Developing a Multi-Joint Upper Limb Exoskeleton Robot for Diagnosis, Therapy, and Outcome Evaluation in Neurorehabilitation

Arm impairments in patients post stroke involve the shoulder, elbow and wrist simultaneously. It is not very clear how patients develop spasticity and reduced range of motion (ROM) at the multiple joints and the abnormal couplings among the multiple joints and the multiple degrees-of-freedom (DOF) during passive movement. It is also not clear how they lose independent control of individual joints/DOFs and coordination among the joints/DOFs during voluntary movement. An upper limb exoskeleton robot, the IntelliArm, which can control the shoulder, elbow, and wrist, was developed, aiming to support clinicians and patients with the following integrated capabilities: 1) quantitative, objective, and comprehensive multi-joint neuromechanical pre-evaluation capabilities aiding multi-joint/DOF diagnosis for individual patients; 2) strenuous and safe passive stretching of hypertonic/deformed arm for loosening up muscles/joints based on the robot-aided diagnosis; 3) (assistive/resistive) active reaching training after passive stretching for regaining/improving motor control ability; and 4) quantitative, objective, and comprehensive neuromechanical outcome evaluation at the level of individual joints/DOFs, multiple joints, and whole arm. Feasibility of the integrated capabilities was demonstrated through experiments with stroke survivors and healthy subjects.

[1]  J. Mansour,et al.  The passive elastic moment at the hip. , 1982, Journal of biomechanics.

[2]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[3]  W. Rymer,et al.  Abnormal muscle coactivation patterns during isometric torque generation at the elbow and shoulder in hemiparetic subjects. , 1995, Brain : a journal of neurology.

[4]  A. Esquenazi,et al.  Common patterns of clinical motor dysfunction , 1997, Muscle & nerve. Supplement.

[5]  Li-Qun Zhang,et al.  Simultaneous and nonlinear identification of mechanical and reflex properties of human elbow joint muscles , 1997, IEEE Transactions on Biomedical Engineering.

[6]  N. Hogan,et al.  Robot-aided neurorehabilitation. , 1998, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[7]  W. Rymer,et al.  Guidance-based quantification of arm impairment following brain injury: a pilot study. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[8]  R. Riener,et al.  Identification of passive elastic joint moments in the lower extremities. , 1999, Journal of biomechanics.

[9]  H. F. Machiel van der Loos,et al.  Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience. , 2000, Journal of rehabilitation research and development.

[10]  Li-Qun Zhang,et al.  Intelligent stretching of ankle joints with contracture/spasticity , 2002, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[11]  N. Hogan,et al.  Assessing the Motor Status Score: A Scale for the Evaluation of Upper Limb Motor Outcomes in Patients after Stroke , 2002, Neurorehabilitation and neural repair.

[12]  William S. Harwin,et al.  Upper Limb Robot Mediated Stroke Therapy—GENTLE/s Approach , 2003, Auton. Robots.

[13]  W. T. Thach,et al.  How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis? , 2004, Brain : a journal of neurology.

[14]  E. Roth,et al.  Biomechanic changes in passive properties of hemiplegic ankles with spastic hypertonia. , 2004, Archives of physical medicine and rehabilitation.

[15]  Mark Ferraro,et al.  Continuous passive motion improves shoulder joint integrity following stroke , 2005, Clinical rehabilitation.

[16]  R. Gorman,et al.  A new method for measuring passive length-tension properties of human gastrocnemius muscle in vivo. , 2005, Journal of biomechanics.

[17]  Ruud W Selles,et al.  Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. , 2005, Archives of physical medicine and rehabilitation.

[18]  Julius P. A. Dewald,et al.  Position-dependent torque coupling and associated muscle activation in the hemiparetic upper extremity , 2007, Experimental Brain Research.

[19]  Maarten J. IJzerman,et al.  Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. , 2006, Journal of rehabilitation research and development.

[20]  Robert Riener,et al.  Robot-aided neurorehabilitation of the upper extremities , 2005, Medical and Biological Engineering and Computing.

[21]  Robert Riener,et al.  ARMin: a robot for patient-cooperative arm therapy , 2007, Medical & Biological Engineering & Computing.

[22]  B. Brewer,et al.  Poststroke Upper Extremity Rehabilitation: A Review of Robotic Systems and Clinical Results , 2007, Topics in stroke rehabilitation.

[23]  J.J. Palazzolo,et al.  Stochastic Estimation of Arm Mechanical Impedance During Robotic Stroke Rehabilitation , 2007, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[24]  Fan Gao,et al.  Altered contractile properties of the gastrocnemius muscle poststroke. , 2008, Journal of applied physiology.

[25]  W. Rymer,et al.  Separate quantification of reflex and nonreflex components of spastic hypertonia in chronic hemiparesis. , 2008, Archives of physical medicine and rehabilitation.

[26]  Maolin Jin,et al.  A Solution to the Accuracy/Robustness Dilemma in Impedance Control , 2009, IEEE/ASME Transactions on Mechatronics.

[27]  Robert Riener,et al.  ARMin III --arm therapy exoskeleton with an ergonomic shoulder actuation , 2009 .

[28]  Sang-Hoon Kang,et al.  Robust IMC based impedance control of robot manipulators = 로봇 매니퓰레이터를 위한 내부모델제어 기반 강인 임피던스 제어 , 2009 .

[29]  Eric Berton,et al.  Determination of passive moment-angle relationships at the trapeziometacarpal joint. , 2010, Journal of biomechanical engineering.

[30]  B. Volpe,et al.  Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper Limb Motor Performance in Patients With Chronic Stroke , 2010, Neurorehabilitation and neural repair.

[31]  Pyung Hun Chang,et al.  Stochastic estimation of human arm impedance under nonlinear friction in robot joints: A model study , 2009, Journal of Neuroscience Methods.

[32]  E. Roth,et al.  Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. , 2011, Clinical biomechanics.

[33]  Li-Qun Zhang,et al.  Robust identification of multi-joint human arm impedance based on dynamics decomposition: A modeling study , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[34]  Yupeng Ren,et al.  Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy Using a Portable Robot , 2011, Neurorehabilitation and neural repair.

[35]  Yupeng Ren,et al.  Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy. , 2011, Journal of applied physiology.

[36]  Pyung Hun Chang,et al.  Stochastic Estimation of Human Arm Impedance Using Robots With Nonlinear Frictions: An Experimental Validation , 2013, IEEE/ASME Transactions on Mechatronics.