Upper-limb impairment after stroke is caused by weakness, loss of individual joint control, spasticity, and abnormal synergies. Upper-limb movement frequently involves abnormal, stereotyped, and fixed synergies, likely related to the increased use of sub-cortical networks following the stroke. The flexible coordination of the shoulder and elbow joints is also disrupted. New methods for motor learning, based on the stimulation of activity-dependent neural plasticity have been developed. These include robots that can adaptively assist active movements and generate many movement repetitions. However, most of these robots only control the movement of the hand in space. The aim of the present text is to analyze the potential of robotic exoskeletons to specifically rehabilitate joint motion and particularly inter-joint coordination. First, a review of studies on upper-limb coordination in stroke patients is presented and the potential for recovery of coordination is examined. Second, issues relating to the mechanical design of exoskeletons and the transmission of constraints between the robotic and human limbs are discussed. The third section considers the development of different methods to control exoskeletons: existing rehabilitation devices and approaches to the control and rehabilitation of joint coordinations are then reviewed, along with preliminary clinical results available. Finally, perspectives and future strategies for the design of control mechanisms for rehabilitation exoskeletons are discussed.
While a large number of robotic exoskeletons have been designed by research teams for rehabilitation, it remains rather difficult to analyse their ability to finely interact with a human limb: no performance indicators or general methodology to characterize this capacity really exist. This is particularly regretful at a time when robotics are becoming a recognized rehabilitation method and when complex problems such as 3-D movement rehabilitation and joint rotation coordination are being addressed. The aim of this paper is to propose a general methodology to evaluate, through a reduced set of simple indicators, the ability of an exoskeleton to interact finely and in a controlled way with a human. The method involves measurement and recording of positions and forces during 3-D point to point tasks. It is applied to a 4 degrees-of-freedom limb exoskeleton by way of example.
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