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Applied Sciences
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The Present and Future of Robotic Technology in Rehabilitation
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The Present and Future of Robotic Technology in Rehabilitation

A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Robotics and Automation".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 29424

Special Issue Editors

Dr. Loredana Zollo

E-Mail Website
Guest Editor
Research Unit of Biomedical Robotics and Biomicrosystems, Faculty Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
Interests: robot-aided rehabilitation; assistive robotics and prostheses; human biomechanics; human-machine interfaces; brain stimulation; sensory feedback restoration; human-in-the-loop assistive robots; closed-loop interfaces for therapy robots; human-robot interaction; neuromodulation and neurorehabilitation
Dr. Irene Aprile

E-Mail Website
Guest Editor
IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143 Firenze, Italy
Interests: robot-aided rehabilitation; assistive robotics and prostheses; neurological diseases; musculoskeletal disorders; postural balance; motor learning; rehabilitation; quality of life; stroke; movement analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The number of people with disabilities and the complexity of their needs continue to rise, despite the improvements in technology and health care. This increase is directly related to the rapid aging of the world population and the consequent burden of aging-associated diseases. Neurological disorders result in lifelong functional disabilities, with a severe impact on patients’ ability to perform activities of daily living and, therefore, on their independence. Similarly, musculoskeletal disorders represent one of the main causes of severe long-term pain and physical disability, increasing markedly with age and occurring especially when workers overexert themselves and perform repetitive tasks.

Rehabilitation robotics is a fast-growing discipline that has received significant attention over time because of an increasing acceptance of the validity of this approach by clinical care providers. The reduction in sensor and actuator costs and the expansion throughout different application domains (from social robotics to rehabilitation) have favored its spread, increasing the number of people whose impairments can be targeted by robotic technologies in the years.

Robotic devices can provide a treatment that is standardized but also tailored to the specific needs of the patient. Moreover, because of their built-in technology in terms of sensors and actuators, robotic devices can provide quantitative measures of the patient’s performance. These instrumental evaluations are easy to perform and make it possible to adapt the therapy according to the progress made by the patient.

This Special Issue aims to report on the most innovative and interesting research in the field of rehabilitation robotics, with applications to people with disabilities due to neurological disorders, musculoskeletal pathologies, or the natural course of aging. Topics include upper-limb and lower-limb rehabilitation robots, social robots, multi-modal human–machine interfaces, post-surgery rehabilitation technologies, objective and quantitative assessment of motor and functional impairment, and the relationship between cognitive impairment and robotic rehabilitation.

Dr. Loredana Zollo
Dr. Irene Aprile
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Applied Sciences is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • robotics
  • rehabilitation
  • upper limb
  • lower limb
  • outcome measures
  • social robot
  • multi-modal human–machine interfaces
  • post-surgery rehabilitation technologies
  • cognitive impairment

Published Papers (6 papers)

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Research

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18 pages, 1983 KiB  
Article
Adjustable Stiffness-Based Supination–Pronation Forearm Physical Rehabilitator
by Adrian Camacho-Ramirez, Juan Carlos Ávila-Vilchis, Belem Saldivar, Adriana H. Vilchis-González and Juan Manuel Jacinto-Villegas
Appl. Sci. 2022, 12(12), 6164; https://0-doi-org.brum.beds.ac.uk/10.3390/app12126164 - 17 Jun 2022
Viewed by 13718
Abstract
This paper reports a new medical device together with a control strategy that focuses on the following tasks: (1) a trajectory tracking problem associated with the supination–pronation motion of the wrist–forearm for purposes of rehabilitation and (2) the adjustment of the system’s stiffness [...] Read more.
This paper reports a new medical device together with a control strategy that focuses on the following tasks: (1) a trajectory tracking problem associated with the supination–pronation motion of the wrist–forearm for purposes of rehabilitation and (2) the adjustment of the system’s stiffness associated with the applied torque guaranteeing the angular motion of the rehabilitator as well as the resistance that potential users must overcome. These two tasks are oriented to regain the range of motion (ROM) of the wrist–forearm and to improve the strength of the associated muscles. It is worth mentioning that this device has not been clinically validated. However, the performance of the closed-loop medical device is validated with preliminary experiments with a healthy subject based on movement patterns involving passive, assisted-resisted, and active phases of rehabilitation protocols. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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13 pages, 2639 KiB  
Article
Modification of Hand Muscular Synergies in Stroke Patients after Robot-Aided Rehabilitation
by Francesco Scotto di Luzio, Francesca Cordella, Marco Bravi, Fabio Santacaterina, Federica Bressi, Silvia Sterzi and Loredana Zollo
Appl. Sci. 2022, 12(6), 3146; https://0-doi-org.brum.beds.ac.uk/10.3390/app12063146 - 19 Mar 2022
Cited by 7 | Viewed by 2353
Abstract
The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are [...] Read more.
The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are still being studied. Recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns, but the muscular patterns of the hand have not completely investigated, although the hand represents a paramount tool for performing activities of daily living (ADLs) and stroke can significantly alter the mobilization of this part of the body. In this context, this study aims at investigating hand muscular synergies in chronic stroke patients and evaluating some possible benefits in the robot-aided rehabilitation treatment of the hand in these subjects. Seven chronic stroke patients with mild-to-moderate impairment (FM>30) were involved in this study. They received a 5-week robot-aided rehabilitation treatment with the Gloreha hand exoskeleton, and muscle synergies of both the healthy and injured hand were evaluated at the beginning and at the end of the treatment. The performed analysis showed a very high degree of similarity of the involved synergies between the healthy and the injured limb both before and after the rehabilitation treatment (mean similarity index values: H-BR: 0.88±0.03, H-AR: 0.94±0.03, BR-AR: 0.89±0.05). The increasing similarity is regarded as an effect of the robot-aided rehabilitation treatment and future activities will be performed to increase the population involved in the study. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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16 pages, 5545 KiB  
Article
Active Disturbance Rejection Control Based Sinusoidal Trajectory Tracking for an Upper Limb Robotic Rehabilitation Exoskeleton
by Sumit Aole, Irraivan Elamvazuthi, Laxman Waghmare, Balasaheb Patre, Tushar Bhaskarwar, Fabrice Meriaudeau and Steven Su
Appl. Sci. 2022, 12(3), 1287; https://0-doi-org.brum.beds.ac.uk/10.3390/app12031287 - 26 Jan 2022
Cited by 10 | Viewed by 1947
Abstract
In this paper, a combined control strategy with extended state observer (ESO) and finite time stable tracking differentiator (FTSTD) has been proposed to perform flexion and extension motion repetitively and accurately in the sagittal plane for shoulder and elbow joints. The proposed controller [...] Read more.
In this paper, a combined control strategy with extended state observer (ESO) and finite time stable tracking differentiator (FTSTD) has been proposed to perform flexion and extension motion repetitively and accurately in the sagittal plane for shoulder and elbow joints. The proposed controller improves the tracking accuracy, performs state estimation, and actively rejects disturbance. A sinusoidal trajectory as an input has been given to a two-link multiple-input multiple-output (MIMO) upper limb robotic rehabilitation exoskeleton (ULRRE) for a passive rehabilitation purpose. The efficacy of the controller has been tested with the help of performance indices such as integral time square error (ITSE), integral square error (ISE), integral time absolute error (ITAE), and integral of the absolute magnitude of error (IAE). The system model is obtained through the Euler–Lagrangian method, and the controller’s stability is also given. The proposed controller has been simulated for ±20% parameter variation with constant external disturbances to test the disturbance rejection ability and robustness against parametric uncertainties. The proposed controller has been compared with already developed ESO-based methods such as active disturbance rejection control (ADRC), nonlinear active disturbance rejection control (NLADRC), and improved active disturbance rejection control (I-ADRC). It has been found that the proposed method increases tracking performance, as evidenced by the above performance indices. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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10 pages, 934 KiB  
Article
Clinical Interpretation of Working Volume and Weight Support in Upper Limb Robotic Neurorehabilitation after Stroke
by Marco Iosa, Alex Martino Cinnera, Fioravante Capone, Alessandro Cruciani, Matteo Paolucci, Vincenzo Di Lazzaro, Stefano Paolucci and Giovanni Morone
Appl. Sci. 2021, 11(24), 12123; https://0-doi-org.brum.beds.ac.uk/10.3390/app112412123 - 20 Dec 2021
Cited by 2 | Viewed by 2144
Abstract
In the past two decades, many studies reported the efficacy of upper limb robotic rehabilitation in patients after stroke, also in its chronic phase. Among the possible advantages of robotic therapy over conventional therapy are the objective measurements of kinematic and kinetic parameters [...] Read more.
In the past two decades, many studies reported the efficacy of upper limb robotic rehabilitation in patients after stroke, also in its chronic phase. Among the possible advantages of robotic therapy over conventional therapy are the objective measurements of kinematic and kinetic parameters during therapy, such as the spatial volume covered by the patient’s upper limb and the weight support provided by the robot. However, the clinical meaning and the usability of this information is still questioned. Forty patients with chronic stroke were enrolled in this study and assessed at the beginning of upper limb robotic therapy (Armeo® Power) and after two weeks (ten sessions) of therapy by recording the working volume and weight support provided by the robot and by administering six clinical scales to assess upper limb mobility, strength, spasticity, pain, neurological deficits, and independency. At baseline, the working volume significantly correlated with spasticity, whereas weight support significantly correlated with upper limb strength, pain, spasticity, and neurological deficits. After two weeks of robotic rehabilitation, all the clinical scores as well as the two parameters improved. However, the percentage changes in the working volume and weight support did not significantly correlate with any of the changes in clinical scores. These results suggest caution in using the robotic parameters as outcome measures because they could follow the general improvement of the patient, but complex relationships with clinical features are possible. Robotic parameters should be analyzed in combination with the clinical scores or other objective measures because they may be informative about therapy progression, and there is a need to combine their clinical, neuroscientific, and biomechanical results to avoid misleading interpretations. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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Review

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13 pages, 471 KiB  
Review
Robot-Assisted Upper Limb Training for Patients with Multiple Sclerosis: An Evidence-Based Review of Clinical Applications and Effectiveness
by Sofia Straudi, Marco Tramontano, Emanuele Francesco Russo, Luca Perrero, Michela Agostini, Marialuisa Gandolfi, Irene Aprile, Matteo Paci, Emanuela Casanova, Dario Marino, Giuseppe La Rosa, Federica Bressi, Silvia Sterzi, Daniele Giansanti, Alberto Battistini, Sandra Miccinilli, Serena Filoni, Monica Sicari, Salvatore Petrozzino, Claudio Marcello Solaro, Stefano Gargano, Paolo Benanti, Paolo Boldrini, Donatella Bonaiuti, Enrico Castelli, Francesco Draicchio, Vincenzo Falabella, Silvia Galeri, Francesca Gimigliano, Mauro Grigioni, Stefano Mazzoleni, Stefano Mazzon, Franco Molteni, Maurizio Petrarca, Alessandro Picelli, Federico Posteraro, Michele Senatore, Giuseppe Turchetti, Giovanni Morone and Working Group Upper Limb “CICERONE” Italian Consensus Conference on Robotic Rehabilitationadd Show full author list remove Hide full author list
Appl. Sci. 2022, 12(1), 222; https://0-doi-org.brum.beds.ac.uk/10.3390/app12010222 - 27 Dec 2021
Cited by 4 | Viewed by 3941
Abstract
Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this [...] Read more.
Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusions. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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Other

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20 pages, 471 KiB  
Systematic Review
Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review
by Nicola Valè, Marialuisa Gandolfi, Laura Vignoli, Anita Botticelli, Federico Posteraro, Giovanni Morone, Antonella Dell’Orco, Eleonora Dimitrova, Elisa Gervasoni, Michela Goffredo, Jacopo Zenzeri, Arianna Antonini, Carla Daniele, Paolo Benanti, Paolo Boldrini, Donatella Bonaiuti, Enrico Castelli, Francesco Draicchio, Vincenzo Falabella, Silvia Galeri, Francesca Gimigliano, Mauro Grigioni, Stefano Mazzon, Franco Molteni, Maurizio Petrarca, Alessandro Picelli, Michele Senatore, Giuseppe Turchetti, Eugenio Guglielmelli, Nicola Petrone, Loris Pignolo, Giulia Sgubin, Nicola Smania, Loredana Zollo, Stefano Mazzoleni and Italian Consensus Conference on Robotic in Neurorehabilitation CICERONEadd Show full author list remove Hide full author list
Appl. Sci. 2021, 11(24), 12061; https://0-doi-org.brum.beds.ac.uk/10.3390/app112412061 - 17 Dec 2021
Cited by 2 | Viewed by 3711
Abstract
In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid [...] Read more.
In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions. Full article
(This article belongs to the Special Issue The Present and Future of Robotic Technology in Rehabilitation)
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