Publication: Development of a hybrid robotic system based on an adaptive and associative assistance for rehabilitation of reaching movement after stroke
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2017
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2017-11-29
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Abstract
Stroke causes irreversible neurological damage. Depending on the location and the size of
this brain injury, different body functions could result affected. One of the most common
consequences is motor impairments. The level of motor impairment affectation varies between
post-stroke subjects, but often, it hampers the execution of most activities of daily living.
Consequently, the quality of life of the stroke population is severely decreased.
The rehabilitation of the upper-limb motor functions has gained special attention in the
scientific community due the poor reported prognosis of post-stroke patients for recovering
normal upper-extremity function after standard rehabilitation therapy. Driven by the advance
of technology and the design of new rehabilitation methods, the use of robot devices,
functional electrical stimulation and brain-computer interfaces as a neuromodulation system
is proposed as a novel and promising rehabilitation tools. Although the uses of these technologies
present potential benefits with respect to standard rehabilitation methods, there still
are some milestones to be addressed for the consolidation of these methods and techniques
in clinical settings.
Mentioned evidences reflect the motivation for this dissertation. This thesis presents the
development and validation of a hybrid robotic system based on an adaptive and associative
assistance for rehabilitation of reaching movements in post-stroke subjects. The hybrid
concept refers the combined use of robotic devices with functional electrical stimulation.
Adaptive feature states a tailored assistance according to the users’ motor residual capabilities,
while the associative term denotes a precise pairing between the users’ motor intent
and the peripheral hybrid assistance. The development of the hybrid platform comprised the
following tasks:
1. The identification of the current challenges for hybrid robotic system, considering twofold
perspectives: technological and clinical. The hybrid systems submitted in literature
were critically reviewed for such purpose. These identified features will lead the
subsequent development and method framed in this work.
2. The development and validation of a hybrid robotic system, combining a mechanical
exoskeleton with functional electrical stimulation to assist the execution of functional
reaching movements. Several subsystems are integrated within the hybrid platform,
which interact each other to cooperatively complement the rehabilitation task. Complementary,
the implementation of a controller based on functional electrical stimulation
to dynamically adjust the level of assistance is addressed. The controller is conceived to
tackle one of the main limitations when using electrical stimulation, i.e. the highly nonlinear
and time-varying muscle response. An experimental procedure was conducted
with healthy and post-stroke patients to corroborate the technical feasibility and the
usability evaluation of the system.
3. The implementation of an associative strategy within the hybrid platform. Three different
strategies based on electroencephalography and electromyography signals were
analytically compared. The main idea is to provide a precise temporal association between
the hybrid assistance delivered at the periphery (arm muscles) and the users’
own intention to move and to configure a feasible clinical setup to be use in real rehabilitation
scenarios.
4. Carry out a comprehensive pilot clinical intervention considering a small cohort of
patient with post-stroke patients to evaluate the different proposed concepts and assess
the feasibility of using the hybrid system in rehabilitation settings.
In summary, the works here presented prove the feasibility of using the hybrid robotic system
as a rehabilitative tool with post-stroke subjects. Moreover, it is demonstrated the adaptive
controller is able to adjust the level of assistance to achieve successful tracking movement
with the affected arm. Remarkably, the accurate association in time between motor cortex
activation, represented through the motor-related cortical potential measured with electroencephalography,
and the supplied hybrid assistance during the execution of functional (multidegree
of freedom) reaching movement facilitate distributed cortical plasticity. These results
encourage the validation of the overall hybrid concept in a large clinical trial including an
increased number of patients with a control group, in order to achieve more robust clinical
results and confirm the presented herein.
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Keywords
Hybrid robotic systems, Neurophysiology, Rehabilitation, Medical treatment