Assistive Robotics for Upper Limb Physical Rehabilitation:A Systematic Review and Future Prospects

Physical assistive robotics are oriented to support and improve functional capacities of people.In physical rehabilitation,robots are indeed useful for functional recovery of affected limb.However,there are still open questions related to technological aspects.This work presents a systematic review of upper limb rehabilitation robotics in order to analyze and establish technological challenges and future directions in this area.A bibliometric analysis was performed for the systematic literature review.Literature from the last six years,conducted between August 2020 and May 2021,was reviewed.The methodology for the literature search and a bibliometric analysis of the metadata are presented.After a preliminary search resulted in 820 articles,a total of 66 articles were included.A concurrency network and bibliographic analysis were provided.And an analysis of occurrences,taxonomy,and rehabilitation robotics reported in the literature is presented.This review aims to provide to the scientific community an overview of the state of the art in assistive robotics for upper limb physical rehabilitation.The literature analysis allows access to a gap of unexplored options to define the technological prospects applied to upper limb physical rehabilitation robotics.

Development of a Wearable Upper Limb Rehabilitation Robot Based on Reinforced Soft Pneumatic Actuators

Dyskinesia of the upper limbs caused by stroke,sports injury,or trafc accidents limits the ability to perform the activities of daily living.Besides the necessary medical treatment,correct and scientifc rehabilitation training for the injured joint is an important auxiliary means during the treatment of the efected upper limb.Conventional upperlimb rehabilitation robots have some disadvantages,such as a complex structure,poor compliance,high cost,and poor portability.In this study,a novel soft wearable upper limb rehabilitation robot(SWULRR)with reinforced soft pneumatic actuators(RSPAs)that can withstand high pressure and featuring excellent loading characteristics was developed.Driven by RSPAs,this portable SWULRR can perform rehabilitation training of the wrist and elbow joints.In this study,the kinematics of an SWULRR were analyzed,and the force and motion characteristics of RSPA were studied experimentally.The results provide a reference for the development and application of wearable upper limb rehabilitation robots.An experimental study on the rotation angle of the wrist and the pressure of the RSPA was conducted to test the efect of the rehabilitation training and verify the rationality of the theoretical model.The process of wrist rehabilitation training was tested and evaluated,indicating that SWULRR with RSPAs will enhance the fexibility,comfort,and safety of rehabilitation training.This work is expected to promote the development of wearable upper-limb rehabilitation robots based on modular reinforced soft pneumatic actuators.

Examination of the Effect of Rehabili-Mouse, a Desktop Rehabilitation Robot for Upper Limb Paresis after Stroke

Background: Active rehabilitation of the paralyzed limb is necessary for functional recovery from upper limb paralysis after stroke. In particular, the amount of training is very important, and robot rehabilitation is useful. However, most conventional robots are expensive, large, and stationary. We have developed Rehabili-Mouse, a new tabletop rehabilitation robot that is compact and portable. The purpose of this study was to conduct paralyzed upper limb training for a patient after stroke using Rehabili-Mouse and to examine its effect. Case: The patient was a 44-year-old man who had left-sided paresis after a right cerebral infarction, 3 months after onset. The training was carried out between February 2021 and March 2021 at Oyu Rehabilitation Hotspring Hospital. The training was 20 minutes of Rehabili-Mouse in addition to 40 minutes of usual occupational therapy and performed five times a week for four weeks. Upper limb functions were evaluated before and after the training, and two questionnaires of patient satisfaction with the device and the training were administered after the completion of the training. Upper limb function improved. The patient’s satisfaction with the device was poor, but his satisfaction with the training was good. Discussion: Training for the paralyzed upper limb after stroke using Rehabili-Mouse improved upper limb function and satisfied the trained patient. We plan to increase the number of cases and conduct further studies.

The Recovery of Complicated Upper Limbs Movement Functions of Poststroke Patients

In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobility. The aim of the study was to evaluate the effectiveness of robotic therapy in the recovery of upper limb function in the chronic stage of stroke. The study involved 52 patients with ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All patients （5 days/wk × 3 wk） got gymnastics by the standard technique, massage, laser, and pulsed currents therapy. Main group patients （n = 36） extra received complex spatial movements, speed, fluidity, precision and agility training by the robotic electromechanical device Multi Joint System （MJS） （40 minutes, 5 days/wk × 3 wk）. Analysis of the results of the study showed a statistically significant difference in improving ROM of the elbow and shoulder joints, speed and accuracy of movement in the main group compared with the control. Hardware recovery of complex spatial upper limb movements in the chronic stage of stroke increases the functionality and independence of the patient＇s domestic skills.

Mechatronic Design of a Robot for Upper Limb Rehabilitation at Home

This paper addresses the design of a novel bionic robotic device for upper limb rehabilitation tasks at home.The main goal of the design process has been to obtain a rehabilitation device,which can be easily portable and can be managed remotely by a professional therapist.This allows to treat people also in regions that are not easily reachable with a significant cost reduction.Other potential benefits can be envisaged,for instance,in the possibility to keep social distancing while allowing rehabilitation treatments even during a pandemic spread.Specific attention has been devoted to design the main mechatronic components by developing specific kinematics and dynamics models.The design process includes the implementation of a specific control hardware and software.Preliminary experimental tests are reported to show the effectiveness and feasibility of the proposed design solution.

上肢机器人辅助干预脑卒中的文献计量分析

目的分析机器人辅助干预脑卒中患者上肢功能的研究进展。方法在Web of Science核心合集中检索自建库至2024年11月关于机器人辅助疗法应用于脑卒中患者上肢功能康复的文献,采用Citespace 6.4.R1工具对该领域文献的来源国家、作者、机构、学科领域、关键词和引文关系等进行文献计量分析,并且绘制知识图谱。结果共纳入英文文献198篇,发文量呈上升趋势,中国、意大利、美国发文量较大,发文量最多的机构是罗马生物医学自由大学,发文量最多的作者是Rosati Giulio。共现频率前3位的关键词有motor recovery、activities of daily living、neuroplasticity。突现强度较高的关键词包括rehabilitation robotics、virtual reality、upper limb rehabilitation等。基于关键词聚类的研究重点方向主要有:对上肢运动功能、感觉功能、日常生活活动能力改善和大脑神经可塑性的相关研究。研究涉及基础医学、临床医学、生物医学工程、康复医学、控制科学与工程等领域。结论机器人辅助干预脑卒中患者上肢功能是一种创新的康复手段。研究热点聚焦于通过机器人辅助干预方法的设计及其效果,研究发现机器人辅助作业疗法可以有效改善患者的上肢功能,促进神经功能重塑,改善上肢主导的日常生活活动能力,并且能够激发患者积极性和康复信心。未来的研究应当更加聚焦于机器人辅助疗法与人工智能、虚拟现实等新兴技术的融合,探索其在精准康复、个性化康复方案制定等方面的应用潜力。

Cable-Driven Parallel Robot Workspace Identification and Optimal Design Based on the Upper Limb Functional Rehabilitation

An assessment of the human motion repeatability for three selected Activities of Daily Living(ADL)is performed in this paper.These exercises were prescribed by an occupational therapist for the upper limb rehabilitation.The movement patterns of five participants,recorded using a Qualisys motion capture system,are compared based on the Analysis of Variance(ANOVA)method.This survey is motivated by the need to find the appropriate task workspace of a 6-degrees of freedom cable-driven parallel robot for upper limb rehabilitation,which is able to reproduce the three selected exercises.This comparison is performed to justify,whether or not,there is enough similarity between the participants’gestures,and so a single reference trajectory can be adopted as the robot-prescribed workspace.Using the results of the comparative study,an optimization process of the sought robot design is carried out,where the structure size and the cable tensions simultaneously minimized.

Adaptive neural tracking control for upper limb rehabilitation robot with output constraints

The authors investigate the trajectory tracking control problem of an upper limb reha-bilitation robot system with unknown dynamics.To address the system's uncertainties and improve the tracking accuracy of the rehabilitation robot,an adaptive neural full-state feedback control is proposed.The neural network is utilised to approximate the dy-namics that are not fully modelled and adapt to the interaction between the upper limb rehabilitation robot and the patient.By incorporating a high-gain observer,unmeasurable state information is integrated into the output feedback control.Taking into consider-ation the issue of joint position constraints during the actual rehabilitation training process,an adaptive neural full-state and output feedback control scheme with output constraint is further designed.From the perspective of safety in human–robot interaction during rehabilitation training,log-type barrier Lyapunov function is introduced in the output constraint controller to ensure that the output remains within the predefined constraint region.The stability of the closed-loop system is proved by Lyapunov stability theory.The effectiveness of the proposed control scheme is validated by applying it to an upper limb rehabilitation robot through simulations.

基于模糊控制的上肢康复机器人变导纳控制

传统固定参数的导纳模型无法对上肢康复机器人的柔顺性实时调节,而现有变参数导纳模型需要结合实际康复需求进行改善。为此,以自主研发的串并混联的末端牵引式上肢康复机器人为研究对象,结合模糊控制与导纳控制,提出了一种面向实际康复需求的新型变导纳控制策略,制定了4条有利于康复效率与安全的模糊规则。该策略利用交互力误差及其变化率作为模糊控制输入,实时改变导纳模型的参数,实现柔顺性自主调节。仿真和实验结果验证了所提出的变导纳模型控制策略可行性和所制定的4条模糊规则的有效性。在患者可适应训练强度的场景中,相较于固定导纳模型,变导纳模型追踪给定路径时产生的冗余路径最多可降低56.13%,提高了康复训练效率;当康复运动超出患者可承受范围时,变导纳模型可提前0.5 s改变追踪路径,提高了康复的安全性。

六自由度上肢康复机器人机构设计及轨迹规划

本研究设计一款六自由度上肢康复机器人,机器人采用绳索驱动、串并联相结合的关节结构形式,能够牵引偏瘫患者的上肢实现多个关节且活动范围较大的康复运动训练。针对上肢康复机器人机构适用性问题,基于运动学理论和D-H坐标系法建立上肢康复机器人本体D-H参数模型,根据空间坐标向量之间的平移、旋转关系,对运动序列建模分析,求解正运动学,通过封闭解法求解逆运动学。基于运动学分析结果,提出五次多项式函数关节空间轨迹规划方法,对上肢提拉抬肘运动进行轨迹规划仿真,验证了康复运动过程中的运动能力。

气动肌肉驱动的上肢康复机器人动力学仿真

针对目前外骨骼机器人本体结构复杂,人机交互安全性不高的问题,结合驱动系统中气动人工肌肉的轻质、大驱动力、高柔顺性和接近人体肌肉的特性,提出一种基于气动肌肉的外骨骼上肢康复机器人。采用蒙特卡罗方法获得机器人的安全工作空间,并基于拉格朗日方程对外骨骼上肢康复机器人进行动力学建模,通过MATLAB软件对上肢康复机器人动力学特性仿真。

3DOF串并混联上肢康复机器人的运动学及工作空间分析

针对上肢受损患者的康复,优化出一款三自由度串并混联上肢康复机器人,使用D-H法建立坐标系,对上肢康复机器人进行正、逆运动学分析和雅克比矩阵的求解,并建立上肢康复机器人末端位姿矩阵,利用蒙特卡洛法对上肢康复机器人工作空间进行研究,使用MATLAB软件进行仿真绘制出上肢康复机器人在工作空间的点阵图,比较分析上肢康复机器人工作空间和目标空间的关系,提出上肢康复机器人使用的优化方案。

上肢康复机器人任务导向性训练对肩关节功能障碍患者的疗效观察

目的:观察上肢康复机器人任务导向性训练治疗肩关节功能障碍的疗效。方法:选取肩关节功能障碍患者58例,随机分为观察组和对照组各29例。2组均接受物理因子与关节松动术联合治疗,在此基础上,对照组增加肌力训练,观察组增加上肢康复机器人任务导向性训练。在治疗前和治疗4周后,采用Constant-Murley肩功能评分量表(CMS)评定比较2组疗效。结果:治疗4周后,2组CMS总分及疼痛、功能活动、关节活动范围、肌力4个分项的评分均高于治疗前(P<0.01);观察组CMS总分及疼痛、关节活动范围、肌力评分3个分项的评分均高于对照组(P<0.05),2组功能活动评分差异无统计学意义。结论:上肢康复机器人的任务导向性训练可以有效减轻患者肩关节疼痛,提高患者的上肢运动功能和康复效果。

智能康复锻炼器改善乳腺癌术后患者自我效能感及患肢功能的观察

目的探讨应用智能康复锻炼器在提升乳腺癌患者术后自我效能感、促进术后患肢功能恢复中的作用及改善术后上肢水肿的效果。方法选取2022年1月至2023年4月在嘉兴市中医医院行乳腺癌根治术+腋窝淋巴结清扫术的患者60例,根据随机数字表法将患者分为对照组(30例)和试验组(30例),对照组患者采用传统方法进行术后上肢功能锻炼,试验组患者采用智能康复锻炼器进行功能锻炼,比较两组患者术后3个月的自我效能感、功能锻炼依从性及术后1个月、3个月的肩关节活动度和上肢水肿发生率。结果术后3个月试验组患者的自我效能感、功能锻炼依从性均高于对照组(P<0.05);术后1个月和3个月试验组患者的肩关节活动度比较优于对照组(P<0.05);术后1个月试验组患者的上肢水肿发生率低于对照组,但差异无统计学意义(P>0.05),术后3个月试验组患者的上肢水肿发生率低于对照组,差异有统计学意义(P<0.05)。结论智能康复锻炼器可提升乳腺癌术后患者的自我效能感,提高功能锻炼依从性,促进患肢的功能恢复,防治术后上肢水肿,值得临床推广。

上肢康复机器人治疗对脑瘫痉挛型偏瘫患儿上肢运动功能恢复的影响

目的:观察上肢康复机器人治疗对脑瘫痉挛型偏瘫患儿患侧上肢运动功能恢复的影响,探索机器人康复训练能否替代人工训练。方法:将脑瘫痉挛型偏瘫患儿49例按照随机数字表法分为对照组(n=25)和观察组(n=24),对照组每天进行常规康复训练2次;观察组进行常规康复训练1次、上肢机器人训练1次,2组均训练8周。治疗前后分别采用脑瘫儿童手功能分级(MACS)、墨尔本单侧上肢功能评定量表(MUUL)进行评定,测量患侧肘关节、肩关节水平位主动活动度(ROM)。结果:与训练前比较,训练后2组MUUL评分均有显著增高(P<0.01),2组间比较差异无统计学意义;训练后2组MACS评分均较训练前有显著降低(P<0.01),2组间比较差异无统计学意义;训练后2组肩关节水平内收ROM均较训练前有显著增加(P<0.01),2组间比较差异无统计学意义;训练后2组肩关节水平外展及肘关节ROM较训练前均有显著增加(P<0.01),观察组更高于对照组(P<0.05)。结论:上肢康复机器人结合常规康复训练能促进脑瘫痉挛型偏瘫患儿上肢运动功能的恢复,上肢康复机器人训练效果与人工效果相当,在某些方面要优于常规人工训练。

上肢康复机器人的发展及应用综述

介绍了康复机器人的理论基础,综述了上肢康复机器人的研究现状,阐述了上肢康复机器人在脑卒中、脑瘫、脊髓损伤、多发性硬化、帕金森等疾病康复中的应用现状,分析了应用上肢康复机器人进行康复训练的优势和不足,指出了实现更高自由度、选材轻量化、提高设备运行安全性、研发智能控制技术、实现较低成本生产、扩大覆盖率是上肢康复机器人未来发展的方向。

智能穿戴康复系统对脑卒中患者上肢运动功能的影响

目的探讨智能穿戴康复系统对脑卒中偏瘫患者上肢运动功能和日常生活能力的影响。方法选取2022年1月至2023年12月于海南省人民医院康复医学科住院治疗的60例脑卒中上肢功能障碍患者作为研究对象,采用简单随机数表法将患者分为对照组和观察组,每组30例,对照组患者采用综合康复治疗,观察组患者在对照组治疗的基础上采用智能穿戴康复系统康复治疗,治疗时长均为两周。入组时和治疗两周后分别采用Fugl-Meyer上肢运动功能评分法(FMA-UE)和改良Barthel指数评分法(MBI)评估两组患者的上肢运动功能和日常生活能力,以评价两组患者治疗后的效果。结果治疗前,两组患者的FMA-UE评分比较差异无统计学意义(P>0.05),治疗后,两组患者的FMA-UE评分均较治疗前明显提高,且观察组患者的FMA-UE评分为(15.27±4.57)分,明显高于对照组的(12.20±4.48)分,差异均有统计学意义(P<0.05);治疗前,两组患者的MBI评分比较差异无统计学意义(P>0.05),治疗后,两组患者的MBI评分均较治疗前明显提高,且观察组患者的MBI评分为(68.83±8.73)分,明显高于对照组的(60.17±11.80)分,差异均有统计学意义(P<0.05)。结论智能穿戴康复系统可明显地促进脑卒中偏瘫患者上肢运动功能康复和提高日常生活能力,为患者重返家庭社会提供有力帮助。

基于电机-磁流变阻尼器混合驱动的绳索牵引上肢康复机器人的设计与应用

传统的末端牵引康复机器人一般使用电机驱动,连杆传动,难以避免惯性和刚性器件对系统动态性能的影响。针对以上问题,研制了一种基于混合驱动的绳索牵引式上肢康复机器人系统。系统采用绳索牵引末端的方式驱动机器人运动,实现在大工作空间内的柔顺操作。设计了具有低惯性特性的电机-磁流变阻尼器混合驱动系统,以替代传统的电机驱动。结合动作捕捉系统,设计了被动和镜像两种训练模式,以实现脑卒中患者的上肢康复训练。实验证明,混合驱动系统可输出3.5 N·m的转矩;被动训练模式中,机器人在600×500×350 mm的工作空间内,轨迹跟踪误差小于8 mm;镜像训练模式中,轨迹平均跟踪误差为6.34 mm。结果表明,系统的驱动方法和训练模式安全有效。

康复机器人结合动作观察疗法对脑卒中患者上肢运动功能康复的影响

目的观察康复机器人结合动作观察疗法对脑卒中患者上肢运动功能康复的作用。方法选择2022年4-12月在联勤保障部队大连康复疗养中心就诊的初发脑卒中患者46例(病程<3个月)。利用随机数字表法将入选患者分为对照组及试验组,每组23人。两组均接受常规康复治疗及上肢康复机器人训练。上肢康复机器人训练前,试验组采用动作观察疗法观看与上肢有关的日常生活动作和活动视频,之后患者想象自己利用患侧上肢完成这些动作;对照组观看英文字母、汉字、几何图形或没有动物及人的视频。治疗前、治疗4周,采用简式Fugl-Meyer运动功能评分-上肢部分(FMA-UE)、运动评定量表上肢部分(MAS-UE)、改良Barthel指数(MBI)对两组患者进行上肢功能评定。结果治疗前,两组患者FMA-UE、MAS-UE、MBI评分均无统计学差异(P>0.05);治疗后,两组FMA-UE、MAS-UE、MBI均显著提高(P<0.001);治疗后,试验组FMA-UE(P=0.039)、MAS-UE(P=0.027)、MBI(P=0.004)高于对照组,差异具有统计学意义。结论康复机器人结合动作观察疗法,能够进一步改善脑卒中患者的上肢运功功能,提高日常生活活动能力。

等速肌力训练结合上肢康复机器人对脑卒中恢复期偏瘫患者上肢功能恢复、生活质量及神经可塑性的影响

目的:探讨等速肌力训练结合上肢康复机器人对脑卒中恢复期偏瘫患者上肢功能恢复、生活质量及神经可塑性的影响。方法:选取2021年3月—2024年3月在宝鸡市人民医院诊治的102例脑卒中恢复期偏瘫患者作为研究对象,按照随机数字表法将其分为对照组(51例,常规训练)和研究组(51例,等速肌力训练结合上肢康复机器人训练),比较两组患者上肢功能恢复、生活质量及神经可塑性。结果:与训练前相比,两组患者训练3个月后上肢动作研究量表(ARAT)、Fugl-Meyer上肢运动功能评价量表(FMA-UE)评分升高(P<0.05),与对照组相比,研究组训练3个月后ARAT、FMA-UE评分更高(P<0.05)。与训练前相比,两组患者训练3个月后脑卒中专用生活质量量表(SS-QOL)各维度评分升高(P<0.05),与对照组相比,研究组训练3个月后SS-QOL各维度评分更高(P<0.05)。与训练前相比,两组患者训练3个月后斜率不对称指数、cM1-Slope、RMT不对称指数降低,i M1-Slope、cM1-RMT升高(P<0.05),与对照组相比,研究组训练3个月斜率不对称指数、cM1-Slope、RMT不对称指数更低,iM1-Slope、cM1-RMT更高(P<0.05)。结论:等速肌力训练结合上肢康复机器人训练应用于脑卒中恢复期偏瘫患者,可促进上肢功能恢复,提升生活质量,改善神经可塑性。