06/05/2020 Introduction to Rehabilitation Robotics Matteo Malosio matteo.malosio@cnr.it Robotics • A robot is ‘‘a reprogrammable, multifunctional manipulator designed to move material, parts, tools, or specialized devices through various programmed motions for the performance of a variety of tasks’’ (Robotic Industries Association) • The industry's current working definition of a robot has come to be understood as any piece of equipment that has three or more degrees of freedom. • In practice, robots are computers with servomechanisms. • A servomechanism is an automatic device that uses error- sensing negative feedback to correct the performance of a mechanism. 1
06/05/2020 Service robotics Surgical robots 2
06/05/2020 Rehabilitation robotics Rehabilitation robotics includes: • Prosthetics A mechanical device that substitutes for a missing part of the human body • Orthotics A mechanism used to assist or support a weak or ineffective joint, muscle, or limb. • Assistive Robots Provide greater independence to people with disabilities Speich J., and Rosen J., “Medical Robotics”, in Encyclopedia of Biomaterials and Biomedical Engineering , 983-993, Marcel Dekker, Inc., 2004 Robotic prosthesis 3
06/05/2020 The actors in rehabilitation Rehabilitation Orthopedic Neurological 4
06/05/2020 Stroke • Loss of brain function due to a disturbance in the blood supply to the brain. • ischemia (lack of blood flow) • hemorrhage (bleeding of blood vessels) • The affected brain area cannot function normally, resulting in: • inability to move one or more limbs on one side of the body CT scan slice of the • failure to understand or formulate speech brain showing a • a vision impairment of one side of the right-hemispheric ischemic stroke. visual field… Neurorehabilitation • Neurological disorders due to cerebrovascular diseases is a relevant world problem. • Rehabilitation has to mitigate negative effects and prevent societal and work relapses. • An effective rehabilitation program can help to: • maintain a patient’s quality of life, • maximize the patient’s physical and psychosocial functions World Health Organization, Neurological disorders affect millions globally: WHO report, WHO Library Cataloguing-in-Publication (2006) 5
06/05/2020 Societal impact • Stroke requires • therapy intensity shortly after the incident • continued therapy in the following period • Stroke events in EU countries (WHO) • 1.1 million per year (2000) -> more than 1.5 million per year (2025) (because of the demographic changes). • Demographic changes • decrease of medical staff and care personnel availability. • European stroke cost if about 38G€/year • (2-3 % of health expenditure for European Union). R4H Roadmap Robotized and multi-sensory systems are considered the most promising technologiies. Source: EU Robotics for Health Roadmap 6
06/05/2020 Neurorehab devices aims • Relieve therapist’ effort • Make the patient partially independent • Objective measures and assessments • Intensity of treatment Motor relearning Cortical activation Cortical activation after treatment before treatment • Function recovery possible due to brain plasticity • Neurorehabilitation is “training the brain” on how to control movement • Sensory feedbacks enhance the cerebral reorganization 7
06/05/2020 “Traditional” rehabilitation Orthopedic rehabilitation 8
06/05/2020 Continuous Passive Motion • A programmed motion law is maintained and controlled by the CPM controller • The patient’s action is considered a disturbance • No feedback from the patient • Feedback from motor sensors Patient Target Actual position position Controller CPM device Doesn’t involve actively (or involve slightly) the patient Actual robot target motion is not modified by the patient Neurological rehabilitation 9
06/05/2020 Assist-as-needed Input/Output devices in rehabilitation 10
06/05/2020 Patient in the loop – force feedback Disturbance Patient Rehab Target Actual Patient exercise position position behaviour Motion Motion Robot planner controller Position/Velocitiy signals Force/Torque signals Patient in the loop – EMG feedback Disturbance Rehab Target Actual Patient exercise position position behaviour Motion Motion Robot Patient planner controller Position/Velocitiy signals Force/Torque signals EMG signals • For patients able to generate a muscular stimulus, • but too weak to perform autonomously a movement. 11
06/05/2020 Force feedback control strategies • Assistive controllers • Impedance-based assistance • Counterbalancing assistance • EMG-based assistance • Performance-based adaptation of task parameters • Challenge-based robotic therapy control algorithms • Resistive strategies • Constraint-induced strategies • Error-amplification strategies L. Marchal-Crespo and D. J. Reinkensmeyer, “Review of control strategies for robotic movement training after neurologic injury.” Journal of neuroengineering and rehabilitation, vol. 6, no. 1, pp. 20+, Jun. 2009. http://www.biomedcentral.com/content/supplementary/1743-0003-6-20-S1.pdf Patient in the loop – EEG feedback Disturbance Rehab exercise Target Actual Patient position position behaviour Motion Motion Robot Patient planner controller Position/Velocitiy signals Force/Torque signals EMG signals EEG signals sweating, temperature, heartbeat, breathing, ... are other possible feedback signals to monitor physio – psicological state 12
06/05/2020 Patient in the loop – multimodal controllers FES controller FES Motion Patient VR controller VR planner Rehab Patient exercise behaviour Motion Robot controller Position/Velocitiy signals Force/Torque signals EMG signals Patient in the Loop Psycho-physio-biomechanical loops König A., "Human-in-the-Loop Control During Robot-Assisted Gait Rehabilitation”, Dissertation ETH No. 19641, Zurich, 2011 13
06/05/2020 Psycho-Physiological feedback Design guidelines of an interactive robot • Compatible with the range of motion (ROM) of the human arms • Torques and motions compatibles with articulations • No hazard and discomfort Schiele, A., van der Helm, F.C.T., 2006, ‘Kinematic design to improve ergonomics in human machine interaction’, IEEE Transactions on Neural Systems and Rehabilitation Engineering 14(4): 456–469. Rocon, E. and Ruiz, A. F. and Raya, R. and Schiele, A. and Pons, J. L. and Belda-Lois, J. M. and Poveda, R. and Vivas, M. J. and Moreno, J. C., 2008, Human–Robot Physical Interaction, Wearable Robots, John Wiley & Sons, Ltd: 127–163. 14
06/05/2020 End-effector / Esoscheletro End-effector Esoscheletro Articolazioni di arti superiori e inferiori Glenohumeral Elbow joint Pronosupination Wrist Spherical + Rotational + Rotational + Universal = 7 Hip Knee Tibiofibular Ankle 15
06/05/2020 End-effector constraint and motion End-effector constraint and motion • Limbs (and articulations) result in a self-adapted configuration • Limbs chains can rotate around proximal-to-distal articulation axis (joint redundancy) 16
06/05/2020 End-effector – Inmotion (MIT Manus) End-effector - MOTORE 17
06/05/2020 Cable-driven upper-limb rehabilitation robots G. Rosati, P. Gallina, and S. Masiero, “Design, Implementation and Clinical Tests of a Wire-Based Robot for Neurorehabilitation”, IEEE Transactions on Neural Systems and Rehabilitation Engineering, 15(4):560–569, 2007. G. Rosati, P. Gallina, A. Rossi, and S. Masiero, "Wire-based robots for upper-limb rehabilitation", International Journal of Assistive Robotics and Mechatronics, 7(2):3–10, 2006. Exoskeletal constraints and motion • Limbs control and movements are obtained Joints by exoskeletal joints movement aligned to human articulations • Limbs chains poses are uniquely determined by exoskeleton joints 18
06/05/2020 Shoulder girdle The clavicle and the scapula Source: Pronk, G.M., 1991. The shoulder girdle: analysed and modelled kinematically. In: Ph.D. Thesis, Delft University of Technology, The Netherlands Shoulder rhythm and humeral ICR displacement Shoulder complex movement is due to a combination of the shoulder girdle and the gleno- humeral joint movement (Shoulder rhythm). The humeral head ICR translates as function of the upper arm elevation angle. (with the permission of Tobias Nef and Robert Riener, ETH and University of Zurich, Switzerland) 19
06/05/2020 Aligned human and robot joints Forces are normal to the bone axis with no axial components constant • The distance between cuffs and joints is constant in the joint range of motion • Relative displacement between skin and bone does not occur Misaligned human and robot joints Forces have a component aligned to the bone axis • The distance between cuffs and joints is not constant in the joint range of motion • Relative displacement between skin and bone can occur (soft tissues compliancy) and proper joint decoupling should be introduced 20
06/05/2020 Esoscheletri per arto superiore ARMEO Power 21
06/05/2020 Esoscheletri antigravitari Esoscheletri per le mani 22
06/05/2020 End-effector arti inferiori – G-EO Esoscheletro arti inferiori - Lokomat 23
06/05/2020 Esoscheletri «ambulanti» arti inferiori 24
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