Passive training with upper extremity exoskeleton robot affects proprioceptive acuity and performance of motor learning

Chiyohara, Shinya; Furukawa, Jun-ichiro; Noda, Tomoyuki; Morimoto, Jun; Imamizu, Hiroshi

doi:10.1038/s41598-020-68711-x

Cited by 27 publications

(18 citation statements)

References 27 publications

(33 reference statements)

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“…Several forms of somatosensory intervention such as passive, repetitive cutaneous stimulation [ 10 , 11 ], passive limb movement training [ 12 ], repeated somatosensory discrimination practice and active sensorimotor training with augmented somatosensory feedback [ 7 , 13 , 14 , 15 ] have been proposed to aid recovery of proprioceptive function and motor function after stroke. Proprioceptive improvements observed after proprioceptive training interventions correlated with improvement of untrained motor performance in healthy young adults [ 16 , 17 ]. This further supports the rationale to implement proprioceptive-motor training for people with stroke.…”

Section: Introductionmentioning

confidence: 99%

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Yeh

Holst-Wolf

Elangovan

et al. 2021

J NeuroEngineering Rehabil

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Background Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. Methods Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). Results Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. Conclusions This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.

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Section: Introductionmentioning

confidence: 99%

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Yeh

Holst-Wolf

Elangovan

et al. 2021

J NeuroEngineering Rehabil

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“…In passive training, the patient is fully relaxed, and movements are fully assisted. This type of training reduces joint stiffness, edema [25] and improves proprioceptive acuity [26]. Active training is a crucial ingredient for recovery following neurological rehabilitation [27], [28], where the patient performs all movements voluntarily to complete therapy tasks; when a therapist or a robot provides some external assistance, this is referred to as active-assisted training.…”

Section: Introductionmentioning

confidence: 99%

Plug-and-Train Robot (PLUTO) for Hand Rehabilitation: Design and Preliminary Evaluation

Nehrujee¹,

Andrew

Reethajanetsurekha

et al. 2021

IEEE Access

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Hand neurorehabilitation involves training movements at the forearm, wrist, fingers, and thumb joints. Assisted training of all these joints requires either one complex multiple degree-of-freedom (DOF) robot or a set of simple robots with one or two DOF. Neither of these is economic or clinically viable. This paper addresses this problem with the PLUg and train rObot (PLUTO)-a single DOF robot that can train multiple joints one at a time. PLUTO has a single actuator with a set of passive attachments/mechanisms that can be easily attached/detached to train for wrist flexion-extension, wrist ulnar-radial deviation, forearm pronation-supination, and gross hand opening-closing. The robot can provide training in active and assisted regimes. PLUTO is linked to performance adaptive computer games to provide feedback to the patients and motivate them during training. As the first step towards clinical validation, the device usability was evaluated by 45 potential stakeholders/end-users of the device, including 15 patients, 15 caregivers, and 15 clinicians with standardized questionnaires: System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Patients and caregivers were administered the questionnaire after a two-session training with the robot. Clinicians, on the other hand, had a single session demo, after which feedback was obtained. The total SUS score obtained from patients, clinicians, and caregivers was 73.3 ± 14.6 (n = 45), indicating good usability. The UEQ score was rated positively in all subscales by both patients and clinicians, indicating that the features of PLUTO match their expectations. The positive response from the preliminary testing and the feedback from the stakeholders indicate that with additional passive mechanisms, assessment features, and optimized ergonomics, PLUTO will be a versatile, affordable, and useful system for hand rehabilitation.

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“…The present task consists of a repetition of sequential finger movements, in which afferent sensory feedback derived from a keystroke is used to correct the subsequent movements for ensuring the spatiotemporal accuracy of those movements 8 . Several studies reported improvement of proprioceptive acuity through repetition of passive movements generated by a robot 30,31 . This may reduce the accuracy demand of the movements, and thereby allow for increasing the maximum rate of the repetitive finger movements.…”

Section: Discussionmentioning

confidence: 99%

Passive somatosensory training enhances piano skill in adolescent and adult pianists: A preliminary study

Furuya

Tanibuchi

Nishioka

et al. 2022

Annals of the New York Academy of Sciences

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Sensory afferent information, such as auditory and somatosensory feedback while moving, plays a crucial role in both control and learning of motor performance across the lifespan. Music performance requires skillful integration of multimodal sensory information for the production of dexterous movements. However, it has not been understood what roles somatosensory afferent information plays in the acquisition and sophistication of specialized motor skills of musicians across different stages of development. In the present preliminary study, we addressed this issue by using a novel technique with a hand exoskeleton robot that can externally move the fingers of pianists. Short‐term exposure to fast and complex finger movements generated by the exoskeleton (i.e., passive movements) increased the maximum rate of repetitive piano keystrokes by the pianists. This indicates that somatosensory inputs derived from the externally generated motions enhanced the quickness of the sequential finger movements in piano performance, even though the pianists did not voluntarily move the fingers. The enhancement of motor skill through passive somatosensory training using the exoskeleton was more pronounced in adolescent pianists than adult pianists. These preliminary results implicate a sensitive period of neuroplasticity of the somatosensory‐motor system of trained pianists, which emphasizes the importance of somatosensory‐motor training in professional music education during adolescence.

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Passive training with upper extremity exoskeleton robot affects proprioceptive acuity and performance of motor learning

Cited by 27 publications

References 27 publications

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Effects of a robot‐aided somatosensory training on proprioception and motor function in stroke survivors

Plug-and-Train Robot (PLUTO) for Hand Rehabilitation: Design and Preliminary Evaluation

Passive somatosensory training enhances piano skill in adolescent and adult pianists: A preliminary study

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