Research on robotic exoskeletons has rapidly expanded over the previous decade. Advances in robotic hardware and energy supplies have enabled viable prototypes for human testing. This review paper ...describes current lower limb robotic exoskeletons, with specific regard to common trends in the field. The preponderance of published literature lacks rigorous quantitative evaluations of exoskeleton performance, making it difficult to determine the disadvantages and drawbacks of many of the devices. We analyzed common approaches in exoskeleton design and the convergence, or lack thereof, with certain technologies. We focused on actuators, sensors, energy sources, materials, and control strategies. One of the largest hurdles to be overcome in exoskeleton research is the user interface and control. More intuitive and flexible user interfaces are needed to increase the success of robotic exoskeletons. In the last section, we discuss promising future solutions to the major hurdles in exoskeleton control. A number of emerging technologies could deliver substantial advantages to existing and future exoskeleton designs. We conclude with a listing of the advantages and disadvantages of the emerging technologies and discuss possible futures for the field.
Abstract Stroke is among the leading causes of long-term disabilities leaving an increasing number of people with cognitive, affective and motor impairments depending on assistance in their daily ...life. While function after stroke can significantly improve in the first weeks and months, further recovery is often slow or non-existent in the more severe cases encompassing 30–50% of all stroke victims. The neurobiological mechanisms underlying recovery in those patients are incompletely understood. However, recent studies demonstrated the brain's remarkable capacity for functional and structural plasticity and recovery even in severe chronic stroke. As all established rehabilitation strategies require some remaining motor function, there is currently no standardized and accepted treatment for patients with complete chronic muscle paralysis. The development of brain–machine interfaces (BMIs) that translate brain activity into control signals of computers or external devices provides two new strategies to overcome stroke-related motor paralysis. First, BMIs can establish continuous high-dimensional brain-control of robotic devices or functional electric stimulation (FES) to assist in daily life activities ( assistive BMI). Second, BMIs could facilitate neuroplasticity, thus enhancing motor learning and motor recovery ( rehabilitative BMI). Advances in sensor technology, development of non-invasive and implantable wireless BMI-systems and their combination with brain stimulation, along with evidence for BMI systems' clinical efficacy suggest that BMI-related strategies will play an increasing role in neurorehabilitation of stroke.
Advances in brain science and computer technology in the past decade have led to exciting developments in brain-computer interface (BCI), thereby making BCI a top research area in applied science. ...The renaissance of BCI opens new methods of neurorehabilitation for physically disabled people (e.g. paralyzed patients and amputees) and patients with brain injuries (e.g. stroke patients). Recent technological advances such as wireless recording, machine learning analysis, and real-time temporal resolution have increased interest in electroencephalographic (EEG) based BCI approaches. Many BCI studies have focused on decoding EEG signals associated with whole-body kinematics/kinetics, motor imagery, and various senses. Thus, there is a need to understand the various experimental paradigms used in EEG-based BCI systems. Moreover, given that there are many available options, it is essential to choose the most appropriate BCI application to properly manipulate a neuroprosthetic or neurorehabilitation device. The current review evaluates EEG-based BCI paradigms regarding their advantages and disadvantages from a variety of perspectives. For each paradigm, various EEG decoding algorithms and classification methods are evaluated. The applications of these paradigms with targeted patients are summarized. Finally, potential problems with EEG-based BCI systems are discussed, and possible solutions are proposed.
The past decades have seen rapid and vast developments of robots for the rehabilitation of sensorimotor deficits after damage to the central nervous system (CNS). Many of these innovations were ...technology-driven, limiting their clinical application and impact. Yet, rehabilitation robots should be designed on the basis of neurophysiological insights underlying normal and impaired sensorimotor functions, which requires interdisciplinary collaboration and background knowledge.Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires a physiological limb muscle activation that can be achieved through functional arm/hand and leg movement exercises and the activation of appropriate peripheral receptors. Such considerations have already led to the development of innovative rehabilitation robots with advanced interaction control schemes and the use of integrated sensors to continuously monitor and adapt the support to the actual state of patients, but many challenges remain. For a positive impact on outcome of function, rehabilitation approaches should be based on neurophysiological and clinical insights, keeping in mind that recovery of function is limited. Consequently, the design of rehabilitation robots requires a combination of specialized engineering and neurophysiological knowledge. When appropriately applied, robot-assisted therapy can provide a number of advantages over conventional approaches, including a standardized training environment, adaptable support and the ability to increase therapy intensity and dose, while reducing the physical burden on therapists. Rehabilitation robots are thus an ideal means to complement conventional therapy in the clinic, and bear great potential for continued therapy and assistance at home using simpler devices.This review summarizes the evolution of the field of rehabilitation robotics, as well as the current state of clinical evidence. It highlights fundamental neurophysiological factors influencing the recovery of sensorimotor function after a stroke or spinal cord injury, and discusses their implications for the development of effective rehabilitation robots. It thus provides insights on essential neurophysiological mechanisms to be considered for a successful development and clinical inclusion of robots in rehabilitation.
To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical ...stakeholder perspectives.
A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features.
The study was conducted at hospital systems in a large metropolitan area.
Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study.
Not applicable.
Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes.
Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems.
Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention.
A spinal cord injury interrupts the communication between the brain and the region of the spinal cord that produces walking, leading to paralysis
. Here, we restored this communication with a digital ...bridge between the brain and spinal cord that enabled an individual with chronic tetraplegia to stand and walk naturally in community settings. This brain-spine interface (BSI) consists of fully implanted recording and stimulation systems that establish a direct link between cortical signals
and the analogue modulation of epidural electrical stimulation targeting the spinal cord regions involved in the production of walking
. A highly reliable BSI is calibrated within a few minutes. This reliability has remained stable over one year, including during independent use at home. The participant reports that the BSI enables natural control over the movements of his legs to stand, walk, climb stairs and even traverse complex terrains. Moreover, neurorehabilitation supported by the BSI improved neurological recovery. The participant regained the ability to walk with crutches overground even when the BSI was switched off. This digital bridge establishes a framework to restore natural control of movement after paralysis.
Traumatic brain injury (TBI) causes lifelong cognitive deficits, most often in executive function (EF). Both musical training and music‐based rehabilitation have been shown to enhance EF and ...neuroplasticity. Thus far, however, there is little evidence for the potential rehabilitative effects of music for TBI. Here, we review the core findings from our recent cross‐over randomized controlled trial in which a 10‐week music‐based neurological rehabilitation (MBNR) protocol was administered to 40 patients with moderate‐to‐severe TBI. Neuropsychological testing and structural/functional magnetic resonance imaging were collected at three time points (baseline, 3 months, and 6 months); one group received the MBNR between time points 1 and 2, while a second group received it between time points 2 and 3. We found that both general EF and set shifting improved after the intervention, and this effect was maintained long term. Morphometric analyses revealed therapy‐induced gray matter volume changes most consistently in the right inferior frontal gyrus, changes that correlated with better outcomes in set shifting. Finally, we found changes in the between‐ and within‐network functional connectivity of large‐scale resting‐state networks after MBNR, which also correlated with measures of EF. Taken together, the data provide evidence for concluding that MBNR improves EF in TBI; also, the data show that morphometric and resting‐state functional connectivity are sensitive markers with which to monitor the neuroplasticity induced by the MBNR intervention.
Here we review the core findings from our recent cross‐over randomized controlled trial (RCT) in which a 10‐week music‐based neurological rehabilitation (MBNR) protocol was administered to 40 patients with moderate‐to‐severe traumatic brain injury (TBI). The data provide evidence for concluding that MBNR improves executive function in TBI.
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