Home-based upper limb stroke rehabilitation mechatronics: challenges and opportunities.

Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010-2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users' function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users' needs.

Considerations for at-home upper-limb rehabilitation technology following stroke: Perspectives of stroke survivors and therapists.

Introduction: This study investigated the needs of stroke survivors and therapists, and how they may contrast, for the design of robots for at-home post stroke rehabilitation therapy, in the Ontario, Canada, context. Methods: Individual interviews were conducted with stroke survivors (n = 10) and therapists (n = 6). The transcripts were coded using thematic analysis inspired by the WHO International Classification of Functioning, Disability, and Health. Results: Design recommendations, potential features, and barriers were identified from the interviews. Stroke survivors and therapists agreed on many of the needs for at-home robotic rehabilitation; however, stroke survivors had more insights into their home environment, barriers, and needs relating to technology, while therapists had more insights into therapy methodology and patient safety and interaction. Both groups felt a one-size-fits-all approach to rehabilitation robot design is inappropriate. Designs could address a broader range of impairments by incorporating household items and breaking activities down into their component motions. Designs should incorporate hand and wrist supports and activities. Designs should monitor trunk and shoulder motion and consider incorporating group activities. Conclusion: While therapists can provide insight in the early stages of design of rehabilitation technology, stroke survivors' perspectives are crucial to designing for the home environment.

Improving Haptic Transparency for Uncertain Virtual Environments Using Adaptive Control and Gain-Scheduled Prediction.

The realism or transparency of haptic interfaces is becoming more critical as they are applied to training in fields like minimally invasive surgery (MIS). Surgical training simulators must provide a transparent virtual environment (VE) at a high update rate. Complex, deformable, cuttable tissue models have nonlinear dynamics and are computationally expensive, making it difficult to provide sufficient update rates. The objective of this work is to improve the transparency for this type of VE by formulating the unknown nonlinear dynamics as a quasi-linear parameter varying (LPV) system and designing a predictor to provide an output at a much higher update rate. An adaptive controller based on gain-scheduled prediction is considered for a nonlinear haptic device and a nonlinear, delayed, and sampled VE. The predictor uses feedback from the more accurate but slow-updating VE to update a simplified dynamic model. The predictor is designed based on numerical solutions to a linear matrix inequality derived using Lyapunov-based methods. Experimental results demonstrate the effectiveness of the gain-scheduled predictor approach and compare it to previous work using a constant-gain predictor. The gain-scheduled predictor results in significant performance improvements compared to a haptic system without prediction, but less significant improvement compared to the constant-gain approach.