An Orthopaedic Robotic-Assisted Rehabilitation Method of the Forearm in Virtual Reality Physiotherapy

Abstract

The use of robotic rehabilitation in orthopaedics has been briefly explored. Despite its possible advantages, the use of computer-assisted physiotherapy of patients with musculoskeletal injuries has received little attention. In this paper, we detailed the development and evaluation of a robotic-assisted rehabilitation system as a new methodology of assisted physiotherapy in orthopaedics. The proposal consists of an enhanced end-effector haptic interface mounted in a passive mechanism for allowing patients to perform upper-limb exercising and integrates virtual reality games conceived explicitly for assisting the treatment of the forearm after injuries at the wrist or elbow joints. The present methodology represents a new approach to assisted physiotherapy for strength and motion recovery of wrist pronation/supination and elbow flexion-extension movements. We design specific game scenarios enriched by proprioceptive and haptic force feedback in three training modes: passive, active, and assisted exercising. The system allows the therapist to tailor the difficulty level on the observed motion capacity of the patients and the kinesiology measurements provided by the system itself. We evaluated the system through the analysis of the muscular activity of two healthy subjects, showing that the system can assign significant working loads during typical physiotherapy treatment profiles. Subsequently, a group of ten patients undergoing manual orthopaedic rehabilitation of the forearm tested the system, under similar conditions at variable intensities. Patients tolerated changes in difficulty through the tests, and they expressed a favourable opinion of the system through the administered questionnaires, which indicates that the system was well accepted and that the proposed methodology was feasible for the case study for subsequently controlled trials. Finally, a predictive model of the performance score in the form of a linear combination of kinesiology observations was implemented in function of difficult training parameters, as a way of systematically individualising the training during the therapy, for subsequent studies.

Serious Gaming Technology in Upper Extremity Rehabilitation: Scoping Review

“…It is worth noting that several studies monitored other kinematic indicators of the patient’s health condition that are not included in the game target classes for describing the patient’s overall improvement [ 21 , 68 , 124 , 126 , 128 , 135 , 137 , 164 ]. Specifically, five studies [ 68 , 124 , 128 , 137 , 164 ] referred to the smoothness of the hand movement, or hand steadiness (jerk), during therapy sessions as the main feature.…”

“…In addition, some studies attempted to either control or monitor patients' movements using medical devices such as EMG [30][31][32]34,41,44,87,112,[134][135][136][137][138][139][140][141][142]. With EMG, it is possible to monitor how the muscles respond to nerve signals.…”

“…These are studies in which robotic gloves were developed to control the fingers [35,42,61,79,[150][151][152][153][154][155][156], and in which robotic arms were created to cover the surface from the shoulder to the wrist [4][5][6][7][8][9][10][11]48,49,110,139,[157][158][159][160][161]. Additionally, many research teams have focused on the development of a handle to obtain control of the arm force and movement [12,56,135,[162][163][164][165][166][167][168][169][170][171][172][173] or similar robotics [174][175][176][177]. A summary of these devices is shown in Figure 4.…”

The Efficacy of Tele-Rehabilitation Program for Improving Upper Limb Function among Adults Following Elbow Fractures: A Pilot Study

“…A recent review surveying gaming and tele-rehabilitation for treating orthopedic injuries [16] showed that the great majority of tele-rehabilitation studies included lower limb orthopedics patients. While advanced technologies for allowing monitored elbow tele-rehabilitation emerge [17,18], literature investigating the value of tele-rehabilitation following elbow injuries is lacking. To the best of our knowledge, while tele-rehabilitation was shown to be a valid and reliable tool for assessment of elbow disorders [19], no previous studies investigated the effect of tele-rehabilitation following elbow fractures.…”

Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial

“…Nowadays, physical therapists work with traditional devices for therapeutic exercise, common in every rehabilitative center, or employ their own strength for manual mobilizations. In contrast to what has been happening in the neuro-rehabilitative field [ 13 – 15 ], in the orthopedic one examples of robot-aided assessment and rehabilitation of wrist injuries are hard to find [ 16 , 17 ]. However, analogously to what has been observed in the neuro-motor reeducation of the upper limb in subjects after stroke or spinal cord injuries [ 18 – 21 ], advantages are expected from the use of these devices for the functional reeducation after wrist traumatic injuries.…”