Development of gait rehabilitation devices: a review of the literature

A "Stroke" is a neurological disease due to poor blood flowing to the brain, resulting in body cell death. It is ranked second as the most common cause of death globally. The "World Health Organization" estimates that about 15 million people suffer a stroke annually. Most stroke survivors have gait disorders, and most patients cannot walk without assistance. Physiotherapy is crucial for stroke patients to recover and maintain their mobility, functionality, and well-being. In the last 20 years, the replacement of physiotherapists with wearable robotics has become essential due to the developing technology, the need for economic growth, and the challenging health circumstances around the world, such as the COVID-19 pandemic recently. Lower Limb Exoskeleton (LLE) represents the solution for stroke patients under such circumstances, though its performance is a critical challenge paid attention to in the industry. This challenge has motivated the researchers to investigate the application of gait rehabilitation. This review presents and discusses the developments in the control system of LLE over the last decade. It also explores the limitations, new directions, and recommendations in LLE development according to the literature.

Intelligent medicine and beyond

With the developments of medical artificial intelligence (AI), meta-data analysis, intelligence-aided drug design and discovery, surgical robots and image-navigated precision treatments, intelligent medicine (IM) as a new era evolved from ancient medicine and biomedical medicine, has become an emerging topic and important criteria for clinical applications. It is fully characterized by fundamental research-driven, new-generation technique-directed as well as state-of-the-art paradigms for advanced disease diagnosis and therapy leading to an even broader future of modern medicine. As a fundamental subject and also a practice-oriented field, intelligent medicine is highly trans-disciplinary and cross-developed, which has emerged the knowledge of modern medicine, basic sciences and engineering. Basically, intelligent medicine has three domains of intelligent biomaterials, intelligent devices and intelligent techniques. Intelligent biomaterials derive from traditional biomedical materials, and currently are endowed with multiple functionalities for medical uses. For example, micro-/nanorobots, smart responsive biomaterials and digital drugs are representative intelligent biomaterials which have been already commercialized and applied to clinical uses. Intelligent devices, such as surgical robots, rehabilitation robots and medical powered exoskeleton, are an important majority in the family of intelligent medicine. Intelligent biomaterials and intelligent devices are more and more closely integrated with each other especially on the occasions of intelligence acquisition, remote transmission, AI-aided analysis and management. In comparison, intelligent techniques are internalized in the former two domains and are playing a critical role in the development of intelligent medicine. Representative intelligent techniques of telemedicine, image-navigated surgery, virtual/augmented reality and AI-assisted image analysis for early-stage disease assessments have been employed in nowadays clinical operations which to a large extent relieved medical labors. In the past decades, China has been in the leading groups compared to international colleagues in the arena of intelligent medicine, and a series of eminent research has been clinically translated for practical uses in China. For instance, the first 5G-aided remote surgery has been realized in Fujian Province in January 2019, which for the first time validated their applicability for human uses. The surgical robots have found China as the most vigorous market, and more than 10 famous Chinese companies are developing versatile surgical robots for both Chinese people and people all over the world. China also applied AI techniques to new drug developments especially in early 2020 when COVID-19 epidemic roared, and several active molecules and drug motifs have been discovered for early-stage COVID-19 screening and treatments. Based on the significance of intelligent medicine and its rapid developments in both basic research and industrials, this review summarized the comprehensive viewpoints of the Y6 Xiangshan Science Conferences titled with Fundamental Principles and Key Technologies of Intelligent Medicine, and gave an in-depth discussion on main perspectives of future developments of the integration of biomaterial and devices, the integration of bioinformatics and medical hardware, and the synergy of biotechnology and intelligence information. It is expected that this featuring article will further promote intelligent medicine to an even broader community not only for scientists but also for industrials, and in the long run embrace a perspective future for its blooming and rich contributions in China in the coming 5 years. © 2023 Chinese Academy of Sciences. All rights reserved.

Development of Elbow-Wrist Telerehabilitation System - An Affordable, Available, Accessible, and Acceptable (4As) System

The application of telerehabilitation system has gained popularity and acceptance recently due to the restrictions in controlling the COVID-19 pandemic. This paper described the development of an elbow-wrist telerehabilitation system that complement the disrupted routine rehabilitation session. The developed system consists of a wearable exoskeleton system that assist in rehabilitation of the elbow and wrist joints for individuals with neurological conditions such as Parkinson's and Spinal Cord Injuries that affects movements of the upper extremities. The two modes of operation available enables the adoption of the 5G technology in the near future. This system also potentially fulfills the requirement of Accessibility, Availability, Affordability, and Acceptability (4As) of Telerehabilitation System in Malaysia. Overall development cost of the system is approximately MYR 500. The system enable rehabilitation to be performed at home-setting with a cloud-based monitoring system that will provide long-term monitoring for clinician's assessment. The project provides a proof-of-concept of such system in the Malaysian context.Clinical Relevance - This work demonstrated the proof-of concept of a 4A system is applicable in the Malaysian context. © 2022 IEEE.

On Understanding the Role of Exoskeleton Robots in Hand Rehabilitation: A Brief Review

Hand rehabilitation has been widely studied since it affects the life quality and independence of those affected. Hand impairment can be caused by several conditions, among them strokes and other cerebrovascular accidents, affecting the capabilities of those who survive them in performing the activities of daily living (ADL). Rehabilitation seeks to restore the ability of a person to perform these crucial ADL. There is a current trend in using robotic rehabilitation and other industry 4.0 tools since it can provide a safe, intensive, and task-oriented at a relatively low cost, which can be combined with other technologies such as virtual and augmented reality, BCI, haptics, and others. Moreover, it can provide accessibility in the face of current panoramas such as COVID-19. Hand exoskeleton robots are one of the most extended robotic devices for rehabilitation. However, a design adapted to the patient's needs is necessary to achieve their capability fully and succeed in rehabilitation. One of the main challenges is that several considerations and parameters affect these devices' design and the broad approaches that can be followed. This brief review aims to understand and empathize as a source of inspiration during the design process of hand exoskeleton robots for rehabilitation. © 2022 IEEE.

Dependency Towards Independence: The Inpatient Rehabilitation of Severe Critical Illness Polyneuropathy Resulting as a Rare Complication of COVID-19

Case Diagnosis: A 50-year-old man developed severe critical illness polyneuropathy, and other severe medical complications, as a rare complication of COVID-19 which required extensive and an unusually long inpatient rehabilitation Case Description or Program Description: This is an unusual case of a 50-year-old man who developed severe critical illness polyneuropathy (CIP) after COVID-19 infection. His acute care stay was notable for respiratory failure, cardiac arrest, pressure sore, and quadriparesis. Diagnostic evaluation was consistent with CIP. He was transferred to a long term acute care hospital (LTACH) for medical care, wound care, pulmonary management and rehabilitation, dependent for all self care and mobility upon admission. His rehabilitation started upon admission to the LTACH. He ultimately fully engaged an interdisciplinary team approach which incorporated specialized technology such as a robotic powered exoskeleton. His length of stay at the LTACH was 10 months, while the average length of stay in LTACH's is approximately 1 month. By the end of his unusually prolonged inpatient stay, he was ambulatory with bilateral ankle foot orthosis and a walker. Setting(s): LTACH Assessment/Results: Upon discharge, he was ambulatory with bilateral ankle foot orthosis, a walker, and was discharged home. Discussion (relevance): The COVID 19 challenges include medical complications, neurologic sequelasuch as CIP, the average length of stays of inpatient care, and insurance approval of inpatient care. A successful strategy for those profoundly impacted requires a comprehensive view of the challenges, engagement of an interdisciplinary team, and powerful patient advocacy. Conclusion(s): This case highlights the importance of recognizing the challenges of COVID 19 infection, reviews interventions in the context of patient's functional goals, reviews the unusually long length of stay that may be required, reviews the advocacy needed to ensure patient access to inpatient rehabilitation, and reviews the literature.

A Design of Self-Assisted Patient Control Technique for Early Rehabilitation Interventions to Prevent the Reduced elbow Joint ROM of COVID-19 Patients

The novel coronavirus, SARS-CoV-2 pandemic has posed new challenges for physiotherapist due to unprecedented acute care patients' surge. It contributed to minimize physical activity, especially reducing the elbow range of motion (ROM). Early rehabilitation and physiotherapy are recommended to combat the adverse effects of extended immobility. However, the increased patient-physiotherapist interaction increased risks of disease transmission. There emerges a need to minimize this interaction and disease transmission probability. This study aims to speed-up the return to regular ROM of COVID-19 patients by developing a self-assisted device for successful elbow therapy. The proposed device referred as 'self-assisted', reflects the idea of active and passive patient intervention and early rehabilitation. The device is designed and programmed to characterize the patients into three levels, depending on their ROM vulnerability: level 1 below 50 degrees, level 2 50 degrees-100 degrees and level 3 above 100 degrees. To examine the efficacy and accuracy of SAPT-COVID-19, eight volunteers with varying ages were selected, who were home-bound due to prolong COVID-19 pandemic and compromised their functional ROM. SAPT-COVID-19 substantially strengthened the elbow ROM for the volunteers and hit the maximum functional ROM over 14 -days exercise session, resulting in approximately 10 improvement in elbow ROM The degree of efficiency of active and passive exercise has also been widely examined. SAPT-COVID-19 is supposed to prevent elbow ROM deterioration and reduce hospitalization, with therapeutic and economic gain and minimized the physiotherapist-patient interactions.

T2Snaker: a Robotic Coach for Table Tennis

The restrictions imposed by the Covid-19 pandemic has significantly affected all aspects of daily life, especially human contact. Accordingly, an essential aspect of human contact is for training and skill acquisition, which is difficult to conduct under such restrictions. Therefore, we developed T2Snaker, a table tennis training system that comprises a robotic appendage to guide user's hand movements within a VR environment. T2Snaker's novelty lies in its flexibility to guide users movements, yet as it is not directly attached to the user's limbs, it does not impose restrictions on their movements like traditional exoskeleton systems. We explain the implementation specifics of T2Snaker and discuss its preliminary evaluation that focused on table-tennis skill acquisition. The results show that T2Snaker has high potential in skill acquisition, and users praised is ability to guide their movements and proposed various potential application domains. We discuss some design insights based on our work and present future research directions. © 2022 Owner/Author.

Robots are a Promising Investment to Fight Pandemics

Coronavirus caused pandemics as many viruses did through human history. The current pandemic causes overwhelmed healthcare system, locked down cities, and massive fatality among humans. Thus, different robots have been used since the COVID outbreak worldwide to reduce spreading infectious diseases and support frontline healthcare workers. This paper sets out the different robots implemented for hospital, non-hospital use, and possible use that can be deployed amidst the pandemic. A literature survey of versatile robots during COVID-19 is introduced. Roboticists contributed with wheeled and drone robots with various applications to assist medical care systems and society during the ongoing crisis. Pandemics are common throughout human history and difficult to avoid or prevent;thus, we intend to encourage societies, academia, engineers and innovators to invest more in robots that cannot catch the virus and consequently introduce beneficial solutions to fight such pandemic in the future. © 2021 IEEE

Demodex folliculorum interaction with SARS-CoV2 from a chitin-lipid perspective

During the outbreak of COVID-19 pandemic, regulatory agencies have attempted to figure out the possible routes of SARS-CoV-2 viral transmission. It is hypothesized that the lipid bilayer surrounding the SARS-CoV-2 improves its ability to remain stable on sebum-rich skin and serves as another possible route of contracting the virus. One possible aspect of these observations that has yet to be explored in detail is what role arthropods that have been associated with human skin infestation, such as Demodecidae or Pyemotidae species, play in viral transmission. It seems likely that arthropod-coronavirus interactions may take place through the molecular attraction forces between the chitin found on the exoskeleton of mites commonly found on human skin and the lipids present on the viral envelope of the SARS-CoV-2. We believe this may mean that arthropods are currently an overlooked cofactor in viral infection which may have some important biomedical implications for both prevention and treatment

Preliminary Study on a Novel Protocol for Improving Familiarity with a Lower-Limb Robotic Exoskeleton in Able-Bodied, First-Time Users.

Lower-limb exoskeletons have been created for different healthcare needs, but no research has been done on developing a proper protocol for users to get accustomed to moving with one. The user manuals provided also do not include such instructions. A pre-test was conducted with the TWIN (IIT), which is a lower-limb exoskeleton made for persons with spinal cord injury. In the pre-test, two healthy, able-bodied graduate students indicated a need for a protocol that can better prepare able-bodied, first-time users to move with an exoskeleton. TWIN was used in this preliminary study and nine users were divided to receive a tutorial or no tutorial before walking with the exoskeleton. Due to COVID-19 regulations, the study could only be performed with healthy, young-to-middle-aged lab members that do not require walking support. The proposed protocol was evaluated with the System Usability Scale, NASA Raw Task Load Index, and two custom surveys. The members who received the tutorial found it easy to follow and helpful, but the tutorial seemed to come at a price of higher perceived mental and physical demands, which could stem from the longer testing duration and the need to constantly recall and apply the things learned from the tutorial. All results presented are preliminary, and it is recommended to include biomechanical analysis and conduct the experiment with more participants in the future. Nonetheless, this proof-of-concept study lays groundwork for future related studies and the protocol will be adjusted, applied, and validated to patients and geriatric users.