Biomechatronics in Medicine and Healthcare

227 Pages·2011·7.623 MB·\227

by  Raymond Tong Kaiyu (Editor)

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Preface
Being multidisciplinary involving subjects such as electronics, mechanics,
medicine and health care, this book provides a fundamental concept as well
as a comprehensive discussion on the field of Biomechatronics. The book is the
resultofseveralyearsofresearchworkbymanygroupsonthedevelopmentand
applicationofbiomechatronicsonhumansubjects. Basicinformationisprovided
inthebeginning of eachchaptertofacilitateclinicians, engineersandstudentsto
havebackgroundknowledge andthenappreciatetheapplicationof thetechnical
as well as clinical aspect at the latter part of the chapter. There is a growing
need for biomechatronic device in medical field hence more research groups are
developingdifferentsystems inthisarea. Thenewdevelopmentcansupportthe
medicalprofessiontohavebetterhealthcare.
The aim of the book is to presentthe insights of expertson emerging technology
and development that are or will be applied in medical professions on a variety
of clinical challenges and then demonstrate how to apply biomechatronic in
providing better care and service. It also incorporates new and exciting mul-
tidisciplinary areas of research across the medical field and engineering field,
suchasrobotictherapeutictrainingsystemforstrokerehabilitation,exoskeletons
for daily activities on persons with disability, Functional Electrical Stimulation
(FES)andWirelessActiveCapsuleEndoscopy. Eachchapterprovidessubstantial
background materials relevant to the particular subject. This can be a primary
referenceforstudentsandresearchersinthefieldofBiomechatronics.
The book is enriched by the contribution of outstanding scientists and experts
worldwide in different topics addressed here. This book would not have been
possible without help and contributions from them and I wish to express my
gratitudetoallofthemfortheirefforts.
TheresearchgroupfromArizonaStateUniversity(USA),consistingofSivakumar
BalasubramanianandJipingHe,havecontributedtoChapter2withnewconcepts
for a wearable exoskeletal system for interactive therapy on upper extremity for
personsafterstroke.
OlivierLambercyandhiscollaborators,oftheETHZurich(Switzerland),National
UniversityofSingapore,SimonFraserUniversity,McGillUniversityandImperial
CollegeLondon,havecontributedtoChapter4withtherobot-assistedrehabilita-
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vi Preface
tionofhandfunctionafterstrokewiththeHapticKnobandtheHandCARE.The
introduction part of neurological basic knowledge of stroke and hand function
afterstrokeprovideagoodbackgroundinformationforstrokerehabilitation.
The book also reflects Japan’s place at the forefront of robotics research. Toru
Suzuki and Eiichi Saitoh from Fujita Health University, Aichi (Japan), have pro-
videdvaluablecontributiontoChapter3aboutawearableexoskeletalrobotWPAL
using inassistinggaitforparaplegia. Researchgroupof Kunihiko Oda,Takehito
Kikuchi, Shiro Isozumi and Junji Furusho, of the Osaka Electro-Communication
University (Japan) and Osaka University (Japan), introduced their isokinetic ex-
ercisemachineusinghighperformancemagnetorheological(MR)fluidbrakeand
iso-contraction exercise in Chapter 11. The third group is Jorge Solis and Atsuo
Takanishi fromWaseda University(Japan). Theyhave contributed toChapter 12
withrobotic-assistedtechnologyofdentalandskinsurgerysimulationformedical
trainingpurposes.
Averyspecialcontribution ofresearchersfromUniversityof Sydney(Australia),
Nur Azah Hamzaid, Che Fornusek and Glen M. Davis, provided a clear intro-
duction of functional electrical stimulation (FES) which is a kind of technology
integratedinbiomechatronicsinChapter7forFES’sapplicationinlegexerciseof
stroketherapy.
I would like to thank the contributions from research groups in Taiwan and
Hong Kong. Chou-Ching K. Lin, Ming-Shaung Ju, Pin-Cheng Kung, Shu-Min
Chen,oftheNationalChengKungUniversityHospitalandNationalChengKung
University(Taiwan),contributedtoChapter9withrobotsforactiverehabilitation
of the upper limbs on the transverse plan for stroke patients. Xiaona Wang and
MaxQ.-H. Meng, of the Chinese Universityof Hong Kong China, contributed to
Chapter13withwirelessactivecapsuleendoscope.
ThereisalsoacontributionfromtheNetherlandsresearchgroup,BirgitI.Molier,
Gerdienke B. Prange, Thijs Krabben, Michiel J. A. Jannink, Jaap H. Buurke, Her-
mie J. Hermens, of the Roessingh Research and Development (theNetherlands),
UniversityofTwenteandRehabilitationCentre’theRoessingh’toChapter10with
upperextremityrehabilitationsystemsandaugmentedfeedback.
Inwritingthis bookI havereceivedthe unstinting supportof mycolleaguesand
studentsintheDepartmentofHealthTechnologyandInformatics,theHongKong
PolytechnicUniversity(PolyU)(HongKong). Thebuild-upofaroboticsystemis
a team work from my graduate students, researchstaff, colleagues in PolyU and
clinical partners. I would to thank all of them, in particular Le Li, Xiaoling Hu,
andNewmenS.K.HofortheircontributionintheintroductiontoBiomechatronics
(Chapter 1), our intention-driven rehabilitation robotic system PolyJbot (Chap-
ter 5), hand robotic system (Chapter 6) and a robotic system combined with FES
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Preface vii
for wrist training (Chapter 8). Persons after stroke gave us a lot of constructive
comments during the experimental setup and system design. I would like to
express my gratitude to their support and feedback. They are the driving force
andIwanttodomoreforthem.
Mostoftheworkpresentedinthisbookhasbeendevelopedaspartoftheproduct
readyforclinicianstoapplyonpersonswithdisability:
• Roboticupper-extremityrepetitivetrainer(ArizonaStateUniversity,USA)
• WPAL—WearablePower-AssistedLocomotor,(FujitaHealthUniversity,Aichi,
Japan)
• HAPTICKNOBandHandCARE—(ETHZurich,NationalUniversityofSinga-
pore,SimonFraserUniversity,McGillUniversityandImperialCollegeLondon)
• PolyJbot—aninteractiveroboticsystemusingEMG(PolyU,HongKong)
Iamverygratefulforallthecontributorsandtheirstrongsupport.
Finally, many thanks to my wife, Wai-nga Lam, and our daughter and son, Lok-
ching Tong and Lok-tin Tong, for their support, encouragement, and patience.
Theyhavebeenmydrivingsource.
RaymondKai-YuTong
AssociateProfessor
TheHongKongPolytechnicUniversity
HongKong
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Contents
Preface v
Contents ix
1. AnIntroductiontoBiomechatronics 1
1.1 WhatisBiomechatronics? . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 WhyStudyBiomechatronics? . . . . . . . . . . . . . . . . . . . . . . 2
1.2.1 AnOverviewoftheNeuromusculoskeletalSystem . . . . 2
1.2.2 TheRoleofBiomechatronics . . . . . . . . . . . . . . . . . . 2
1.2.3 WhatwouldbeaBiomechatronicSystemLookLike? . . . 4
1.3 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2. AWearableExoskeletalRehabilitationRobotforInteractiveTherapy 9
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.2 WhatisRobot-AssistedRehabilitation? . . . . . . . . . . . . . . . . 10
2.2.1 WhyisitUsed? . . . . . . . . . . . . . . . . . . . . . . . . . 10
2.3 ReviewofRehabilitationRobotsfortheUpper-Extremity . . . . . . 12
2.4 RoboticUpper-extremityRepetitiveTrainer–RUPERT . . . . . . . . 15
2.5 RobotControllerandTherapyModes . . . . . . . . . . . . . . . . . 19
2.5.1 RUPERTControllerOverview . . . . . . . . . . . . . . . . . 19
2.5.2 RobotTherapyModes. . . . . . . . . . . . . . . . . . . . . . 21
2.6 AVirtualReality-BasedBiofeedbackInterface . . . . . . . . . . . . 23
2.7 ClinicalStudy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.7.1 PreliminaryResults . . . . . . . . . . . . . . . . . . . . . . . 25
2.8 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3. DevelopmentofGait-AssistedRobotWPAL(Wearable
Power-AssistLocomotor)forParaplegia 31
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2 OverviewofGaitReconstructionofSciWithOrthoses . . . . . . . . 31
3.3 IntroductionofWalkingAbilityandPredictionofWalkingAbility
ofPrimewalk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3.4 LimitationofOrthosisandFutureofRobotics . . . . . . . . . . . . 35
3.4.1 BasicInformationofWPAL. . . . . . . . . . . . . . . . . . . 37
3.4.2 AbilitiesofWPAL . . . . . . . . . . . . . . . . . . . . . . . . 39
3.5 AdvantagestoIntroduceRoboticstoSciGaitReconstruction . . . . 40
3.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
ix
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4. Robot-Assisted Rehabilitation of Hand Function After Stroke
withtheHapticKnobandtheHandCARE 43
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
4.2 Handfunctionafterstroke . . . . . . . . . . . . . . . . . . . . . . . . 45
4.3 Robot-assistedRehabilitationofHandFunction . . . . . . . . . . . 46
4.3.1 TheHapticKnob . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.3.2 TheHandCARE . . . . . . . . . . . . . . . . . . . . . . . . . 48
4.3.3 RehabilitationExercisesandStrategies . . . . . . . . . . . . 48
4.4 Promisesofrobot-assistedtherapyofhandfunction . . . . . . . . . 51
4.4.1 ImprovementinMotorFunction. . . . . . . . . . . . . . . . 51
4.4.2 ImprovedForceControl . . . . . . . . . . . . . . . . . . . . 52
4.4.3 EvolutioninMuscleActivityPatterns. . . . . . . . . . . . . 53
4.4.4 ImprovementinOutcomeMeasures . . . . . . . . . . . . . 55
4.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
5. ANovelContinuousIntention-DrivenRehabilitationRobotand
ItsTrainingEffectiveness 61
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
5.2 Rehabilitation Robotic Systemwith Continuous Intention Driven
Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
5.2.1 TheRoboticSystem . . . . . . . . . . . . . . . . . . . . . . . 63
5.2.2 RobotasanEvaluationSystem . . . . . . . . . . . . . . . . 66
5.3 EvaluationonTrainingEffectiveness . . . . . . . . . . . . . . . . . . 68
5.3.1 Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
5.3.2 TrainingEffects . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.5 FutureStudies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.6 Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
6. HandRehabilitationRobotusingElectromyography 77
6.1 IntroductiontoRehabilitationRobots . . . . . . . . . . . . . . . . . 77
6.1.1 RehabilitationforHandFunctions. . . . . . . . . . . . . . . 78
6.2 DesignoftheHandRehabilitationRobot . . . . . . . . . . . . . . . 78
6.2.1 TaskTrainingWearableHandSystem . . . . . . . . . . . . . 79
6.2.2 HandFunctionTrainingandEvaluationSystem. . . . . . . 79
6.3 ExperimentProcedure . . . . . . . . . . . . . . . . . . . . . . . . . . 81
6.3.1 CalibrationofRangeofMotion . . . . . . . . . . . . . . . . 82
6.3.2 EMGElectrodePlacement . . . . . . . . . . . . . . . . . . . 83
6.3.3 MaximumVoluntaryContraction . . . . . . . . . . . . . . . 83
6.3.4 ControlStrategiesusingInteractiveEMGSignals . . . . . . 84
6.3.5 HardwareandSoftwareInterfaces . . . . . . . . . . . . . . 84
6.4 Pilot Clinical Evaluation of Hand Functions of ELDERLY and
StrokeSubjects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
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6.4.1 EMGSignalAnalysis . . . . . . . . . . . . . . . . . . . . . . 86
6.4.2 MaximumVoluntaryForceAnalysis . . . . . . . . . . . . . 87
6.4.3 Rangeofmotionanalysis . . . . . . . . . . . . . . . . . . . . 89
6.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
6.6 Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
7. FunctionalElectricalStimulationLegExercise:FromTechnology
toTherapy 93
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
7.2 ExerciseforPeoplewithNeurologicalDisabilities . . . . . . . . . . 93
7.2.1 SpinalCordInjuryandExercise . . . . . . . . . . . . . . . . 94
7.3 ElectricalStimulationofMuscles . . . . . . . . . . . . . . . . . . . . 94
7.3.1 StimulationWaveforms . . . . . . . . . . . . . . . . . . . . . 95
7.3.2 PulseFrequency . . . . . . . . . . . . . . . . . . . . . . . . . 95
7.3.3 IntermittentStimulation . . . . . . . . . . . . . . . . . . . . 96
7.3.4 ElectrodeTypesandPlacements . . . . . . . . . . . . . . . . 96
7.3.5 FESMuscleFatigueandMuscleFibreRecruitment . . . . . 97
7.4 Fes-EvokedExercise . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.4.1 BenefitsofFES-evokedExercise . . . . . . . . . . . . . . . . 98
7.4.2 PerformanceControl . . . . . . . . . . . . . . . . . . . . . . 98
7.5 TechnicalDevelopmentofFesExerciseMachines . . . . . . . . . . 99
7.5.1 FESCycling. . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
7.5.2 MotorizedFESCycleErgometers . . . . . . . . . . . . . . . 100
7.5.3 IsokineticFESCyclingExercise . . . . . . . . . . . . . . . . 100
7.5.4 IsokineticCadenceControl . . . . . . . . . . . . . . . . . . . 101
7.5.5 IsokineticFESLegSteppingExercise . . . . . . . . . . . . . 102
7.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
8. Combined Functional Electrical Stimulation (FES) and Robotic
SystemDrivenbyUserIntentionforPost-Stroke
WristRehabilitation 109
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
8.2 TheCombinedFes-RobotSystem . . . . . . . . . . . . . . . . . . . . 110
8.3 SystemPerformanceEvaluation. . . . . . . . . . . . . . . . . . . . . 114
8.4 Fes-RobotAssistedWristTraining . . . . . . . . . . . . . . . . . . . 118
8.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
8.6 Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
9. Development of Robots for Active Rehabilitation of the upper
LimbsontheTransversePlanforStrokePatients 125
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
9.2 OurPlanarRehabRobotforUpperLimbs . . . . . . . . . . . . . . . 128
9.3 EvaluationofBenefitsforRehabilitationwithRobots . . . . . . . . 133
9.4 FutureDevelopment . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
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9.5 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
10. UpperExtremityRehabilitationSystemsandAugmentedFeedback 143
10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.2 Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.2.1 Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
10.2.2 Impairments . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
10.2.3 Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
10.3 RehabilitationTherapy . . . . . . . . . . . . . . . . . . . . . . . . . 145
10.3.1 KeyElements . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
10.3.2 CurrentTherapies . . . . . . . . . . . . . . . . . . . . . . . . 146
10.4 RoboticDevices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
10.4.1 PassiveandActiveMovement . . . . . . . . . . . . . . . . . 147
10.4.2 GravityCompensation . . . . . . . . . . . . . . . . . . . . . 147
10.5 AugmentedFeedback . . . . . . . . . . . . . . . . . . . . . . . . . . 148
10.5.1 Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
10.5.2 Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
10.6 FutureResearch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
10.7 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
11. IsokineticExerciseMachineUsingHighPerformanceMRFluid
BrakeandIso-ContractionExercise 157
11.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
11.2 ConventionalIsokineticExercise&Proposed
Iso-contractionExercise . . . . . . . . . . . . . . . . . . . . . . . . . 158
11.2.1 ConventionalIsokineticExercise. . . . . . . . . . . . . . . . 158
11.2.2 Hill’sequation . . . . . . . . . . . . . . . . . . . . . . . . . . 159
11.2.3 ProposalofIso-contractionExercise . . . . . . . . . . . . . . 160
11.3 ExperimentalSetup . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
11.3.1 MRFluidBrake . . . . . . . . . . . . . . . . . . . . . . . . . 161
11.3.2 MuscleStrengthEvaluationandTrainingusing
MRFluidBrake . . . . . . . . . . . . . . . . . . . . . . . . . 162
11.4 IsokineticExercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
11.4.1 ControlMethod . . . . . . . . . . . . . . . . . . . . . . . . . 164
11.4.2 ExperimentalMethod . . . . . . . . . . . . . . . . . . . . . . 165
11.4.3 ExperimentalResults . . . . . . . . . . . . . . . . . . . . . . 165
11.5 Iso-ContractionExercise . . . . . . . . . . . . . . . . . . . . . . . . . 167
11.5.1 ControlMethod . . . . . . . . . . . . . . . . . . . . . . . . . 167
11.5.2 ExperimentalMethod . . . . . . . . . . . . . . . . . . . . . . 168
11.5.3 ExperimentalResults . . . . . . . . . . . . . . . . . . . . . . 168
11.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
12. Robotic-AssistedTechnologyforMedicalTrainingPurposes 171
12.1 MotorControlandLearning . . . . . . . . . . . . . . . . . . . . . . . 171
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