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Mechatronics
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A R T I C L E I N F O A B S T R A C T
Keywords: Therapeutic exercises play an important role in the physical therapy and the rehabilitation. The exercises that
Upper limb rehabilitation can be assisted by a physiotherapist are increasingly being performed by the rehabilitation robots partially or
Therapeutic exercise robot fully due to their various merits. This study aims to develop a complete rehabilitation system, which consists of a
Hybrid impedance control rehabilitation robot, an HMI and a hybrid impedance controller that can model all the therapeutic exercises for
an upper limb rehabilitation. The 3-DOF upper limb rehabilitation robot is able to perform the movements of
flexion–extension and ulnar–radial deviation for the wrist, and the movement of pronation–supination for the
forearm. The experimental studies were conducted with healthy subjects and patients. First, the experiments
were done with the healthy subjects to prove the control performance of the robotic system. The results showed
that the hybrid impedance controlled robot can perform the therapeutic exercises very successfully. Then, the
experimental studies were carried out with the real patients in a clinical environment. At the end of the treat-
ment process, remarkable improvements were observed in terms of the limb force in all of the patients.
1. Introduction patients, the cost of the rehabilitation process, and the constraints in the
existing devices and equipments of the therapeutic exercises are the
Rehabilitation is a treatment process to bring an individual with a main problems of the rehabilitation process. For these reasons, the re-
physical disability, which might be congenital or happen due to an searches on the use of robots in the rehabilitation process have in-
illness, injury, or accident, to the best condition medically, socially and creased in the last 15 years [3]. The robots make a significant con-
vocationally, and to reduce the negative results of permanent diseases tribution to the rehabilitation process in terms of the cost, the duration
to minimum [1]. A limb, which is injured due to the age-associated of therapy, the objective evaluation, the remote control, and enabling
muscle disabilities, work or traffic accidents, wars and chronic diseases, home care. The rehabilitation robots can be classified in four groups
needs rehabilitation to refunction fully or partially. Making a limb [4]:
functional and increasing the force of a muscle are crucial problems.
The return of those people to their social life is also highly important for • “The assistive robots” supporting the movements of disabled people
themselves, their families, and the society they live in. in the activities of their daily lives,
One of the elements of the rehabilitation is the refunction of the • “The prostheses” fulfilling the functions of the severed limb for
limbs, such as arms and legs. The therapeutic exercises play a crucial amputees,
role in the process of refunction. A physiotherapist can make the patient • The robots used for the gait rehabilitation,
perform the therapeutic exercises, which consist of the passive and • “The therapeutic exercise robots” help patients perform passive,
active exercises, or the patient can perform by himself or herself de- active and resistive exercises.
pending on his or her physical condition. Especially, in populous
countries, where the number of physiotherapists per patient is not en- The system of interest in this research, which aims the therapeutic
ough (to set an example, in Turkey, physiotherapists are allowed to exercises, is for the rehabilitation of the wrist and the forearm and
accept 16 patients in a day [2]), the transportation problems of belongs to the class of the therapeutic exercise robots.
☆
This paper was recommended for publication by Associate Editor Kong Kyoungchul.
⁎
Corresponding author.
E-mail address: eakdogan@yildiz.edu.tr (E. Akdoğan).
https://doi.org/10.1016/j.mechatronics.2017.12.001
Received 27 September 2016; Received in revised form 6 July 2017; Accepted 3 December 2017
Available online 13 December 2017
0957-4158/ © 2017 Elsevier Ltd. All rights reserved.
E. Akdoğan et al. Mechatronics 49 (2018) 77–91
The rehabilitation robots developed for the upper-limb rehabilita- stiffness. Another system designed for localizing tumours in the body
tion can be compared in terms of the capacity of the movement and has 7-DOF and is controlled by a hybrid impedance control approach
exercise, the mechanical properties, and the control methods. The [30]. A 3-DOF system using both the impedance control and the hybrid
systems in the literature are capable of performing one or some of the impedance control for the rehabilitation of the wrist, the forearm, and
following exercises: The passive, the active assisted, and the resistive. the shoulder was developed by Wang et al. [31]. The system was de-
The mechanical parts of the systems were mostly developed by either signed for the motor recovery in the stroke patients by training the
using already available robotic manipulators or designing robotic ma- upper-limb through the predetermined tasks.
nipulators or exoskeletons from scratch. The widely used control ap- Akdogan and his colleagues were developed a 3-DOF system, which
proaches in the rehabilitation are as follows: The convential control uses the impedance control in the therapeutic exercises, for the re-
methods, such as PID or PD, the direct torque control, the admittance habilitation of the lower-limb [32,33]. In this system, to establish the
control, and the impedance control. therapeutic exercise modes, the PID control was used for the position-
The most well-known robotic system of the upper-limb rehabilita- based exercises, and the impedance control was used for the force-based
tion studies is the MIT-MANUS (Massachusetts Institute of Technology- exercises [34]. These two techniques were used by switching between
MANUS) developed by Krebs et al. [5,6]. The robot was developed for each other in the exercises requiring both the position control and the
the rehabilitation of the shoulder and the elbow and has 3-DOF. The impedance control (active assistive exercises). Two disadvantages ap-
system can perform the passive, the active assisted, and the resistive peared in this point. One is that having the trajectory of force by using
exercises. It can reteach the limb the motion limits of the limb and can the position-based impedance model is not possible, since the trajectory
implement applications based on target trajectory. The impedance of force changes depending on the impedance parameters. In the ex-
control method was used in the control of the system. In their study, ercises requiring the PID and impedance control, the numbers of
Reinkensmeyer et al. designed a 4-DOF mechanism, called ARM-Guide parameters are three for the impedance control (the coefficients of in-
(Assisted Rehabilitation and Measurement), for the rehabilitation of the ertia, stiffness, and damping) and three for the PID control. The six
shoulder and the elbow [7]. The system can perform the passive, active parameters in total must be set properly. Another disadvantage is the
assisted, and resistive exercises. The PD position control and the direct occurrence of instability due to the disturbances, such as the noise, in
torque control methods were used in the control of the system. The the process of decision to perform switching. Thus, the control of the
REHAROB by Toth et al. was designed by using a 6-DOF industrial system affected unfavorably. For this reason, the hybrid impedance
robot for the rehabilitation of the shoulder, the elbow, and the forearm control method is highly suitable to perform the control of the required
[8]. The system has the capacity of performing passive exercises for position and force as well as the desired mechanical impedance for the
decreasing the spasticity. The robot is taught the movements by a therapeutic exercises.
physiotherapist through the direct teaching method using an artificial Some preliminary studies having more direct relation with this
intelligence based control algorithm. study should be cited: [35–37]. Mainly, the concept of the discussed
An exoskeleton robot called ARMin was developed by Riener et al. system in this work and some experimental results with healthy sub-
for the rehabilitation of the shoulder and the elbow [9]. The robot has jects are explained in [35] and [36]. These works do not include clinical
6-DOF (four active and two passive) and can perform passive and active results and detailed system identification studies.
assisted exercises. The system can implement applications based on There are some commercial therapeutic exercise machines available
target trajectory, can feed the audio and visual information back, and in the market, such as Biodex, Cybex and Kincom. These devices are
has the ability of gravity compensation. The admittance and impedance passive machines and they cannot change the applied position and force
control approaches were used in the control of the system. The use of to a patient during the exercise. They are single degree of freedom. For
such exoskeleton robots in the rehabilitation have generated an im- different type movement, additional apparatus are needed. Therefore,
mense interest and many studies using the aforementioned control the higher degree of freedom intelligent robotic systems which can
approaches reported in the literature [10–22]. change the exercise procedure according to patient’s situation are ap-
Lum et al. designed a system, MIME (Mirror Image Movement pear to be more useful than passive exercise machines.
Enabler), by using PUMA 360 robot for the rehabilitation of the In this study, the hybrid impedance control of this robot manip-
shoulder and the wrist [23]. This system has 4-DOF and uses “mirror ulator was implemented for the rehabilitation of the wrist and the
therapy” method in implementing the passive, active assisted, and re- forearm. First, the performance of the system was shown by the ex-
sistive exercises. Additionally, the system can regain the limb the limits perimental studies carried out with healthy subjects. The results in-
of the range of motion (ROM) and implement the mirror therapy and dicated that the hybrid impedance control based robotic system can
the applications based on the target trajectory. The PID position control perform the passive, the active assistive, and the resistive exercises very
and the direct torque control methods were used in the control of the accurately. Then, the experimental studies were carried out with real
system. A similar study using the mirror therapy method was presented patients in a clinical environment. At the end of the treatment process,
by Lewis et al. [24]. In their study, the system was controlled by using improvements were observed in terms of limb force in all of the pa-
EMG (electromyography) - based admittance control method. One of tients. The results are presented in terms of the ROM (Range of Motion),
the control approaches fitting well to the control of interaction between the limb force, etc.
the robot and the human is the admittance control and it plays an The contribution of this study into the literature is that the ther-
important role in the rehabilitation [25–27]. In the admittance control, apeutic exercises (passive, active assistive, resistive) were performed
the robot adjusts the desired motion based on the measurements of the under a single control structure using hybrid impedance control and the
interaction forces. effectiveness of this control method was shown by clinical experiments.
The hybrid impedance control method was developed by Anderson In the literature, any study using hybrid impedance control in modeling
and Spong [28]. In this technique, the strategies of “the impedance all the therapeutic exercises does not exist. Also, another contribution is
control” and “the hybrid force-position control” are combined in a the development of an intelligent human–machine interface (HMI).
framework. By doing so, both the position and the impedance-based This powerful HMI was developed by combining knowledge- and rule-
force controls are implemented within a single control structure. Re- based intelligent techniques and a conventional control technique.
searchers have used the hybrid impedance control in various applica-
tions. Wang et al. developed a hybrid impedance controlled 3-DOF 2. System description
system by using the PUMA 562 robot [29]. The robot has a tactile
sensor on its end-effector and designed for massaging. Selection of the The developed rehabilitation support system consists of a phy-
desired impedance value allows massaging in certain levels of the siotherapist, a patient, a robot manipulator, and an HMI. The block
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E. Akdoğan et al. Mechatronics 49 (2018) 77–91
HUMAN
ROBOT
MACHINE
MANIPULATOR
INTERFACE
Results Reaction
Force & Position
PHYSIOTHERAPIST Feedback PATIENT
• The robot was designed as of three-degree-of-freedom to perform Actuators and drivers. There are three servo motor/gears/encoder
the movements of pronation–supination, ulnar–radial deviation, and
flexion–extension. The motion limits of the robot manipulator are in combinations (Maxon EC-max) and three servo motor drivers (Maxon
accordance with the motion limits of human. The relevant values EPOS 2 50/5), which are responsible for the actuation in the system.
are given in Table 1. The specifications of motors, gears, and encoders are given in Table 2.
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Data acquisition cards. In the system, for the analog inputs, the analog detailed block diagram of the system is shown in Fig. 4. The HMI
outputs and the encoder data, NI PCI-6225, NI PCI-6703, and NI PCI- consists of the main controller, the graphical user interface (GUI), the
6601 DAQ cards are used, respectively, at the sampling time of 1 ms. rule base, the data base, and the hybrid impedance controller. As it is
understood, the HMI is an original software structure developed by
using a knowledge and rule-based approach. It includes intelligence and
2.2. Human–Machine interface
a conventional controller, which is the hybrid impedance controller.
The main controller is responsible for the communication between all
The HMI controls the system and establishes the communication
the units. The physiotherapist enters the information about the patient
between the patient, robot manipulator, and physiotherapist. The
Patient PC
TCP/IP Connection UDP Connection
Analog Motor
Torque
Output Board Drivers
Encoder
Position Encoder
Input Board
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Table 2 experiments with real patients were carried out in a clinical environ-
Technical specifications of the actuator–gearbox–encoder combinations. ment. In these experiments, the system was tested by the isotonic and
isometric exercises depending on the patient profile. The experimental
Axis Motor Reduction Encoder Output Torque
results of healthy subjects and patients are given in Section 5 in detail.
Pronation–Supination Maxon EC- 103:1 256 pulse/rev 20.747 Nm Among the exercise types, the passive exercise requires the position
max 30 control; the isotonic–isometric–robo resistive mode requires the force
Ulnar–Radial dev. Maxon EC- 86:1 500 pulse/rev 3.46 Nm
control; and the active assistive exercise requires both the position
max 30
Flexion–Extension Maxon EC- 128:1 500 pulse/rev 2.88 Nm control and the force control. Therefore, the HMI makes the hybrid
max 22 impedance controller operate in the position-force mode or the hybrid
control mode according to the exercise type. The detailed explanations
on the performed exercise types in terms of the inputs and the control
Table 3 methods are given as follows.
The measurement ranges of the force sensor.
Data Rule
Human Machine
Base Base
Interface
Impedance Parameters
Impedance
Parameters Torque Robot
Patient & Exercise Main Controller Hybrid Impedance
Information and GUI Controller Manipulator
Position & Force
Trajectory
Sensors
Position & Force
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A game, which the patient tries to follow the position of a ball, was System identification
developed. The amplitude and period of sinusoidal trajectory of the ball
and the target force value are set via the GUI. The outputs obtained at Performance of the hybrid impedance control depends on the ac-
the end of the exercise are the limb force, the force error, the limb curacy of the mathematical model of the system, since it includes direct
position and the position error. cancellation of dynamics. Hence, we identified the base parameters
listed in Table 4 to improve the performance of the system.
There are ten inertial parameters per link,
2.2.4. Isometric exercise
Through this exercise, the level of muscle contraction is increased [Ixx,i, Ixy, i , Ixz, i , Iyy, i , Iyz, i , Izz, i , mi rci, x , mi rci, y, mi rci, z , mi],
without causing a change in the length of the muscle. It can be per-
which are called the standard inertial parameters. The first six para-
formed by pressing a stationary object, by opposing the manual act of
meters are the moments of inertia, mi is the mass, and rci, x , rci, y, rci, z are
the physiotherapist or by holding a weight in a static condition. At the
the positions of the center of mass in x, y, and z coordinates. In order to
beginning of the exercise, the robot moves to target position where the
facilitate the identification process, a minimum set of inertial para-
isometric exercise will be performed (position control mode). After
meters, which are called the base parameters such as listed in Table 4,
reaching the target position, the control mode is switched to the force
are calculated. We refer the reader to [39] for the calculation of the
control mode. At that point, the robot applies a force to the subject’s
base parameters.
limb. The task of the subject is to keep the limb constant against this
Let us call the unknown base parameters vector
external force. In the developed game, the subject tries to keep the ball
p = [p1 , p2 , …, p17 , fc1 , fv1 , fc2 , fv2 , fc3 , fv3 ]T . The system dynamics in
at the target position. The constant position, the target force and the
(1) are linear with respect to the system parameters when qi, q̇i and q̈i
number of repetition are set via the GUI. The output of the exercise is
are known:
the limb position and force.
Φ(q, q˙ , q¨) p = τ ,
2.2.5. Robo-Resistive exercise where Φ is the regressor matrix. Consider we have M observations data,
It is aimed in this type of exercise that the patient follows the target we end up with overdetermined set of equations A p = b with
at various difficulty levels and values of the ROM. This exercise is not 1 1 1
similar to other resistive exercises, e.g., isotonic, isometric, etc. In ⎡ Φ(q , q˙ , q¨ ) ⎤ ⎡τ ⎤
1
⎢ Φ(q2 , q˙ 2 , q¨2) ⎥ ⎢ τ2 ⎥
contrast to conventional resistive exercises, this exercise is performed
A=⎢
⎢
· ⎥,
⎥ b = ⎢ · ⎥.
against different resistance levels which is adjusted according to the set · ⎢ ·· ⎥
⎢ · ⎥ ⎢ M⎥
impedance parameters. Because of this, the exercise is called robo-re- ⎢ Φ(q M , q˙ M , q¨ M ) ⎥
⎣ ⎦ ⎣τ ⎦ (3)
sistive exercise in this study. To model this exercise, hybrid impedance
control is used in force control mode with different levels of impedance The condition number of the matrix A determines the sensitivity of
parameters (low, medium, high, highest). The details of the selection of the least square solution of parameters, p, with respect to sensor noises.
impedance parameters are given in Section 4. The task of the patient is The trajectory of qi, q̇i and q̈i determines the condition number of the
to follow the ball representing ROM in the game screen. The inputs are matrix A. Our aim is to find the optimal trajectories for each link, which
the velocity of the ball, the ROM, and the resistance level of the ex- minimize the condition number of A, to obtain more accurate results as
ercise. The outputs are the limb position and the position error. in [40].
Let us represent the trajectories of each link as a finite Fourier
series:
3. Dynamic analysis of the robot manipulator
Ni
ai bli
Obtaining the dynamic model of the robot manipulator is very im- qi (t ) = ∑ ω l l sin(ωf lt ) − ωf l
cos(ωf lt ) + qi0
l=1 f
portant for the control. Particularly, in the impedance control method, Ni
the system parameters must be known with high accuracy to achieve a q˙ i (t ) = ∑ ali cos(ωf lt ) + bli cos(ωf lt )
good control performance. In this section, the dynamic equations of the l=1
system are obtained and its parameters are calculated by using a system Ni
identification method. The MATLAB™Symbolic Toolbox was used to q¨i (t ) = ∑ − ali ωf l sin(ωf lt ) + bli ωf l cos(ωf lt )
l=1
obtain the dynamic equations of the robot manipulator in this study.
The robot dynamic equation is expressed by the following nonlinear with ωf is the fundamental pulsation of the Fourier series, al and bl are
equation: the coefficients and Ni is the number of harmonics. The trajectory is
optimized by the following constrained optimization problem:
τ = M (q) q¨ + C (q, q˙ ) + G (q) + F (q˙ ) − J T (q) Fe , (1)
δ * = arg mincond(δ , ωf )
δ (4)
where M(q), C(q), G(q), J(q) are the inertia, the Coriolis and centrifugal,
the gravitational and the Jacobian matrices, respectively. The vector q subject to
is the angular position of the robot joints. The vector Fe is the force
qmin ≤ q (t ) ≤ qmax (5)
applied by the patient to the end effector, which is the output of the
force sensor. The vector F (q˙ ) contains friction forces. The friction is − qmax ≤ q˙ (t ) ≤ q˙max (6)
assumed to be a simple Coulomb-viscous model for each link i ∈ {1, 2,
3}: − q¨max ≤ q¨ (t ) ≤ q¨max . (7)
fi (q˙i ) = fci sign(q˙ i ) + fvi q˙i , (2) where δ is the vector containing Fourier coefficients as
and F (q˙ ) = [f1 (q˙ 1), f2 (q˙ 2), f3 (q˙ 3)]T where fci ’s are the Coulomb friction δ = [a11, …, a N1 i , q10 , a12, …, a N2i , q20 , a13, …, a N3i , q30 , b11, …, b N1 i ,
coefficients and fvi ’s are the viscous friction coefficients. Assignment of b12, …, b N2i , b13, …, b N3i ].
the coordinate frames of the links and the corresponding
Denavit–Hartenberg parameters can be seen in Fig. 5. For the calcula- and δ* is the optimal δ which minimizes the condition number of matrix
tion of the matrices M(q), C(q) and G(q), we refer the reader to [38]. A. The parameters ωf and Ni are pre-chosen before optimization. We
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Link di θi ai αi
1 0 q1 0 90◦
2 0 90◦ + q2 0 90◦
3 0 q3 l1 0◦
x1
x0
z3 y0 z2
z0 y1 z1 Link 1
l1
x3 y3 x2
z3 y2
x3 y3 Link 2
Link 3
Fig. 5. The coordinate frames of the links and the Denavit–Hartenberg parameters of the assigned coordinate frames.
Table 4
Base inertial parameters of the robot manipulator and identification results.
position
velocity
0.2
acceleration
-0.2
0 1 2 3 4 5 6 7 8 9 10
Time (sec)
Trajectory of Link 2 Trajectory of Link 3
2
rad, rad/s, rad/s
2
1
1
0 0
-1
-1
-2
-2
0 5 10 0 5 10
Time (sec) Time (sec)
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The desired dynamic behaviour of the robot manipulator after ap- (21)
plying position based impedance control can be given as: to obtain the desired dynamics. In (21), I denotes the identity matrix.
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E. Akdoğan et al. Mechatronics 49 (2018) 77–91
The operator diag[x1, x2 , …, x n] denotes a block diagonal matrix 5.1. Experiments with healthy subjects
whose elements on the main block diagonal are x1, x2, ⋅⋅⋅, xn. Here, m
is the mass, m∼ is the moment of inertia, b is the coefficient of linear The therapeutic exercise implementation capacity of the robotic
damping, b͠ is the coefficient of rotational damping, k is the stiffness, rehabilitation system was tested with three voluntary healthy subjects.
k͠ is stiffness for the rotational spring and s is the switch value of the The physical properties of the healthy subjects are given in Table 7. In
impedance controller. Those parameters are adjusted to determine the selection of the subjects, similarity in the physical properties was
the difficulty level of the exercise whereas s is adjusted to model the considered. The experiments were performed for the movements of the
exercise types. Selection of the parameter s with respect to exercise flexion–extension, the ulnar–radial deviation, and the pronation–supi-
type can be seen in Table 5. The impedance parameters corre- nation. The passive, active assistive, isotonic, and isometric exercises
sponding to the difficulty levels are presented in Table 6. Non- were performed through these movements. The subjects grasped the
parametric values are used to prevent the motion except for the handle and their forearms were fastened to the robot. The input data
flexion–extension trajectory. according to the type of exercise was entered through the GUI. All
• Ulnar–Radial deviation: During this movement, the origin of the movements were repeated 10 times. The force and position tracking
coordinate system of the end-effector moves in the x0 and z0 axes errors of the subjects were evaluated by means of the performance
and rotates about the y0 axis. To model this movement, selection of measures: The mean value, the standard deviation and the RMS. The
the parameters are given below: performed experiments and the results are presented in the following
∼, 1], sections in detail.
Md = diag[m, 100, m , 1, m
Bd = diag[b, 1000, b, 10, b͠ , 10],
5.1.1. Passive exercise
K d = diag[k, 10000, k, 100, k͠ , 100], In the passive exercise, the robot manipulator makes the patient’s
S = diag[s, 1, s, 1, s, 1]. limb move within the ROM. The position trajectory of the robot ma-
nipulator is determined by the HMI through the entered information of
Table 6
Impedance parameter values used in the experiments for different difficulty levels. Table 7
Physical properties of the healthy subjects.
∼)
Difficulty level (m) (m (b) (b͠ ) (k) (k͠ )
Subject Sex Age Weight Height
Low 1.25 0.0125 10 0.1 100 1
Medium 2.50 0.0250 20 0.2 200 2 A Male 23 75 kg 176 cm
High 5.00 0.0500 40 0.4 400 4 B Male 22 70 kg 180 cm
Very high 7.50 0.0750 80 0.8 800 8 C Male 24 80 kg 178 cm
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Table 8
Position tracking error results for passive exercise.
Motion Subject ROM (°) Period (sec) Repetition Position tracking error
40
20
Actual
Desired
1
Error ( ° )
-1
0 2 4 6 8 10 12 14 16 18 20
Time (sec)
Table 9
Position tracking error results for active assistive exercise.
Motion Subject ROM (°) Period (sec) Repetition Position tracking error
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Fig. 8. The active assistive pronation exercise result for the healthy
0
Subject C. This figure shows (from top to bottom) the desired and
Position (°)
actual(subject) position trajectory, the force trajectory of subject and
-20 the switching signal of the hybrid impedance controller. The subject
could not move his limb in the second and seventh seconds. The
switching signal was activated in these moments to help the subject
-40 Actual to complete his motion.
Desired
-60
15
10
Force (N)
-5
Assistance
Active
Passive
0 1 2 3 4 5 6 7 8 9
Time (sec)
Table 10
Isometric exercise experiments on the healthy subjects.
Motion Subject Ref. force (N) Repetition Pat. force Force Tracking Error
tracking error are under 0.8% for the extension–flexion, 1.16% for the is stationary or started to move in the opposite direction. The entered
ulnar–radial deviation, and 0.8% for the pronation–supination. It is information are the target position, the type of movement, the speed,
evaluated by considering all the movements that the robot manipulator and the exercise duration. The subject is asked to grasp and move the
was able to perform the passive exercise under 1.2% performance. In handle till a certain point, where the subject is asked not to move his or
parallel with this, the robot manipulator was able to track the desired her joint. From the point where the limb is stationary, the manipulator
trajectory with an error under one degree, as shown in Fig. 7. It is tracks the predetermined trajectory with high accuracy and return to
understood that the system can perform the passive exercises. the start position. This measurement was repeated 10 times. The results
obtained from all the subjects are given in Table 9. The mean values of
5.1.2. Active assistive exercise the manipulator’s position tracking error are under 0.865% for the
This exercise is described that the patient moves his or her limb extension–flexion, 0.229% for the ulnar–radial deviation, and 0.275%
actively and a physiotherapist assists him or her to complete the for the pronation–supination. To give an example, the experiment result
movement from the point where the patient is not able to move his or for the pronation movement of the Subject C, where the ROM was
her limb further. Modeling the exercise in the system is as follows: The chosen as 60°, is given in Fig. 8. As it can be seen from the figure, the
hybrid impedance controller operates in the force control mode, if the subject moved his limb by applying force at the seconds 1–2 and 5–7.
subject can move his or her limb. The position control mode is switched When the subject was not able to move his limb at the seconds 2 and 7,
from the point where the limb cannot be moved. The decision for the decision signal became active and the robot manipulator tracked
switching between these modes is done by continuously checking the the reference trajectory after switching from the force control mode to
variation in the position. The switching is performed if the robotic arm the position control mode. It is understood that the system can perform
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5 Fig. 9. The isometric flexion exercise result for the healthy subject A.
This figure shows (from top to bottom) the desired and actual(subject)
force trajectory, the limb position trajectory of the subject. When the
subject stops his limb (3rd and 12th seconds), the robot applies an
0
external force (10 N) to the limb of the subject. When the subject stops
his limb at 40° (3rd and 12th seconds), the robot applies an external
Force (N)
force (10 N) to the limb of the subject. The subject tries to keep his
-5
limb position constant.
-10
-15 Actual
Desired
-20
40
Position (°)
20
0
0 2 4 6 8 10 12 14 16 18 20
Time (sec)
Table 11
Isotonic exercise experiments on healthy subjects.
Motion Subject Ref. force (N) Repetition Force (N) Force tracking error
the active assistive exercises. pronation–supination. It is meaningful that the errors are high in the
movement of the ulnar–radial deviation for all the patients, since the
experiments exhibited that the relevant muscles are difficult to control
5.1.3. Isometric exercise against constant forces. To give an example, the experiment result with
The purpose of the isometric exercise is to cause a change in the the Subject A is given in Fig. 9. In that experiment, the Subject A was
muscle contraction and not in the length of the muscle. This exercise is asked to reach 40° ROM and to oppose the predetermined 10 N force
modeled as follows: The hybrid impedance controller is in the force generated by the robot manipulator. As shown in the bottom plot in
control mode. The subject starts to move his or her limb. When the Fig. 9, the subject moved his wrist from 0° to 40° together with the
motion of the limb stops, the robot manipulator applies an opposite manipulator and stopped at 40°. His stop was detected by the HMI and
force to the limb and the subject tries to oppose this force. The subject an opposing 10 N force was applied by the manipulator at the seconds 3
was asked to grasp and move the handle in the isometric exercise. The and 12. In this time interval, the subject performs the isometric exercise
robot applied a predetermined and constant force to the subject in the against 10 N force at a constant position. It is understood that the
opposite direction at the point where the limb becomes stationary. This manipulator can perform the isometric exercises.
movement was repeated 10 times.
In Table 10, the results for the force tracking errors of the subjects
are given according to the types of movements. The mean values of the 5.1.4. Isotonic exercise
manipulator’s position tracking error are under 0.275% for the ex- In this exercise, the subject moves his or her limb while the robot
tension–flexion, 13.6% for the ulnar–radial deviation, and 1.1% for the manipulator generates an opposite force. The subject does work by
88
E. Akdoğan et al. Mechatronics 49 (2018) 77–91
in Table 14. Two pictures from the treatment process are shown in
-10
Fig. 11. All patients had full ROM and needed to strengthen their
-20 muscles. Therefore, isotonic and isometric exercises were applied to
patients for the flexion–extension movement.
-30
A four-step procedure, whose flowchart given in Fig. 12, were ap-
plied in each session (two sessions per week) of the rehabilitation. The
Decision
Active
procedure is explained in detail as follows:
Passive
89
E. Akdoğan et al. Mechatronics 49 (2018) 77–91
YES
NO
Passive Exercises
Enrollment Need to Physiotherapist YES
Exercise Finish completed
NO continue? checks results
succesfully ?
YES NO
Scheduling to
next session
Table 13
Clinical test results.
Flexion force(N) Extension force(N) Flexion force(N) Extension force(N) Flexion force(N) Extension force(N) Flexion force(N) Extension force(N)
1 20 10 18 30 33 20 15 25
2 18 9 23 38 35 28 19 26
3 20 16 23 37 55 30 16 25
4 22 18 35 39 50 40 23 31
5 24 20 30 35 55 35 24 28
6 27 18 36 40 40 36
7 28 18 38 44 44 38
8 30 17
9 32 20
10 30 21 The patient has reached the sufficient level of the muscle activity
11 34 23
12 33 23
13 30 20
Mean 26.8 17.9 29.0 37.6 45.6 30.6 25.9 29.9
Std Dev. 5.4 4.3 7.7 4.4 10.8 7.5 11.6 5.3
Max 34 23 38 44 55 40 44 38
Table 14 which were carried out with healthy subjects. Then, experiments were
The dynamometer data of the patients.a carried out with patients in a clinical environment. As a result of these
experiments, the increase in muscle strength was observed in all the
Patient 1 Patient 2 Patient 3 Patient 4
patients. In the next study, an adaptive impedance controller will be
B.T. A.T. B.T. A.T. B.T. A.T. B.T. A.T. developed for individuals and this controller will be tested with pa-
tients.
Right hand 9.0 18.0 35.0 36.0 39.0 38.0 2.0 9.5
Left hand 20.0 19.0 7.0 16.5 9.5 17.0 27.0 28.0
Acknowledgment
a
B. T. = Before Treatment, A. T. = After Treatment. The units are in kilogram.
This work was supported by the Scientific and Technological
decided that the force exerted by the patients will not increase. As can Research Council of Turkey (TUBITAK) under grant number 111M603.
be seen from Table 13, at the end of the exercises, it was observed that
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