دانلود رایگان مقاله انگلیسی یک رباتیک ارتوپدی - روش توانبخشی کمکی دست در فیزیوتراپی واقعیت مجازی - هینداوی 2018

The use of robotic rehabilitation in orthopaedics has been briefly explored. Despite its possible advantages, the use of computerassisted physiotherapy of patients with musculoskeletal injuries has received little attention. In this paper, we detailed the development and evaluation of a robotic-assisted rehabilitation system as a new methodology of assisted physiotherapy in orthopaedics. *e proposal consists of an enhanced end-effector haptic interface mounted in a passive mechanism for allowing patients to perform upper-limb exercising and integrates virtual reality games conceived explicitly for assisting the treatment of the forearm after injuries at the wrist or elbow joints. *e present methodology represents a new approach to assisted physiotherapy for strength and motion recovery of wrist pronation/supination and elbow flexion-extension movements. We design specific game scenarios enriched by proprioceptive and haptic force feedback in three training modes: passive, active, and assisted exercising. *e system allows the therapist to tailor the difficulty level on the observed motion capacity of the patients and the kinesiology measurements provided by the system itself. We evaluated the system through the analysis of the muscular activity of two healthy subjects, showing that the system can assign significant working loads during typical physiotherapy treatment profiles. Subsequently, a group of ten patients undergoing manual orthopaedic rehabilitation of the forearm tested the system, under similar conditions at variable intensities. Patients tolerated changes in difficulty through the tests, and they expressed a favourable opinion of the system through the administered questionnaires, which indicates that the system was well accepted and that the proposed methodology was feasible for the case study for subsequently controlled trials. Finally, a predictive model of the performance score in the form of a linear combination of kinesiology observations was implemented in function of difficult training parameters, as a way of systematically individualising the training during the therapy, for subsequent studies.

Conclusions

Rehabilitation robotics offers the possibility of new methods of physiotherapy in orthopaedics with patients with musculoskeletal injuries, such bone fractures. As a study case, here we presented a new approach to assisted orthopaedic rehabilitation method of the forearm, involving the elbow and wrist joints. Our proposal combines an end-effector robotic system and a virtual-reality mediated software application with the capability of delivering passive, active, and assisted exercising training of flexion/extension and pronation/supination of injured elbow affecting the forearm. *e proposed methodology exploits some existing methods reported separately for neurorehabilitation but integrated within a new framework conceived explicitly for the orthopaedics clinical goal of recovery of functional range of motion, strength, pain reduction, and stiffness prevention. We studied the possibilities of personalising the exercise’s intensity and modify it manually according to the kinesiologic performance of the patient, within safe and moderate controlled online increments during the games, in a more systematic way than traditional manual physiotherapy. *e results of our experiments in healthy participants and patients showed that the proposed strategy is suitable. Besides its limitations, the present work contributed to promoting the development of new assisted methods in orthopaedics and further research in this area. We conclude that the proposed approach may have the potential of enhancing the current manual methods, incrementing the hours of therapy per patients and the number of patients simultaneously and reducing the treatment discharge periods. Future work involves the validation of the system during interventional clinical studies combining manual and assisted sessions some days per week during the whole duration of treatments. Additionally, the developing of other scenarios and the extension of the current system to other musculoskeletal deficits of the upper limb involving other movements would be valuable and may promote the development of new physiotherapy patient-specific methods in the scope of orthopaedic rehabilitation.