Evaluation of Exoskeleton for Upper Limb Rehabilitation in Neurological Patients

"Upper limb exoskeleton with four actuated degrees of freedom (shoulder horizontal adduction/abduction, shoulder flexion/extension, humeral rotation, elbow flexion/extension), and one passive degree of freedom (wrist pronation/supination), implementing different rehabilitative strategies.~The intervention consists of the execution of different exercises with the affected arm supported by the AGREE device. The subject is actively involved in the exercises and the system provides different kinds of assistance that can be tailored according to the patient's status.~The following exercises can be performed:~* anterior reaching (in a plane or in the space)~* lateral elevation of the arm~* hand to mouth movements with or without an object in the hand~* moving objects (on a plane or in the space)~* exergames.~A subset of exercises is defined based on the patient's capability."

After patient's preparation (tDCS and FES) the FEXO assessment is conducted. The subject performs FEXO assessment games. This stage is also used to calibrate the reach and grasp movement intention EEG patterns. The movement is recorded using internal kinematic sensors; therefore, these measures can be extracted for both reaching and lifting movements. Trunk forward bending is measured to avoid compensatory movements when doing reaching assessment. The clinician then reviews the plan for today's session: game selection, number of repetitions and assistance levels. The patient gets ready to play the games and the clinician starts the first activity of the active stage of FEXO therapy. The patient plays the game and sees his own results. The clinician monitors patient activity, assistance levels, effort and signs of discomfort. The patient plays the next game and sees his own results, and the clinician checks the patient's progress with the results overview.

"It consists of a combination of different treatment modalities among the following, based on the patient's specific needs:~* Upper limb passive motion~* Occupational therapy exercises~* Constraint-induced movement therapy~* Upper limb active movement (reaching, grasping, elevation, spatial orientation)~* Repetitive task training"