Special Issue "Rehabilitation Robotics: Recent Advancements and New Perspectives about Training and Assessment of Sensorimotor Functions"

A special issue of Applied Sciences (ISSN 2076-3417).

Deadline for manuscript submissions: closed (31 May 2019).

Special Issue Editors

Dr. Jacopo Zenzeri
Website
Guest Editor
Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Italy
Interests: rehabilitation robotics, motor learning, computational motor control
Dr. Francesca Marini
Website
Guest Editor
Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Italy
Interests: rehabilitation robotics, robotic assessment of the sensorimotor functions, motor control and learning

Special Issue Information

Dear Colleagues, 

The mortality rate of people with neurological disorders (e.g., stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, and many others) is continuously decreasing, thanks to the advancements made in related clinical research. Conversely, an effective rehabilitation intervention for surviving patients, who will exhibit permanent motor deficits, has not been found or developed yet. As a result, neurological disorders are the leading cause of long-term disability in the adult world, entailing an enormous societal problem, with still no solution.

Successful approaches seem to be focused on developing therapies that promote neuroplasticity. One of the most promising among them is the exploitation of robotics technology, so called “rehabilitation robotics”. This discipline aims at developing novel solutions for assisted therapy and objective functional assessment of patients with reduced motor and/or sensory abilities. These solutions augment existing conventional therapeutic protocols, in order to improve the patient’s recovery process. However, how can robots be useful in this process, and what is the rationale for their introduction in the rehabilitation arena, are just two of the many questions to be answered.

Nowadays, rehabilitation robotics can be considered a very fertile multidisciplinary research area, where technology plays a pivotal role in enabling translational applications of most advanced findings in neuroscience, human biology and clinical rehabilitation.

This Special Issue aims to cover all aspects mentioned above, highlighting recent advances in the development of robotic devices and algorithms for their control, with a particular focus on the assessment and training of sensorimotor functions. 

Dr. Jacopo Zenzeri
Dr. Francesca Marini
Guest Editors

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Keywords

  • Rehabilitation robotics
  • Robotic assessment
  • Robot-assisted therapy
  • Robot design
  • Robot control
  • Computational neurorehabilitation
  • Robotics for clinical neuroscience
  • Neuromodulation
  • Brain machine interfaces in rehabilitation
  • Neural processes of rehabilitation

Published Papers (8 papers)

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Research

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Open AccessArticle
Upper Limb Robotics in Rehabilitation: An Approach to Select the Devices, Based on Rehabilitation Aims, and Their Evaluation in a Feasibility Study
Appl. Sci. 2019, 9(18), 3920; https://doi.org/10.3390/app9183920 - 18 Sep 2019
Cited by 3
Abstract
Robot-mediated therapy is a viable approach for upper limb rehabilitation. The upper limb is a highly complex segment and the identification of the appropriate devices capable of rehabilitating it globally (from the shoulder to the hand) in clinical practice is crucial. In this [...] Read more.
Robot-mediated therapy is a viable approach for upper limb rehabilitation. The upper limb is a highly complex segment and the identification of the appropriate devices capable of rehabilitating it globally (from the shoulder to the hand) in clinical practice is crucial. In this work, we aimed: (i) to describe an approach used in identifying a set of technological and robotic devices to globally treat the upper limb, and (ii) to evaluate the feasibility of the identified set in clinical practice. Using an ad-hoc form, a multidisciplinary team identified a set of four robotic and sensor-based devices to treat globally the upper limb. Then, 30 stroke patients were enrolled and assigned to two groups: the robotic group (RG), where patients were treated with the robotic set, or the conventional group (CG). All patients were evaluated before and after the treatment. In the RG the patients used all the devices (one in each rehabilitation session); the treatment was well accepted, without drop-outs or adverse events. Using a multidisciplinary approach, we identified a set of technological and robotic devices to treat the upper limb globally, and then we experimented to ascertain its feasibility, in a pilot study. Robotics offers a considerable number of devices for rehabilitation that should be selected according to rehabilitation aims and feasibility in clinical practice. Full article
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Open AccessArticle
Exoskeleton for Gait Rehabilitation: Effects of Assistance, Mechanical Structure, and Walking Aids on Muscle Activations
Appl. Sci. 2019, 9(14), 2868; https://doi.org/10.3390/app9142868 - 18 Jul 2019
Cited by 5
Abstract
Several exoskeletons have been developed and increasingly used in clinical settings for training and assisting locomotion. These devices allow people with severe motor deficits to regain mobility and sustain intense and repetitive gait training. However, three factors might affect normal muscle activations during [...] Read more.
Several exoskeletons have been developed and increasingly used in clinical settings for training and assisting locomotion. These devices allow people with severe motor deficits to regain mobility and sustain intense and repetitive gait training. However, three factors might affect normal muscle activations during walking: the assistive forces that are provided during walking, the crutches or walker that are always used in combination with the device, and the mechanical structure of the device itself. To investigate these effects, we evaluated eight healthy volunteers walking with the Ekso, which is a battery-powered, wearable exoskeleton. They walked supported by either crutches or a walker under five different assistance modalities: bilateral maximum assistance, no assistance, bilateral adaptive assistance, and unilateral adaptive assistance on each leg. Participants also walked overground without the exoskeleton. Surface electromyography was recorded bilaterally, and the statistical parametric mapping approach and muscle synergies analysis were used to investigate differences in muscular activity across different walking conditions. The lower limb muscle activations while walking with the Ekso were not influenced by the use of crutches or walker aids. Compared to normal walking without robotic assistance, the Ekso reduced the amplitude of activation for the distal lower limb muscles while changing the timing for the others. This depended mainly on the structure of the device, and not on the type or level of assistance. In fact, the presence of assistance did not change the timing of the muscle activations, but instead mainly had the effect of increasing the level of activation of the proximal lower limb muscles. Surprisingly, we found no significant changes in the adaptive control with respect to a maximal fixed assistance that did not account for subjects’ performance. These are important effects to take into careful considerations in clinics where these devices are used for gait rehabilitation in people with neurological diseases. Full article
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Open AccessArticle
External Robotic Arm vs. Upper Limb Exoskeleton: What Do Potential Users Need?
Appl. Sci. 2019, 9(12), 2471; https://doi.org/10.3390/app9122471 - 17 Jun 2019
Cited by 1
Abstract
Robotic devices that practically assist activities of daily living (ADL) are scarce. The aim of this study was to investigate practical demands of potential users of external robotic arms and upper limb exoskeletons for assistance in ADL. A survey was performed in rehabilitation [...] Read more.
Robotic devices that practically assist activities of daily living (ADL) are scarce. The aim of this study was to investigate practical demands of potential users of external robotic arms and upper limb exoskeletons for assistance in ADL. A survey was performed in rehabilitation clinics in individuals with functional impairments in the upper extremity, divided into unilateral (UIG, n = 24) and bilateral impairment groups (BIG, n = 24). Descriptive analyses were performed for current dependency, objective importance, and subjective necessity of the 18 ADLs by using a 5-point Likert scale. Overall, handling foods, dressing, and moving close items were highly necessary functions for both robot types. The UIG demonstrated a high demand for self-exercise using exoskeletons, whereas one-hand ADLs showed low necessity. In the UIG, the exoskeleton had significantly higher demands than the external robotic arm in washing face (p = 0.005) and brushing teeth (p = 0.007). The subjects in the BIG replied that cleaning desks and eating are highly necessary abilities for the external robotic arm; and transfer and wheelchair control, for exoskeletons. In the BIG, the exoskeleton showed significantly higher necessity than the external robotic arms in dressing (p = 0.010), making phone calls (p = 0.026), using a smartphone (p = 0.011), and writing (p = 0.005). The practical demands of potential users were affected by laterality and robot type. Further robot developments should involve essential functions based on the survey results to meet end-user needs. Full article
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Open AccessArticle
Prototype of an Ankle Neurorehabilitation System with Heuristic BCI Using Simplified Fuzzy Reasoning
Appl. Sci. 2019, 9(12), 2429; https://doi.org/10.3390/app9122429 - 14 Jun 2019
Abstract
Neurorehabilitation using a brain–computer interface (BCI) requires machine learning, for which calculations take a long time, even days. However, the demands of actual rehabilitation are becoming increasingly rigorous, requiring that processes be completed within tens of minutes. Therefore, we developed a new effective [...] Read more.
Neurorehabilitation using a brain–computer interface (BCI) requires machine learning, for which calculations take a long time, even days. However, the demands of actual rehabilitation are becoming increasingly rigorous, requiring that processes be completed within tens of minutes. Therefore, we developed a new effective rehabilitation system for treating patients such as those with stroke hemiplegia. The system can smoothly perform rehabilitation training on the day of admission to the hospital. We designed a heuristic BCI with simplified fuzzy reasoning, which can detect motor intention signals from an electroencephalogram (EEG) within several tens of minutes. The detected signal is sent to the newly developed ankle rehabilitation device (ARD), and the patient repeats the dorsiflexion motion by the ARD. Full article
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Open AccessArticle
Modular Design and Decentralized Control of the Recupera Exoskeleton for Stroke Rehabilitation
Appl. Sci. 2019, 9(4), 626; https://doi.org/10.3390/app9040626 - 13 Feb 2019
Cited by 12
Abstract
Robot-assisted therapy has become increasingly popular and useful in post-stroke neurorehabilitation. This paper presents an overview of the design and control of the dual-arm Recupera exoskeleton to provide intense therapist-guided as well as self training for sensorimotor rehabilitation of the upper body. The [...] Read more.
Robot-assisted therapy has become increasingly popular and useful in post-stroke neurorehabilitation. This paper presents an overview of the design and control of the dual-arm Recupera exoskeleton to provide intense therapist-guided as well as self training for sensorimotor rehabilitation of the upper body. The exoskeleton features a lightweight design, high level of modularity, decentralized computing, and various levels of safety implementation. Due to its modularity, the system can be used as a wheel-chair mounted system or as a full-body system. Both systems enable a wide range of therapies while efficiently grounding the weight of the system and without compromising the patient’s mobility. Furthermore, two rehabilitation therapies implemented on the exoskeleton system, namely teach & replay therapy and mirror therapy, are presented along with experimental results. Full article
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Review

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Open AccessReview
Perspectives and Challenges in Robotic Neurorehabilitation
Appl. Sci. 2019, 9(15), 3183; https://doi.org/10.3390/app9153183 - 05 Aug 2019
Cited by 8
Abstract
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic [...] Read more.
The development of robotic devices for rehabilitation is a fast-growing field. Nowadays, thanks to novel technologies that have improved robots’ capabilities and offered more cost-effective solutions, robotic devices are increasingly being employed during clinical practice, with the goal of boosting patients’ recovery. Robotic rehabilitation is also widely used in the context of neurological disorders, where it is often provided in a variety of different fashions, depending on the specific function to be restored. Indeed, the effect of robot-aided neurorehabilitation can be maximized when used in combination with a proper training regimen (based on motor control paradigms) or with non-invasive brain machine interfaces. Therapy-induced changes in neural activity and behavioral performance, which may suggest underlying changes in neural plasticity, can be quantified by multimodal assessments of both sensorimotor performance and brain/muscular activity pre/post or during intervention. Here, we provide an overview of the most common robotic devices for upper and lower limb rehabilitation and we describe the aforementioned neurorehabilitation scenarios. We also review assessment techniques for the evaluation of robotic therapy. Additional exploitation of these research areas will highlight the crucial contribution of rehabilitation robotics for promoting recovery and answering questions about reorganization of brain functions in response to disease. Full article
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Open AccessFeature PaperReview
Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders
Appl. Sci. 2019, 9(13), 2689; https://doi.org/10.3390/app9132689 - 01 Jul 2019
Abstract
Neuromotor disorders negatively affect the sensorimotor system, limiting the ability to perform daily activities autonomously. Rehabilitation of upper limb impairments is therefore essential to improve independence and quality of life. In the last two decades, there has been a growing interest in robot-assisted [...] Read more.
Neuromotor disorders negatively affect the sensorimotor system, limiting the ability to perform daily activities autonomously. Rehabilitation of upper limb impairments is therefore essential to improve independence and quality of life. In the last two decades, there has been a growing interest in robot-assisted rehabilitation as a beneficial way to promote children recovery process. However, a common understanding of the best drivers of an effective intervention has not been reached yet. With this aim, the current study reviewed the existing literature on robot-assisted rehabilitation protocols for upper extremities in children, with the goal of examining the effects of robotic therapy on their sensorimotor recovery process. A literature search was conducted in several electronic database to identify the studies related to the application of robotic therapy on upper limbs in the pediatric population. We analyzed three reviews and 35 studies that used 14 different robotic devices, and an overview of their characteristics, applications in the clinical setting and results is provided. Besides, the potential benefits of robot-assisted assessment and therapy are discussed to identify the key factors yielding positive outcomes in children. Finally, this review aim to lay the foundations for more effective neuroplasticity-enhancement protocols and elicit insights into robot-based approaches. Full article
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Open AccessReview
Robotics in Health Care: Perspectives of Robot-Aided Interventions in Clinical Practice for Rehabilitation of Upper Limbs
Appl. Sci. 2019, 9(13), 2586; https://doi.org/10.3390/app9132586 - 26 Jun 2019
Cited by 5
Abstract
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding [...] Read more.
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for increasing the assimilation of motor gains could be relevant factors to develop more accepted robot-aided systems in clinical practice. Full article
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