Development of Self-Adaptable Mechanism to Compensate Angle-Dependent Flexor Tone of the Elbow Joint Post-stroke: A Pilot Study.

Upper extremity impairments are common among stroke survivors. Robotic devices enable a high-dose of repetitive training for patients, but most systems are confined to the laboratory settings due to their complexity and power requirements. Previously we developed a passive elbow device that can counteract the angle-dependent tone of flexor muscles with hypertonia, but its efficacy was found limited as the increase in passive assistance during elbow extension was found not sufficient to provide assistance to those with more severe impairments. Therefore, in this study, we developed a 'self-adaptable' passive device that adjusts its assistance level based on the movements of patients. In addition to the morphological design to adjust moment arms of the elastic components, we incorporated a self-adaptation mechanism, in which the lengths of the elastic bands were adjusted by a pair of miniature linear motors based on the joint position feedback signals. The capacity of the device was then tested in a pilot testing with two healthy subjects, for whom angle-dependent flexion torque was implemented to simulate flexor hypertonia. The additional adjustment of passive component lengths was found to further increase the elbow extension assistance as the elbow joint extended. The proposed self-adapting mechanism, which does not require any complex control input from the experimenters, can be incorporated with the existing passive device to improve its functional efficacy in home-based training.

Algorithms and Analyses for Joint Spectral Image Reconstruction in Y-90 Bremsstrahlung SPECT.

Quantitative yttrium-90 (Y-90) SPECT imaging is challenging due to the nature of Y-90, an almost pure beta emitter that is associated with a continuous spectrum of bremsstrahlung photons that have a relatively low yield. This paper proposes joint spectral reconstruction (JSR), a novel bremsstrahlung SPECT reconstruction method that uses multiple narrow acquisition windows with accurate multi-band forward modeling to cover a wide range of the energy spectrum. Theoretical analyses using Fisher information and Monte-Carlo (MC) simulation with a digital phantom show that the proposed JSR model with multiple acquisition windows has better performance in terms of covariance (precision) than previous methods using multi-band forward modeling with a single acquisition window, or using a single-band forward modeling with a single acquisition window. We also propose an energy-window subset (ES) algorithm for JSR to achieve fast empirical convergence and maximum-likelihood based initialization for all reconstruction methods to improve quantification accuracy in early iterations. For both MC simulation with a digital phantom and experimental study with a physical multi-sphere phantom, our proposed JSR-ES, a fast algorithm for JSR with ES, yielded higher recovery coefficients (RCs) on hot spheres over all iterations and sphere sizes than all the other evaluated methods, due to fast empirical convergence. In experimental study, for the smallest hot sphere (diameter 1.6cm), at the 20th iteration the increase in RCs with JSR-ES was 66 and 31% compared with single wide and narrow band forward models, respectively. JSR-ES also yielded lower residual count error (RCE) on a cold sphere over all iterations than other methods for MC simulation with known scatter, but led to greater RCE compared with single narrow band forward model at higher iterations for experimental study when using estimated scatter.

Passive Elbow Movement Assistant (PEMA): A portable exoskeleton to compensate angle-dependent tone profile of the elbow joint post-stroke.

Significant impairments in upper extremity function are commonly observed after neurological injuries such as stroke. While the efficacy of robotic training has been demonstrated, the use of these devices is confined to the laboratory setting due to its complexity and power requirements. In this study, we developed a passive, portable device (Portable Elbow Movement Assistant; PEMA) that can provide assistance during elbow movements of stroke survivors. The geometric properties of the device were designed to allow morphological changes in the elastic components during movements, so that the assistance produced by the elastic component counteract the angle-dependent flexor hypertonia commonly observed in stroke survivors. A mathematical model for the proposed design was first developed to characterize the assistance provided by the device. The capacity of the device was then tested in a pilot testing with four healthy subjects, for whom a custom device to simulate elbow flexor hypertonia (providing an increased resistance for the extended posture) was implemented. The proposed device was found to effectively counteract the angle-dependent flexion moment, produced by the hypertonia simulator, as a significant decrease was observed in the slope of the angle-activation relationship (movement phase) and activation level (hold phase) of the triceps brachii muscle. The assistance did not affect the activation of the antagonist muscle (biceps brachii), indicating an independent modulation of the agonist and antagonist muscles resulted from the assistance.