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Efficacy of the Regent Suit-based rehabilitation on gait EMG patterns in hemiparetic subjects: a pilot study.
Iuppariello, L, D'addio, G, Romano, M, Bifulco, P, Pappone, N, Lanzillo, B, Cesarelli, M
European journal of physical and rehabilitation medicine. 2018;(5):705-716
Abstract
BACKGROUND The recovery of the functional limb mobility of patients with cerebral damages can take great benefit of the role offered by proprioceptive rehabilitation. Recently have been developed a special Regent Suit (RS) for rehabilitative applications. Actually, there are preliminary studies which describes the effects of RS on gait recovery of stroke patients in acute stage, but none in chronic stage. Moreover, it is known that motor recovery does not always reflect improvements of the muscle activity and coactivity. AIM: To investigate the effects of proprioceptive stimulation induced by the Regent Suit (RS) on the EMG patterns during gait in post-stroke chronic patients. DESIGN Randomized controlled trial. SETTING S. Maugeri Foundation, Telese Terme (BN), Italy. POPULATION Patients have been randomly assigned into two equal groups of 20 patients: experimental group and traditional group. Further, a control group of 20 healthy subjects have been enrolled. METHODS The traditional group attended a rehabilitation program composed by neuro-motor exercises without the RS, the experimental group performed the same rehabilitation program while wearing the RS. The NIH Stroke Scale (NIHSS), the Barthel Index (BI), the Functional Independent Measure (FIM) and the Berg Balance Scale (BBS) have been evaluated. EMG analysis has been performed considering the muscle activation timing over the gait of the soleus, tibialis anterior, semitendinosus and vastus lateralis muscles by decomposing the EMG signals into Gaussian pulses. Then, the symmetry of muscle activation and the muscle synergy patterns over the gait cycle have been assessed. RESULTS The proprioceptive stimulation of the RS-based treatment induces higher and remarkable restoration of the normal muscle activation timing, also increasing the muscle symmetry and reducing the pathological muscle coactivation on both affected and non-affected sides. CONCLUSIONS These results suggest confirm that a RS-based treatment is more effective than usual care in improving the EMG patterns during locomotion and daily living activities in chronic post-stroke subjects. CLINICAL REHABILITATION IMPACT The proprioceptive rehabilitation Regent Suit based has an impact on motor function in stroke patients during gait.
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The Feasibility of a Completely Automated Total IV Anesthesia Drug Delivery System for Cardiac Surgery.
Zaouter, C, Hemmerling, TM, Lanchon, R, Valoti, E, Remy, A, Leuillet, S, Ouattara, A
Anesthesia and analgesia. 2016;(4):885-93
Abstract
BACKGROUND In this pilot study, we tested a novel automatic anesthesia system for closed-loop administration of IV anesthesia drugs for cardiac surgical procedures with cardiopulmonary bypass. This anesthesia drug delivery robot integrates all 3 components of general anesthesia: hypnosis, analgesia, and muscle relaxation. METHODS Twenty patients scheduled for elective cardiac surgery with cardiopulmonary bypass were enrolled. Propofol, remifentanil, and rocuronium were administered using closed-loop feedback control. The main objective was the feasibility of closed-loop anesthesia defined as successful automated cardiac anesthesia without manual override by the attending anesthesiologist. Secondary qualitative observations were clinical and controller performances. The clinical performance of hypnosis control was the efficacy to maintain a bispectral index (BIS) of 45. To evaluate the hypnosis performance, BIS values were stratified into 4 categories: "excellent," "good," "poor," and "inadequate" hypnosis control defined as BIS values within 10%, ranging from 11% to 20%, ranging from 21% to 30%, or >30% of the target value, respectively. The clinical performance of analgesia was the efficacy to maintain NociMap values close to 0. The analgesia performance was assessed classifying the NociMap values in 3 pain control groups: -33 to +33 representing excellent pain control, -34 to -66 and +34 to +66 representing good pain control, and -67 to -100 and +67 to +100 representing insufficient pain control. The controller performance was calculated using the Varvel parameters. RESULTS Robotic anesthesia was successful in 16 patients, which is equivalent to 80% (97.5% confidence interval [CI], 53%-95%) of the patients undergoing cardiac surgery. Four patients were excluded from the final analysis because of technical problems with the automated anesthesia delivery system. The secondary qualitative observations revealed that the clinical performance of hypnosis allowed an excellent and good control during 70% (97.5% CI, 63%-76%) of maintenance time and an insufficient clinical performance of analgesia for only 3% (97.5% CI, 1%-6%) of maintenance time. CONCLUSIONS The completely automated closed-loop system tested in this investigation could be used successfully and safely for cardiac surgery necessitating cardiopulmonary bypass. The results of the present trial showed satisfactory clinical performance of anesthesia control.
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Three-dimensional, task-specific robot therapy of the arm after stroke: a multicentre, parallel-group randomised trial.
Klamroth-Marganska, V, Blanco, J, Campen, K, Curt, A, Dietz, V, Ettlin, T, Felder, M, Fellinghauer, B, Guidali, M, Kollmar, A, et al
The Lancet. Neurology. 2014;(2):159-66
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Abstract
BACKGROUND Arm hemiparesis secondary to stroke is common and disabling. We aimed to assess whether robotic training of an affected arm with ARMin--an exoskeleton robot that allows task-specific training in three dimensions-reduces motor impairment more effectively than does conventional therapy. METHODS In a prospective, multicentre, parallel-group randomised trial, we enrolled patients who had had motor impairment for more than 6 months and moderate-to-severe arm paresis after a cerebrovascular accident who met our eligibility criteria from four centres in Switzerland. Eligible patients were randomly assigned (1:1) to receive robotic or conventional therapy using a centre-stratified randomisation procedure. For both groups, therapy was given for at least 45 min three times a week for 8 weeks (total 24 sessions). The primary outcome was change in score on the arm (upper extremity) section of the Fugl-Meyer assessment (FMA-UE). Assessors tested patients immediately before therapy, after 4 weeks of therapy, at the end of therapy, and 16 weeks and 34 weeks after start of therapy. Assessors were masked to treatment allocation, but patients, therapists, and data analysts were unmasked. Analyses were by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT00719433. FINDINGS Between May 4, 2009, and Sept 3, 2012, 143 individuals were tested for eligibility, of whom 77 were eligible and agreed to participate. 38 patients assigned to robotic therapy and 35 assigned to conventional therapy were included in analyses. Patients assigned to robotic therapy had significantly greater improvements in motor function in the affected arm over the course of the study as measured by FMA-UE than did those assigned to conventional therapy (F=4.1, p=0.041; mean difference in score 0.78 points, 95% CI 0.03-1.53). No serious adverse events related to the study occurred. INTERPRETATION Neurorehabilitation therapy including task-oriented training with an exoskeleton robot can enhance improvement of motor function in a chronically impaired paretic arm after stroke more effectively than conventional therapy. However, the absolute difference between effects of robotic and conventional therapy in our study was small and of weak significance, which leaves the clinical relevance in question. FUNDING Swiss National Science Foundation and Bangerter-Rhyner Stiftung.
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A linear-actuated torsional device to replicate clinically relevant spiral fractures in long bones.
Edwards, WB, Troy, KL
Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine. 2012;(9):729-33
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Abstract
To better understand the mechanisms underlying spiral fracture we would like to carry out biomechanical tests of long bones loaded in torsion to failure. A device was fabricated to perform torsional tests of long bones using a single-axis linear actuator. The principal operation of the device was to transform the vertical displacement of a material testing machine's linear actuator into rotational movement using a spur gear and rack system. Accuracy and precision of the device were quantified using cast-acrylic rods with known torque-rotation behavior. Cadaveric experimentation was used to replicate a clinically relevant spiral fracture in eleven human proximal tibiae; strain-gage data were recorded for a single specimen. The device had an experimental error of less than 0.2 Nm and was repeatable to within 0.3%. Strain gage data were in line with those expected from pure torsion and the cadaveric tibiae illustrated spiral fractures at ultimate torque and rotation values of 130.6 +/- 53.2 Nm and 8.3 +/- 1.5 degrees, respectively. Ultimate torque was highly correlated with DXA assessed bone mineral density (r = 0.87; p < 0.00 1). The device presented is applicable to any torsional testing of long bone when only a single-axis linear actuator is available.
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Improved single- and multi-contact life-time testing of dental restorative materials using key characteristics of the human masticatory system and a force/position-controlled robotic dental wear simulator.
Raabe, D, Harrison, A, Ireland, A, Alemzadeh, K, Sandy, J, Dogramadzi, S, Melhuish, C, Burgess, S
Bioinspiration & biomimetics. 2012;(1):016002
Abstract
This paper presents a new in vitro wear simulator based on spatial parallel kinematics and a biologically inspired implicit force/position hybrid controller to replicate chewing movements and dental wear formations on dental components, such as crowns, bridges or a full set of teeth. The human mandible, guided by passive structures such as posterior teeth and the two temporomandibular joints, moves with up to 6 degrees of freedom (DOF) in Cartesian space. The currently available wear simulators lack the ability to perform these chewing movements. In many cases, their lack of sufficient DOF enables them only to replicate the sliding motion of a single occlusal contact point by neglecting rotational movements and the motion along one Cartesian axis. The motion and forces of more than one occlusal contact points cannot accurately be replicated by these instruments. Furthermore, the majority of wear simulators are unable to control simultaneously the main wear-affecting parameters, considering abrasive mechanical wear, which are the occlusal sliding motion and bite forces in the constraint contact phase of the human chewing cycle. It has been shown that such discrepancies between the true in vivo and the simulated in vitro condition influence the outcome and the quality of wear studies. This can be improved by implementing biological features of the human masticatory system such as tooth compliance realized through the passive action of the periodontal ligament and active bite force control realized though the central nervous system using feedback from periodontal preceptors. The simulator described in this paper can be used for single- and multi-occlusal contact testing due to its kinematics and ability to exactly replicate human translational and rotational mandibular movements with up to 6 DOF without neglecting movements along or around the three Cartesian axes. Recorded human mandibular motion and occlusal force data are the reference inputs of the simulator. Experimental studies of wear using this simulator demonstrate that integrating the biological feature of combined force/position hybrid control in dental material testing improves the linearity and reduces the variability of results. In addition, it has been shown that present biaxially operated dental wear simulators are likely to provide misleading results in comparative in vitro/in vivo one-contact studies due to neglecting the occlusal sliding motion in one plane which could introduce an error of up to 49% since occlusal sliding motion D and volumetric wear loss V(loss) are proportional.
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Robotic-assisted treatment of celiac artery compression syndrome: report of a case and review of the literature.
Meyer, M, Gharagozloo, F, Nguyen, D, Tempesta, B, Strother, E, Margolis, M
The international journal of medical robotics + computer assisted surgery : MRCAS. 2012;(4):379-83
Abstract
BACKGROUND The surgical management of celiac artery compression syndrome (CACS) is controversial. Controversies include the appropriate surgical technique, the surgical approach, and the utility of postoperative stents. The literature is reviewed, and a case of CACS is presented in which a robotic-assisted division of the median arcuate ligament (MAL) was performed. METHODS Robotic-assisted treatment of celiac artery syndrome was carried out using six (five 1 cm and one 2 cm) abdominal incisions. The robotic device was used to expose the aorta and celiac artery and divide the median arcuate ligament. RESULTS Postoperatively, the patient's postprandial abdominal pain subsided. On 16 month follow-up, the patient was doing well, tolerated an unrestricted diet without symptoms, and exhibited weight gain. CONCLUSION This case is the second reported in the literature and demonstrates that the robotic approach to division of the MAL is feasible, safe, and efficacious.
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Three-dimensional computer-aided human factors engineering analysis of a grafting robot.
Chiu, YC, Chen, S, Wu, GJ, Lin, YH
Journal of agricultural safety and health. 2012;(3):181-94
Abstract
The objective of this research was to conduct a human factors engineering analysis of a grafting robot design using computer-aided 3D simulation technology. A prototype tubing-type grafting robot for fruits and vegetables was the subject of a series of case studies. To facilitate the incorporation of human models into the operating environment of the grafting robot, I-DEAS graphic software was applied to establish individual models of the grafting robot in line with Jack ergonomic analysis. Six human models (95th percentile, 50th percentile, and 5th percentile by height for both males and females) were employed to simulate the operating conditions and working postures in a real operating environment. The lower back and upper limb stresses of the operators were analyzed using the lower back analysis (LBA) and rapid upper limb assessment (RULA) functions in Jack. The experimental results showed that if a leg space is introduced under the robot, the operator can sit closer to the robot, which reduces the operator's level of lower back and upper limbs stress. The proper environmental layout for Taiwanese operators for minimum levels of lower back and upper limb stress are to set the grafting operation at 23.2 cm away from the operator at a height of 85 cm and with 45 cm between the rootstock and scion units.
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Comparison of the FreeHand® robotic camera holder with human assistants during endoscopic extraperitoneal radical prostatectomy.
Stolzenburg, JU, Franz, T, Kallidonis, P, Minh, D, Dietel, A, Hicks, J, Nicolaus, M, Al-Aown, A, Liatsikos, E
BJU international. 2011;(6):970-4
Abstract
OBJECTIVE • To assess, in a prospective randomized study, the efficiency of the FreeHand® (Prosurgics Ltd, Bracknell, UK) compared to manual camera control during the performance of endoscopic extraperitoneal radical prostatectomy (EERPE). PATIENTS AND METHODS • Three surgeons performed 50 EERPE for localized prostate cancer. In group A (n= 25), procedures were performed with manual control of the camera by the assistant, whereas group B (n= 25) patients were treated with the assistance of the FreeHand® robotic device. • The EERPE procedure was divided into several steps. • Total operation duration, time for each surgical step, number of camera movements, number of movement errors, number of times the lens was cleaned, blood loss and margin status were compared. RESULTS • No statistically significant difference was observed in terms of patient age, preoperative prostate-specific antigen level, Gleason score, positive cores and prostate volume. • The average operation duration required for the performance of each step did not differ significantly between the two groups. • Significant differences in favour of the FreeHand® camera holder were observed in case of horizontal and zooming camera movement, camera cleaning and camera errors. • Vertical camera movements were performed significantly faster by the human assistant compared to the robotic camera holder. • The average total operation duration was similar for both groups. • Positive surgical margins were detected in one patient in each group (4% of the patients). CONCLUSIONS • A comparison of the FreeHand® robotic camera holder with human camera control during EERPE showed a similar time requirement for the performance of each step of the procedure. • The robotic system provided accurate and fast movements of the camera without compromising the outcome of the procedure.
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Experimental validation of a polyvinylidene fluoride sensing element in a tactile sensor.
Yahud, S, Dokos, S, Morley, JW, Lovell, NH
Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference. 2010;:5760-3
Abstract
A tactile sensor for robotic applications is described, inspired by the mechanoreceptors in the glabrous skin of the human hand, in order to replicate the sensory function of both slow adapting and fast adapting mechanoreceptors. Strain gauges were used for the slow adapting receptors, and polyvinylidene fluoride (PVDF) film was used to replicate the fast adapting receptors. A finite element analysis (FEA) model was used to predict the output response of the PVDF film, and verified experimentally. The PVDF film was observed to respond linearly to mechanical stress and exhibited increased gain at higher frequencies. "Ramp and hold" stimuli were applied to the tactile unit sensor, and the PVDF film only responded at contact onset and offset, similar to the response of fast adapting receptors. The PVDF acted as a dynamic sensing element for the proposed tactile sensor unit.
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Using a healing robot for the scientific study of shirodhara. Altered states of consciousness and decreased anxiety through Indian dripping oil treatments.
Uebaba, K, Xu, FH, Tagawa, M, Asakura, R, Itou, T, Tatsuse, T, Taguchi, Y, Ogawa, H, Shimabayashi, M, Hisajima, T
IEEE engineering in medicine and biology magazine : the quarterly magazine of the Engineering in Medicine & Biology Society. 2005;(2):69-78