A Simple Robotic System for Neurorehabilitation

In the recent past, several researchers have shown that important variables in relearning motor skills and in changing the underlying neural architecture after stroke are the quantity, duration, content, and intensity of training sessions. Unfortunately, when traditional therapy is provided in a hospital or rehabilitation center, the patient is usually seen for few hours a week. Robot-mediated therapies could improve this situation but even if interesting results have been achieved by several groups, the use of robot-mediated therapy has not become very common in clinical practice. This is due to many different reasons (e.g., the “technophobia” of some clinicians, the need for more extensive clinical trials) but one of the more important is the cost and the complexity of these devices which make them difficult to be purchased and used in all the clinical centers. The aim of this work was to verify the possibility of improving motor recovery of hemiparetic subjects by using a simple mechatronic system. To achieve this goal, our system (named “MEchatronic system for MOtor recovery after Stroke” (MEMOS)) has been designed with the aim of using mainly “off-the-shelf products” with only few parts simply manufactured with standard technology, when commercial parts were not available. Moreover, the prototype has been developed taking into account the requirements related to the clinical applicability such as robustness and safety. The MEMOSsystem has been used during clinical trials with subjects affected by chronic hemiparesis (<6 months from the cerebrovascular accident). The results obtained during these experiments seem to showthat notwithstanding the simple mechatronic structure characterizing theMEMOSsystem, it is able to help chronic hemiparetics to reduce their level of impairment. Further clinical experiments with acute and chronic subjects will be carried out in order to confirm these preliminary findings. Moreover, experiments for tele-rehabilitation of patients will be also carried out. Silvestro Micera was born in Taranto, Italy, on August 31, 1972. He received the University degree (Laurea) in electrical engineering from the University of Pisa, Pisa, Italy, in 1996, and the Ph.D. degree in biomedical engineering from the Scuola Superiore Sant'Anna, Pisa, Italy, in 2000. From 1998 to 2001, he was the Project Manager of the EU GRIP Project (ESPRIT LTR Project 26322, “An integrated system for the neuroelectrIic control of grasp in disabled persons”). During 1999, he was a Visiting Researcher at the Center for Sensory-Motor Interaction, Aalborg University. Since May 2000, he has been an Assistant Professor of Biomechanical Engineering at the Scuola Superiore Sant'Anna. He is currently involved in several projects on neuro-robotics and rehabilitation engineering. His research interests include the development of neuro-robotic systems (interfacing the central and peripheral nervous system with robotic artefacts) and the development of mechatronic and robotic systems for function restoration in disabled persons. Dr. Micera is an Associate Editor of the IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING and member of the IEEE Engineering in Medicine and Biology and Robotics and Automation Societies. M. Chiara Carrozza received the Laurea degree in physics from the University of Pisa, Pisa, Italy, in 1990. Since 2001, she has been an Associate Professor of biomedical robotics at the Scuola Superiore Sant'Anna, Pisa, Italy. She is the co-cordinator of the Advanced Robotics Technology and Systems Laboratory where she is responsible for some national and international projects in the fields of biorobotics. Her research interests are in the fields of biorobotics (artificial hands, upper limb exoskeletons), rehabilitation engineering (neurorehabilitation, domotic, and robotic aids), and biomedical microengineering (microsensors, tactile sensors). She is an author of several scientific papers and international patents. Eugenio Guglielmelli received the Laurea degree and the PhD in electronics engineering from the University of Pisa, Italy, in 1991 and in 1995, respectively. He is currently Associate Professor of Bioengineering at Campus Bio-Medico University in Rome, Italy, where he teaches the courses of Bio-Mechatronics and of Rehabilitation Bioengineering, and where he also recently co-founded the new Research Laboratory of Biomedical Robotics & Electro-Magnetic Compatibility. He has been working in the field of biomedical robotics over the last fifteen years at Scuola Superiore Sant'Anna where he also served from 2002 to 2004 as the Head of the Advanced Robotics Technology & Systems Laboratory (ARTS Lab), founded by prof. Paolo Dario in 1991. His main current research interests are in the fields of novel theoretical and experimental approaches to human-centered robotics and to biomporphic control of mechatronic systems, and in their application to robot-mediated motor therapy, assistive robotics, neuro-robotics and neuro-developmental engineering. He serves in the Editorial Board of the International Journal on Applied Bionics and Biomechanics. He has been Guest Co-Editor of the Special Issue on Rehabilitation Robotics of the International Journal ‘Autonomous Robots’. He is member of the IEEE Robotics & Automation Society, of the IEEE Engineering in Medicine & Biology Society, of the Society for Neuroscience, and of the Association for the Advancement of Assistive Technology in Europe (AAATE). He served (2002–03) as the Secretary of the IEEE Robotics & Automation Society (RAS) and he is currently Co-chair of the RAS Technical Committee on Rehabilitation Robotics. He serves in the Programme Committees of several International Conferences, such as ICRA, IROS, ICAR, AIM, BIOROB and others. He was/is a member of the Organizing Committees of ICAR2003, IROS2004, IFAC/SYROCO2006 and ICRA2007. Giovanni Cappiello received the M.E. degree from the University of Pisa, Pisa, Italy. He is currently working towards the Ph.D. degree in robotics at the ARTS Lab of the Scuola Superiore Sant'Anna Pisa. He worked on the RTR IV Prosthetic Hand Project. Among his research interests are rehabilitation technologies, biomedical and surgical devices, osseointegration, and biomimetic artificial sensors. He is involved in the design of antropomorphic hands and arm and in the exploitation of compliant joints. Franco Zaccone was born in Policoro, Italy. He received the University degree (Laurea) in electrical engineering from the University of Pisa, Pisa, Italy, in 2000. Since June 2000, he has been a Research Assistant at the Advanced Robotics Technologies and Systems Laboratory, Scuola Superiore Sant'Anna, Pisa. His research interests include the design of hardware systems for rehabilitation engineering and motion analysis. Cinzia Freschi was born in Caserta, Italy, on December 25, 1969. She received the University degree (Laurea) in computer engineering from the University of Pisa, Pisa, Italy, in 1998. Since 1998, she has been research assistant at the Advanced Robotics Technology and Systems Laboratory (ARTSLAB), Scuola Superiore Sant'Anna. Her research interests are in the filed of rehabilitation engineering and neuro-robotics. Roberto Colombo received the Dr. Eng. degree in electrical engineering from the Politecnico of Milano, Milan, Italy, in 1980. Since 1981, he has been a Research Engineer in the Bioengineering Department of the “Salvatore Maugeri” Foundation, IRCCS, Rehabilitation Institute, Veruno, Italy. From 1998 to 2001, he was a Partner of the European Community project “Prevention of muscular disorders in operation of computer input devices (PROCID).” From 2001 to 2004, he was the Coordinator of the project “Tecniche robotizzate per la valutazione ed il trattamento riabilitativo delle disabilitá motorie dell'arto superiore,” 2001-175, funded by the Italian Ministry of Health. His research interests include robot-aided neurorehabilitation, muscle tone and spasticity evaluation, muscle force and fatigue assessment, speech production mechanisms study, cardiovascular control assessment by spectral analysis of heart rate variability signals, and respiratory mechanics assessment. He has taught several national courses in the field of neurorehabilitation. He is the author of over 20 papers and the co-editor of one book on the subject of speech production mechanisms. Alessandra Mazzone received the degree (Diploma) in computer science, from the ITIS “Leonardo da Vinci,” Borgomanero, Italy, in 1988. Since 1989, she has been a Programmer at the Bioengineering Department, the Fondazione Salvatore Maugeri, Rehabilitation Institute of Veruno (NO), Italy. Her research interests include robot-aided neurorehabilitation, cardiovascular control assessment by spectral analysis of heart rate variability signals, and respiratory mechanics assessment. Carmen Delconte received the Diploma in neurophysiology techniques from the University of Pavia, Pavia, Italy, in 1989. She is currently with the Clinical Neurophysiology Unit, Scientific Institute of Veruno “Salvatore Maugeri” Foundation, Rehabilitation Institute, Veruno, Italy. Her research concerns the quantification of muscle tone, emg-biomechanical studies, and the robotic rehabilitation of upper limb in cerebrovascular diseases. She has been published in the clinical and electrophisiological field of neuromuscular diseases and on the topic of stroke patients rehabilitation. Her current research is focused on the evaluation and treatment of upper limbs disorders like spasticity and paresis. Dr. Delconte is a member of the Italian Neurophysiology Technician Society. Fabrizio Pisano received the M.D. degree from the University of Milan, Milan, Italy, in 1981. In 1986, he completed his training as resident in neurology and became Neurologist at the same University He was a teacher in “Electromyography” from 1991 to 1997 at the School of Physical Medicine and Rehabilitation, the University of Turin, Torino, Italy. He has taught several national and international electromyographic courses on hand neuromotor rehabilitation, occupational pathology, rehabilitation therapy, muscle fatigue, posture and movement, clinical neurophysiology, and EMG Culture. He was a Scientific Project co-leader of a telethon program (1994–1996); speech motor control in ALS; a search for an early marker of disease. He was the Project Leader of “Quantitative Analysis of Spastic Hypertonia” by the Istituto Superiore della Sanitá during 1998–1999. He was the Clinical Scientific Leader of the INAIL project “International clinical survey over functional electrical stimulation.” He was the Scientific Project Leader of the Clinical Neurophysiology Unit of the project “Tecniche robotizzate per la valutazione ed il trattamento riabilitativo delle disabilitá motorie dell'arto superiore,” 2001-175, funded by the Italian Ministry of Health. He is currently a Neurologist and the Head of the Clinical Neurophysiology Unit, ”Salvatore Maugeri” Foundation, IRCCS, Rehabilitation Institute, Veruno, Italy. He has been published in the clinical and electrophysiological field of neuromuscular diseases and on the topic of stroke patients rehabilitation. His current research interests are in evaluation and treatment of upper limb disorders like spasticity and paresis. Dr. Pisano is a Member of the Italian Neurological Society and the Italian Clinical Neurophysiology Society. Giuseppe Minuco received the Dr. Eng. degree in mechanical engineering from the Politecnico Milano, Milan, Italy, in 1972, and a postgraduate degree in biomedical engineering from the Faculty of Medicine, Bologna, Italy, in 1975. He is currently Head of the Bioengineering Department, “Salvatore Maugeri” Foundation, IRCCS, Pavia, Italy. He is Chair of the Technical Scientific Committee of “CBIM” (Medical Informatics and Bioengineering Consortium) Pavia, Italy. He is Member of the Editorial Board of The Monaldi Archives for Chest Disease and of Giornale Italiano di Medicina del Lavoro ed Ergonomia. Has taught several courses in healthcare management. His main interests are in the fields of rehabilitation engineering, clinical engineering, medical informatics, and telemedicine. Paolo Dario received the Dr. Eng. degree in mechanical engineering from the University of Pisa, Pisa, Italy, in 1977. He is currently a Professor of Biomedical Robotics at the Scuola Superiore Sant'Anna, Pisa, Italy. He also teaches courses at the School of Engineering of the University of Pisa, and at the Campus Biomedico University, Rome, Italy. He has been a Visiting Professor at Brown University, Providence, RI, at the Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, Switzerland, and at Waseda University, Tokyo, Japan. He was the founder of the Advanced Robotics Technologies and Systems (ARTS) Laboratory and is currently the co-cordinator of the Center for Research in Microengineering (CRIM) Laboratory of the Scuola Superiore Sant'Anna, where he supervises a team of about 70 researchers and Ph.D. students. He is also the Director of the Polo Sant'Anna Valdera and a Vice-Director of the Scuola Superiore Sant'Anna. His main research interests are in the fields of medical robotics, mechatronics, and micro/nanoengineering, and specifically in sensors and actuators for the above applications. He is the coordinator of many national and European projects, the editor of two books on the subject of robotics, and the author of more than 200 scientific papers (75 in ISI journals). He is Editor-in-Chief, Associate Editor, and Member of the Editorial Board of many international journals. Prof. Dario served as President of the IEEE Robotics and Automation Society during 2002–2003, and he is currently Co-Chair of the Technical Committees on Bio-robotics and of Robo-ethics of the same society. He is a Fellow of the European Society on Medical and Biological Engineering, and a recipient of many honors and awards, such as the Joseph Engelberger Award. He is also a Member of the Board of the International Foundation of Robotics Research (IFRR).