Biomedical Engineering Reference
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the voluntary functions of the upper limb, which could be roughly divided into
the shoulder/elbow part and the wrist/hand part. Increases in the FMA scores
suggest an improvement in the related motor functions. The MAS measures
the involuntary muscle spasticity when doing passive joint movements (such as
extension/flexion to test the flexors and the extensors). A decrease in the MAS
reflexes released muscle spasticity in the associated muscles. The ARAT also
measures the upper limb voluntary functions, while more focuses on hand/finger
functions. Most of the ARAT tasks require voluntary motions of fingers, such
as pinch, grip, and grasp. Increased ARAT score suggested improved upper
limb motor functions, especially in the hand and fingers. Increased scores in
the FIM instrument may reflect improved independency in general tasks related
to daily activities. Besides the clinical scores, the motor recovery process was
also monitored by the parameters of RMSE, EMG activation levels of ECR, FCR,
BIC, and TRI muscles, and co-contraction indexes of the different muscle pairs in
tracking trials when there was neither FES and robot supports, nor resistive torque
(i.e., 0% assistance and 0% resistance). Table 8.2 shows the comparison between
the clinical scores before and after the training.
Improvements with statistical
significance (P
0.05, paired-t-test) were found in the FMA (Wrist/Hand), MAS
(Wrist), and ARAT in the post-training tests. The increased FMA (Wrist/Hand)
suggested an improvement in the voluntary motor function in the wrist joint; and
the improved ARAT score also suggested a better voluntary performance in finger
functions, which was absent in our previous pure interactive robot-assisted wrist
training (Hu et al . 2009). It was interesting that when doing the post-training
ARAT assessments, the main improvement in almost all subjects was in the finger
pinch function, e.g. picking up a marble with different sizes. A release in muscle
spasticity related to the wrist joint was found after the training as assessed by
the MAS (wrist). However, the release of muscle tone in the elbow joint was not
significant at present. There was no change in the daily independency after the
training either, as assessed by the FIM instrument.
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Figure 8.7 The assistive and resistive scheme used in a training session. The assistive gains
are the gain values of both the FES and robot parts in the interactive control. The resistive
coefficient is a percentage value applied to the constant resistance during the wrist flexion
and extension phases.
 
 
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