the caregivers while significantly reducing perception of trunk and shoulder pain in patients during its use. Conclusions: The newly designed WPSD is a valuable system for the improvement of medical assistance to wheelchair-bound post-stroke patients by reducing pain and number of re-positioning manoeuvres. The WPSD might be applicable to any group of patients who need posture control in either wheelchair or common chair with arms support.Item A compact system for simultaneous stimulation and recording for closed-loop myoelectric control(2021-12) Garenfeld, Martin A.; Jorgovanovic, Nikola; Ilic, Vojin; Strbac, Matija; Isakovic, Milica; Dideriksen, Jakob L.; Dosen, Strahinja; Tecnalia Research & Innovation; SGBackground.Despite important advancements in control and mechatronics of myoelectric prostheses, the communication between the user and his/her bionic limb is still unidirectional, as these systems do not provide somatosensory feedback. Electrotactile stimulation is an attractive technology to close the control loop since it allows flexible modulation of multiple parameters and compact interface design via multi-pad electrodes. However, the stimulation interferes with the recording of myoelectric signals and this can be detrimental to control.Item A decision support system for electrode shaping in multi-pad FES foot drop correction(2017-07-03) Malešević, Jovana; Dedijer Dujović, Suzana; Savić, Andrej M.; Konstantinović, Ljubica; Vidaković, Aleksandra; Bijelić, Goran; Malešević, Nebojša; Keller, Thierry; Tecnalia Research & Innovation; SG; MercadoBackground: Functional electrical stimulation (FES) can be applied as an assistive and therapeutic aid in the rehabilitation of foot drop. Transcutaneous multi-pad electrodes can increase the selectivity of stimulation; however, shaping the stimulation electrode becomes increasingly complex with an increasing number of possible stimulation sites. We described and tested a novel decision support system (DSS) to facilitate the process of multi-pad stimulation electrode shaping. The DSS is part of a system for drop foot treatment that comprises a customdesigned multi-pad electrode, an electrical stimulator, and an inertial measurement unit. Methods: The system was tested in ten stroke survivors (3-96 months post stroke) with foot drop over 20 daily sessions. The DSS output suggested stimulation pads and parameters based on muscle twitch responses to short stimulus trains. The DSS ranked combinations of pads and current amplitudes based on a novel measurement of the quality of the induced movement and classified them based on the movement direction (dorsiflexion, plantar flexion, eversion and inversion) of the paretic foot. The efficacy of the DSS in providing satisfactory pad-current amplitude choices for shaping the stimulation electrode was evaluated by trained clinicians. The range of paretic foot motion was used as a quality indicator for the chosen patterns. Results: The results suggest that the DSS output was highly effective in creating optimized FES patterns. The position and number of pads included showed pronounced inter-patient and inter-session variability; however, zones for inducing dorsiflexion and plantar flexion within the multi-pad electrode were clearly separated. The range of motion achieved with FES was significantly greater than the corresponding active range of motion (p < 0.05) during the first three weeks of therapy. Conclusions: The proposed DSS in combination with a custom multi-pad electrode design covering the branches of peroneal and tibial nerves proved to be an effective tool for producing both the dorsiflexion and plantar flexion of a paretic foot. The results support the use of multi-pad electrode technology in combination with automatic electrode shaping algorithms for the rehabilitation of foot drop.Item European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus: data synthesis from systematic reviews, clinical practice guidelines and expert consensus(2021-12) Prange-Lasonder, Gerdienke B.; Alt Murphy, Margit; Lamers, Ilse; Hughes, Ann-Marie; Buurke, Jaap H.; Feys, Peter; Keller, Thierry; Klamroth-Marganska, Verena; Tarkka, Ina M.; Timmermans, Annick; Burridge, Jane H.; Tecnalia Research & InnovationBackground: Technology-supported rehabilitation can help alleviate the increasing need for cost-effective rehabilitation of neurological conditions, but use in clinical practice remains limited. Agreement on a core set of reliable, valid and accessible outcome measures to assess rehabilitation outcomes is needed to generate strong evidence about effectiveness of rehabilitation approaches, including technologies. This paper collates and synthesizes a core set from multiple sources; combining existing evidence, clinical practice guidelines and expert consensus into European recommendations for Clinical Assessment of Upper Limb In Neurorehabilitation (CAULIN). Methods: Data from systematic reviews, clinical practice guidelines and expert consensus (Delphi methodology) were systematically extracted and synthesized using strength of evidence rating criteria, in addition to recommendations on assessment procedures. Three sets were defined: a core set: strong evidence for validity, reliability, responsiveness and clinical utility AND recommended by at least two sources; an extended set: strong evidence OR recommended by at least two sources and a supplementary set: some evidence OR recommended by at least one of the sources. Results: In total, 12 measures (with primary focus on stroke) were included, encompassing body function and activity level of the International Classification of Functioning and Health. The core set recommended for clinical practice and research: Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT); the extended set recommended for clinical practice and/or clinical research: kinematic measures, Box and Block Test (BBT), Chedoke Arm Hand Activity Inventory (CAHAI), Wolf Motor Function Test (WMFT), Nine Hole Peg Test (NHPT) and ABILHAND; the supplementary set recommended for research or specific occasions: Motricity Index (MI); Chedoke-McMaster Stroke Assessment (CMSA), Stroke Rehabilitation Assessment Movement (STREAM), Frenchay Arm Test (FAT), Motor Assessment Scale (MAS) and body-worn movement sensors. Assessments should be conducted at pre-defined regular intervals by trained personnel. Global measures should be applied within 24 h of hospital admission and upper limb specific measures within 1 week. Conclusions: The CAULIN recommendations for outcome measures and assessment procedures provide a clear, simple, evidence-based three-level structure for upper limb assessment in neurological rehabilitation. Widespread adoption and sustained use will improve quality of clinical practice and facilitate meta-analysis, critical for the advancement of technology-supported neurorehabilitation.Item HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke: telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke(2021-03) Rozevink, Samantha G.; van der Sluis, Corry K.; Garzo, Ainara; Keller, Thierry; Hijmans, Juha M.; Tecnalia Research & Innovation; Medical TechnologiesHoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke). Patients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.Item Interaction force and motion estimators facilitating impedance control of the upper limb rehabilitation robot(IEEE Xplore, 2017-08-15) Mancisidor, Aitziber; Zubizarreta, Asier; Cabanes, Itziar; Bengoa, Pablo; Jung, Je Hyung; Ajoudani, Arash; Artemiadis, Panagiotis; Beckerle, Philipp; Grioli, Giorgio; Lambercy, Olivier; Mombaur, Katja; Novak, Domen; Rauter, Georg; Rodriguez Guerrero, Carlos; Salvietti, Gionata; Amirabdollahian, Farshid; Balasubramanian, Sivakumar; Castellini, Claudio; Di Pino, Giovanni; Guo, Zhao; Hughes, Charmayne; Iida, Fumiya; Lenzi, Tommaso; Ruffaldi, Emanuele; Sergi, Fabrizio; Soh, Gim Song; Caimmi, Marco; Cappello, Leonardo; Carloni, Raffaella; Carlson, Tom; Casadio, Maura; Coscia, Martina; De Santis, Dalia; Forner-Cordero, Arturo; Howard, Matthew; Piovesan, Davide; Siqueira, Adriano; Sup, Frank; Lorenzo, Masia; Catalano, Manuel Giuseppe; Lee, Hyunglae; Menon, Carlo; Raspopovic, Stanisa; Rastgaar, Mo; Ronsse, Renaud; van Asseldonk, Edwin; Vanderborght, Bram; Venkadesan, Madhusudhan; Bianchi, Matteo; Braun, David; Godfrey, Sasha Blue; Mastrogiovanni, Fulvio; McDaid, Andrew; Rossi, Stefano; Zenzeri, Jacopo; Formica, Domenico; Karavas, Nikolaos; Marchal-Crespo, Laura; Reed, Kyle B.; Tagliamonte, Nevio Luigi; Burdet, Etienne; Basteris, Angelo; Campolo, Domenico; Deshpande, Ashish; Dubey, Venketesh; Hussain, Asif; Sanguineti, Vittorio; Unal, Ramazan; Caurin, Glauco Augusto de Paula; Koike, Yasuharu; Mazzoleni, Stefano; Park, Hyung-Soon; Remy, C. David; Saint-Bauzel, Ludovic; Tsagarakis, Nikos; Veneman, Jan; Zhang, Wenlong; Tecnalia Research & Innovation; Medical TechnologiesIn order to enhance the performance of rehabilitation robots, it is imperative to know both force and motion caused by the interaction between user and robot. However, common direct measurement of both signals through force and motion sensors not only increases the complexity of the system but also impedes affordability of the system. As an alternative of the direct measurement, in this work, we present new force and motion estimators for the proper control of the upper-limb rehabilitation Universal Haptic Pantograph (UHP) robot. The estimators are based on the kinematic and dynamic model of the UHP and the use of signals measured by means of common low-cost sensors. In order to demonstrate the effectiveness of the estimators, several experimental tests were carried out. The force and impedance control of the UHP was implemented first by directly measuring the interaction force using accurate extra sensors and the robot performance was compared to the case where the proposed estimators replace the direct measured values. The experimental results reveal that the controller based on the estimators has similar performance to that using direct measurement (less than 1 N difference in root mean square error between two cases), indicating that the proposed force and motion estimators can facilitate implementation of interactive controller for the UHP in robot-mediated rehabilitation trainings.Item MERLIN: Upper-Limb Rehabilitation Robot System for Home Environment(Springer Science and Business Media Deutschland GmbH, 2022) Garzo, Ainara; Arcas-Ruiz-Ruano, Javier; Dorronsoro, Iñigo; Gaminde, Gabriel; Jung, Je Hyung; Téllez, Javier; Keller, Thierry; Medical Technologies; Tecnalia Research & InnovationArmAssist is a cost-effective robotic system for post-stroke upper-limb rehabilitation. The system incorporates the ArmAssist Assessment platform based on serious games that enables fast, quantitative and automatic evaluation of the arm functions. The aim of the MERLIN European project is to bring this system to the patients’ homes to personalize the therapy with reduced supervision while increasing the number of movement repetitions to improve the effectiveness. To this end, the ArmAssist system developed by TECNALIA, has been integrated with GMV’s Antari Home Care platform, to customize and supervise the training remotely. Additionally, several technical improvements have been done to enhance the usability and functionality of the system according to the patients and therapists’ feedback. In this paper, the technical progress of the MERLIN system is presented.Item On the design of EEG-based movement decoders for completely paralyzed stroke patients(2018-11-20) Spüler, Martin; López-Larraz, Eduardo; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical TechnologiesBackground: Brain machine interface (BMI) technology has demonstrated its efficacy for rehabilitation of paralyzed chronic stroke patients. The critical component in BMI-training consists of the associative connection (contingency) between the intention and the feedback provided. However, the relationship between the BMI design and its performance in stroke patients is still an open question. Methods: In this study we compare different methodologies to design a BMI for rehabilitation and evaluate their effects on movement intention decoding performance. We analyze the data of 37 chronic stroke patients who underwent 4 weeks of BMI intervention with different types of association between their brain activity and the proprioceptive feedback. We simulate the pseudo-online performance that a BMI would have under different conditions, varying: (1) the cortical source of activity (i.e., ipsilesional, contralesional, bihemispheric), (2) the type of spatial filter applied, (3) the EEG frequency band, (4) the type of classifier; and also evaluated the use of residual EMG activity to decode the movement intentions. Results: We observed a significant influence of the different BMI designs on the obtained performances. Our results revealed that using bihemispheric beta activity with a common average reference and an adaptive support vector machine led to the best classification results. Furthermore, the decoding results based on brain activity were significantly higher than those based on muscle activity. Conclusions: This paper underscores the relevance of the different parameters used to decode movement, using EEG in severely paralyzed stroke patients. We demonstrated significant differences in performance for the different designs, which supports further research that should elucidate if those approaches leading to higher accuracies also induce higher motor recovery in paralyzed stroke patients.Item Real-Time Control of a Multi-Degree-of-Freedom Mirror Myoelectric Interface During Functional Task Training(2022-03-11) Sarasola-Sanz, Andrea; López-Larraz, Eduardo; Irastorza-Landa, Nerea; Rossi, Giulia; Figueiredo, Thiago; McIntyre, Joseph; Ramos-Murguialday, Ander; Tecnalia Research & Innovation; Medical Technologies; Robótica MédicaMotor learning mediated by motor training has in the past been explored for rehabilitation. Myoelectric interfaces together with exoskeletons allow patients to receive real-time feedback about their muscle activity. However, the number of degrees of freedom that can be simultaneously controlled is limited, which hinders the training of functional tasks and the effectiveness of the rehabilitation therapy. The objective of this study was to develop a myoelectric interface that would allow multi-degree-of-freedom control of an exoskeleton involving arm, wrist and hand joints, with an eye toward rehabilitation. We tested the effectiveness of a myoelectric decoder trained with data from one upper limb and mirrored to control a multi-degree-of-freedom exoskeleton with the opposite upper limb (i.e., mirror myoelectric interface) in 10 healthy participants. We demonstrated successful simultaneous control of multiple upper-limb joints by all participants. We showed evidence that subjects learned the mirror myoelectric model within the span of a five-session experiment, as reflected by a significant decrease in the time to execute trials and in the number of failed trials. These results are the necessary precursor to evaluating if a decoder trained with EMG from the healthy limb could foster learning of natural EMG patterns and lead to motor rehabilitation in stroke patients.Item Requirements for Upper-Limb Rehabilitation with FES and Exoskeleton(Springer Science and Business Media Deutschland GmbH, 2021-02-06) Kim, Woojin; Joe, Hyunwoo; Kim, Hyun Suk; Lee, Seung Jun; Yoon, Daesub; Jung, Je Hyung; Acuña, Borja Bornail; Lee, Hooman; Raton, Javier Fínez; Isoird, Carlos Fernández; Mariñelarena, Iker; Alonso, Miguel Angel Aldudo; Shin, Myung Jun; Park, Tae Sung; Singh, Madhusudan; Kang, Dae-Ki; Lee, Jong-Ha; Tiwary, Uma Shanker; Singh, Dhananjay; Chung, Wan-Young; Medical Technologies; Tecnalia Research & InnovationIn the last work, we have presented the scope of our project, i.e. use cases of activities of daily living (ADL) for the on-going project a.k.a. iCARE. The project mainly handles the upper-limb rehabilitation in general, however, we have narrowed down the scope and focus on, in terms of the phase of the stroke recovery, the target body area of rehabilitation and the level of muscle function. In this paper, we have drawn the user and system requirements before design the specific functions of the targeted device. First, we have defined the stakeholders for the device and the rehabilitation service scenarios. Next, the user requirements are defined and finally the related system requirements are drawn.Item Robot-supported assessment of balance in standing and walking(2017-08-14) Shirota, Camila; van Asseldonk, Edwin; Matjačić, Zlatko; Vallery, Heike; Barralon, Pierre; Maggioni, Serena; Buurke, Jaap H.; Veneman, Jan F.; Tecnalia Research & Innovation; Medical TechnologiesClinically useful and efficient assessment of balance during standing and walking is especially challenging in patients with neurological disorders. However, rehabilitation robots could facilitate assessment procedures and improve their clinical value. We present a short overview of balance assessment in clinical practice and in posturography. Based on this overview, we evaluate the potential use of robotic tools for such assessment. The novelty and assumed main benefits of using robots for assessment are their ability to assess 'severely affected' patients by providing assistance-as-needed,as well as to provide consistent perturbations during standing and walking while measuring the patient's reactions. We provide a classification of robotic devices on three aspects relevant to their potential application for balance assessment: 1) how the device interacts with the body, 2) in what sense the device is mobile, and 3) on what surface the person stands or walks when using the device. As examples, nine types of robotic devices are described, classified and evaluated for their suitability for balance assessment. Two example cases of robotic assessments based on perturbations during walking are presented. We conclude that robotic devices are promising and can become useful and relevant tools for assessment of balance in patients with neurological disorders, both in research and in clinical use. Robotic assessment holds the promise to provide increasingly detailed assessment that allows to individually tailor rehabilitation training, which may eventually improve training effectiveness.Item A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting(2021-02) Guillén-Climent, Silvia; Garzo, Ainara; Muñoz-Alcaraz, María Nieves; Casado-Adam, Pablo; Arcas-Ruiz-Ruano, Javier; Mejías-Ruiz, Manuela; Mayordomo-Riera, Fernando Jesús; Tecnalia Research & Innovation; Medical TechnologiesNeuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.