A robo-mechatronic system conceived for the motor rehabilitation and functional recovery of the upper limbs of patients with severe stroke outcomes. Aramis is composed of two symmetrical exoskeletons each having 5 degrees of active freedom and 2 degrees of passive freedom to allow being adjusted precisely on the different patients. The patient is seated in an adjustable chair that is placed in the centre between the two exoskeletons he or she is wearing. The kinematic chain of each exoskeleton was reproduced starting from the natural movements of the human arm. Each exoskeleton is “master” and “slave” of the other and can record the movement of the healthy limb and replicate it on the hemiplegic limb. The rehabilitation program is established by the rehabilitator. The system allows customising sessions or using preloaded programs and rehabilitation sessions. The patient, wearing the exoskeletons in a maximum time of 5 minutes, starts the session in total safety with minimum supervision by the therapist. The Aramis operating methods include:
– the possibility of recording the three-dimensional movement in space with the healthy limb and repeating it asynchronously on the hemiplegic limb;
– the possibility of recording the three-dimensional movement in space with the healthy limb and replicating it in sync on both exoskeletons;
– the possibility of the intervention by the robot in active-assisted mode if the patient does not manage to complete the movement of his or her previous registration. In this last mode, an index can be extrapolated relative to the activity carried out by the patient and to the activity carried out by the robot. Lastly, in the active-assisted mode it is possible to select a percentage of completion of the movement recorded by the patient in order to gradually increase it to stimulate the patient in doing the exercise successfully.
The study protocol was approved in September 2009 by the Ministry of Health and Social Affairs Department of Innovation Directorate-General Medical and Pharmaceutical Devices and by the Local Ethics Committee and in accordance with the Helsinki Declaration.
It is a sensor device made by Tyromotion for the rehabilitation of the upper limb with particular interest in the movement of the shoulder, elbow and wrist joints. The device has a handy sensor handle connected to the PC and integrated into additional platforms to monitor vertical and horizontal movements of the shoulders (housing platform for the forearm) and hand rotation (spherical platform for the hand). Pablo has four sensors, three which detect accelerations in the three spatial dimensions and the other one detects the strength. Data are recorded as quantitative measurements of isometric force of the hand and isotonic rotation angles of the hand that allow the pronation and supination movements of the wrist. The methods of use of the device consist of both evaluation and rehabilitation exercises. The evaluation concerns the grip and strength of the hands (grip/extension strength, precision grip, lateral grip, interdigital grip, tridigital grip), shoulder movements (abduction, adduction, flexion and shoulder extension), movements of the elbow (flexion and extension of the elbow), movements of the wrist (supination, pronation, flexion, extension, ulnar/radial abduction) and finally the strength control index. Rehabilitation is allowed by performing one-dimensional precision and reaction exercises, two-dimensional motor and cognitive exercises and virtual reality exercises.
A sensor device made by Tyromotion for the rehabilitation of the fine motility of the hands and with particular interest in the movement of the fingers. In fact, the device simulates the natural movement of the fingers in three possible modes: passive, assisted and active. Besides, being a valid rehabilitative tool, it also has the function of being a tool to assess muscle tone and spasticity. Specifically, to these pathological conditions, it is possible to perform dedicated training exercises aimed at the spasticity and sensitivity recovery.
A virtual reality device for the upper limb rehabilitation. In detail, it consists of a movement detection system (recordable by an infrared camera) that interacts with a software system that converts the movement of the upper limb into executive activities to perform the various rehabilitation exercises that are displayed on a monitor placed in front of the patient. Two types of scenarios have been implemented with the possibility of carrying out the exercises without any distinction between the right or left upper limb.
Khymeia VRRS (Virtual Reality Rehabilitation System)
A Class I medical device certified internationally and based on a virtual reality rehabilitation and tele-rehabilitation system. The extreme ease of use, the high ability of customisation, the complete automatic reporting, the tele-rehabilitation function, are some of the guiding principles of the ongoing development of the system. In fact, VRRS is conceived as a “central HUB” to which it is possible to connect a series of specialised peripheral devices via USB, completely synchronised and integrated with the system. VRRS, with the exclusive magnetic kinematic acquisition system, is used as a clinical routine for the rehabilitation of a wide spectrum of pathologies through the numerous rehabilitative modules including a vast library of clinically validated exercises for the neurological recovery (motor, cognitive, speech therapy, posturographic, hand, fingers and wrist, cervical head, immersive virtual reality, occupational therapy, muscle synergies) and orthopaedic (ankle, knee, pelvis, hip, hand, fingers, wrist, elbow, shoulder, back, cervical head).