Patent Application
20080294074
Stroke is a leading cause of permanent disability in adults, with clinical symptoms such as, weakness, spasticity, contracture, loss of dexterity, and pain at the paretic side. Approximately 70% to 80% of people who sustain a stroke have upper-extremity impairment and require continuous long-term medical care to reduce their physical impairment. The traditional view on poststroke rehabilitation is that significant improvements in motor recovery only occur within the first year after stroke, associated greatly with the spontaneous recovery of the injured brain. However, recent studies suggest that intensive therapeutic interventions, such as constraint-induced movement therapy and task-relevant repetitive practice of the affected limb, can also contribute to significantly reduced motor impairment and improved functional use of the affected arm in persons with chronic stroke.
In the absence of direct repair on the damaged brain tissues after stroke, neuro-rehabilitation is an arduous process, because poststroke rehabilitation programs are usually time-consuming and labor-intensive for both the therapist and the patient in one-to-one manual interaction. Recent technologies have made it possible to use robotic devices as assistance by the therapist, providing safe and intensive rehabilitation with repeated motions to persons after stroke. Commonly reported motion types provided by developed rehabilitation robots are: (1) continuous passive motion, (2) active-assisted movement, and (3) active-resisted movement. During treatment with continuous passive motion, the movements of the patient's limb(s) on the paretic side are guided by the robot system as the patient stays in a relaxed condition. This type of intervention was found to be effective in temporarily reducing hypertonia in chronic stroke, and in maintaining joint flexibility and stability for persons after stroke in the early stage. In active-assisted robotic treatment (or interactive robotic treatment), the rehabilitation robot would provide external assisting forces when the patient could not complete a desired movement independently. Robotic treatment with active-resisted motion involved voluntarily completing movements against programmed resistance.
Despite positive documentation of overall clinical outcomes following robot-assisted rehabilitation of chronic stroke, and easily modifiable system capable of training multiple bodily limbs in multiple planes have not been developed. The majority systems require multiple modules that must be switched out to accommodate different modes of training.
It is an object of the present invention to provide a robotic training system and modules for multiple limb training and overcome the disadvantages and problems in the prior art.
The present invention proposes a robotic training system having a rotational unit and utilizing multi-orientational modules, such rotational units and modules allowing the system to train different limbs, and different joints within a limb in different planes (x, y, or z).
The rotational unit of the robotic system is capable of being operational within an orientation range of 90°, i.e. from totally horizontal to totally vertical. The module is mounted on the rotational unit and can accommodate a limb at various angles to allowing training in different planes, as well as training different joints of the limb.
The use of the rotational unit and module in the present invention assists in training multiple joints using one module as opposed to “switching out” or changing modules. The requirement of “switching out” modules requires additional time and effort.
These and other features, aspects, and advantages of the apparatus and methods of the present invention will become better understood from the following description, appended claims, and accompanying drawings where:
The following description of certain exemplary embodiment(s) is merely exemplary in nature and is in no way intended to limit the invention, its application, or uses. Throughout this description, the term “training” refers to methods applied by or to a user to teach or re-learn skills, including physical skills, and mental skills.
The term “limb” refers to an arm or leg with all its components. The term “joint” refers to a place of union between two or more bones. Them term “electronically operable” shall refer to systems generally employing microprocessors, resistors, capacitors, inductors, and sensors for extracting information from mechanical inputs and outputs via electrical actuators to mechanical systems
Now, to
The present invention relates to a robotic system for training different joints in different planes. Multi-orientation modules are utilized with the robotic system to allow particular training, whereby one module can be used for training as opposed to “switching out” one module for another. The following figures present the robotic system and the modules to be used therewith, as well as providing information on the type of bodily movements to be trained using the robotic system.
The control tower 101 has as a purpose providing a stand for the multi-orientation module 111. Further, the control tower 101 may be used as housing for electronics and mechanical components used to operate the system 100.
Examples of electronic components housed in the control tower 101 include breadboards, resistors, capacitors, wire connectors, Integrated Circuits, and the like. Power converting equipment, such as AC to DC converters can be stored therein. Further, the control tower 101 can house computing components, such as permanent or short-term memory, microprocessors, connections for user interface devices, wireless communication equipment such as antennas, WIFI, Bluetooth™, and the like. Other necessary, components, well-known in the art such as fan, backup power equipment, and heat disspators can be included. In other embodiments, the computing components can be housed in a separate unit 110, such as a computer, laptop, or PDA.
The control tower 101 can serve as a conduit between a user of the system 100 and a trainer. Suitable users of the system 100 are preferably human patients requiring neuromuscular rehabilitation, such rehabilitation being required following a stroke, traumatic injury incurred during an accident or war, or long term disability such as palsy, for example cerebral palsy or elderly persons with motor function disability or weakness. A trainer utilizing the system on a users behalf can include human and non-human entities. Non-human entities include computer programs, possessing algorithms capable of training and interacting with a user. Human entities include doctors, nurses, health care professionals, and physical therapists as examples. The trainer can include one or more of a human and non-human entity, for example the human entity may program the non-human entity to perform a specific training program to be applied to the user. The trainer(s) can communicate with the control tower 101 via direct means, such as a control board attached directly to the control tower 101, or by indirect means such as by wireless communication with an off sight computer. Indirect means can include a PDA, computer, laptop, etc.
Regarding dimensions, design, and size, the control tower 101 in
The rotational motor tower 103 serves as a conduit between the module 111 and the control tower 101. The rotational motor tower 101 also serves to allow training of different joints and limbs of the user. As will be discussed later, the rotational motor tower 103 is a multi-component unit capable of multi-plane movement when interacting with the user.
As shown in the embodiment of
The rotational motor tower 103 can be electronically connected to the control tower 101, such as through wires. In one embodiment, the rotational motor tower 103 is set apart from the control tower 101, i.e., not physically connected thereto. In another embodiment, the rotational motor tower 103 is physically connected to the control tower 101.
A multi-orientation module 111 is attached to the rotational motor tower 103. The module 111 is suitable for interacting with the user by allowing the user to position a limb thereon for treatment. The module 111 can operate when the rotational motor tower 103 is vertical or horizontal, or somewhere in-between.
As will be discussed later, the module 111 is capable of training a multiple different joints without requiring multiple modules.
A user positioning unit 107 is provided with the system 100. The user positioning unit 107 can be, for example a chair, a table, vertical supporter, and the like. In one embodiment, the user positioning unit 107 is a chair. The user positioning unit 107 has as a goal providing support to the body of the user while a limb is being trained. The user positioning unit 107 should solely secure the user in order to gain accurate measurements during training. Safe securing can occur by utilizing restraining means such as belts or chains. The user positioning unit 107 may be height and position adjustable, for example by allowing a unit which is a chair to recline to a flat table, or adjusting the height of the chair relative to the ground to accommodate table users. Adjusting the height and position of the chair can be performed manually, or by automatic means, for example having a chair automatically adjust itself in response to information about a specific user being entered into a computer system, such computer system being connected to the chair.
The user positioning unit 107 can be placed on a track 109. The track 109 allows the user positioning unit 107 to be moved horizontally to accommodate particular users. The track 109 can also keep the user positioning unit 107 at a standard distance from the control unit 101. The track 109 can be attached to the chassis of the control tower 101 or be “stand alone”.
A feedback monitor 105 is included in the system 100. The feedback monitor 105 is used for visually instructing the user during a training session, as well as providing information on the results of the user's training. The monitor 105 can be, for example, a computer monitor. The monitor 105 can also have speakers stored thereon for providing available instruction or feedback to the user. The monitor 105 can be physically attached to the control unit 101, accepting electrical communication from the unit 101. However, the monitor 105 may be a distance from the unit 101, i.e., not physically attached. In such an embodiment, communication may be by wireless means. In one embodiment, the user interacts with the monitor 105 by touching the monitor, i.e. the monitor is touch screen operable.
The various components of the robotic system of the present invention will now be disclosed.
The housing 211 can be plastic or metal. The housing should insulate and protect the inner workings of the rotational motor tower 203.
The platter 209 is used to support the training of the multi-orientation module (not shown). As will be discussed later, training occurs by allowing the user to rotate his limb joint, such as an elbow, in response to a training program. The platter 209 by physical means is able to limit the degree of rotation by the user's limb joint. The diameter of the platter 209 should be suitable for accommodating the multi-joint module.
The shaft 207, as shown in the
One or more blocks 205 are positioned on the platter 209 to effectually desist the movement of the platter 209 and hence the multi-orienting module in a particular range of movement. In one embodiment, two blocks may be placed between 0° to 90° apart around the circumference of the platter 209.
As mentioned previously, the rotational motor tower 400 includes a shaft 401. The shaft 401 is preferably square or rectangular shaped, and designed, in terms of size, to fit a female counterpart on a multi-orientation module (not shown). Blocks 403 are utilized to limit the range of movement of a multi-orientation module when attached to the unit 400. A platter 405 provides support to multi-orientation module and retains the blocks 403. A pillow block 407 is used to support all unnecessary forces except the rotational force on the motor shaft. Connectors 411 are used to mount the rotation shaft 409 on the torque sensor. Handles 413 are mounted on the control tower (not shown), on either side of the rotational motor tower 411, the handles 413 usually incorporating a gear-typed locking mechanisms to lock the tower 400 when orientation is changed. A torque sensor 415 is included, such sensor 415 can include strain gauges, slip rings, wireless telemetry, rotary transformers, conditioning electronics, and converter. A knob 417 is used to lock motor rotation, which is for torque measurement at a fixed angle through the torque sensor 415. A motor 419 is used to generate torque to the tower 400.
The robotic system of the present invention is designed to accept multi-orientation modules. Primarily, the modules are used to train a user's joints, such as wrist joint, elbow joint, knee joint, hip joint, and ankle joint on both the right and left sides. The modules can train between a total horizontal to a total vertical orientation. The modules are capable of providing a variety of muscle training, including but not limited to elbow flexion, elbow extension, ankle dorsiflexion, and ankle plantar flexion, infraspinatus and tenes minor training, subscapularis training, wrist flexion, wrist extension, knee flexion, and knee extension. The modules can be adjusted in dimensions in order to accommodate different users.
The inner components of the module 500 include but are not limited to an upper plate 511 for facilitating training around the elbow joint of the user, a side bar 513 for allowing sufficient in-tandem behavior between the elbow joint and the wrist joint of the user, a main bar 512 and a distal plate 515 for facilitating training around the wrist joint of the user.
When in use, the system of the present invention transfers information to and from the control unit, monitors bio-electrical signals, such as electromyographic signals (EMG), mechanomyographic signals (MMG), electroencephalographic signals (EEG), electroneurographic signals (ENG), etc., to analyze, utilize, and store information on the user's training progress, and provides feedback to the user. Further to monitoring bio-electrical signals, the bio-electrical signals are also used to adjust the training of the user's limb, such as by increasing or decreasing torque applied to the multi-orientation module.
In
To record the performance of the user 700 during training, electrodes 709 are attached to the user 700 in specific locations. In one embodiment, electrodes 709 are attached in locations thought to generate EMG signals that will be affected during testing, for example the muscle belly of biceps brachii, triceps brachii (lateral head), anterior deltoid, and posterior deltoid. The electrodes 709 can be attached to the skin surface. While not all locations for attachment of electrodes is given herein, it is well within the knowledge of one with ordinary skill to know which areas to attach electrodes to when measuring EMG.
The electrodes 709 are used for measuring and transmitting EMG signals 711 from the user 700. Signals 711 may be transmitted in a wired fashion, or witlessly, depending on whether the electrodes possess wireless components.
EMG signals 711 from the electrodes 709 are collected by a circuit processor 713. The processor 713 can have the capability to convert the signals 711, for example from analog to digital, amplify the signals 711, filter the signals 711, compare the signals 711, such as comparing a true measured signal against a desired reference signal, or smooth out the signals 711, such as by removing noise. The processor 713 can have multiple capabilities, for example amplifying the signals 711 and filtering the signals 711.
A resultant signal 715 is generated by the processor 713 and forwarded to a controller 717. In a preferred embodiment, the resultant signal 715 is digital. Through the controller 715, the resultant signal 715 can be used to adjust the training program. Specifically, the controller 717 can adjust the torque assistance delivered by the module 703 by forwarding a signal 721 to the control tower 704. The torque assistance can be increased or decreased depending on the users' results during training. The usage of the resultant signal 715 by the controller 717 allows for real time training adjustment as compared with adjusting after training has been completed.
The resultant signal 715 is also preferably passed through the controller 719 and stored on a storage device 727.
As previously stated, the controller 717 is used for accepting resultant signal 715. The controller 717 is also used for delivering an initial training program to the control unit 704, which can be visualized on the display 705 and adhered to by the user 717. The controller 717 may include microprocessors, algorithms, graphic cards, user interface devices, such as keyboards, mouse, wireless technology components such as antennas, and the like. In one embodiment, the controller 717 is positioned within the control tower 704. In another embodiment, the controller 717 is at a remote location from the control tower 704, whereby communication can be had by, for example, satellite communication, WIFI, or internet lines.
The control tower 704 can also deliver signals 723/725 to a storage device 727 for further analysis. Signals, such as a measured torque signal 723 and a measured joint angle signal 725 to be sent can relate to those gathered during training, specific to the control unit 704 such as degree of the rotational motor tower (not shown) 704, range movement limitation, speed of movement of the module 703, torque sensor datex, etc.
The storage device 727 can either be permanent, such as ROM, or temporary such as RAM. Like the controller 717, the storage device 727 can be on-site or at a remote location from the control unit 704, communicating therewith by wireless means or internet technology.
As stated throughout, via the rotational motor tower and multi-orientation module, the system is able to train different joints of a user's limb in different planes with one module. The system trains by providing a target goal for the user to strive for, and providing assistance to the user to obtain the target goal. In striving for the target goal, the user is required to move their limb. For example, the target goal may be an object, real or imaginary, the user must aim for. In one embodiment, the target goal is a visual object on a computer screen, such object moving based on an algorithm. The user is required to track the object as it moves. Tracking occurs by moving the module-attached limb in the plane that the module is oriented in (x, y, or z).
During tracking, active-assisted torques are generated by the motor systems during extension of the users limb. A supportive torque is controlled by electromyographic signals delivered from the user to a controller of the system.
The active-assisted torque during the extension movement is defined as:
T
a
=G·T
IMVE
·M
t (1)
where G is a constant gain used to adjust the magnitude of the assistive torque and TIMVE is the maximum value of the extension torque at the elbow angle of 90°. Mt in equation 1 is defined as
where EMGMUS was muscle electromyographic activity after the processes of full-wave rectification and moving average, EMGmrest was the averaged EMGMUS during the resting state, and EMGtIMVE was the maximum value of EMGMUS during IMVE. The reasons for applying supportive torques in extension only include that same users usually have more difficulty in carrying out extension than flexion, and their flexors are commonly more spastic than extensors. It has been found that the elbow tracking and reaching performances of poststroke subjects can be immediately improved when employing this type of active-assisted robot devices.
Resistive torques can also be applied to training with values of a percentage of the torques during the maximum voluntary contractions (extension and flexion), that is
T
r
=a·T
MVC
where Tr was the resistive torque, a was the percentage, and TMVC that includes 2 parts, the maximum TIMVF (applied in the flexion phase only) and TIMVE (applied in the extension phase only). The net torque provided by the robot during the training is
T
n
=T
a
−T
r
where Ta is the supportive torque and Tr was the resistive torque. The purposes of applying the resistive torques proportional to the IMVF and IMVE during the training are (1) to improve the muscle force generation of a paretic limb, and (2) to keep the effective muscular effort at a level associated with a possible increase in muscle force during the training. Although Ta and Tr would tend to cancel, the 2 torques are directly related to the own effort of the users during the training. Therefore, the net torque provided by the robot is interactive to the motor ability of subjects.
7 hemiplegic subjects after stroke were recruited. All of the subjects were in the chronic stage (at least 1 year postonset of stroke; 6 men, 1 woman; age, 51.1±9.7 y). All subjects received a robot-assisted elbow training program using the present invention consisting of 20 sessions, with at least 3 sessions a week and at most 5 sessions a week, and finished in 7 consecutive weeks. Each training session was completed in 1.5 hours. Before and after the training, we adopted 2 clinical scales to evaluate the voluntary motor function of the paretic upper limb (the elbow and shoulder) of the subjects, including the Fugl-Meyer Assessment (FMA; for elbow and shoulder; maximum score, 42) and the Motor Status Scale (MSS; shoulder/elbow; maximum score, 40). Spasticity of the paretic elbow of each subject before and after the training was assessed by the Modified Ashworth Scale (MAS) score. The clinical assessments of this study were conducted by a blind therapist.
During each training session, each subject was comfortably seated, and the affected upper limb was placed horizontally on an electromyography-driven motor system with the elbow joint positioned at the origin. The forearm of the affected side was placed on a manipulandum, which could rotate with the motor; and the elbow angle signals were measured by the motor via readings of the positions of the manipulandum. A belt was used to fasten the shoulder joint in order to keep the joint position still during elbow extension and flexion. Electromyography electrode pairs with a center separation of 2 cm were attached to the skin surface of the muscle belly of biceps brachii (BIC), triceps brachii (TRI), anterior deltoid (AD), and posterior deltoid (PD). The positions of the electromyography electrode pairs were not moved once placed. The electromyographic signals were preamplified, band-pass filtered (from 10 to 500 Hz) and recorded through an analog-to-digital card, together with the angle signals, with a sampling frequency of 1000 Hz.
The electromyographic signals for the muscles of interest during the resting state were first recorded before any voluntary motion taken by a subject in each session, which served as the electromyographic baselines of the individual muscles for the session. The isometric maximum voluntary flexion (IMVF; duration, 5 s) and extension (IMVE; duration, 5 s) of the elbow at a 90° elbow angle were then measured at a repetition of 3 times, respectively, with a 5-minute rest break in between each contraction to avoid muscle fatigue. During the training, each subject was required to carry out voluntary elbow flexion and extension in the elbow range from 0° to 90° (0° representing full extension) by tracking a target cursor moving at an angular velocity of 10° per second on the screen for both flexion and extension.
10° per second was chosen as a reasonable speed for subjects after stroke to follow, in order to prevent too difficult or too easy a pace for the subjects to achieve. Each subject was allowed to practice tracking for 10 minutes before the start of the training for them to familiarize themselves with the course. In each training session, there were 18 tracking trials, and each trial had 5 cycles of elbow extension and flexion. In all trials, active-assisted torques were given in extension associated with the gain, G in equation 1, equal to 0%, 50%, and 100% alternatively applied to the tracking trials in a session. Resistive torques were applied to each trial.
Electromyographic activity from the muscles of interest and angle signals during the training were recorded and stored in a computer during the even sessions of the training for processing. The elbow angle signals were low-pass filtered with a cutoff frequency of 20 Hz. The torque signals during the IMVF and IMVE were also low-pass filtered with a cutoff frequency of 10 Hz. A forth-order, zero-phase forward and reverse Butterworth digital filter was adopted for the filtering processes.
The coactivations among muscle pairs during the training were studied by the cocontraction index (CI), that is,
where Aij(t) was the overlapping activity of electromyographic linear envelopes for muscles i and j, and T was the length of the signal. The value of a cocontraction index for a muscle pair varied from 0 (no overlapping at all in the signal trial) to 1 (total overlapping of the 2 muscles with both electromyographic levels kept at 1 during the trial). The representative segments of electromyographic envelopes from the muscle pairs in a tracking trial are shown in
In this study, significant motor improvements assessed by MAS, FMA, and MSS were observed after the 20-session training on elbow tracking task actively assisted by the robot. The electromyographic activation levels of the major agonist and antagonist muscle pair of the elbow joint, biceps brachii and triceps brachii, significantly decreased in the first half of the training course, which was associated with an improvement in tracking skill and a decrease in spasticity. The electromyographic level of the anterior deltoid also decreased during the training, suggesting a better isolation of elbow movements from the shoulder in the paretic limb. The results obtained provided further understanding of the recovery process, especially muscle coordination, during interactive robot-assisted training, which would be useful for the design of robot-assisted training programs.
Having described embodiments of the present system with reference to the accompanying drawings, it is to be understood that the present system is not limited to the precise embodiments, and that various changes and modifications may be effected therein by one having ordinary skill in the art without departing from the scope or spirit as defined in the appended claims.
In interpreting the appended claims, it should be understood that:
a) the word “comprising” does not exclude the presence of other elements or acts than those listed in the given claim;
b) the word “a” or “an” preceding an element does not exclude the presence of a plurality of such elements;
c) any reference signs in the claims do not limit their scope;
d) any of the disclosed devices or portions thereof may be combined together or separated into further portions unless specifically stated otherwise; and
e) no specific sequence of acts or steps is intended to be required unless specifically indicated.
