Backgrounds: Exoskeletons development arises with a leading role in neurorehabilitation technologies; however, very few prototypes for upper limbs have been tested, contrasted and duly certified in terms of their effectiveness in clinical environments in order to incorporate into the health system. The purpose of this pilot study was to determine if robotic therapy of Hemiplegic Shoulder Pain (HSP) could lead to functional improvement in terms of diminishing of pain, spasticity, subluxation, the increasing of tone and muscle strength, and the satisfaction degree. Methods: An experimental study was conducted in 16 patients with painful shoulder post-ischemic stroke in two experimental groups: conventional and robotic therapy. At different stages of its evolution, the robotic therapy effectiveness applied with anti-gravitational movements was evaluated. Clinical trial was developed at the Physical Medicine and Rehabilitation Department of the Surgical Clinical Hospital "Dr. Juan Bruno Zayas Alfonso" in Santiago de Cuba, from September 2016 -March 2018. Among other variables: the presence of humeral scapular subluxation (HSS), pain, spasticity, mobility, tone and muscle strength, and the satisfaction degree were recorded. Results with 95% reliability were compared between admission and third months of treatment. The Mann-Whitney U-Test, Chi-Square and Fisher's Exact Tests were used as comparison criteria. Results: Robotic therapy positively influenced in the decrease and annulment of pain and the spasticity degree, reaching a range increase of joint movement and the improvement of muscle tone.

Influencia de la asimetría de la marcha en el comportamiento biomecánico de las articulaciones de cadera en pacientes con prótesis transfemorales Influence of gait asymmetry on hip joints biomechanical behavior in patients with transfemoral prostheses

IntroIntroducción: Un exoesqueleto se conceptualiza como un mecanismo estructural externo cuyos segmentos y articulaciones se corresponden con las del cuerpo humano y es capaz de coordinar y amplificar sus movimientos. El objetivo del trabajo se enfoca en desarrollar una tecnología de plataforma robótica de asistencia y métodos de cuantificación para la rehabilitación motora de miembros superiores en ambientes clínicos y ambulatorios para pacientes con afecciones motoras como resultados de enfermedades cerebrovasculares.Métodos: Se presenta a partir de una concepción integradora el diseño del prototipo de un exoesqueleto que permite al paciente realizar movimientos combinados a partir de los cuatro grados de libertad que provee el dispositivo de rehabilitación. El sistema es controlado por medio de una interfaz de usuario desarrollada en Labview que soporta el control e interacción del usuario con el exoesqueleto, lo cual posibilita que el terapeuta puede modificar la rutina que debe realizar el paciente incluyendo nuevas trayectorias y el número de repeticiones a seguir por el exoesqueleto en las articulaciones de hombro, codo y muñeca. Adicionalmente, posibilita la retroalimentación visual de la actividad electromiográfica del paciente durante la rehabilitación.Resultados: Se presenta el diseño mecánico de la armadura, implementación de los sistemas de potencia, el desarrollo del sistema de control y de la interfaz de usuario así como su integración con el sistema mecánico.Conclusiones: Se desarrolla y pone en funcionamiento una avanzada plataforma robótica capaz de desarrollar diversas rutinas terapéuticas combinando 4 grados de libertad en hombro, codo y muñeca, capaz de controlar a través de la interfaz desarrollada desplazamientos regulados, exactos y repetitivos, así como seguir cronológicamente la evolución del paciente registrando la actividad mioeléctrica durante el proceso de rehabilitación.<br /><br /><br /><br />Background: Robot-assisted therapy or exoskeleton is an active mechanical device that can be easily adjusted to fit a different patient limb length, and is able to coordinate and amplify movements. The aim of this study focuses on developing a robotic training system and quantification methods for upper limbs rehabilitation in clinic environments to be used in survivor stroke patients with motor disorders or loss of physical strength on one side of the body.Methods: From an integrated approach, a design of one exoskeleton is presented which allows patients perform complex movements in four degrees of freedom (DOF) rehabilitation system. The system is controlled by means of user interface developed with Lab view v8.6 software that supports control and user interaction with the exoskeleton; so it’s possible for therapist to modify the patient routine including new movements and a number of repetitions in articulating joints of shoulder, elbow and wrist. On other hand system permits bio- feedback of electromyogram patient activity during rehabilitation sessions.Results: Biomechanical analyses and structure design, implementation of power systems, the development of the control system and user interface as well as its integration with the mechanical system is presented.</p><p><br />Conclusions: A robot arm exoskeleton device with four DOF; able to develop complex, accurate and repetitive therapeutic routines for articulating joints of shoulder, elbow and wrist trough an interface is shown. The device permits to follow chronologically patient outcomes recording the electromyogram activity during rehabilitation progress.