A domestic robotic rehabilitation device for assessment of wrist function for outpatients.

INTRODUCTION: Available robot-assisted stroke rehabilitation systems are often limited in their utilization in the home environment, due to several barriers such as high cost, absence of therapists, tedious training tasks, or encumbering interfaces. This paper presents a low-cost robotic rehabilitation and assessment device for restoring wrist function, offering wrist exercises incorporating pronation-supination and flexion-extension movements. Furthermore, the device is designed for the assessment of joint stiffness of the wrist, and range of motion in two degrees of freedom. Methods: Mechanical/electrical design of the device as well as the control system is described. A preliminary evaluation focused on the measurement of the torsional stiffness of the limb is presented. It is evaluated by reconstructing the known stiffness values of torsional springs by measuring the motor current required to displace them. RESULTS: The device demonstrates the ability to determine the stiffness of an object with low-cost hardware. Use case scenarios of the device for training and assessment of the wrist are presented, allowing for a range of motion of ± 75 ° and ± 65 ° , for pronation-supination and flexion-extension respectively. CONCLUSION: The device shows potential to help objectively quantify the stiffness of the wrist movement, which consecutively could be used to represent and quantify the degree of impairment of patients after stroke in a more objective manner. Further clinical study is necessary to examine this.

Design and Characterization of an Actuated Drill Mockup for Orthopedic Surgical Training.

Haptic feedback in virtual reality-based trainers for surgical bone drilling is mostly provided via impedance-controlled haptic devices. Due to this, the displayable maximum stiffness is limited. In addition, vibration feedback is often only of reduced fidelity. To overcome these shortcomings, we have developed a hand-held, actuated admittance-controlled drill mockup, comprising enhanced kinesthetic and tactile feedback. This article reports on design and characterization of the device, and highlights its use for training. Kinesthetic feedback is provided through haptic augmentation, employing a ball-screw mechanism acting on a retractable drill-bit. Feedback computation relies on admittance control, thus allowing for stable display of very high resistance forces, and thus material stiffness, which cannot be achieved with standard impedance-control approaches. For the tactile mechanism, a modified linear vibration actuator is directly attached to the mockup handle, improving signal transmission. Tactile feedback computation is based on an extension of a previously proposed power spectral density control method. Frequency-specific gains are adjusted in real-time, compensating for differences between desired and measured vibrations. The performance of the device is characterized in several experiments, including comparisons to drilling with a real drill into artificial bone samples. In addition, several user studies have been carried out. We illustrate the capability of the mockup to render bone samples with different material layer stiffness and thickness. Moreover, we show that the mockup system allows for the same training effect as when rehearsing with a real drill.

Correlations between MRI findings and outcome of capsular distension in adhesive capsulitis of the shoulder.

[Purpose] The aim of this study was to investigate the association between magnetic resonance imaging (MRI) findings in patients with adhesive shoulder capsulitis and the therapeutic effect of capsular distension. [Subjects and Methods] We retrospectively reviewed the medical records of 57 patients who underwent capsular distension therapy after a diagnosis of adhesive capsulitis with clinical and MRI scans. Axillary joint capsular thickness by MRI was graded as I (≤3.6 mm), II (3.7-4.2 mm), and III (≥4.3 mm). Subcoracoid fat obliteration of the rotator interval was graded subjectively as absent, partial, and complete. [Results] Capsular thickness and fat replacement were correlated with passive range of motion (PROM) and pain score on a visual analog scale (VAS) by analysis of variance with a Bonferroni correction before treatment and by analysis of covariance with a Bonferroni correction after treatment. Visual analog scale (VAS) for patients with all grades decreased significantly after treatment and passive range of motion (PROM) for patients with all grades improved. No difference was detected between grades. [Conclusion] Although MRI is useful to evaluate adhesive capsulitis, MRI findings of shoulder did not predict the prognosis after capsular distension treatment.

Head-Mounted Sensory Augmentation Device: Designing a Tactile Language.

Sensory augmentation operates by synthesizing new information then displaying it through an existing sensory channel and can be used to help people with impaired sensing or to assist in tasks where sensory information is limited or sparse, for example, when navigating in a low visibility environment. This paper presents the design of a 2nd generation head-mounted vibrotactile interface as a sensory augmentation prototype designed to present navigation commands that are intuitive, informative, and minimize information overload. We describe an experiment in a structured environment in which the user navigates along a virtual wall whilst the position and orientation of the user's head is tracked in real time by a motion capture system. Navigation commands in the form of vibrotactile feedback are presented according to the user's distance from the virtual wall and their head orientation. We test the four possible combinations of two command presentation modes (continuous, discrete) and two command types (recurring, single). We evaluated the effectiveness of this 'tactile language' according to the users' walking speed and the smoothness of their trajectory parallel to the virtual wall. Results showed that recurring continuous commands allowed users to navigate with lowest route deviation and highest walking speed. In addition, subjects preferred recurring continuous commands over other commands.

Quantification of long cane usage characteristics with the constant contact technique.

While a number of Electronic Travel Aids (ETAs) have been developed over the past decades, the conventional long cane remains the most widely utilized navigation tool for people with visual impairments. Understanding the characteristics of long cane usage is crucial for the development and acceptance of ETAs. Using optical tracking, cameras and inertial measurement units, we investigated grasp type, cane orientation and sweeping characteristics of the long cane with the constant contact technique. The mean cane tilt angle, sweeping angle, and grip rotation deviation were measured. Grasp type varied among subjects, but was maintained throughout the experiments, with thumb and index finger in contact with the cane handle over 90% of the time. We found large inter-subject differences in sweeping range and frequency, while the sweeping frequency showed low intra-subject variability. These findings give insights into long cane usage characteristics and provide critical information for the development of effective ETAs.

Identification of Vibrotactile Patterns Encoding Obstacle Distance Information.

Delivering distance information of nearby obstacles from sensors embedded in a white cane-in addition to the intrinsic mechanical feedback from the cane-can aid the visually impaired in ambulating independently. Haptics is a common modality for conveying such information to cane users, typically in the form of vibrotactile signals. In this context, we investigated the effect of tactile rendering methods, tactile feedback configurations and directions of tactile flow on the identification of obstacle distance. Three tactile rendering methods with temporal variation only, spatio-temporal variation and spatial/temporal/intensity variation were investigated for two vibration feedback configurations. Results showed a significant interaction between tactile rendering method and feedback configuration. Spatio-temporal variation generally resulted in high correct identification rates for both feedback configurations. In the case of the four-finger vibration, tactile rendering with spatial/temporal/intensity variation also resulted in high distance identification rate. Further, participants expressed their preference for the four-finger vibration over the single-finger vibration in a survey. Both preferred rendering methods with spatio-temporal variation and spatial/temporal/intensity variation for the four-finger vibration could convey obstacle distance information with low workload. Overall, the presented findings provide valuable insights and guidance for the design of haptic displays for electronic travel aids for the visually impaired.

Advanced Augmented White Cane with obstacle height and distance feedback.

The white cane is a widely used mobility aid that helps visually impaired people navigate the surroundings. While it reliably and intuitively extends the detection range of ground-level obstacles and drop-offs to about 1.2 m, it lacks the ability to detect trunk and head-level obstacles. Electronic Travel Aids (ETAs) have been proposed to overcome these limitations, but have found minimal adoption due to limitations such as low information content and low reliability thereof. Although existing ETAs extend the sensing range beyond that of the conventional white cane, most of them do not detect head-level obstacles and drop-offs, nor can they identify the vertical extent of obstacles. Furthermore, some ETAs work independent of the white cane, and thus reliable detection of surface textures and drop-offs is not provided. This paper introduces a novel ETA, the Advanced Augmented White Cane, which detects obstacles at four vertical levels and provides multi-sensory feedback. We evaluated the device in five blindfolded subjects through reaction time measurements following the detection of an obstacle, as well as through the reliability of dropoff detection. The results showed that our aid could help the user successfully detect an obstacle and identify its height, with an average reaction time of 410 msec. Drop-offs were reliably detected with an intraclass correlation > 0.95. This work is a first step towards a low-cost ETA to complement the functionality of the conventional white cane.

Robot-assisted assessment of vibration perception and localization on the hand.

Sensory perception is crucial for motor learning and the control of fine manipulations. However, therapy after stroke still strongly focuses on the training of motor skills. Sensory assessments are often left out or provide only very subjective data from poorly controlled stimuli. This paper presents a vibration detection/localization test with the Robotic Sensory Trainer, a device that focuses entirely on the assessment and training of sensory function of the hand, with the aim of gaining insights into the prevalence and severity of sensory deficits after stroke, and to provide semiobjective data on absolute and difference perception thresholds in patients. An initial feasibility study investigated localization performance and reaction time during the discrimination of vibration stimuli presented in four locations on the dominant and nondominant hands of 13 healthy volunteers. High correct detection rates were observed (mean ± SD of 99.6% ± 0.6%), touch screen PC Robotic Sensory Trainer which were found to be significantly different between stimulus locations on the dominant hand. Average correct detection rates were not statistically different between dominant and nondominant hand. These data will serve as baseline for future measurements on elderly and stroke subjects, and suggest that data from the nonimpaired hand could be used to identify and assess sensory deficits in the affected hand of stroke patients.

Design of a robotic device for assessment and rehabilitation of hand sensory function.

This paper presents the design and implementation of the Robotic Sensory Trainer, a robotic interface for assessment and therapy of hand sensory function. The device can provide three types of well controlled stimuli: (i) angular displacement at the metacarpophalangeal (MCP) joint using a remote-center-of-motion double-parallelogram structure, (ii) vibration stimuli at the fingertip, proximal phalange and palm, and (iii) pressure at the fingertip, while recording position, interaction force and feedback from the user over a touch screen. These stimuli offer a novel platform to investigate sensory perception in healthy subjects and patients with sensory impairments, with the potential to assess deficits and actively train detection of specific sensory cues in a standardized manner. A preliminary study with eight healthy subjects demonstrates the feasibility of using the Robotic Sensory Trainer to assess the sensory perception threshold in MCP angular position. An average just noticeable difference (JND) in the MCP joint angle of 2.46° (14.47%) was found, which is in agreement with previous perception studies.

Gold-catalyzed cycloisomerization of o-alkynylbenzaldehydes with a pendant unsaturated bond: [3 + 2] cycloaddition of gold-bound 1,3-dipolar species with dipolarophiles.

[reaction: see text] A new and novel Au-catalyzed cycloisomerization of ynals bearing a pendant unsaturated bond leading to synthetically valuable [6.7.n]-tricyclic compounds were developed. This study strongly supports the intermediacy of [3 + 2] cycloaddition proposed by DFT calculation and provides an easy access to key skeletons found in a variety of natural products.