Department of Biomedical Engineering, Catholic University of America, Washington, DC, 20064, USA.
Center for Applied Biomechanics and Rehabilitation Research MedStar National Rehabilitation Hospital, Washington, DC, 20010, USA.
J Neuroeng Rehabil. 2018 Mar 2;15(1):13. doi: 10.1186/s12984-018-0352-4.
Robotic devices for neurorehabilitation of movement impairments in persons with stroke have been studied extensively. However, the vast majority of these devices only allow practice of stereotyped components of simulated functional tasks in the clinic. Previously we developed SpringWear, a wearable, spring operated, upper extremity exoskeleton capable of assisting movements during real-life functional activities, potentially in the home. SpringWear assists shoulder flexion, elbow extension and forearm supination/pronation. The assistance profiles were designed to approximate the torque required to move the joint passively through its range. These three assisted DOF are combined with two passive shoulder DOF, allowing complex multi-joint movement patterns.
We performed a cross-sectional study to assess changes in movement patterns when assisted by SpringWear. Thirteen persons with chronic stroke performed range of motion (ROM) and functional tasks, including pick and place tasks with various objects. Sensors on the device measured rotation at all 5 DOF and a kinematic model calculated position of the wrist relative to the shoulder. Within subject t-tests were used to determine changes with assistance from SpringWear.
Maximum shoulder flexion, elbow extension and forearm pronation/supination angles increased significantly during both ROM and functional tasks (p < 0.002). Elbow flexion/extension ROM also increased significantly (p < 0.001). When the subjects volitionally held up the arm against gravity, extension at the index finger proximal interphalangeal joint increased significantly (p = 0.033) when assisted by SpringWear. The forward reach workspace increased 19% (p = 0.002). Nine subjects could not complete the functional tasks unassisted and only one showed improvement on task completion with SpringWear.
SpringWear increased the usable workspace during reaching movements, but there was no consistent improvement in the ability to complete functional tasks. Assistance levels at the shoulder were increased only until the shoulder could be voluntarily held at 90 degrees of flexion. A higher level of assistance may have yielded better results. Also combining SpringWear with HandSOME, an exoskeleton for assisting hand opening, may yield the most dramatic improvements in functional task performance. These low-cost devices can potentially reduce effort and improve performance during task practice, increasing adherence to home training programs for rehabilitation.
用于脑卒中患者运动功能障碍神经康复的机器人设备已得到广泛研究。然而，这些设备绝大多数仅能在临床环境中模拟功能任务的刻板组件进行练习。此前，我们开发了 SpringWear，这是一种可穿戴的、由弹簧驱动的上肢外骨骼，可以在日常生活活动中辅助运动，可能是在家里。SpringWear 辅助肩部弯曲、肘部伸展和前臂旋前/旋后。辅助轮廓旨在近似被动地通过关节的范围所需的扭矩。这三个辅助自由度与两个被动肩部自由度相结合，允许复杂的多关节运动模式。
我们进行了一项横断面研究，以评估 SpringWear 辅助时运动模式的变化。13 名慢性脑卒中患者进行了运动范围 (ROM) 和功能任务，包括用各种物体进行的拾取和放置任务。设备上的传感器测量所有 5 个自由度的旋转，运动学模型计算手腕相对于肩部的位置。采用受试者内 t 检验确定 SpringWear 辅助时的变化。
ROM 和功能任务时，最大肩部弯曲、肘部伸展和前臂旋前/旋后角度显著增加 (p<0.002)。肘部弯曲/伸展 ROM 也显著增加 (p<0.001)。当受试者主动将手臂举过头顶对抗重力时，SpringWear 辅助时食指近节指间关节伸展角度显著增加 (p=0.033)。向前伸展工作空间增加了 19% (p=0.002)。9 名患者无法独立完成功能任务，只有 1 名患者在使用 SpringWear 时完成任务的能力有所提高。
SpringWear 增加了伸手运动时的可用工作空间，但在完成功能任务的能力方面没有一致的改善。肩部的辅助水平仅增加到肩部可以主动保持在 90 度弯曲的程度。更高的辅助水平可能会产生更好的结果。另外，将 SpringWear 与 HandSOME（一种用于辅助手部张开的外骨骼）结合使用，可能会使功能任务表现的改善更加显著。这些低成本设备有可能在任务练习期间减少努力并提高性能，增加对康复家庭训练计划的坚持。
