Method and apparatus for automating arm and grasping movement training for rehabilitation of patients with motor impairment

• US 8,834,169 B2
• Filed: 08/30/2006
• Issued: 09/16/2014
• Est. Priority Date: 08/31/2005
• Status: Active Grant

• Current Assignee: Regents of the University of California (University of California)
• Original Assignee: Regents of the University of California (University of California)
• Inventors: Reinkensmeyer, David, Sanchez, Robert J. Jr., Shah, Punit, Smith, Robert F. Jr.
• Primary Examiner(s): Yip, Jack
• Application Number:
  US11/512,670
• Publication Number:
  US 20070060445A1
• Time in Patent Office: 2,939 Days
• Field of Search: 434/247, D24/188, 601/5, 601/33, 482/8, 600/587
• US Class Current: 434/247
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/1124 Determining motor skills
• CPC Class Codes: A61B 5/4519 Muscles A61B5/389, A61B5/224 take precedence
• CPC Class Codes: A61B 5/4528 Joints A61B5/4533, A61B5/4538 take precedence
• CPC Class Codes: A61B 5/486 Bio-feedback A61B5/375 takes precedence
• CPC Class Codes: A61F 5/0102 specially adapted for correcting deformities of the limbs or for supporting them; Ortheses, e.g. with articulations
• CPC Class Codes: A61H 1/0237 for the lower limbs
• CPC Class Codes: A61H 1/0274 for the upper limbs
• CPC Class Codes: A61H 1/0281 Shoulder
• CPC Class Codes: A61H 2201/5007 computer controlled
• CPC Class Codes: A61H 2201/5064 Position sensors
• CPC Class Codes: B25J 9/0006 Exoskeletons, i.e. resembling a human figure
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising

Abstract

A method and apparatus for upper limb rehabilitation training of coordinated arm/forearm, forearm/forearm and grasping movements of a motor impaired patient comprises a nonrobotic, passive support, an arm/forearm sensor, a gripping device, a grip sensor capable of measuring an impaired grasping force of a grasping of the patient, a computer to process measurements of coordinated and simultaneous impaired arm/forearm, forearm/forearm and grasping movements to control a graphical representation of the arm/forearm and grasping movements in interaction with a virtual environment, and to provide a visual feedback signal to the patient of simulated normal activities of daily living performed with enhanced motor ability relative to the actual impaired motor ability. A visual feedback signal of the simulated activities of daily living is provided to motivate the patient to perform the upper limb rehabilitation movement training despite limited motor ability.

Claims

1. An apparatus for upper limb rehabilitation training of coordinated arm/forearm and grasping movements of a patient comprising:

a spring-actuated counterbalanced arm/forearm support which is an articulated exoskeleton worn by the patient and coupled to a stand relieving at least a portion of the weight of an arm and forearm of the patient and to increase the range of movement of the arm and forearm with at least three degrees of freedom to simulate multi-joint coordination exercises that require coordination of the arm and hand, wherein the portion of the weight of the arm and forearm is relieved from the patient during the entire simulation of the multi-joint coordination exercises;

a plurality of arm/forearm measurement sensors coupled to the arm/forearm support capable of measuring joint angles of the impaired arm and forearm movements of the arm/forearm of the patient;

a sensor capable of measuring impaired grasping force or measuring impaired movement of a hand of the patient;

a computer coupled to the arm/forearm measurement means and the grasping measurement means to process measurements of impaired arm/forearm and grasping movements to control a graphical representation of the arm/forearm and grasping force in interaction with a virtual environment, and to provide a visual feedback signal to the patient of simulated multi-joint coordination exercises that require coordination of the arm and hand performed with enhanced motor ability relative to the actual impaired motor ability; and

a display device coupled to the computer to display the visual feedback signal of the simulated multi-joint coordination exercises that require coordination of the arm and hand,

wherein motivation of the patient to perform the upper limb rehabilitation movement training is provided despite limited motor ability.

2. The apparatus of claim 1 where the support comprises an adjustment means for varying a force level required to move the arm and forearm, and where the computer automatically adjusts a plurality of parameters according to patient completion of the simulated multi-joint coordination exercises that require coordination of the arm and hand, wherein the computer further comprises means for automatically varying a range of movement of the arm and forearm required to successfully perform the simulated multi-joint coordination exercises that require coordination of the arm and hand based upon previous patient performance.

3. The apparatus of claim 1 where the computer comprises an adjustment means for automatically varying a threshold level of the grasping force and releasing movement required to successfully perform the simulated multi-joint coordination exercises that require coordination of the arm and hand based upon previous patient performance.

4. The apparatus of claim 1 where the spring-actuated counterbalanced arm/forearm support comprises an elastic suspension and a five degrees-of-freedom mechanism which counterbalances the weight of the arm/forearm using the elastic suspension.

5. The apparatus of claim 1 where the spring-actuated counterbalanced arm/forearm support comprises means for performing multi-joint coordination exercises that require coordination of the arm and hand in the virtual environment.

6. The apparatus of claim 1 where the spring-actuated counterbalanced arm/forearm support comprises a five degrees-of-freedom, back-drivable mechanism using elastic bands wrapped around two four bar linkages to counterbalance the arm/forearm.

7. The apparatus of claim 1 where the spring-actuated counterbalanced arm/forearm support has a distal tip and a plurality of movement axes, and where the arm/forearm measurement sensor provides measurement resolution of the distal tip of the spring-actuated counterbalanced arm/forearm support sufficient to allow individuals with severe weakness to simulate multi-joint coordination exercises that require coordination of the arm and hand in a virtual reality environment.

8. The apparatus of claim 1 where the arm/forearm measurement sensor measures impaired arm and forearm movements without initial zeroing, so that no initialization procedures are required.

9. The apparatus of claim 1 where the grip sensor measures impaired grasping force and releasing movement without initial zeroing, so that no initialization procedures are required.

10. The apparatus of claim 1 where the hand gripper comprises a fluidic bladder and the grip sensor comprises a pressure sensor coupled to the bladder.

11. The apparatus of claim 1 further comprising a remote computer network coupled to the computer from which network the computer is controlled to adjust the parameters of a plurality of simulated multi-joint coordination exercises that require coordination of the arm and hand.

12. The apparatus of claim 1 where the computer generates quantitative feedback of performance.

13. The apparatus of claim 1 where the computer generates a rehabilitative therapy and therapeutic history of performance.

14. The apparatus of claim 1 where the spring-actuated counterbalanced arm/forearm support facilitates forearm/forearm supination and pronation, elbow flexion and extension, in combination with shoulder internal and external rotation, flexion and extension, and abduction and adduction.

15. An apparatus for automating upper-extremity rehabilitation therapy for a motor impaired stroke patient comprising:

a spring-actuated counterbalanced gravity assistance articulated exoskeleton worn by the patient and coupled to a stand providing arm/forearm support and relieving at least a portion of the weight of an arm and forearm of the patient with at least three degrees of freedom to simulate multi-joint coordination exercises that require coordination of the arm and hand, wherein the portion of the weight of the arm and forearm is relieved from the patient during the entire simulation of the multi-joint coordination exercises;

a plurality of arm/forearm movement sensors coupled to the exoskeleton for measuring arm and forearm movement and joint angles of the motor impaired stroke patient;

a sensor for measuring grasping force and release movement of the motor impaired stroke patient; and

a computer controlled by virtual reality software and coupled to the arm/forearm movement sensors and sensor for measuring grasping force and release movement for generating a visual display of simulated multi-joint coordination exercises that require coordination of the arm and hand performed with enhanced motor ability relative to the actual impaired motor ability,

wherein motivation of the patient to perform the upper-extremity rehabilitation movement therapy is provided by the computer automatically adjusting a plurality of parameters according to patient completion of the simulated multi-joint coordination exercises that require coordination of the arm and hand.

16. A computerized method for upper limb rehabilitation arm/forearm and grasping movement training of a patient comprising:

facilitating movement of an arm and forearm of the patient with a spring-actuated counterbalanced arm/forearm support which is an articulated exoskeleton worn by the patient and coupled to a stand relieving at least a portion of the weight of the arm and forearm of the patient;

relieving the portion of the weight of the arm and forearm from the patient during an entire simulation of multi-joint coordination exercises;

measuring impaired arm and forearm movements of the patient with at least three degrees of freedom in three dimensional space;

measuring impaired grasping force of the patient or impaired movement of a hand of the patient;

generating visual feedback to the patient of the simulated multi-joint coordination exercises that require coordination of the arm and hand in a virtual environment performed with enhanced motor ability relative to the actual impaired motor ability by use of a computer having arm/forearm measurement and grasping measurements as inputs; and

motivating the patient to perform the upper limb rehabilitation movement training by the computer automatically adjusting a plurality of parameters according to patient completion of the simulated multi-joint coordination exercises that require coordination of the arm and hand.

17. The method of claim 16 where motivating the patient to perform the upper limb rehabilitation movement further comprises automatically varying the movement or range of motion required of the arm and forearm to successfully perform the simulated multi-joint coordination exercises that require coordination of the arm and hand based upon previous patient performance.

18. The method of claim 16 where motivating the patient to perform the upper limb rehabilitation movement further comprises automatically varying a threshold level required of the grasping force to successfully perform the simulated multi-joint coordination exercises that require coordination of the arm and hand based upon previous patient performance.

19. The method of claim 16 where facilitating movement of an arm and forearm of the patient with a spring-actuated counterbalanced arm/forearm support comprises employing an elastic suspension and a five degrees-of-freedom mechanism to counterbalances the weight of the arm and forearm using the elastic suspension.

20. The method of claim 16 where facilitating movement of an arm and forearm of the patient with a spring-actuated counterbalanced arm/forearm support comprises facilitating multi-joint coordination exercises that require coordination of the arm and hand reaching, drawing, eating, cooking, and cleaning movements in the virtual environment.

21. The method of claim 16 where facilitating movement of an arm and forearm of the patient with a spring-actuated counterbalanced arm/forearm support comprises employing a five degrees-of-freedom, back-drivable mechanism using elastic bands wrapped around two four bar linkages to counterbalance the arm/forearm.

22. The method of claim 16 where measuring impaired arm and forearm movements comprises measuring arm and forearm movements with a resolution of a distal tip of the spring-actuated counterbalanced arm/forearm support within 1 cm for each of a plurality of movement axes in the virtual environment.

23. The method of claim 16 where measuring impaired arm and forearm movements comprises measuring arm and forearm movements without initial zeroing, so that no initialization procedures are required.

24. The method of claim 16 where measuring impaired grasping force comprises measuring grasping force without initial zeroing, so that no initialization procedures are required.

25. The method of claim 16 where measuring impaired grasping force comprises measuring pressure changes in a fluidic bladder squeeze grasped by the patient.

26. The method of claim 16 further comprising communicating with a remote computer network coupled to the computer from which network and controlling the computer to set the parameters in a plurality of simulated multi-joint coordination exercises that require coordination of the arm and hand.

27. The method of claim 26 where controlling the computer to provide the parameters in a plurality of user-selected simulated multi-joint coordination exercises that require coordination of the arm and hand comprises setting the movement range and grasp threshold and target location for multi-joint coordination exercises that range the arm and forearm within the virtual environment.

28. The method of claim 16 further comprising generating quantitative feedback of performance.

29. The method of claim 16 further comprising generating a program of rehabilitative therapy and a corresponding therapeutic history of performance.

30. The method of claim 16 where facilitating movement of an arm and forearm comprises facilitating forearm and forearm supination and pronation, elbow flexion and extension, in combination with shoulder internal and external rotation, flexion and extension, and abduction and adduction.

31. A method for automating upper-extremity rehabilitation therapy for a motor impaired stroke patient comprising:

providing arm/forearm support using a spring-actuated counterbalanced gravity assistance exoskeleton worn by the patient and coupled to a stand relieving at least a portion of the weight of an arm and forearm of the patient;

relieving the portion of the weight of the arm and forearm from the patient during an entire simulation of multi-joint coordination exercises;

measuring arm and forearm movement of the motor impaired stroke patient with at least three degrees of freedom in three dimensional space;

measuring grasping force of the motor impaired stroke patient; and

generating a visual display of the simulated multi-joint coordination exercises that require coordination of the arm and hand using a computer controlled by virtual reality software as if performed with enhanced motor ability relative to the actual impaired motor ability and having the measured arm/forearm movement and the measured grasping force or movement as inputs; and

motivating the patient to perform the upper-extremity rehabilitation movement therapy by the computer automatically adjusting a plurality of parameters according to patient completion of the simulated multi-joint coordination exercises that require coordination of the arm and hand.

32. An apparatus for upper limb rehabilitation training of coordinated arm/forearm and grasping movements of a patient comprising:

a spring-actuated counterbalanced arm/forearm support coupled to a stand relieving at least a portion of the weight of an arm and forearm of the patient and to facilitate movement of the arm and forearm of the patient wherein the portion of the weight of the arm and forearm is relieved from the patient during the entire simulation of the multi-joint coordination exercises;

a arm/forearm measurement sensor capable of measuring impaired arm and/or forearm movements of the arm/forearm of the patient;

a sensor capable of measuring impaired grasping force or impaired movement of a hand of the patient;

a computer coupled to the arm/forearm measurement means and the grasping measurement means to process measurements of impaired arm/forearm and grasping movements to control a graphical representation of the arm/forearm and grasping force in interaction with a virtual environment, and to provide a visual feedback signal to the patient of the simulated multi-joint coordination exercises that require coordination of the arm and hand performed with enhanced motor ability relative to the actual impaired motor ability; and

a display device coupled to the computer to display the visual feedback signal of the simulated multi-joint coordination exercises that require coordination of the arm and hand,

wherein motivation of the patient to perform the upper limb rehabilitation movement training is provided despite limited motor ability.