Dynamics analysis and simulation experiments of twist spring drive upper limb rehabilitation robot

For patients with upper limb dysfunction after stroke, robot-assisted rehabilitation training plays an important role in functional recovery. The existing upper limb rehabilitation robots have some problems, such as complex mechanisms, insufficient compliance, and can only realize the rehabilitation training of shoulder and elbow joints in the horizontal plane. This research proposes a novel end-effector upper limb rehabilitation robot with three degrees of freedom. Two horizontal rotation freedoms are driven by motors and one vertical translation freedom is driven by a pneumatic cylinder. So it can realize the spatial rehabilitation training of shoulder and elbow joints. The rotation and translation transformation of the robot can be represented by a dual quaternion, which is concise in form and clear in the physical meaning. Therefore, this article adopts dual quaternions to complete the robot’s kinematics modeling, inverse kinematics calculation, and terminal spiral motion trajectory planning. To improve the low-speed moving performance of the spiral motion, a sliding mode control strategy plus feedforward compensation is employed to control the displacement of the cylinder. Experiments show that the robot can realize proximal joints training and has good position tracking accuracy (tracking error is within 2 mm) with smoothness under the proposed control strategy, which can guarantee the accuracy and comfort of passive rehabilitation training, contributing to restoring the function of the impairment upper limbs.

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

Hemiplegia resulting from a stroke leads to a distinct gait pattern and dysfunction in the upper limb. The objective of this study was to determine a correlation between the functionality of the upper limb and selected spatiotemporal parameters of gait in patients with hemiplegia following a stroke. The study comprised a sample of 80 outpatients (45 males and 35 females) with post-stroke hemiplegia, with an average age of 60.78 years, selected using a convenient sampling method. To assess the functionality of the affected upper limb, the study employed the QuickDASH questionnaire, which is a shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire. Concurrently, the participants were recorded on video while performing the 4-meter walk test (4mWT). The recorded videos were meticulously analyzed using Kinovea software (version 0.8.15) to calculate gait parameters such as comfortable and maximum speeds, stride length and time on the paretic and affected side, number of steps taken to cover the 4m, and cadence. Pearson Correlation analysis was conducted to explore potential associations between these gait parameters and the QuickDASH score, with a significance level of p < 0.05.
 The findings revealed significant correlations between upper limb functionality and selected gait parameters. Reduced upper limb functionality correlated with decreased comfortable speed (p < 0.05), maximum speed (p < 0.05), and cadence (p < 0.05) during the 4mWT. In contrast, impaired upper limb function linked to prolonged time to complete the 4m distance (p < 0.05), increased steps taken by both affected (p < 0.05) and unaffected (p < 0.05) sides, and extended stride time on both sides (p < 0.05). However, no substantial correlation emerged between upper limb functionality and stride length on either side (p > 0.05).
 In conclusion, this study emphasizes the correlation between upper limb functionality and specific gait parameters in post-stroke hemiplegic patients. The correlation between upper limb functionality and selected spatiotemporal parameters of gait underscores the necessity for integrated rehabilitation strategies targeting both upper limb and gait training. These findings contribute to a deeper comprehension of the connection between upper limb disability and gait parameters, emphasizing the significance of personalized treatments in order to maximize the restoration of functionality in individuals who have suffered a stroke.

IntroductionEmerging evidence suggests that robotic devices for upper limb rehabilitation after a stroke may improve upper limb function. For robotic upper limb rehabilitation in stroke to be successful, patients’ experiences...

Purpose. Although sensorimotor deficits have been identified in isolated upper limb joints of patients with rheumatoid arthritis (RA), relatively little is known about the presence or consequences of sensorimotor deficits in the upper limb as a whole. To address this, we compared sensorimotor and functional performance in multiple upper limb joints of patients with RA and healthy subjects.Methods. Global upper limb strength, proprioception (joint position sense) and the time taken to perform 2 common functional daily activities (dressing and eating) were estimated in 31 RA patients and 18 healthy subjects. Disability, pain and clinical disease activity were also assessed in the RA patients.Results. The RA patients were weaker (mean difference 280N, 95% Confidence Interval 172 to 389; P < 0.001), had poorer functional performance (6 sec, CI 8.1 – 23.9; P < 0.001), hand grip strength (117 mmHg, CI 61 – 173; P < 0.001) and proprioceptive acuity (2°, CI 0.4 – 3.5; P < 0.05) than the healthy subjects. Upper limb functional performance and disability in the RA patients were inversely associated with global upper limb (r = −0.54 to −0.36) and hand grip strength (r = −0.51 to −0.32) but not proprioception (r = 0.55 – 0.11).Conclusions. Compared to healthy subjects, patients with RA had global upper limb sensorimotor deficits. Weakness contributes to poor upper limb function and disability in patients with RA, although the clinical importance of proprioception is unclear.

BackgroundRecovery of upper limb function after stroke is poor. The acute to subacutephase after stroke is the optimal time window to promote the recovery ofupper limb function. The dose and content of training providedconventionally during this phase is however, unlikely to be adequate todrive functional recovery, especially in the presence of severe motordisability. The current study concerns an approach to address thisshortcoming, through evaluation of the SMART Arm, a non-robotic device thatenables intensive and repetitive practice of reaching by stroke survivorswith severe upper limb disability, with the aim of improving upper limbfunction. The outcomes of SMART Arm training with or withoutoutcome-triggered electrical stimulation (OT-stim) to augment movement andusual therapy will be compared to usual therapy alone.Methods/DesignA prospective, assessor-blinded parallel, three-group randomised controlledtrial is being conducted. Seventy-five participants with a first-everunilateral stroke less than 4 months previously, who present with severe armdisability (three or fewer out of a possible six points on the MotorAssessment Scale [MAS] Item 6), will be recruited from inpatientrehabilitation facilities. Participants will be randomly allocated to one ofthree dose-matched groups: SMART Arm training with OT-stim andusual therapy; SMART Arm training without OT-stim and usualtherapy; or usual therapy alone. All participants will receive 20 hours ofupper limb training over four weeks. Blinded assessors will conduct fourassessments: pre intervention (0-weeks), post intervention (4-weeks), 26weeks and 52 weeks follow-up. The primary outcome measure is MAS item 6. Allanalyses will be based on an intention-to-treat principle.DiscussionBy enabling intensive and repetitive practice of a functional upper limb taskduring inpatient rehabilitation, SMART Arm training with or without OT-stimin combination with usual therapy, has the potential to improve recovery ofupper limb function in those with severe motor disability. The immediate andlong-term effects of SMART Arm training on upper limb impairment, activityand participation will be explored, in addition to the benefit of trainingwith or without OT-stim to augment movement when compared to usual therapyalone.Trial registrationACTRN12608000457347

Efecto del tratamiento de radioterapia en el hombro homolateral en mujeres intervenidas de cáncer de mama

The kinetic chain approach to shoulder rehabilitation has become a standard of care within sports medicine. Attempting to incorporate the kinetic chain method of proximal stability for distal mobility requires a stable base of not only the lower extremity but also the upper extremity. Therefore, it was the purpose of this study to quantify muscle activation of the upper and lower extremity during common shoulder rehabilitation exercises using the Bodyblade. An observational descriptive study design was used. Thirty healthy collegiate graduate students (age: 23.5 ± 1.34 years; height: 174.4 ± 11.0 cm; weight: 76.6 ± 16.9 kg), regardless of gender, consented to participate. The independent variables were the 2 observational categories of exercise and muscle. The dependent variable was considered muscle activation as presented as percent maximum voluntary isometric contraction. Results revealed moderate to moderately strong activation of both the musculature of the upper and lower extremity while performing the shoulder rehabilitation exercises. The findings of this study demonstrate that any of these exercises may be incorporated into a shoulder rehabilitation program. The muscle activations described in this study are beneficial in choosing appropriate exercises to perform during shoulder rehabilitation. Information from this study can be applied to the kinetic chain approach to shoulder rehabilitation where focus is on the movement pattern. The Bodyblade is a unique rehabilitation tool because a variety of kinetic chain movement pattern exercises allow for scapular control via muscle activation about the hip and shoulder.

Following stroke, upper limb impairment is common and frequently limits ability to perform everyday activities. Due to limited resources, current therapy levels are insufficient to optimise functional improvement. Robotic devices have potential to augment upper limb stroke rehabilitation, but knowledge regarding the optimal device features and intervention parameters is limited. This systematic review and meta-analysis aimed to determine the efficacy of upper limb robotic rehabilitation compared with conventional rehabilitation, and to critically explore the device features and programme parameters that influence rehabilitation outcomes. Six electronic databases were searched for RCTs that compared dose-matched robotic versus conventional rehabilitation following stroke, and measured activity level changes in upper limb outcomes. The efficacy of robotic compared with conventional rehabilitation was evaluated using random-effects (I2 ≥ 50%) or fixed-effect (I2 < 50%) models. A systematic categorization of robotic device features and intervention parameters was conducted to facilitate subgroup analyses and meta-regression, enabling exploration of how these factors influence rehabilitation outcomes. The review included 54 studies, involving 2744 participants. Meta-analysis demonstrated that robotic rehabilitation had a small, statistically significant positive effect on upper limb capacity compared with conventional rehabilitation (SMD 0.14, 95% CI [0.02, 0.26]), however these gains were not maintained at follow-up (SMD 0.05, 95% CI [-0.13, 0.24]). No significant differences were found between robotic and conventional rehabilitation for ADL outcomes either post-treatment (SMD 0.04, 95% CI [- 0.05, 0.13]) or at follow-up (SMD 0.05, 95% CI [-0.13, 0.24]). Subgroup analyses provided crucial insights into the factors influencing robotic rehabilitation efficacy, revealing significant effects of device assistance (p = 0.0046), joints mobilized (p = 0.0133), degrees of freedom (p = 0.012), device laterality (p = 0.0048), and the number of devices used (p = 0.0001). The results suggest that robotic rehabilitation does not result in clinically meaningful improvement in either upper limb capacity or ADL performance. However, this study's novel subgroup analyses highlight specific device features and intervention parameters that significantly influence efficacy. These findings provide critical guidance for the design, implementation, and future research of robotic rehabilitation.

BackgroundUpper limb disability is a common musculoskeletal condition frequently associated with neck pain. Recent literature has reported the need to utilise validated upper limb outcome measures in the assessment and management of patients with neck pain. However, there is a lack of clear guidance about the suitability of available measures, which may impede utilisation. This review will identify all available measures of upper limb function developed for use in neck pain patients and evaluate their measurement and practical properties in order to identify those measures that are most appropriate for use in clinical practice and research.Methods/designThis review will be performed in two phases. Phase one will identify all measures used to assess upper limb function for patients with neck pain. Phase two will identify all available studies of the measurement and practical properties of identified instrument. The COnsensus-based Standards for selection of health Measurement INstrument (COSMIN) will be used to evaluate the methodological quality of the included studies. To ensure methodological rigour, the findings of this review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline.DiscussionOptimal management of patients with neck pain should incorporate upper limb rehabilitation. The findings of this study will assist clinicians who seek to utilise suitable and accurate measures to assess upper limb function for a patient with neck pain. In addition, the findings of this study may suggest new research directions to support the development of upper limb outcome measures for patients with neck pain.Systematic review registrationPROSPERO CRD42015016624

The upper-limb rehabilitation robots can be developed as an efficient tool for motor function assessments. Circle-drawing has been used as a specific task for robot-based motor function measurement. The upper-limb movement-related kinematic and kinetic parameters measured by motion and force sensors embedded in the rehabilitation robots have been widely studied. However, the muscle synergies characterized by multiple surface electromyographic (sEMG) signals in upper limbs during human-robot interaction (HRI) with circle-drawing movements are rarely investigated. In this research, the robot-assisted and constrained circle-drawing movements for upper limb were used to increase the consistency of muscle synergy features. Both clockwise and counterclockwise circle-drawing tasks were implemented by all healthy subjects using right hands. The sEMG signals were recorded from six muscles in upper limb, and nonnegative matrix factorization (NMF) analysis was utilized to obtain muscle synergy information. Both synergy pattern and activation coefficient were calculated to represent the spatial and temporal features of muscle synergies, respectively. The results obtained from the experimental study confirmed that high structural similarity of muscle synergies was found among the subjects during HRI with circle-drawing movement by healthy subjects, which indicates healthy people may share a common underlying muscle control mechanism during constrained upper-limb circle-drawing movement. This study indicates the muscle synergy analysis during the HRI with constrained circle-drawing movement could be considered as a task for upper-limb motor function assessment.

Aim: To find out correlation between heavy school bags and upper limb disabilities among school going children. Methods: This descriptive cross-sectional survey, using non-probability convenience sampling, was conducted on 396 students of 11 to 15 years after ethical approval in 6 months. Height (in cm) and weight (in Kg) were noted and BMI was calculated. Students with the normal BMI were included in the study. Weigh of the students were recorded with their shoes off while the weight of the bags was calculated with all the stationary included. Quick DASH scale score was calculated and correlated with the weight of the bag by applying Chi-Square test. Results: The mean age of the participants was13.49±1.12 years. The mean weight of the school bag was 6.10±2.1Kgs while the students were carrying more than one-quarter of their body weight. The disability calculated from the quick DASH scale was as high as 40%. Chi-square showed a significant correlation between the upper limb disabilities and the weight of the bag. Conclusion: The study showed that there is a significant correlation that the use of heavy school bags can cause upper limb disabilities in children. Keywords: Heavy School Bags, Upper Limb Disabilities, Children, Disabilities of Arm Shoulder and Hand

Masturbation is a little-discussed topic but an ubiquitous reality. Masturbation practices are multidimensional and influenced by sociocultural, religious, physical and psychological factors. The social discourses most often conveyed concerning people with disabilities aggravate their image as immature, asexual people. The aim of this article is to document the masturbation practices of men and women with upper limb disabilities. To do so, a qualitative methodology was used, involving semistructured interviews with 18 people with upper limb disabilities, aged 18 years and over. The results of the study show that the realities they face have both similarities and differences, but all subjects encountered substantial difficulties. Similarities included a significant need to discover their sexuality during adolescence as well as diverse issues related to a mismatch between body schema and social norms and difficulties masturbating due to lack of comfort. Differences included men having greater anatomical knowledge than women. The main reason why people with disabilities experience such difficulties is that these issues have not been given much attention and few solutions exist. To promote these people’s sexual autonomy via masturbation, a set of solutions is suggested, including educational and hospital programs, guides, training, adaptation of sex toys, and legalization of appropriate sexual assistance.

Background and Overview: Myoelectric Elbow-Wrist-Hand Orthosis (MEWHO) is a revolutionary assistive device designed to provide enhanced functionality and independence to individuals with upper limb disabilities. This abstract provides an overview of the key features, working principles, and potential benefits of the MEWHO. The MEWHO is a custom-designed orthotic device that utilizes advanced myoelectric technology to detect and interpret the user's residual muscle signals from the forearm. These signals are then translated into precise movements, allowing the orthosis to mimic natural joint motions of the elbow, wrist, and hand. The system's sophisticated sensors and algorithms enable seamless and intuitive control, making it a user-friendly and efficient tool for daily activities. The key components of the MEWHO include an elbow joint with adjustable flexion and extension, a wrist joint providing pronation and supination, and a multi-articulated hand with finger flexion and extension capabilities. The device is lightweight, durable, and comfortable to wear, encouraging prolonged use and minimizing fatigue for the user. The primary application of the MEWHO is to assist individuals with conditions such as brachial plexus injury, spinal cord injuries, and stroke. By restoring hand dexterity, enabling object manipulation, and supporting various grasping patterns, the orthosis empowers users to perform a wide range of activities, from simple tasks like eating and dressing to more complex actions involving tools and instruments. In addition to enhancing functional independence, the MEWHO has shown promising results in rehabilitative settings. It can be used as a valuable tool for upper limb rehabilitation, promoting motor learning, and providing proprioceptive feedback to the user. Therapists can customize the orthosis settings to suit individual needs, tailoring the training process for optimal outcomes. Despite its many advantages, the MEWHO also faces some challenges, such as cost, availability, and the need for skilled training for both users and caregivers. However, ongoing research and advancements in technology are continuously addressing these limitations, making myoelectric orthoses increasingly accessible and affordable. In this chapter, we have tried to propose a novel 3D-printed Elbow wrist hand orthosis that is controlled by electromyography (EMG) signals. In conclusion, the Myoelectric Elbow-Wrist-Hand Orthosis represents a significant step forward in the field of assistive technology, offering a comprehensive solution for individuals with upper limb disabilities. As the device evolves and becomes more widely available, it holds the promise of transforming the lives of countless individuals, granting them newfound independence and a higher quality of life.

Jin's three needle (JTN) is a commonly utilized treatment for ischemic stroke in China. Mirror therapy (MT) is also gradually transitioning from treating limb discomfort to restoring motor function in the damaged limb. Investigations into the 2 treatments' mechanisms of action are still ongoing. We used functional magnetic resonance imaging (fMRI) technique in this study to examine the effects of JTN combined with mirror therapy MT on brain function in patients with upper limb dysfunction in ischemic stroke, as well as potential central mechanisms. The goal was to provide a solid evidence-based medical basis to support the continued use of JTN combination MT. This study will be a single-blind, randomized, and controlled experiment. Randomization was used to assign 20 patients who met the study's eligibility requirements to the JTN + MT treatment group or the JTN control group. Each intervention will last for 4 weeks, with 6 days of treatment per week. The JTN acupuncture points are 3 temporal acupuncture points on the opposite side of the wounded limb, 3 hand acupuncture points on the injured upper limb, 3 shoulder acupuncture points, Renzhong and Baihui, The (JTN + MT) group simultaneously takes MT for 30 minutes. fMRI of the brain using BOLD and T1-weighted images was done both before and after therapy. Brain areas exhibiting changes in regional homogeneity during the pre and posttreatment periods were analyzed. By the end of the treatment course, Jin three-needle therapy plus MT activated more relevant brain functional regions and increased cerebral blood oxygen perfusion than Jin three-needle therapy alone (P <.05). In patients with upper limb impairment following an ischemic stroke, JTN with MT may improve brain function reconstruction in the relevant areas.