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Background: Spasticity of the ankle can occur in multiple sclerosis and stroke, and can significantly reduce quality of life by impeding walking and other activities of daily living. Robot driven continuous passive motion (CPM) of the ankle may be a beneficial rehabilitation strategy for lower limb spasticity management, but, objective measures of decreased spasticity and improved locomotion remains uncertain. Additionally, the acute and chronic effects of CPM on spinal cord excitability are unknown. Objectives: To evaluate: 1) the acute changes in spinal cord excitability induced by 30 min of CPM at the ankle joint, in neurologically intact individuals and in those with lower limb spasticity; and, 2) chronic training-induced effects of 6 weeks of bilateral CPM training on reflex excitability and locomotion in those with lower limb spasticity. Methods: Spinal cord excitability was assessed using Hoffmann (H-) reflex recruitment curves, collected immediately before and following 30 min of CPM of the right (neurologically intact) or more affected (clinical) ankle. A multiple baseline repeated measures study design was used to assess changes following 18 bilateral CPM training sessions. Spasticity and locomotion were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Results: Twenty-one neurologically intact (6 female, 15 male, mean age 24.5 ± 1.7y) and 9 participants with spasticity (3 female, 6 male, mean age 58.9 ± 9.7y) due to various neurological conditions including stroke (n=4), MS (n=3), spinal cord injury (n=1), and cerebral palsy (n=1). In the neurologically intact group, CPM produced a bi-directional modulation of H-reflex creating ‘facilitation’ (n=12) (31.4 ± 20.9% increase in H-reflex amplitude) and ‘suppression’ (n=9) (32.9 ± 21.0% decrease in H-reflex amplitude) groups. In the clinical participants, acute CPM before training significantly increased H-reflex recruitment curve variables H@Thres and H@50; but there was no significant effect of acute CPM post-training. Baseline reflex excitability following training was reduced on the MA side for H@Thres, H@50 and H@100 by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. On the less affected side there was a significant decrease in H@Thres and H@50 by 83.4 ± 29.0% and 76.0 ± 28.3%. Time to complete the 10 m Walk Test was not different (5.2 ± 7.9% change, p = 0.06), and time to complete the Timed Up and Go was decreased (9.5 ± 12.3% change, p = 0.05). Spasticity of the ankle plantar flexor muscles, assessed by the Modified Ashworth Scale, was reduced in 4 participants with spasticity. Conclusion: Acute and chronic CPM of the ankle can significantly alter spinal cord excitability. CPM training may be a useful strategy to decrease spasticity of the ankle plantar flexors. / Graduate / 2018-09-15

A prestação de serviços na área da saúde apresenta uma demanda por novas tecnologias. Os fisioterapeutas utilizam desde equipamentos mais simples aos mais complexos para auxiliar na elaboração do diagnóstico cinético funcional, na prescrição, planejamento, ordenação, análise, supervisão e avaliação das atividades fisioterapêuticas dos clientes. Considerando a importância da articulação do cotovelo para as atividades de vida diárias dos indivíduos, bem como a complexa reabilitação das articulações do cotovelo e radioulnares, que requerem intervenção precoce para evitar a rigidez articular, a perda de amplitude de movimento e de força; foi identificada a necessidade de desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Assim, essa tese tem como objetivo geral desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Os objetivos específicos são: (i) analisar os estudos científicos e patentes que abordam o desenvolvimento de equipamentos de Movimentação Passiva Contínua para a reabilitação do cotovelo e antebraço; (ii) realizar a análise funcional e operacional de equipamentos para a reabilitação do cotovelo a antebraço disponíveis no mercado; (iii) identificar os requisitos dos stakeholders da cadeia de valor do produto para o desenvolvimento de um equipamento inovador para a reabilitação do cotovelo e antebraço; (iv) desenvolver o módulo de vibração muscular localizada do equipamento inovador para a reabilitação do cotovelo e antebraço; (v) desenvolver o módulo de Movimentação Passiva Contínua do equipamento inovador para a reabilitação do cotovelo e antebraço; (vi) avaliar a utilização do equipamento inovador para a reabilitação do cotovelo e antebraço em seres humanos. Para atingir os objetivos desta tese foram utilizadas metodologias e ferramentas para a gestão do processo de desenvolvimento de produtos, bem como testes experimentais dos protótipos funcionais com seres humanos. Os resultados envolvem a obtenção de conhecimento científico acerca do tema do desenvolvimento de equipamentos inovadores para a área da saúde, bem como o protótipo funcional de um equipamento inovador para a reabilitação do cotovelo e antebraço, apresentados na forma de seis estudos científicos. / The healthcare service rendering requests new technologies. Physical therapists use equipments from the simplest to the most complex to assist in the developing of functional kinetic diagnosis, prescription, planning, managing, analyzing, monitoring and evaluation of customers’ therapy activities. A need of developing a novel equipment for the elbow and forearm rehabilitation came from the importance of the elbow joint for the daily living activities of people and the complex rehabilitation of elbow and radioulnar joints. These joints require early intervention to prevent joint stiffness, loss of range of motion and strength. Based on this context, the general goal of this PhD thesis is to develop a novel device for elbow and forearm rehabilitation. The specific goals are: (i) analyze the scientific studies and patents about the development of Continuous Passive Motion devices for the elbow and forearm rehabilitation; (ii) analyze functional and operationally the devices for the elbow and forearm rehabilitation which are available in the market; (iii) identify the stakeholder requirements of the device value chain to develop a novel device for the elbow and forearm rehabilitation; (iv) develop the local muscle vibration module of the novel device for the elbow and forearm rehabilitation; (v) develop the Continuous Passive Motion module of the novel device for the elbow and forearm rehabilitation; (vi) evaluate the use of the novel device for the elbow and forearm rehabilitation on human subjects. Management product development process methodogies and tools, as well as experimental tests of the functional prototypes on human subjects were used to achieve the thesis goals. The results include the generation of scientific knowledge about the development of new devices for the health area, as well as a functional prototype of the novel equipment for the elbow and forearm rehabilitation presented as six scientific studies.

A prestação de serviços na área da saúde apresenta uma demanda por novas tecnologias. Os fisioterapeutas utilizam desde equipamentos mais simples aos mais complexos para auxiliar na elaboração do diagnóstico cinético funcional, na prescrição, planejamento, ordenação, análise, supervisão e avaliação das atividades fisioterapêuticas dos clientes. Considerando a importância da articulação do cotovelo para as atividades de vida diárias dos indivíduos, bem como a complexa reabilitação das articulações do cotovelo e radioulnares, que requerem intervenção precoce para evitar a rigidez articular, a perda de amplitude de movimento e de força; foi identificada a necessidade de desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Assim, essa tese tem como objetivo geral desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Os objetivos específicos são: (i) analisar os estudos científicos e patentes que abordam o desenvolvimento de equipamentos de Movimentação Passiva Contínua para a reabilitação do cotovelo e antebraço; (ii) realizar a análise funcional e operacional de equipamentos para a reabilitação do cotovelo a antebraço disponíveis no mercado; (iii) identificar os requisitos dos stakeholders da cadeia de valor do produto para o desenvolvimento de um equipamento inovador para a reabilitação do cotovelo e antebraço; (iv) desenvolver o módulo de vibração muscular localizada do equipamento inovador para a reabilitação do cotovelo e antebraço; (v) desenvolver o módulo de Movimentação Passiva Contínua do equipamento inovador para a reabilitação do cotovelo e antebraço; (vi) avaliar a utilização do equipamento inovador para a reabilitação do cotovelo e antebraço em seres humanos. Para atingir os objetivos desta tese foram utilizadas metodologias e ferramentas para a gestão do processo de desenvolvimento de produtos, bem como testes experimentais dos protótipos funcionais com seres humanos. Os resultados envolvem a obtenção de conhecimento científico acerca do tema do desenvolvimento de equipamentos inovadores para a área da saúde, bem como o protótipo funcional de um equipamento inovador para a reabilitação do cotovelo e antebraço, apresentados na forma de seis estudos científicos. / The healthcare service rendering requests new technologies. Physical therapists use equipments from the simplest to the most complex to assist in the developing of functional kinetic diagnosis, prescription, planning, managing, analyzing, monitoring and evaluation of customers’ therapy activities. A need of developing a novel equipment for the elbow and forearm rehabilitation came from the importance of the elbow joint for the daily living activities of people and the complex rehabilitation of elbow and radioulnar joints. These joints require early intervention to prevent joint stiffness, loss of range of motion and strength. Based on this context, the general goal of this PhD thesis is to develop a novel device for elbow and forearm rehabilitation. The specific goals are: (i) analyze the scientific studies and patents about the development of Continuous Passive Motion devices for the elbow and forearm rehabilitation; (ii) analyze functional and operationally the devices for the elbow and forearm rehabilitation which are available in the market; (iii) identify the stakeholder requirements of the device value chain to develop a novel device for the elbow and forearm rehabilitation; (iv) develop the local muscle vibration module of the novel device for the elbow and forearm rehabilitation; (v) develop the Continuous Passive Motion module of the novel device for the elbow and forearm rehabilitation; (vi) evaluate the use of the novel device for the elbow and forearm rehabilitation on human subjects. Management product development process methodogies and tools, as well as experimental tests of the functional prototypes on human subjects were used to achieve the thesis goals. The results include the generation of scientific knowledge about the development of new devices for the health area, as well as a functional prototype of the novel equipment for the elbow and forearm rehabilitation presented as six scientific studies.

A prestação de serviços na área da saúde apresenta uma demanda por novas tecnologias. Os fisioterapeutas utilizam desde equipamentos mais simples aos mais complexos para auxiliar na elaboração do diagnóstico cinético funcional, na prescrição, planejamento, ordenação, análise, supervisão e avaliação das atividades fisioterapêuticas dos clientes. Considerando a importância da articulação do cotovelo para as atividades de vida diárias dos indivíduos, bem como a complexa reabilitação das articulações do cotovelo e radioulnares, que requerem intervenção precoce para evitar a rigidez articular, a perda de amplitude de movimento e de força; foi identificada a necessidade de desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Assim, essa tese tem como objetivo geral desenvolver um equipamento inovador para a reabilitação do cotovelo e antebraço. Os objetivos específicos são: (i) analisar os estudos científicos e patentes que abordam o desenvolvimento de equipamentos de Movimentação Passiva Contínua para a reabilitação do cotovelo e antebraço; (ii) realizar a análise funcional e operacional de equipamentos para a reabilitação do cotovelo a antebraço disponíveis no mercado; (iii) identificar os requisitos dos stakeholders da cadeia de valor do produto para o desenvolvimento de um equipamento inovador para a reabilitação do cotovelo e antebraço; (iv) desenvolver o módulo de vibração muscular localizada do equipamento inovador para a reabilitação do cotovelo e antebraço; (v) desenvolver o módulo de Movimentação Passiva Contínua do equipamento inovador para a reabilitação do cotovelo e antebraço; (vi) avaliar a utilização do equipamento inovador para a reabilitação do cotovelo e antebraço em seres humanos. Para atingir os objetivos desta tese foram utilizadas metodologias e ferramentas para a gestão do processo de desenvolvimento de produtos, bem como testes experimentais dos protótipos funcionais com seres humanos. Os resultados envolvem a obtenção de conhecimento científico acerca do tema do desenvolvimento de equipamentos inovadores para a área da saúde, bem como o protótipo funcional de um equipamento inovador para a reabilitação do cotovelo e antebraço, apresentados na forma de seis estudos científicos. / The healthcare service rendering requests new technologies. Physical therapists use equipments from the simplest to the most complex to assist in the developing of functional kinetic diagnosis, prescription, planning, managing, analyzing, monitoring and evaluation of customers’ therapy activities. A need of developing a novel equipment for the elbow and forearm rehabilitation came from the importance of the elbow joint for the daily living activities of people and the complex rehabilitation of elbow and radioulnar joints. These joints require early intervention to prevent joint stiffness, loss of range of motion and strength. Based on this context, the general goal of this PhD thesis is to develop a novel device for elbow and forearm rehabilitation. The specific goals are: (i) analyze the scientific studies and patents about the development of Continuous Passive Motion devices for the elbow and forearm rehabilitation; (ii) analyze functional and operationally the devices for the elbow and forearm rehabilitation which are available in the market; (iii) identify the stakeholder requirements of the device value chain to develop a novel device for the elbow and forearm rehabilitation; (iv) develop the local muscle vibration module of the novel device for the elbow and forearm rehabilitation; (v) develop the Continuous Passive Motion module of the novel device for the elbow and forearm rehabilitation; (vi) evaluate the use of the novel device for the elbow and forearm rehabilitation on human subjects. Management product development process methodogies and tools, as well as experimental tests of the functional prototypes on human subjects were used to achieve the thesis goals. The results include the generation of scientific knowledge about the development of new devices for the health area, as well as a functional prototype of the novel equipment for the elbow and forearm rehabilitation presented as six scientific studies.

This thesis presents a novel table top hand rehabilitation device. The purpose for creating this device is to assist therapists in treatment of hand after injury. Injuries to the hand are common and can be very debilitating since our hands are our primary means for interacting with our world. The device is capable of independently mobilizing the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) in the fingers of the hand, and recording their motion. The device is capable of moving either joint through a range of 0° to 90°, and can be used for either the left or right hand. In the Continuous Passive Motion (CPM) mode, the device moves the MCP and PIP joints through a trajectory that approximates healthy hand motion, known as the minimum jerk model. This is done using a Proportional Integral Differential (PID) controller, which compares the actual position of the device to the desired minimum jerk trajectory. The trajectory following of the minimum jerk model was found to be successful with a maximum error of only 1.46° in the MCP joint and 2.10° in the PIP joint across all trials with injured participants with an average error of 0.11° and 0.14° for the MCP and PIP joints respectively. The device also incorporated various user-friendly features such as user-defined maximum permitted torque, range of motion limits, speed control, and visual feedback. A survey of the participant’s perceived comfort, safety, smoothness and passivity produced positive results. The average responses of the injured hand participants to questions of perceived Comfort, safety and Smoothness were above 9 out of 10 for each question. The average increases in ROM for the active extension of the MCP joint and the PIP joint were 3.3° and 3.2° respectively. The average increases in ROM for the flexion of the MCP joint and the PIP joint were 8.9° and 7.2° respectively. This is a sign that the device has an effect on the participant even if this effect can not be shown to last beyond the one hour session. It will require further testing with a long term group of participants and a control group to determine if this is a lasting effect and if the device is ready for clinical use. The active resistance and haptic modes are both operational but require additional work to increase smoothness and stability before testing can begin.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research demonstrates the development of a new principle of operation for elbow and forearm continuous passive motion (CPM) equipment. For that were integrated knowledges of Physical Therapy and Production Engineering to make a prototype of a CPM device for the purpose of enabling the programming of various sequences of passive movements of elbow and forearm by means of computerized numerical control (CNC). The conceptual design of prototype mechanical equipment was carried out, as well as the construction and development of a program to specify the principles of operation of the equipment. Computerized CPM allows the independent or synchronized passive movements on two axes: elbow flexion/extension and forearm pronation/supination. The prototype has stepper motors connected to a microcomputer by means of drivers. The motors are controlled by commercial CNC machine software control. The language read and interpreted by this program is generated by other software, this was developed for this equipment to facilitate its use by the Physical Therapists. It has language accessible to this professionals and it allows the insertion of such variables as time and angle. The software calculates the speed of movement with these variables automatically. Data entered into the program are saved and generate a text file with standard CNC language, which is recognized by the program control. The sequences of movements are created by Physical Therapist and adapted to patients according to treatment goals and the individual characteristics. The control software also provides the flexion/extension and pronation/supination range of motion (ROM) passive evaluation, the data of each patient can be stored for monitoring progress and possible reuse. Based on what was done, we can assert that this operating principle can be used in CPM device, the software developed can be used on any machine of this type wich CNC principle of operation and if them have the availability of two axes of movement. This technique can be used to other equipments specific to the health area. / Neste trabalho é demonstrado o desenvolvimento de um novo princípio de operação para equipamentos de movimentação passiva contínua (CPM) para cotovelo e antebraço. Foram integrados conhecimentos de Fisioterapia e Engenharia de Produção para construir um protótipo de um equipamento de CPM que possibilite a programação de variadas sequências de movimentos passivos do cotovelo e antebraço por meio de técnicas empregadas em equipamentos com Comando Numérico Computadorizado (CNC). Foi realizado o projeto conceitual da mecânica do protótipo, sua posterior construção e desenvolvido um programa para especificar os princípios de operação do equipamento. O CPM Computadorizado possibilita os movimentos passivos independentes ou sincronizados em dois eixos: flexão/extensão do cotovelo e pronação/supinação do antebraço. Possui motores de passo, conectados a um microcomputador por meio de driveres. Os motores são comandados por um software controle comercial de máquina CNC. A linguagem lida e interpretada por este programa é gerada por outro software, o qual foi desenvolvido para este equipamento, visando facilitar a utilização pelo fisioterapeuta. Ele disponibiliza, em linguagem acessível ao profissional da área, a inserção de variáveis como tempo e ângulo, com as quais calcula automaticamente a velocidade de movimento. Os dados inseridos no programa são salvos e geram um arquivo texto com linguagem CNC padronizada reconhecida pelo programa controle. As sequências de movimentos são criadas pelo fisioterapeuta e adaptadas aos pacientes, de acordo com os objetivos do tratamento e as características individuais. O software controle proporciona também uma avaliação passiva da amplitude de movimento (ADM) da flexão/extensão e pronação/supinação e os dados de cada paciente podem ser armazenados para acompanhamento da evolução e possível reutilização. Com base no que foi realizado, é possível afirmar que este princípio de operação pode ser empregado em equipamentos de CPM e o software desenvolvido pode ser utilizado em qualquer máquina deste tipo com princípio de operação CNC, onde exista a disponibilidade de dois eixos de movimentos. Esta técnica ainda pode ser utilizada em outros equipamentos específicos da área da saúde.

Doctor of Philosophy (PhD) / With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Doctor of Philosophy (PhD) / With improvements in actuation technology and sensory systems, it is becoming increasingly feasible to create powered exoskeletal garments that can assist with the movement of human limbs. This class of robotics referred to as human-machine interfaces will one day be used for the rehabilitation of paralysed, damaged or weak upper and lower extremities. The focus of this project was the development of an exoskeletal interface for the rehabilitation of the hands. A novel sensor was designed for use in such a device. The sensor uses simple optical mechanisms centred on a spring to measure force and position simultaneously. In addition, the sensor introduces an elastic element between the actuator and its corresponding hand joint. This will allow series elastic actuation (SEA) to improve control and safely of the system. The Hand Rehabilitation Device requires multiple actuators. To stay within volume and weight constraints, it is therefore imperative to reduce the size, mass and efficiency of each actuator without losing power. A method was devised that allows small efficient actuating subunits to work together and produce a combined collective output. This work summation method was successfully implemented with Shape Memory Alloy (SMA) based actuators. The actuation, sensory, control system and human-machine interface concepts proposed were evaluated together using a single-joint electromechanical harness. This experimental setup was used with volunteer subjects to assess the potentials of a full-hand device to be used for therapy, assessment and function of the hand. The Rehabilitation Glove aims to bring significant new benefits for improving hand function, an important aspect of human independence. Furthermore, the developments in this project may one day be used for other parts of the body helping bring human-machine interface technology into the fields of rehabilitation and therapy.

Background and Purpose. Tibial head fracture (THF) rehabilitation is still a challenge in clinical practice. Short-term use of continuous passive motion (CPM) postoperatively for THFs can increase knee range of motion (ROM) immediately, and its effect on enhanced rehabilitation also ended when the CPM application was discontinued. The aim of this study was to investigate the effect on the recovery of prolonged use of CPM in the postoperative treatment of THFs. Methods. 60 patients with THFs were randomly and equally divided into the CPM group and non-CPM group. Both groups immediately received CPM and conventional physical therapies during hospitalization. After discharge, the non-CPM group was treated with conventional physical therapy alone, while the CPM group received conventional physical training in combination with CPM treatment. At 6 weeks and 6 months postoperatively, the primary outcome which was knee ROM and the secondary outcome which was knee functionality and quality of life were evaluated. Results. The CPM group had a significantly increased ROM at both follow-up time points. The Knee Society Score, UCLA activity score, and the EuroQoL as well as the pain analysis showed significantly better results of the CPM group than the non-CPM group. Conclusions. The prolonged application of CPM therapy is an effective method to improve the postoperative rehabilitation of THFs.