The Cortical Response Evoked by Robotic Wrist Perturbations Reflects Level of Proprioceptive Impairment After Stroke

Background: Proprioception is important for regaining motor function in the paretic upper extremity after stroke. However, clinical assessments of proprioception are subjective and require verbal responses from the patient to applied proprioceptive stimuli. Cortical responses evoked by robotic wrist perturbations and measured by electroencephalography (EEG) may be an objective method to support current clinical assessments of proprioception.Objective: To establish whether evoked cortical responses reflect proprioceptive deficits as assessed by clinical scales and whether they predict upper extremity motor function at 26 weeks after stroke.Methods: Thirty-one patients with stroke were included. In week 1, 3, 5, 12, and 26 after stroke, the upper extremity sections of the Erasmus modified Nottingham Sensory Assessment (EmNSA-UE) and the Fugl-Meyer Motor Assessment (FM-UE) and the EEG responses (64 channels) to robotic wrist perturbations were measured. The extent to which proprioceptive input was conveyed to the affected hemisphere was estimated by the signal-to-noise ratio (SNR) of the evoked response. The relationships between SNR and EmNSA-UE as well as SNR and time after stroke were investigated using linear regression. Receiver-operating-characteristic curves were used to compare the predictive values of SNR and EmNSA-UE for predicting whether patients regained some selective motor control (FM-UE > 22) or whether they could only move their paretic upper extremity within basic limb synergies (FM-UE ≤ 22) at 26 weeks after stroke.Results: Patients (N = 7) with impaired proprioception (EmNSA-UE proprioception score < 8) had significantly smaller SNR than patients with unimpaired proprioception (N = 24) [EmNSA-UE proprioception score = 8, t(29) = 2.36, p = 0.03]. No significant effect of time after stroke on SNR was observed. Furthermore, there was no significant difference in the predictive value between EmNSA-UE and SNR for predicting motor function at 26 weeks after stroke.Conclusion: The SNR of the evoked cortical response does not significantly change as a function of time after stroke and differs between patients with clinically assessed impaired and unimpaired proprioception, suggesting that SNR reflects persistent damage to proprioceptive pathways. A similar predictive value with respect to EmNSA-UE suggests that SNR may be used as an objective predictor next to clinical sensory assessments for predicting motor function at 26 weeks after stroke.

A Compact Soft Robotic Wrist Brace With Origami Actuators

Wrist disability caused by a series of diseases or injuries hinders the patient’s capability to perform activities of daily living (ADL). Rehabilitation devices for the wrist motor function have gained popularity among clinics and researchers due to the convenience of self-rehabilitation. The inherent compliance of soft robots enabled safe human-robot interaction and light-weight characteristics, providing new possibilities to develop wearable devices. Compared with the conventional apparatus, soft robotic wearable rehabilitation devices showed advantages in flexibility, cost, and comfort. In this work, a compact and low-profile soft robotic wrist brace was proposed by directly integrating eight soft origami-patterned actuators on the commercially available wrist brace. The linear motion of the actuators was defined by their origami pattern. The extensions of the actuators were constrained by the brace fabrics, deriving the motions of the wrist joint, i.e., extension/flexion, ulnar/radial deviation. The soft actuators were made of ethylene-vinyl acetate by blow molding, achieving mass-production capability, low cost, and high repeatability. The design and fabrication of the soft robotic wrist brace are presented in this work. The experiments on the range of motion, output force, wearing position adaptivity, and performance under disturbance have been carried out with results analyzed. The modular soft actuator approach of design and fabrication of the soft robotic wrist brace has a wide application potential in wearable devices.

Mechanical Design of a Bioinspired Compliant Robotic Wrist Rehabilitation Equipment

Early social reintegration of patients with disabilities of the wrist is possible with the help of dedicated rehabilitation equipment. Using such equipment reduces the duration of recovery and reduces significantly rehabilitation costs. Based on these considerations the paper puts forward a novel constructive solution of rehabilitation equipment that ensures the simultaneous passive mobilization of the radiocarpal, metacarpophalangeal, and interphalangeal joints. The novelty of this equipment consists in the bioinspired concept of the hand support based on the Fin-Ray effect and in driving it by means of a pneumatic muscle, an inherently compliant actuator. The paper places an emphasis on the compliant character of the rehabilitation equipment that is responsible for its adaptability to the concrete conditions of patient pain tolerability.

Abnormal microscale neuronal connectivity triggered by a proprioceptive stimulus in dystonia

We investigated modulation of functional neuronal connectivity by a proprioceptive stimulus in sixteen young people with dystonia and eight controls. A robotic wrist interface delivered controlled passive wrist extension movements, the onset of which was synchronised with scalp EEG recordings. Data were segmented into epochs around the stimulus and up to 160 epochs per subject were averaged to produce a Stretch Evoked Potential (StretchEP). Event-related network dynamics were estimated using a methodology that features Wavelet Transform Coherency (WTC). Global Microscale Nodal Strength (GMNS) was introduced to estimate overall engagement of areas into short-lived networks related to the StretchEP, and Global Connectedness (GC) estimated the spatial extent of the StretchEP networks. Dynamic Connectivity Maps showed a striking difference between dystonia and controls, with particularly strong theta band event-related connectivity in dystonia. GC also showed a trend towards higher values in dystonia than controls. In summary, we demonstrate the feasibility of this method to investigate event-related neuronal connectivity in relation to a proprioceptive stimulus in a paediatric patient population. Young people with dystonia show an exaggerated network response to a proprioceptive stimulus, displaying both excessive theta-band synchronisation across the sensorimotor network and widespread engagement of cortical regions in the activated network.