Abstract This study is aimed at reviewing the various literature on the robot-based rehabilitation and the associated technical issues, augmentation, utilization, and safeties. During recent years, Biorobotics and Collaborative Robots have played a remarkable role to provide fast, accurate and efficient therapy and assistance. Most of these robots are equipped with various types of devices to control the intensity, duration, and precision of the training while some feedback systems have also been used to monitor the efficiency of the process and help physicians and therapists to furnish a high quality treatment. Haptic devices, Electromyography (EMG)/Electroencephalography (EEG) sensors, virtual environment and other interactive approaches have been utilized to optimize the process and to investigate different mental as well as physiological aspects. This review paper provides a comprehensive background on the human robot interactions and their outcomes in medical settings and potential research areas in the domain.

Abstract Design fixation has been extensively studied in the context of engineering design, leading to several interventions to reduce its negative effects. The concept of mental fixation has roots in diverse psychological contexts from Freudian psychoanalysis to Gestaltism and eating disorders. Although the underlying concepts are similar, the phenomenon has different names, including mental set, rumination, functional fixedness, obsession, etc. Mental fixation in its various forms is always a barrier to problem solving, whether the problem is a psychological disorder or an engineering-design task. The present paper explores the applicability to design fixation of cognitive therapy, a form of psychotherapy that relies on questioning to identify and modify inaccurate perceptions. Originally developed to treat depression, it is now used to treat a variety of psychiatric disorders. Specific interventions used in cognitive therapy are described in detail towards developing new means of overcoming design fixation. These interventions include cognitive restructuring and exposure response prevention. Also explored are links to other research results from psychology and cognitive science, including focused distraction, and the effects of music and physical exercise. In addition to developing new interventions, existing design-fixation interventions can also be supplemented using insights from these research results.

In robotic rehabilitation the interaction is usually implemented by means of robots based on multi-Degree of Freedom (DOF) open kinematic chains. Despite their inherent flexibility these machines are expensive, complex and require routine maintenance and IT support. In contrast, mechanisms based on closed kinematic chains and especially 1-DOF four- and six bar linkages are simple, yet capable of generating paths with complex kinematic characteristics. These mechanisms are preferable when simplicity and cost are the major criteria, for example in the case of community-based rehabilitation in developing countries. On the other hand, rehabilitation using 1-DOF limits flexibility and potentially impairs the exercise effectiveness, since the patient does not have access to a variety of kinematic challenges. Nevertheless, by careful ergonomic design and by considering varying time constraints, link rotation ranges and varying link lengths this limitation can be overcome. This work aims to demonstrate the potential of 1-DOF four-bar linkages to provide flexibility in therapy by considering a Hoeken’s straight line four-bar linkage. After the mechanism is dimensioned, a previously developed method is employed for establishing a final prototype design which accounts for significant neurophysiological models such as Minimum Jerk Model, Fitts’s Law and Just Noticeable Differences. Given the mechanism characteristics, its potential for generation of exercises that vary with respect to temporal and spatial characteristics is demonstrated.

This paper presents the design, control, and validation of a soft robotic exoskeleton system, the REHAB Glove, for hand rehabilitation. The system is comprised of five hybrid soft-and-rigid robotic digits that apply controlled flexion and extension motion to fingers. The previous actuator design of the soft robotic digit was improved for kinematic compatibility with anatomical motions of the hand in relation to range of motion, center of rotation, and dorsal skin lengthening. The design was validated using motion capture and analysis. A position control algorithm, which controls finger angular trajectories (angular position and velocity), was developed based on motion sensor feedback. The operation of this algorithm was verified using a 90° digit tip trajectory with two angular velocities of 15°/sec and 30°/sec. A pilot study was carried out with five healthy individuals to evaluate the performance of the REHAB Glove in providing therapeutic schemes. The results show that the REHAB Glove is able to provide controlled motion compatible with the kinematics and dynamics of the human.

It has become evident through studies both computational and otherwise, that the characteristics of blood flow through a mechanical heart valve is closely tied to its thrombogenic profile and clinical performance. Despite progress in the field, there remains an unmet clinical need for a heart valve that is both durable and free from the need for anticoagulation therapy. We designed a prototype for a novel mechanical heart valve with the aim of improving hemodynamic performance and obviating the need for anticoagulant therapy. In this paper we present the results of a computational study that compared our prototype mechanical heart valve with a popular commercially available valve, the Medtronic ATS valve. Our results show that the unique design features of our prototype leads to a reduction turbulent flow, along with a reduction in velocity jets by up to 28%, pressure gradient across the valve by 36.7%, and increases in the effective orifice area of the valve by 25.7%.

Stroke basically consists in brain-cells death due to lack or excess of blood. Stroke has many important consequences and falls are one of the most concerning. Falls can produce several injures from minor lacerations to fractures and death. It has been found that balance and gait impairments after stroke are important risk factors for fall. Hence, improving balance and gait ability in stroke survivors can significantly reduce falls rate. In this literature review, we review the main characteristic and the therapeutic results of different therapeutic interventions aimed at improving balance and walking ability. The main therapeutic interventions included are the Bobath therapy, exercise-based interventions, orthotic and assistive devices, modality treatments, alternative therapies, robotic-assisted training, and computational-based interventions. The parameters considered as evidence of balance and/or gait recovery after a specific intervention are: walking speed (WS), cadence, endurance, stride/step length, weight/walking symmetry, and sway. Our main findings are: 1) The wide use of the Bobath concept is not well supported by evidence due to its performance has been found to be inferior to some exercises-based interventions such as walking training; 2) exercises-based interventions were classified as strength and task-specific training. The former improves muscular and bone health, aerobic capability, and prepares the patient to perform a more demanding activity. The latter is designed as a repetitive training of a functional activity, mainly walking, and sit to stand exercises, which improve both gait and balance. Orthotic and assistive devices have effects on balance and gait but only while they are worn or used; 3) robotic assisted walking-training presented similar results to overground or treadmill walking training in terms of walking speed and balance recovery. However, the most important advantage lies on the reduction of burden for therapists; 4) thee most important use of motion analysis is as a tool for identify the causes deficits in a patient and the to design a therapy in accordance; 5) motion synthesis can be used as a tool to answer very specific questions related to capabilities/limitations of a patient. For instance, “what would be the effect of increasing hip-torque capability of a stroke survivor on the walking-symmetry?” The answer to this question would either help to design an exercise/intervention or to discard such intervention due to low impact; 6) some treatments are added to a main therapy to increase its effect on a given parameter. Functional electrical stimulation, which is added to cycling training to improve motion patterns. Biofeedback is used during balance training to reduce weight-asymmetry. And virtual reality and video games are used to increase motivation and permanence of patient on a therapy; 7) we found some alternative or no widely used therapies. Among the most promising we can mention Tai-Chi exercises, which integrates physical and mental activities to improve balance and gait and rhythmic auditory stimulation that improves WS and weight-symmetry; and 8) orthotics devices help to reduce falls by extending the base of support but the effect appears only while they are worn. In general, there is not an ultimate therapy able to fit to every patient. The choice should depend on patient’s goals and conditions. Moreover, falls can not be eliminated but they can be substantially reduced by improving balance and gait.

This paper presents a novel six-bar Sit-to-Stand (STS) linkage mechanism integrated in a multi-functional assistive device 1 , that helps improve mobility of individuals with lower extremity weaknesses. The six-bar linkage follows the J-shaped trajectory of the shoulder-joint and maintains orientation of the supporting bar for the comfort and ergonomics. An overall goal was to design a device that is comfortable to the user during STS transformation, compact, light-weight, portable and one that requires minimum number of external actuators. By following the natural posture and movement of certain joints, a biomechanically correct STS motion is achieved. A natural motion ensures minimum stresses on joints and muscles and if the user can move their legs, they can undergo ambulation therapy and stimulate functional neural pathways. Dynamic analysis is done on the mechanism to design a frame and to select actuators for lifting a person weighing 300lbs. The device was tried by individuals with lower extremity weaknesses and the results showed that it lifts users well and also helps balance and stabilize them during ambulation.

Earlier diagnosis plays a pivotal role in clinical applications, since it can strongly reduce the incidence and impact of many diseases and, consequently, the reduction of health care costs. This last aspect depends strongly from right therapy prescriptions, especially when there are various opportunities. Within this context, Clinical Decision Support Systems (CDSS) could bring several benefits. In this paper, we propose a CDSS with the aim of improving the clinician practice based on recommendations, assessment of the patient and screening of patients with risk factors to prevent chronic venous insufficiency (CVI) complications. The proposed CDSS is implemented in the Nu.Sa. cloud system, which involves thousands of italian General Practitioners (GPs) collecting data (EHR data, personal data, patient’s medical history) from millions of patients. The proposed architecture is designed to collect data from a distributed scenario where GPs are collecting clinical history and pharmacy or second level hospitals gather data from medical devices connected to the cloud over a standard data architecture. We show that exploiting the integration of the medical device VenoScreen Plus with the patient EHR, this CDSS is capable to improve preventive care, to enhance clinical performance, to influence clinical decision making and to significantly improve the decision quality levering on data driven approach.

Ulceration of the foot is one of the most common complications of diabetes mellitus and diabetes-related cause of hospitalization and lower extremity amputations. There have been proposed several treatments and utilized different devices to prevent or at least improve this. It has been shown physical therapy interventions are the most effective in the treatment of diabetic foot wounds among of all the proposed treatments, where a fully controlled motion in patients’ foot is desired on a pure rotational trajectory. Therefore, parallel robots represent a good candidate for this rehabilitation purpose because of their high accuracy. This paper is devoted to designing optimal structures of three six-degree-of-freedom parallel robots (i.e. Stewart, HEXA, and INRIA Active Wrist) for the lower extremity rehabilitation by the use of the genetic algorithm and Monte Carlo method. For this purpose, several key designing parameters such as the size of the platform, the length of manipulators, actuators’ parameters, and reachable workspace are considered. These designing parameters are optimized such that results in the best systems’ kinematics and dynamics performance. Consequently, the advantages and disadvantages of each platform are discussed.

Oxygen concentration devices currently on the market have many shortcomings. They are bulky and difficult to carry. They alter a patient’s outward image with a visual mark of disability. They do not change oxygen delivery in any way to adjust to the patient’s health. They also lack indicators to help the patient decide when to begin or end a therapy session. Some patient’s decide not to take oxygen therapy as a result of these shortcomings. Those that use these devices may receive over oxygenation or under oxygenation due to the mentioned pitfalls. Any of the shortcomings described can be life threatening to the patient. The present innovation is a proposed system for oxygen delivery that adjusts flowrate based on the patient health and requires no user input to begin or end a therapy session. This paper presents a unique wearable device design for delivering oxygen in a pressure based concentration system.

Intrathecal (IT) drug delivery is a preferred treatment for chronic pain, brain cancers and spasticity. However, the application of IT drug delivery treatment is still limited by the large patient-to-patient variations and numerous kinds of rare genetic diseases. A fast, relatively cheap and subject-specific in-vitro method to study the drug bio-dispersion mechanism and optimize the intrathecal drug therapies for individual patients is in great need. In this study, we will investigate the model design and additive manufacturing process for producing a subject-specific spine model, which will simulate the interaction of the real human spine with cerebrospinal fluid (CSF). Research issues including watertight 3D printable model construction and 3D printing of anatomical accurate, physiological functional spine models are discussed in this paper. A pipeline of additive manufacturing in-vitro subject-specific models for study of cerebrospinal fluid and drug transport in spine is presented.

In this paper, we are presenting a framework for capturing human motions using Microsoft Kinect sensor for the purpose of 1) generating task positions for mechanism and robot synthesis, and 2) generation and visualization of B-spline inter-polated and approximated motion from the captured task positions. The theoretical foundation of this work lies in Kinematic Mapping, Dual and Bi-quaternions, and NURBS (Non-Uniform Rational B-spline) geometry. Lately, Kinect has opened doors for creation of natural and intuitive human-machine interactive (HMI) systems in medicine, robotic manipulation, CAD, and many other fields, where visual-sensing and -capture is a central theme. Kinect has made a huge impact in physical therapy area, achieving new benchmarks in tele-rehabilitation by improving physical exercise assessment, monitoring and supervision using the skeletal data. Moreover, Kinect’s depth sensing capability has helped in retrieving depth information required for robotic vision in grasping, object recognition which was previously done using computationally demanding computer vision algorithms. Kinect’s point cloud data with interactive gestures has proven to be useful in various CAD software for conceptual design of shapes. Mechanism synthesis is one of the areas in Kinematics, where Kinect-provided skeletal data can be leveraged to design and develop highly customized end-user collaborated mechanism solutions. We demonstrate that using Kinect, OpenGL, and Openframeworks, we can capture discrete (or, key) rigid body displacements, continuous motions, and generate and visualize rational B-spline motions from captured key positions. Capturing only a few key positions results in significant data savings and also provides a natural way to create tasks for mechanism synthesis problems. The output is a set of dual quaternions and 4 × 4 homogeneous transforms representing a task motion, which can be used as an input for mechanism synthesis applications. The tool produced also allows users to generate trajectories of various points on a moving rigid body interactively. A Kinect-based capture of such motions can help create highly-customized assistive devices for people who suffer from a range of motion-related difficulties due to old age or disabilities.

Health games are increasingly seen as a means to address issues from therapy and rehabilitation. Yet, as a transformative technology, rarely have such games been explored or exploited to assist research into pathologies. Serious games for research (SGR) to uncover pathologies would allow clinicians to develop new differential diagnostics while providing a positive experience for the subject. This paper is not about game design; nevertheless it presents an outlook to considerations that could be taken forward when developing health-based SGRs for pathomechanics, etiopathogenesis and biofeedback. This work relates to preliminary studies on balance challenges manifested in pathologies of the central nervous system. As technology advancements seek to augment human sensory contact between virtual and real worlds this may impact on how virtual environments are used and designed in future. As a consequence heightened sensory (or lack of thereof) may result in falls, for example users with vestibular disorder — because postural stability is a key aspect of motor ability that allows individuals to sustain and maintain the desired physical position of their body Here, our investigation is specific to functional correspondence of the incidental properties in human body sway between healthy subjects and subjects with dyslexia. Our early results suggest postural sway between healthy subjects and those with mild disorders can be distinguished.

The ability to deliver DNA sequences and molecular loads into the nucleus of a cell is a large area of interest in the medical community, and has numerous applications including gene therapy. Different methods of gene delivery each have their own advantages and disadvantages. Experimentation was performed using a new technique called nanoinjection to determine how force affects the efficiency and viability of the injection process. Nanoinjection, which utilizes an array of millions of solid microlances made on a 2 cm square silicon chip to inject cells, allows us to inject hundreds of thousands of cells at a time with high efficiencies. The solid nature of the lances allows them to be smaller, increasing cell viability. HeLa cells were used for testing in conjunction with an injection device that allowed for precise control of the injection force. Propidium iodide (PI), a dye that fluoresces when bound to DNA and doesn’t penetrate the membrane of living cells, was injected to monitor the efficiencies of transporting molecular loads across the cell membrane. The data was normalized to the controls for both efficiency (PI uptake) and viability to make it easier to see and determine trends. Results indicate a slow rise in injection efficiency from 0 to 1.8 Newtons of force where it reaches a maximum efficiency of 4.11 when normalized to the PI uptake of the positive controls. The data then levels, averaging an efficiency of approximately 3.1. The slow rise is likely due to more of the cells being punctured as the force increases until most have been punctured and the efficiency levels off. Viability had no clear trend, only varying between 0.97 and 1.04 when normalized to the viability of the negative controls.

Assisted motor therapies play a critical role in enhancing the functional musculoskeletal recovery and neurological rehabilitation. Our focus here is to assist the performance of repetitive motor-therapy of the human lower limbs — in both the sagittal and frontal planes. Hence, in this paper, we develop a lightweight, reconfigurable hybrid (articulated-multibody and cable) based robotic rehabilitative device as a surrogate for a human physiotherapists and analyze feasibility and performance. A hybrid cable-actuated articulated multibody system is formed when multiple cables are attached from a ground-frame to various locations on the lower limbs. The combined system now features multiple holonomic cable-loop-closure constraints acting on a tree-structured multibody system. Hence the paper initially focuses on developing the Newton-Euler dynamic equilibrium equations of the cable-driven lower limbs to develop a symbolic analysis framework. The desired motion for the proposed rehabilitative exercise are prescribed based upon normative subjects motion patterns. Trajectory-tracking within this system is realized by a position-based impedance controller in task-space and a feedback-linearized PD controllers in joint-space. Careful coordination of the multiple cable-motors are now necessary in order to achieve the co-robotic control of the overall system, avoiding development of internal stresses and ensuring continued satisfaction of the unilateral cable-tension constraints throughout the workspace. This is now evaluated via a simulation case-study and development of a physical testbed is underway.

This paper introduces an effective engineered rehabilitation system for understanding and inducing functional recovery of hemiparetic limbs based on the concept of timing-dependent induction of neural plasticity. Limb motor function is commonly impaired after neurologic injury such as stroke, with hemiparesis being one of the major impairments. In an emerging unique intervention for hemiparesis, named repetitive facilitation exercise, or RFE, a therapist manually applies brief mechanical stimuli to the peripheral target muscles (e.g., tapping, stretching of tendon/muscle) immediately before a patient intends to produce a movement with the muscle. The practice of this rehabilitation procedure by a skilled therapist often leads to dramatic rehabilitation outcomes. However, unskilled therapists, most likely due to the inaccuracy of the timing of peripheral stimulation in reference to the intention of movement (i.e. motor command), are unable to recreate the same rehabilitation results. Robotic rehabilitation, on the other hand, can improve the reliability and efficacy of the operation by satisfying the timing precision required by the therapy. This study demonstrates the use of a pneumatically-driven MRI-compatible robot for RFE assessment. The pressure dynamics of the system is studied for an accurate estimation on the time of response of the robot. The required temporal precision of the therapy is obtained and the use of the device is validated through experiments on a human subject.

This paper presents the design and application of the SAFER glove in the field of hand rehabilitation. The authors present preliminary results on a new hand grasping rehabilitation learning system that is designed to gather kinematic and force information of the human hand and to playback the motion to assist a user in common hand grasping movements, such as grasping a bottle of water. The fingertip contact forces during grasping have been measured by the SAFER Glove from 12 subjects. The measured fingertip contact forces were modeled with Gaussian Mixture Model (GMM) based on machine learning approach. The learned force distributions were then used to generate fingertip force trajectories with a Gaussian Mixture Regression (GMR) method. To demonstrate the glove’s potential to manipulate the hand, experiments with the glove fitted on a wooden hand to grasp various objects were performed. Instead of defining a grasping force, contact force trajectories were used to control the SAFER Glove to actuate/assist this hand while carrying out a learned grasping task. To prove that the hand can be driven safely by the haptic mechanism, force sensor readings placed between each finger and the mechanism have been plotted. The experimental results show the potential of the proposed system in future hand rehabilitation therapy.

Robot-assisted rehabilitation techniques have advantages over conventional physiotherapy in terms of control accuracy, repeatability and objectiveness. Several systematic reviews on the effectiveness of robot-assisted ankle rehabilitation have been conducted. It was found that most were effective for the treatment of ankle injuries, although the comparative results could not be identified. However, evidence involving the clinical effectiveness of robotic ankle therapy on adult patients with cerebral palsy (CP) is lacking. This paper presents a case study of robot-assisted ankle rehabilitation on an adult patient with CP. Biomechanical outcomes were evaluated before and after each session with a 10-week-intervention trial by using a Continuous Passive Motion (CPM) device (ARTROMOT ® -SP3) for ankle rehabilitation. Both passive and passive-active programs were conducted. Evaluation measures include ankle range of motion (ROM), stiffness and active strength. Experimental results show a distinct recovery progress in ankle movement ability. The participant achieved increased ankle ROM and active strength, and decreased ankle stiffness. This case report demonstrates the effectiveness of robotic training to recover a CP patient’s motor functions and also provides a basis for future study with more clinical trials.

Recent researches have demonstrated that cells ingest mitochondrial by endocytosis to repair cell damage. This new mitochondrial therapy approach can be used for curing particular disease of neuropathy related diseases. Hence the obtainment of high quality and healthy mitochondria play an important role in mitochondrial based disease therapy. In this study, we propose a cascade microfluidic device for green extraction of healthy mitochondria. The geometry of the device was designed using the commercially available COMSOL package. Soft lithography process was than conducted to realize the device of PDMS. We used C2-GFP cells to demonstrate the efficiency of the proposed cascade microfluidic device. The total protein assay kit (complex I-V) was conducted to examine the extractive protein and the SDS page (Tom 20) was used for measuring the activity of the extracted mitochondria. Experimental results illustrate that the complex I-V expression of the extracted mitochondria by the proposed device is much higher than that of the extracted mitochondria by conventional kit. Furthermore, the results of the Tom 20 expression also demonstrate that our device is able to extract more amounts of mitochondria than the conventional kit.

The accurate reconstruction of a human digital dental model represents a wide research area within the orthodontic field due to its importance for the customization of patient treatments. Usually, 3-D dental root geometries are obtained by segmenting tomographic data. However, concerns about radiation doses may be raised since tomographic scans produce a greater X-ray dose than conventional 2-D panoramic radiographs (PAN). The present work is aimed at investigating the possibility to retrieve 3-D shape of individual teeth by exposing the patient to the minimum radiation dose. The proposed methodology is based on adapting general CAD templates over patient-specific dental anatomy, which is reconstructed by integrating the optical digitization of dental plaster models with a PAN image. The radiographic capturing process is simulated through the Discrete Radon Transform (DRT) and performed onto the patient crowns geometry obtained by segmenting the digital plaster model. A synthetic PAN image is then reconstructed and used to integrate the radiographic data within the digitized plaster model, thus allowing to retrieve roots information which guide the CAD templates adapting over the patient anatomy.