Kim Jonghyun, Sin Minki, Kim Won-Seok, Min Yu-Sun, Kim Woojin, Park Daegeun, Paik Nam-Jong, Cho Kyujin, Park Hyung-Soon
School of Mechanical Engineering, Sungkyunkwan University, Suwon, South Korea.
Department of Medical Assistant Robot, Daegu Research Center, Korea Institute of Machinery and Materials, Daegu, South Korea.
Front Neurol. 2020 Dec 3;11:583101. doi: 10.3389/fneur.2020.583101. eCollection 2020.
Upper limb hemiparesis is the most common impairment in stroke survivors, and adequate assessment is crucial for setting the rehabilitation strategy and monitoring the effect of treatment. However, adequate timely assessments are difficult due to the limited accessibility to clinics for stroke survivors. We designed this study to investigate whether teleassessments for motor impairments of the spastic elbow (i.e., passive range of motion (PROM), muscle strength, and spasticity) are feasible in stroke survivors. To implement a telerobotic system for remote assessment with physical interaction, we constructed a system with a master robot interacting with a doctor (assessor) and a slave robot interacting with the elbow of a subject with stroke. The master robot is operated by the doctor, where the torque and the speed are transferred to the slave robot via the Internet, and the reaction of the patient's elbow to the slave robot's movement is measured with a torque sensor, then finally transferred back to the master robot. An intercontinental remote assessment, which is considered one of the worst possible scenarios, was used as a clinical test to strictly check the feasibility. For the clinical tests, the examiner for the teleassessment was located at a lab in the National Institutes of Health (NIH, Bethesda, MD, USA) while the stroke patients were located at Seoul National University Bundang Hospital (Bundang, Kyeonggido, South Korea). In total, 12 stroke patients' elbows (age range, 28-74; M:F = 6:6) were tested. For the PROM, the absolute difference between two assessments (in-person vs. remote) was 5.98 ± 3.51° on average (range, 0-11.2). The agreements for the strength and the spasticity of elbow flexor between in-person and remote assessments were substantial ( = 0.643) and fair ( = 0.308), respectively. No adverse events were observed during or immediately after the telerobotic assessment. Internet-based telerobotic remote assessment for motor impairment of spastic elbow in stroke using our system is feasible even in the worst setting, with too long of a distance and a delayed communication network.
上肢偏瘫是中风幸存者最常见的损伤，充分评估对于制定康复策略和监测治疗效果至关重要。然而，由于中风幸存者前往诊所的机会有限，及时进行充分评估很困难。我们设计了这项研究，以调查对痉挛性肘部运动障碍（即被动活动范围（PROM）、肌肉力量和痉挛）进行远程评估在中风幸存者中是否可行。为了实现用于远程评估且具有物理交互的远程机器人系统，我们构建了一个系统，其中主机器人与医生（评估者）交互，从机器人与中风患者的肘部交互。主机器人由医生操作，扭矩和速度通过互联网传输到从机器人，患者肘部对从机器人运动的反应通过扭矩传感器测量，然后最终传回主机器人。作为一项临床测试，我们采用了洲际远程评估（这被认为是最糟糕的情况之一）来严格检验可行性。对于临床测试，远程评估的检查者位于美国国立卫生研究院（NIH，马里兰州贝塞斯达）的一个实验室，而中风患者位于韩国京畿道盆唐的首尔国立大学盆唐医院。总共对12名中风患者的肘部（年龄范围28 - 74岁；男:女 = 6:6）进行了测试。对于被动活动范围，两次评估（面对面评估与远程评估）之间的平均绝对差值为5.98±3.51°（范围为0 - 11.2）。面对面评估与远程评估之间，肘部屈肌力量和痉挛的一致性分别为中等（κ = 0.643）和一般（κ = 0.308）。在远程机器人评估期间或之后，未观察到不良事件。使用我们的系统对中风患者痉挛性肘部运动障碍进行基于互联网的远程机器人远程评估，即使在距离过长和通信网络延迟的最糟糕情况下也是可行的。
