CardioVR-ReTone—Robotic Exoskeleton for Upper Limb Rehabilitation following Open Heart Surgery: Design, Modelling, and Control

Following cardiac surgery, patients experience difficulties with the rehabilitation process, often finding it difficult, and therefore lack the motivation for rehabilitation activities. As the number of people aged 65 and over will rise by 207 percent globally by 2050, the need for cardiac rehabilitation will significantly increase, as this is the main population to experience heart problems. To address this challenge, this paper proposes a new robotic exoskeleton concept with 12 DoFs (6 DoFs on each arm), with a symmetrical structure for the upper limbs, to be used in the early rehabilitation of cardiac patients after open-heart surgery. The electromechanical design (geometric, kinematic, and dynamic model), the control architecture, and the VR-based operating module of the robotic exoskeleton are presented. To solve the problem of the high degree of complexity regarding the CardioVR-ReTone kinematic and dynamic model, the iterative algorithm, kinetic energy, and generalized forces were used. The results serve as a complete model of the exoskeleton, from a kinematic and dynamic point of view as well as to the selection of the electric motors, control system, and VR motivation model. The validation of the concept was achieved by evaluating the exoskeleton structure from an ergonomic point of view, emphasizing the movements that will be part of the cardiac rehabilitation.

What Happens When Robots Punish? Evaluating Human Task Performance During Robot-Initiated Punishment

This article examines how people respond to robot-administered verbal and physical punishments. Human participants were tasked with sorting colored chips under time pressure and were punished by a robot when they made mistakes, such as inaccurate sorting or sorting too slowly. Participants were either punished verbally by being told to stop sorting for a fixed time, or physically, by restraining their ability to sort with an in-house crafted robotic exoskeleton. Either a human experimenter or the robot exoskeleton administered punishments, with participant task performance and subjective perceptions of their interaction with the robot recorded. The results indicate that participants made more mistakes on the task when under the threat of robot-administered punishment. Participants also tended to comply with robot-administered punishments at a lesser rate than human-administered punishments, which suggests that humans may not afford a robot the social authority to administer punishments. This study also contributes to our understanding of compliance with a robot and whether people accept a robot’s authority to punish. The results may influence the design of robots placed in authoritative roles and promote discussion of the ethical ramifications of robot-administered punishment.

Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study

Background Evidence is emerging for the use of overground lower limb robotic exoskeletons in the rehabilitation of people with spinal cord injury (SCI), with suggested benefits for gait speed, bladder and bowel function, pain management and spasticity. To date, research has focused on devices that require the user to support themselves with a walking aid. This often precludes use by those with severe trunk, postural or upper limb deficits and places the user in a suboptimal, flexed standing position. Free-standing exoskeletons enable people with higher level injuries to exercise in an upright position. This study aimed to evaluate the feasibility of therapy with a free-standing exoskeleton for those with SCI, and to determine the potential health-related benefits of this intervention. Methods This 12-week intervention study with 12-week waitlist control and 12-week follow up, provided people with SCI scoring < 5 on the mobility section of the spinal cord independence measure (SCIM-III) twice weekly therapy in the REX (Rex Bionics, Auckland, NZ), a free-standing lower limb robotic exoskeleton. The primary outcome measure of interest was function, as measured on the SCIM-III. A battery of secondary outcomes was included. Participants also completed a survey on their perceptions of this treatment modality, to determine acceptability. Results Forty-one potential participants were screened for eligibility. Two females (one ASIA A, one ASIA C) and one male (ASIA B) completed all 24 intervention sessions, and the follow up assessment. One participant showed positive trends in function, fatigue, quality of life and mood during the intervention phase. Grip and quadriceps strength, and lower limb motor function improved in another. Two improved their percentage of lean body mass during the intervention phase. Remaining results were varied across patients, time points and outcomes. The intervention was highly acceptable to all participants. Conclusion With three of 41 potential participants being eligible and completing this study, our results show that there are potential benefits of exercise in a free-standing exoskeleton for people with severe mobility impairment due to SCI, for a small subset of patients. Further research is warranted to determine those most likely to benefit, and the type of benefit depending on the patient characteristics. Trial registration The trial was registered prospectively on 20 April 2018 at www.anzctr.org.au/ (ACTRN12618000626268)

Robotic Exoskeleton Gait Training in Stroke: An Electromyography-Based Evaluation

The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been recruited and underwent either conventional gait training or experimental training, including overground gait training using a wearable powered exoskeleton alongside conventional therapy. Before and after the rehabilitation treatment, we assessed: (i) gait functionality by means of clinical scales combined to obtain a Capacity Score, and (ii) gait neuromuscular lower limbs pattern using superficial EMG signals. Both groups improved their ability to walk in terms of functional gait, as detected by the Capacity Score. However, only the group treated with the robotic exoskeleton regained a controlled rhythmic neuromuscular pattern in the proximal lower limb muscles, as observed by the muscular activation analysis. Coherence analysis suggested that the control group (CG) improvement was mediated mainly by spinal cord control, while experimental group improvements were mediated by cortical-driven control. In subacute stroke patients, we hypothesize that exoskeleton multijoint powered fine control overground gait training, alongside conventional care, may lead to a more fine-tuned and efficient gait pattern.

Cardiac Rehabilitation Early after Sternotomy Using New Assistive VR-Enhanced Robotic Exoskeleton—Study Protocol for a Randomised Controlled Trial

(1) Background and objective: Cardiac rehabilitation (CR) means delivering health education by structured exercises with the means of risk reduction, in a cost-effective manner. Well-conducted CR improves functional capacity, decreases re-hospitalization, and reduces mortality up to 25%. We bring to attention the protocol of a randomised control trial with the aim of validating the prototype of an assistive upper-body robotic exoskeleton system enhanced with a non-immersive virtual reality exergame (CardioVR-ReTone) in patients who undergone cardiac surgery. (2) Methods: Description of the CardioVR-ReTone system and the technical specification, followed by the group selection, randomization and evaluated variables. (3) Expected results: The primary outcome measurement is the modification of life quality at the end of the CR exercise training program. Secondary outcomes will encompass measurements of sternal stability, muscular activity, cardiac response to exercise, pain level and compliance/adherence to CR. (4) Conclusions: Implementing these novel features of the CardioVR-ReTone system, addressability, and efficacy of CR, so problematic in certain situations and especially in cardiac surgery, will be greatly facilitated, being independent of the skills and availability of the rehabilitation therapist.