Akremi H1, Higgins J1,2, Aissaoui R3, Nadeau S4
1Université de Montréal, School of Rehabilitation Montreal, Montreal, Canada, 2Centre de Recherche Interdisciplinaire en Réadaptation, Montreal, Canada, 3École de Technologie Supérieure, Département de Génie de la Production Automatisée, Montreal, Canada, 4Université de Montréal, School of Rehabilitation, Montreal, Canada
Background: Bilateral Upper Limb (UL) coordination is necessary to improve accomplishment of daily activities but is often severely affected after stroke.
Purpose: This study aims first, to present a new bilateral exerciser as a tool to quantify and retrain UL coordination in individuals post-stroke. Second, to document the feasibility and performance of a group of chronic stroke individuals in terms of kinetic and kinematic parameters during a session of rehabilitation training.
Methods: The bilateral exerciser was developed by a team of rehabilitation engineers, physical and occupational therapists as well as end-users. The design criteria were to:
1) allow the execution of repeated active and passive bilateral UL movements in variable directions using instrumented handle;
2) be usable by severely and mildly impaired patients;
3) enable control of the mode of bilateral movements by clinicians (i.e. synchronous and asynchronous modes) and select the magnitude of the controlled variable (i.e. linear slider velocity, resistance and excursion);
4) provide real-time visual feedback of the strength produced by the user during training;
5) carry out training in sitting or standing.
Using the universal design approach, linear actuators that allow for precise control of linear position, velocity and acceleration were selected. Each actuator was coupled with an instrumented handle and mounted on a rail, allowing for repeated pushing and pulling movements for different ranges of motion.
Results: The exerciser fulfills our main design criteria with some exceptions. To respect budget constraints, its use is limited to movements performed in sitting, as well as to participants that can hold the handles. The exerciser allows performing repeated linear forward and backward movements of the UL. The ROM of the rails is 75 cm allowing the elbow flexion angle to vary from 80° to full extension with ROM in shoulder abduction from the neutral to 50°. The linear speed of the handle ranges from 0 (static) to 115°/s. The maximal resistance force can reach the value of 636 N. The exerciser allows three modes of motions: passive, assistive and resistive force. Ten post-stroke subjects (median age; 60,5 years time post-stroke; 4 months) able to hold a handle participated. All participants were able to execute 30 min protocol with one bilateral pushing task lasting 6 min: this was repeated for both sides (paretic and no-paretic). The real-time visual feedback was easy to follow. Resistance was personalized and normalized to 15 and 30% of the maximal voluntary force production. Maximal forces generated by the UL ranged from 65-170 N and the range of motion from 22 to 37cm. Only one participant with moderate pain at the paretic shoulder complained after using the exerciser. No other adverse effect was reported.
Conclusion(s): The exerciser is a promising tool to assess UL bilateral coordination. Future studies will help to get insight into the personalized dose of training and to demonstrate the added value provided by the apparatus.
Implications: This device allows researchers and rehabilitation professionals to assess bilateral coordination and has the potential to provide different modalities of bilateral training for UL.
Keywords: Bilateral coordination, upper limb, stroke
Funding acknowledgements: REA foundation, INTER network for financial support, Emeraux B. data collection, Marineau D., Gourdou P., Goyette M., for technical support.
Purpose: This study aims first, to present a new bilateral exerciser as a tool to quantify and retrain UL coordination in individuals post-stroke. Second, to document the feasibility and performance of a group of chronic stroke individuals in terms of kinetic and kinematic parameters during a session of rehabilitation training.
Methods: The bilateral exerciser was developed by a team of rehabilitation engineers, physical and occupational therapists as well as end-users. The design criteria were to:
1) allow the execution of repeated active and passive bilateral UL movements in variable directions using instrumented handle;
2) be usable by severely and mildly impaired patients;
3) enable control of the mode of bilateral movements by clinicians (i.e. synchronous and asynchronous modes) and select the magnitude of the controlled variable (i.e. linear slider velocity, resistance and excursion);
4) provide real-time visual feedback of the strength produced by the user during training;
5) carry out training in sitting or standing.
Using the universal design approach, linear actuators that allow for precise control of linear position, velocity and acceleration were selected. Each actuator was coupled with an instrumented handle and mounted on a rail, allowing for repeated pushing and pulling movements for different ranges of motion.
Results: The exerciser fulfills our main design criteria with some exceptions. To respect budget constraints, its use is limited to movements performed in sitting, as well as to participants that can hold the handles. The exerciser allows performing repeated linear forward and backward movements of the UL. The ROM of the rails is 75 cm allowing the elbow flexion angle to vary from 80° to full extension with ROM in shoulder abduction from the neutral to 50°. The linear speed of the handle ranges from 0 (static) to 115°/s. The maximal resistance force can reach the value of 636 N. The exerciser allows three modes of motions: passive, assistive and resistive force. Ten post-stroke subjects (median age; 60,5 years time post-stroke; 4 months) able to hold a handle participated. All participants were able to execute 30 min protocol with one bilateral pushing task lasting 6 min: this was repeated for both sides (paretic and no-paretic). The real-time visual feedback was easy to follow. Resistance was personalized and normalized to 15 and 30% of the maximal voluntary force production. Maximal forces generated by the UL ranged from 65-170 N and the range of motion from 22 to 37cm. Only one participant with moderate pain at the paretic shoulder complained after using the exerciser. No other adverse effect was reported.
Conclusion(s): The exerciser is a promising tool to assess UL bilateral coordination. Future studies will help to get insight into the personalized dose of training and to demonstrate the added value provided by the apparatus.
Implications: This device allows researchers and rehabilitation professionals to assess bilateral coordination and has the potential to provide different modalities of bilateral training for UL.
Keywords: Bilateral coordination, upper limb, stroke
Funding acknowledgements: REA foundation, INTER network for financial support, Emeraux B. data collection, Marineau D., Gourdou P., Goyette M., for technical support.
Topic: Robotics & technology; Neurology: stroke; Musculoskeletal: upper limb
Ethics approval required: Yes
Institution: Institut de réadaptation Gingras-Lindsay
Ethics committee: Comité d’éthique des établissements du CRIR
Ethics number: CRIR-1202-0117
All authors, affiliations and abstracts have been published as submitted.
