Utilizing the intelligence edge framework for robotic upper limb rehabilitation in home

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.

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...

Background: Stroke contributes to disability and mortality worldwide, with upper limb impairments significantly reducing arm and hand function, leading to profound disability. Traditional rehabilitation often lacks effectiveness in fully restoring upper limb function post-stroke. Powered exoskeletal systems offer adaptive support customized to stroke survivors’ needs. This review explores their development, advancements, and clinical applications, emphasizing their potential to improve motor recovery and independence in stroke survivors. Aim: To review evidence of the Soft Robotics for upper limb function in individuals with stroke. Relevance: This study explores the evidence of Soft Robotics as an intervention in Upper limb rehabilitation in Stroke, providing valuable insights for advancing evidence – based practices in physiotherapy. Methods: Data Identification- Search was done on the Pubmed databases, and search engines google scholar, research gate, Sci-Hub, Directory of Open Access Journals. Study Selection-Articles were identified. 10 studies published between 2018 to 2024 were reviewed. Results: A total of 10 studies of Soft Robotics f as an intervention in Upper limb rehabilitation in Stroke, most studies reflect significant improvement in hand function, more accurate &amp; more portable, reducing cost of rehabilitation, friendly use- user interface thus enhance independence among stroke survivors. Conclusion: Development of Soft Robotics as an intervention in Upper limb rehabilitation in Stroke, shows promising results in field of rehabilitation. Future research should focus on exploring more data, improved customization and clinical trials, affordability, and home-based designs to broaden accessibility&amp; effectiveness in rehabilitation.

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Virtual reality (VR) with its engagement, interaction, and real time feedback could be a solution, with immersive VR systems having preliminary evidence in stroke to be more effective in improving UL outcomes in comparison to non-immersive VR. However, immersive VR research is limited within the realm of MS rehabilitation. Therefore, the main aim of the PhD was to explore immersive VR as an approach for UL rehabilitation for people with MS (pwMS). This was achieved in four stages: 1) a systematic review of the current evidence for VR in UL rehabilitation in MS; 2) predevelopment focus groups to determine requirements for the development of bespoke immersive VR games; 3) software development of bespoke VR games to potentially improve UL function for pwMS; and 4) a feasibility study of the games and immersive VR for pwMS’ UL rehabilitation. The systematic review initially yielded ten articles with varying study design, VR intervention and UL outcome measures used. There were some statistically significant improvements after VR interventions in outcomes such as in nine-hole peg test (NHPT), hand grip strength and active range of motion. There were however conflicting results regarding if VR was more effective than conventional approaches. Whilst the review demonstrated there were positive results for VR improving UL function, most of the studies had small sample sizes and were inadequately powered, and the level of immersion on effectiveness in MS remains unknown. The predevelopment focus groups recruited ten pwMS and eight specialist clinicians to explore their views on immersive VR as an approach to UL rehabilitation and determine requirements to develop VR games for this purpose. PwMS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to their UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a potential solution, as it was convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. Although, there were shared concerns about cybersickness and disengagement while using VR approaches. Finally, both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and pwMS suggesting more abstract activities. Recommendations were made for the development of VR rehabilitation games which could be personalised and customisable for the varying abilities of pwMS. Using theme-based content analysis and requirement analysis, requirements for the software development of immersive VR games were created and developed using Unity game engine. Three games, “Piano”; “Catch-a-falling-star” and “VR Whack-a-mole” which targeted dexterity and strength for pwMS were developed, with different difficulty levels implemented to adapt to varying ability of pwMS. The final stage of this PhD was a randomised, controlled feasibility study to investigate an intervention of immersive VR involving the three co-produced games for pwMS’ UL rehabilitation. Participants were randomised to either an intervention group consisting of 30 minutes of VR co-produced games, twice/week, for eight weeks, or to a control group of usual care. Participants were recruited from the NHS and third sector organisations. Nineteen pwMS were recruited (intervention n=11, control n=8), with a recruitment rate of 3.2 participants/month. Only minor adverse events were reported (n=9), such as fatigue and UL pain. Adherence was good with 87% (±12%) session completed, and two dropouts were reported in the control group. There were positive trends for improving NHPT and hand grip strength, but there was an observed ceiling effect in the Action Research Arm Test. Participants reported high levels of satisfaction and good usability of the co-produced VR games, as measured by the USE questionnaire. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. Participants suggested more variety and progression of exercises for future development. Overall, these studies show that immersive VR has the potential to be beneficial for UL rehabilitation and is feasible and safe for pwMS. Therefore, future work should refine VR games for long-term application and explore the clinical and cost effectiveness of this approach.

Dynamic evaluation mechanisms of the human upper limb are of great value for research and applications in upper limb rehabilitation, especially for the development of robotic upper limb rehabilitation systems. This paper proposes a muscle force prediction method based on the Hill muscle model. The proposed approach, which combines sEMG signals and kinematic data, provides a deep understanding of the dynamic motion mechanisms and parameters that characterize the upper limbs of the human body. The study provides a theoretical benchmark for the evaluation of rehabilitation training practices and for improved designs of upper limb rehabilitation robots that are used for upper limb neuro-rehabilitation. Specifically, the system collected motion data and sEMG signals from the upper limbs of the human body through a high-speed infrared motion capture system and skin sEMG sensors. By applying human kinematics and dynamics theories, real-time joint angle and torque information was obtained and imported into OpenSim. This platform can simulate the real-time muscle force values produced by the upper limbs during movements. The myoelectric signals were first filtered to remove noise, and an exponential model was then used to obtain the muscle activation. These data were then entered into the Hill-type prediction model to determine an individual’s muscle forces. In this paper, grasping movements commonly used in everyday situations were taken as a testing case. The results of the experiments showed that an individual’s muscle forces can be predicted using a Hill-type model. The results are consistent with those from simulated muscle force models and can reflect the real forces experienced during upper limb exercises.KeywordsMuscle forceUpper limb movementHuman–robot interactionBiomechanics analysissEMG signals

Background Home-based robotic therapy is a trend of post-stroke upper limb rehabilitation. Although home-based upper limb rehabilitation robots have been developed over several decades, no design specification has been published. Objectives To identify and synthesize design requirements considering user and technology needs for a home-based upper limb rehabilitation robot through a scoping review. Method Studies published between 1 January 2000 and 10 June 2020 in Scopus, Web of Science and PubMed database regarding design requirements for upper limb rehabilitation robots from of stroke survivors or therapists were identified and analyzed. We use 'requirement' as something that is needed or wanted. Two physiotherapists ranked the requirements identified from literature review. Results Nine studies were selected for review. They identified 42 requirements regarding functionality (n = 11, 26.2% of total requirements), usability (n = 16, 38.0% of total requirements), software (n = 14, 33.3% of total requirements) and safety (n = 1, 2.4% of total requirements). The main implementation barriers with respect to adherence and monitoring were space, operation, and cost. Conclusion This is the first research to summarize the design requirements for home-based upper limb rehabilitation robots for stroke survivors. The need for a safe, comfortable, easy to use device which can be individualized and promote specific movements and tasks emerged. The result of this paper captures the design requirements that can be used in future for the development of a design specification. It provides designers and researchers guidance about the real-world needs for home-based upper limb rehabilitation robots for stroke.

INTRODUCTION:Stroke causes physiologic functional changes such as vascular resistance and arterial remodeling. This study aimed to explore the effects of 3-month regular home-based exercise rehabilitation on brachial flow-mediated dilation (FMD), daily physical activity, and upper and lower extremity sensorimotor of the acute ischemic stroke patients.MATERIALS AND METHODS:This randomized control trial was done from August 2017 to September 2018. Patients with unilateral ischemic stroke were recruited from inpatient wards at an educational hospital. Patients were randomly assigned to the home-based rehabilitation program (intervention group) or usual care (control group). Fugl-Meyer upper and lower extremity sensorimotor score and Barthel score were evaluated in both the groups before and 3 months after baseline assessment. Furthermore, brachial artery vasomotor reactivity (FMD) hemiparetic arm assessed vascular health. The intervention group received home-based rehabilitation exercise program for 3 months. The control group did not receive home-based rehabilitation program and incentive telephone call. All data were collected and analyzed by SPSS software (version 20) and appropriate statistical tests.RESULTS:Forty ischemic stroke patients (twenty in the intervention group and twenty in the control group) were examined. Results showed that Barthel score and Fugl-Meyer upper and lower extremity score and FMD in the intervention group were significantly higher than the control group after 3-month home-based exercise rehabilitation (P < 0/001).CONCLUSION:Twelve-week regular home-based exercise training was well tolerated by the intervention group. After this period, improvements were reported in brachial FMD as well as daily physical activity and upper and lower extremity functional capacity.

Stroke is one of the leading causes of upper extremity disability around the world. Whenever a stroke happens stroke survivor’s brain commands cannot reach some muscles of upper extremities although those muscles could contract. Therefore, shoulder, elbow or wrist joint cannot perform expected motion, and this will hamper their activities of daily living (ADLs). The objective of rehabilitation is to externally drive the upper extremity move to improve muscle movements. The current state of upper extremity rehabilitation may improve by using a model-based computer simulation of arm movement for personalizing robotic devices and interventions. This study attempts to review technologies used in upper extremity rehabilitation on two aspects: computer models and robotic devices. A summary of existing virtual upper extremity models is provided. As well, different robotic devices that are developed for upper limb rehabilitation is also discussed here.

BackgroundTelerehabilitation allows patients to engage in therapy away from healthcare facilities, often in the comfort of their homes. Studies have suggested that it can effectively improve motor and cognitive function. However, its applicability may be limited to patients with severe impairments who require physical assistance. The proposed study aims to evaluate the feasibility and effects of a home-based rehabilitation program for post-stroke patients, based on the use of a planar robot, able to overcome the limitations posed by the COVID-19 pandemic.MethodsWe enrolled 20 patients with stroke (11 men, aged 66.1 ± 9.2 years). Patients underwent 20 one-hour robotic upper limb rehabilitation sessions, consisting of the execution of planar point-to-point reaching exercises, using a robotic device in their own home, with the remote supervision of a physical therapist. We assessed the feasibility of this intervention by examining adverse events, patient satisfaction (measured on a Likert scale), usability (using the System Usability Scale, SUS), acceptability (evaluated through the Technology Acceptance Model questionnaire, TAM+), and pain onset (measured with the Numeric Rating Scale). To gauge the clinical effects of the treatment, we analyzed changes in the motor and sensory components of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) before and after the intervention.ResultsThe approach was safe, as we did not observe any adverse events, and patients did not experience an increase in pain levels. Patients expressed their appreciation for the treatment, providing an average Likert scale score of 8 out of 10. The usability of the treatment received high marks, with an average SUS score of 78 ± 12. Similarly, the treatment acceptability was favorable, with all examined domains scoring above 4, indicating a positive attitude towards the proposed solution. Moreover, we observed a statistically significant improvement in the motor part of the FMA-UE (p < 0.001).ConclusionOur results demonstrate the feasibility, safety, and effectiveness of employing a rehabilitation robot for upper limb rehabilitation in post-stroke patients within a home-based environment. These findings mark a significant step in advancing innovative and easily accessible rehabilitation options for stroke survivors, ensuring uninterrupted care and creating new opportunities to enhance their functional abilities.Trial registrationclinicaltrial.gov (NCT05250934).

Annually, 15 million in world population experiences stroke. Nearly 9 million stroke survivors every year experience mild to severe disability. The loss of upper extremity function in stroke survivors still remains a major rehabilitation challenge. The proposed EMG —Annually, 15 million in world population experiences stroke. Nearly 9 million stroke survivors every year experience mild to severe disability. The loss of upper extremity function in stroke survivors still remains a major rehabilitation challenge. The proposed EMG based FES system can be used for effective upper limb motor re-education in post stroke upper limb rehabilitation. The governing feature of the designed system is its synchronous activation, in which the FES stimulation is dependent on the amplitude of the EMG signal acquired from the unaffected upper limb muscle of the hemiplegic patient. This proportionate operation eliminates the undesirable damage to the patient’s skin by generating stimulus in proportion to voluntary EMG signals. This feature overcomes the disadvantages of currently available manual motor re-education systems. This model can be used in home-based post stroke rehabilitation, to effectively improve the upper limb functions.

IntroductionApproximately 30% of stroke survivors experience an upper limb impairment, which impacts on participation and quality of life. Gaming devices (Nintendo Wii) are being incorporated into rehabilitation to improve function. We explored the stroke survivor experience of gaming as an upper limb intervention.MethodsSemi-structured, individual interviews with stroke survivors living within the UK were completed. Interviews were audio-recorded, transcribed verbatim and analysed using Framework methods. Transcripts were coded and summarised into thematic charts. Thematic charts were refined during analysis until the final framework emerged.ResultsWe captured experiences of 12 stroke survivors who used Nintendo Wii. Gaming devices were found to be acceptable for all ages but varying levels of enthusiasm existed. Enthusiastic players described gaming as having a positive impact on their motivation to engage in rehabilitation. For some, this became a leisure activity, encouraging self-practice. Non-enthusiastic players preferred sports to gaming.ConclusionAn in-depth account of stroke survivor experiences of gaming within upper limb rehabilitation has been captured. Suitability of gaming should be assessed individually and stroke survivor abilities and preference for interventions should be taken into consideration. There was no indication that older stroke survivors or those with no previous experience of gaming were less likely to enjoy the activity.

BackgroundIt is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies.AimTo determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke.MethodAn analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life.ResultsBy 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome.ConclusionAdditional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term.Trial RegistrationACTRN12615000616572 (12/06/2015).

The global incidence of spinal cord injury (SCI) is between 10 and 80 new cases per million people each year. This equates to between 250,000 and 500,000 injuries worldwide per year. In the United Kingdom, approximately 4400 people per year sustain an SCI. People with tetraplegia report upper limb function as their highest priority for improvement after SCI. Using immersive virtual reality (VR) headsets, physical rehabilitation exercises can be completed in engaging digital environments. Immersive VR therefore has the potential to increase the amount of therapy undertaken, leading to improvements in arm and hand function. There is little evidence supporting immersive VR as exercise in SCI, especially while patients with SCI are undergoing acute rehabilitation. In SCI research, co-design of new interventions is not a widely adopted approach, yet people with tetraplegia want to contribute with their expert knowledge on their experiences of SCI. This study aims to explore the lived experiences of people with tetraplegia and specialist SCI therapists related to acute upper limb rehabilitation and identify design considerations for VR-based interventions targeting the upper limb. We conducted 7 online focus groups using Microsoft Teams: 4 with people with tetraplegia (n=15; age range, 36-65 years) and 3 with occupational therapists and physiotherapists specializing in SCI rehabilitation (n=11). Participants were asked to discuss their experiences and expertise about acute SCI upper limb rehabilitation and their opinions and ideas on the use of VR for upper limb rehabilitation. The transcripts were analyzed using content analysis, enabling the proposition of design characteristics of a VR-based intervention for upper limb exercise. The study identified 5 major themes describing the clinical features, treatment, and recovery of people with SCI during the acute stage of SCI, their motivations for participating in therapy, and suggestions for the design of a VR intervention in treating the upper limbs following SCI. The themes identified in this study allow the elicitation of software requirements for a bespoke immersive VR platform for upper limb rehabilitation following SCI. They can also contribute to a better understanding of the advantages of using VR as an adjunct to upper limb rehabilitation. Additionally, participants used their expertise to suggest factors that would enable the development of a usable and effective intervention, as well as identifying potential pitfalls and software features to avoid during intervention development. These findings can be used to design accessible VR applications for use by people with tetraplegia and their therapists.

Stroke is a common healthcare problem, leading to disability and significantly impacting individuals' quality of life. A customised device was suggested to be used for roboticassisted therapy to meet different stroke survivors' needs. However, most existing upper limb rehabilitation robots only offer a generic handgrip, which fails to meet the various needs of stroke survivors with different spastic patterns and levels of upper limb weakness. This study investigates the technical and clinical feasibility of customised handgrips to meet stroke survivors' needs through an online questionnaire with 25 therapists and parametric handgrip designs. One wrist support and two different handgrips were designed, and their size (e.g., length and width) can be adapted based on the individual anthropology data. By using the additive manufacturing method, the manufacturing cost of bespoke handgrip is reduced by up to 15 %. Additionally, more than 90 % of professionals $(\mathrm{n}=23)$ stated the positive impact of customised handgrip on rehabilitation outcomes and $72 \%(\mathrm{n}=18)$ would like to use it with stroke survivors due to its high accessibility and variability. The results indicate that a customised handgrip has the potential to benefit the stroke rehabilitation from both technical and clinical perspectives.

Stroke patients in rehabilitation period often encounter problems such as high training cost and weak self supervision. We proposed a rehabilitation evaluation method of upper limb function based on wearable inertial sensor data acquisition auxiliary equipmen, which aims to realize the self-monitoring and evaluation of rehabilitation of patients in the middle and late stage of upper limb function rehabilitation. We have used three inertial sensing units MPU6050 to make wearable upper limb rehabilitation training auxiliary equipment, which can collect the motion data of stroke patients in rehabilitation period during daily rehabilitation training. Combined with lindmark upper limb rehabilitation scale, we collected eight hand gesture data for upper limb rehabilitation exercise evaluation. For the original data, quaternion data and Euler angle data, we established upper limb rehabilitation training action evaluation models based on libsvm, multi-layer LSTM and cnn-lstm neural network respectively to evaluate the rehabilitation status of patients. The results show that CNN LSTM model has the best performance, with the recognition accuracy of 99.67%, followed by multi-layer LSTM, and the model recognition accuracy of 97.00%. The work of this paper will provide a reference for patients in the middle and later rehabilitation stage of upper limb after stroke to realize their own supervised rehabilitation training and recovery state evaluation.KeywordsInertial sensorsWearable devicesUpper limb rehabilitation training and assessment