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Principles of New Technologies. Audience Principles of New Technologies 2 Clinicians Scientist s Engineer s Others.

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Presentation on theme: "Principles of New Technologies. Audience Principles of New Technologies 2 Clinicians Scientist s Engineer s Others."— Presentation transcript:

1 Principles of New Technologies

2 Audience Principles of New Technologies 2 Clinicians Scientist s Engineer s Others

3 Societal drivers Reasons for New Technologies Principles of New Technologies 3 Technological drivers Clinical drivers Ageing of population Cost of health care Burden in daily life Available technology Fast growing Home use Unused recovery potential Evidence-based knowledge

4 Usage of New Technologies Principles of New Technologies 4 motor learning brain injury therapy assessmentsdaily activities New technologies for enhanced and effective therapy … … and assessing recovery progress

5 Integration of New Technologies Principles of New Technologies 5 Clinicians design assessments and treatment programs using the technologies to improve patient’s rehabilitation

6 Potential influence of New Technologies Principles of New Technologies 6 Advanced Rehabilitation Technology Varied, goal oriented repetitions at limit of performance & Feedback from successful performance Reduce support Increase challenge Movement & sensory input Muscle strength Neuroplasticity Motor Learning Improved performance

7 Contents 1. Robot-assisted Therapy 2. Non-actuator Devices 3. Functional Electrical Stimulation (FES) 4. Sensor Technology 5. Virtual Reality 6. Brain Stimulation Principles of New Technologies 7

8 ROBOT-ASSISTED THERAPY Principles of New Technologies 8 1

9 Rehabilitation Robotics Idea of using robots for rehabilitation emerged during the 1980’s Free therapists from heavy, repetitive work Increase consistency and volume of repetitions Principles of New Technologies 9 “Rehabilitation Robotics has been defined a special branch of robotics which focuses on machines that can be used to help people recover from severe physical trauma or assist them in activities of daily living.” History and Future of Rehabilitation Robotics, Frumento et al. 2010 Concept: arm/leg orthosistherapeutic robot += (industrial) robot

10 Robotic Therapy: Elements Principles of New Technologies 10 Mechanical structure Moveable segments and joints Actuators Convert energy into motion and force, e.g. motors Sensors Measure physical parameters, e.g. position, force, orientation, torque Controller Uses sensor data to control actuators Patient interface Attaches to patient and transmits forces from the robot, e.g. cuffs User interface Enables user to adjust controller settings Power source Provides electricity to drive actuators, controller power source controller actuator s sensors patient interface user interfac e mechanical structure

11 Attachment Location Upper limbs Lower limbs How to categorize robot-assisted therapeutic devices? Robotic Therapy: Devices Principles of New Technologies 11 Mechanical structure Exoskeletons End-effector-based Control strategies Full guidance Patient-cooperative Free Space

12 Robotic Therapy: Exoskeletons Attached to body or body parts Joints transmit forces to different robotic segments Allows production of physiological movements Combination with treadmills, body- weight-support, functional electrical stimulation, virtual reality Principles of New Technologies 12 “A wearable robot or external structural mechanism with joints and links corresponding to those of the human body.” Pons et al., 2006; History and Future of Rehabilitation Robotics, 2010 Upper limbsLower limbs

13 Attached to single body segment Transmit force via mechanical movement chain Combination with treadmills, body- weight-support, functional electrical stimulation, virtual reality Principles of New Technologies 13 “Robotic devices that provide support and forces to the patient’s limb only at its most distal part (end effector) which is attached to patient’s extremity.” Maciejasz et al., 2014 Upper limbsLower limbs Robotic Therapy: End-Effector Devices

14 Exoskeletons vs. End-Effector Devices Principles of New Technologies 14 ExoskeletonEnd-effector-based Simpler structure / control Easy to adjust to patient Limb posture not fully determined Limited force / position data Risk of joint injury Joint axes fully determined Physiological movements Force and position data of each joint Robot axes have to allign with anatomical axes Longer set-up times Challenging anatomical constraints

15 finger 6+1 DoF Robotic Therapy: Upper Limbs Principles of New Technologies 15 LateralityDegrees of freedom Individual limbs Parethic or unaffected arm individually Both arms together Amount of degrees of freedom Single limbs Combination of limbs elbo w 2 DoF bilateral unilateral

16 Robotic Therapy: Lower Limbs Principles of New Technologies 16 Gait training active orthoses Automated body- weight support training Exoskeleton combined with treadmill Support position and motion control of leg joints Compensate for weakness and deformities treadmill foot-plates overground Automated body- weight support training End-effector based device Body-weight support follows patient Allows natural walking but requires muscle activity

17 Robotic Therapy: Control Strategies Principles of New Technologies 17 Patient-cooperative control Guided movements Partial support to initiate and perform movement Haptic simulation for interactive environment Free space Negligible interaction with robot Full guidance Predefined motion performed by robot Muscle activity not required

18 Robotic Therapy: Advantages I Principles of New Technologies 18 Robot-assisted TherapyConventional Therapy Supports therapistLimited by manpower High reliability Poor movement repeatability High amounts of repetitions / intensity Limited number of repetitions Individually adjustable assistance Difficult for severely affected patients

19 Robotic Therapy: Advantages II Principles of New Technologies 19 Robot-assisted TherapyConventional Therapy Quantifiable and objective assessments Imprecise or subjective assessments Highly motivating for some Motivation dependent on patient therapist relationship Detailed and timed sensory feedback Subjective feedback New interventions

20 Robotic Therapy: Limitations Principles of New Technologies 20 Robot-assisted TherapyConventional Therapy Costly (short-term)Less costly (short-term) Space consumingNo big space requirements Risk of obsolenscenceNo risk of obsolenscence Devices specific for individual limbs Treatment of any body part Lacks degree of feedback or flexibility High degree of feedback or flexibility Limited communicationCommunication dependent on therapist $ XL

21 Linkage to Neural Principles and Learning Principles of New Technologies 21 Optimal Difficulty Level Repetitions More repetitions Automated administration Assistance Practice Time Increased practice time Less need for supervision Higher motivation Individually adjustable difficulty Added resistance Decreased support/assistance

22 Linkage to Neural Principles and Learning Principles of New Technologies 22 Feedback Simplified part practice Bilateral/unilateral Partial movements Reduced degrees of freedom Segmentation Motivation Increased motivation success through assistance Various feedback forms Inherent and augmented haptic feedback Assistance as-needed

23 NON-ACTUATOR DEVICES Principles of New Technologies 23 2

24 Non-Actuator Devices Principles of New Technologies 24 Non-actuator devices emerged from improvement ideas for robotic therapy Decrease device complexity and cost Increase safety for patients Improve training of functional movements and activities of daily living Concept: actuators/motorsnon-actuator devices -= therapeutic robot

25 Non-Actuator Devices: Elements Principles of New Technologies 25 Weight support Static balancing mechanisms using links, springs or wires Sensors Measure physical parameters, e.g. position, force, orientation, torque Patient interface Attaches to patient and transmits forces from the device, e.g. cuffs User interface Enables user to adjust controller settings patient interface user interfac e weight support sensors

26 Non-Actuator Devices: Upper/Lower Limbs Principles of New Technologies 26 Upper limbsLower limbs Arm weight support against gravity Ellbow, finger or wrist joint support Static body weight support against gravity Hip, knee or ankle joint support

27 Non-Actuator vs. Robotic Devices Principles of New Technologies 27 Non-actuator devicesRobotic devices Movement guidance for optimal trajectory Full movement support even for severely impaired patients Adjustable resistance Expensive and heavy More complex to use More safety precautions needed Significant lower costs Less weight Easier to use and intrinsically safe No power source needed No support other than against gravity No movement correction Limited resistance

28 Non-Actuator Devices: Advantages Principles of New Technologies 28 Non-actuator DevicesConventional Therapy Supports therapistLimited by manpower Higher amount of repetitions / intensity Limited number of Repetitions Assistance against gravityAssistance against gravity with therapist Quantifiable and objective Assessments Imprecise or subjective Assessments Highly motivating for some Motivation dependent on patient therapist relationship Detailed and timed sensory feedback Subjective feedback

29 Non-Actuator Devices: Limitations Principles of New Technologies 29 Non-actuator DevicesConventional Therapy Space consumingNo big space requirements Risk of obsolenscenceNo risk of obsolenscence Devices specific for individual limbs Treatment of any body part Lacks degree of feedback or flexibility High degree of feedback or flexibility Limited communicationSocial interaction XL

30 FUNCTIONAL ELECTRICAL STIMULATION (FES) Principles of New Technologies 30 3

31 Functional Electrical Stimulation Originated from electrotherapy Originally used in neuroprostheses to substitute impaired function Only usable if nerves and muscles are intact Principles of New Technologies 31 Electrical stimulation that results in cordinated muscle contractions and generate functional movements such as standing, walking, or grasping is called functional electrical stimulation (FES). Dietz et al. 2012, Neurorehabilitation Technology Concept: electricity patternfunctional electrical stimulation += muscle

32 FES: Elements Principles of New Technologies 32 Stimulator Determines simulation strength (current or voltage), frequency and length Electrodes Apply voltage to skin Power source Provides electricity to give stimulation power source stimulator electrode s

33 FES: Stimulation Parameters Pulse frequency High enough required (smooth contractions vs. series of twitches) Higher frequency results in stronger contractions but muscles tires quickly Ideal frequency: 12-16 Hz (upper) and 18-25 Hz (lower) Pulse amplitude/duration Increasing pulse amplitude or duration increases strength of contraction Too high amplitudes activate pain nerves Duration of 200-400 us Principles of New Technologies 33

34 FES: Electrodes Principles of New Technologies 34 Surface electrodesSubcutaneous electrodes noninvasive medium conducting current to underlying skin (e.g. water, conductive gel) pericutaneous implanted inserted through skin temporary implanted under skin permanent

35 FES: Surface Electrodes Principles of New Technologies 35 Advantages Non invasive method Multiple muscles can be stimulated with a single electrode Easy to apply and generally inexpensive $ Disadvantages Poor selectivity No option of stimulating deeper located musles Variable stimulation response needing time to reposition electrodes Higher voltage required

36 Advantages PericutaneousImplanted Good selectivity Constant stimulus perception response Lower voltage required FES: Subcutaneous Electrodes Principles of New Technologies 36 Disadvantages PericutaneousImplanted Invasive surgery Saftey (risk of infection, broken electrode parts)

37 FES: Application Principles of New Technologies 37 NeuroprothesesNeuromodulation Lost functions (walking, grasping) are restored by using electrical signals to replace motor commands or afferent signals Open-loopClosed-loop Preprogrammed stimuli without sensory feedback Sensory feedback adjusts stimulus intensity in order to control movement Nerve activity is altered through the delivery of electrical stimulation to normalize or modulate nerve function.

38 FES: Advantages and Limitations Principles of New Technologies 38 Advantages Production of ‘natural movements’ Replaces impaired or lost feedback Prevention of muscle atrophy, increase in strength Usable at home Limitations Muscle fatigue Skin irritation Variable stimulus tolerance, pain Electrode placement difficulty

39 SENSOR TECHNOLOGY Principles of New Technologies 39 4

40 Sensor Technology Altered demographics raise some fundamental questions: How do we care for an increasing number of individuals with complex medical conditions? How do we provide quality care to those in areas with reduced access to providers? How do we maximize the independence and participation of an increasing number of individuals with disabilities? Principles of New Technologies 40 “A device that measures or detects a real-world condition, such as motion, heat or light and converts the condition into an analog or digital representation.” Free Online Encyclopedia Concept: display sensor technology += sensor

41 Sensor Technology: Elements Principles of New Technologies 41 Sensing and data collection hardware To collect physiological and movement data Communication hardware and software To relay data to a remote center Data analysis techniques To extract clinically-relevant information from physiological and movement data Communication hardware and software Sensing and data collection hardware Data analysis techniques

42 Sensor Technology: Key Enabling Factors Principles of New Technologies 42 Micro Fabrication Miniaturization System-on-chip Low cost Mobile Technology Gateway Localization Computation Communication Technology Low-power Wireless standards

43 Sensor Technology: Field of Application Principles of New Technologies 43 Physiological sensing Biochemical sensing Motion sensing Diagnostic applications Monitoring applications On-going treatment

44 Sensor Technology in Rehabilitation I Principles of New Technologies 44 Health and wellnessSafety monitoringHome rehabilitation Activity monitoring Fall/seizure detection Therapeutic exercise «Aging in place» Combination of virtual reality

45 Sensor Technology in Rehabilitation II Principles of New Technologies 45 Assessment of treatment efficacy Early detection of disorders Disease management Patient status Achieve early detection of changes in patient’s status requiring clinical intervention By knowing what happens between outpatient visits, treatment interventions can be fine-tuned to the needs of individual patients

46 Sensor Technology: Advantages and Limitations Principles of New Technologies 46 Advantages Affordable for majority of patients Solve patient access issues (patients living far away from therapy centre) Increase patient independence and participation Limitations Technical barriers such as limitations of currently available battery technology Cultural barriers associated with the use of medical devices for home- based clinical monitoring

47 VIRTUAL REALITY Principles of New Technologies 47 5

48 Virtual Reality Idea of using virtual reality for rehabilitation emerged during the mid to late 1990s Defined trajectory in virtual environment had to be reproduced by patients (Holden et al. 1999) Increase motivation and simplify feedback information (knowledge of performance) Principles of New Technologies 48 “Virtual reality typically refers to the use of interactive stimulations created with computer hardware and software to present users with opportunities to engage in environments that appear to be and feel similar to real-world objects and events.” Weiss et al. 2004 Concept: display virtual reality += user input/tracking device

49 Model of VR-based rehabilitation Principles of New Technologies 49 goal is to help the patient achieve participation in the real world environment by overcoming, adapting to or minimizing the environmental barriers transfer of trained skills or tasks as well as environmental modifications from the virtual environment to the real world Task performance within virtual environment Real world Transfer phase «Interaction space» Performance in real world Activity Participation

50 Virtual Reality: Principles Principles of New Technologies 50 Output periphery Input periphery Technical actors Human sensors Human actorsTechnical sensors User environment Virtual environment

51 Virtual Reality: Elements Principles of New Technologies 51 Hardware components Primary user input (Keyboard, Mouse, Joystick/3D Pointing Devices/Whole-hand and body input) Tracking interface (Measure head, body, hand or eye motion) Visual, auditory, haptic interface Software components Input process Simulation process Rendering process World database Software component s Hardware component s

52 Virtual Reality: Hardware Principles of New Technologies 52 Helmet or mask providing visual and auditory stimuli LCD or CRT for stereo images. Option of built-in head- tracker and stereo headphones Head-Mounted Display (HMD) Head-coupled stereoscopic display device CRT for high-resolution Built-in tracking Projection of stereo images on a room-sized cube Head tracking continuously adjust the projection to the current position of the leading viewer Binocular Omni- Orientation Monitor (BOOM) Cave Automatic Virtual Environment (CAVE) Sensors on fingers plus position/orientation tracking Enables natural interaction with virtual objects Data Glove Control Devices Control virtual objects in 3 dimensions (Joystick, mouse)

53 53 Virtual Reality: Software (Architecture) Input processor Stimulation processor Rendering processor World database Position & Orientation Visual, Auditory, Haptic Principles of New Technologies

54 Virtual Reality: Fields of Application Principles of New Technologies 54 Design, engineering, manufacturing and marketing Medicine and healthcare Hazardous operations in extreme or hostile surroundings Training in military and industrial machine operation, medical teaching and surgery planning/training

55 Total-body movement Non-Immersive Immersive Virtual Reality: Devices Principles of New Technologies 55 Non total-body movement Motion capture via sensor device Motion capture via camera/video Interaction via keyboard, mouse, joystick Rehabilitation specific Commercially available Rehabilitation specific Commercially available Rehabilitation specific Commercially available Head mounted display Force feedback gloves Camera detects users’ body movements Motion sensors detect movement of device (remote control, glove) or user movement on/in device (platform, robot) Mouse, joystick or keyboard Fully immersed; first person view Mirror-image reflection Represented as an avatar or user invisible; 1st person or 3rd person view

56 Virtual Reality: Immersive Devices First person view of 3D virtual world Users wears head mounted display Feel of presence Virtual scene is responding to the subjects action Principles of New Technologies 56 “The goal of Immersive VR is to completely immerse the user inside the computer generated world, giving the impression to the user that he/she has “stepped inside” the synthetic world.” Furht 2008, Encyclopedia of Multimedia

57 Virtual Reality: Non-Immersive Devices Use of monitor to display the visual world Interact through motion detecting interfaces Subjects do fully respond in the real environment Principles of New Technologies 57 “In non-immersive systems, the VR system often consists of a computer monitor, mouse, keyboard and possibly joysticks, haptic devices and force sensors.” Ortiz-Catalan et al., 2014

58 Virtual Reality: Advantages Principles of New Technologies 58 Advantages Intensive training (repetition) and increased motivation by feedback information Improve approach efficacy and outcome by making tasks easier, less demanding and less tedious VR environments are flexible and customizable for different therapeutic purposes

59 Virtual Reality: Limitations Principles of New Technologies 59 Limitations Lack of standards, frameworks and compatibility Dizziness, headache, cyber sickness Legal aspects: registration as medical device High costs - fully immersive systems

60 Linkage to Neural Principles and Learning Effectiveness of New Technologies 60 Feedback Learning process must be reinforced by feedback Feedback links patient’s performance to successful task outcome RepetitionsMotivation Motivation is needed to repetitively carry out task Repetitions are important to promote motor learning and cortical plasticity + = Increasing difficulty Increasing skills Too hard Too easy Ideally difficulty progression

61 BRAIN STIMULATION Principles of New Technologies 61 6

62 Brain Stimulation First century AD Roman physician Scribonius Largus applied electric torpedo fish to patients’ bodies to treat headaches. Scientific research originated from electrotherapy in the early 19th century. Potential for treating depression, chronic pain, help recover faster from strokes etc. Principles of New Technologies 62 Brain stimulation is a technique that applies direct (electrodes) or indirect (magnetic coil) electrical stimulation to a population of neurons in the brain. Adapted from Wikipedia Concept: electricitybrain stimulation += brain

63 Brain Stimulation: Elements Principles of New Technologies 63 Stimulator Determines stimulation strength, frequency and length Electrodes or magnetic coil Apply voltage to skin or magnetic field Power source Provides electricity to give stimulation stimulator electrode s magnetic coil power source or

64 Brain Stimulation: Methods Principles of New Technologies 64 Transcranial magnetic stimulation (TMS) Transcranial direct current stimulation (tDCS) Deep brain stimulation (DBS) NoninvasiveInvasive Magnetic coil & magnetic field Electrodes & current

65 Brain Stimulation: TMS Principles of New Technologies 65 A noninvasive technique that consists of a magnetic field emanating from a wire coil held outside the head. The magnetic field induces an electrical current in nearby regions of the brain. MedicineNet.com Figure 2. Schematic representation of how to assess brain plasticity with TMS. As recorded using either electromyography (EMG) or electroencephalography (EEG), brain responses to TMS can be measured as motor evoked potentials (when TMS is applied to motor cortex) or localized evoked field potentials. Comparison of these TMS- based measures of cortical reactivity before and after a given intervention (e.g., PAS, rTMS, TBS, task) can provide an index of brain plasticity in response to that intervention. Principle: Activates or suppresses activity in cortical regions Repetitive TMS outlasts stimulation period up to hours Allows accurate mapping of muscle representation Useful for characterizing CNS injuries Causes resting neurons to fire

66 Brain Stimulation: tDCS Principles of New Technologies 66 A noninvasive technique which uses constant, low current delivered directly to the brain area of interest via small electrodes. Adapted from Wikipedia Principle: Modulation of brain activity that can be applied before or during practice. Anodal region: depolarizes neuronal membrane, making it more likely to fire. Cathodal region: hyperpolarizes neuronal membrane, making it less likely to fire. Believed to modulate firing rate of active neurons

67 TMS vs. tDCS Principles of New Technologies 67 Transcranial magnetic stimulation TMS Transcranial direct current stimulation tDCS Lasts up to hours In general low-cost Low risk of adverse effects Reliable sham condition Poor spatial and temporal resolution Concurrent modulation of brain area under reference electrode Protocols less established Can result in transient headaches Lasts up to hours Good spatial and temporal resolution (ms) Well established protocols Expensive Risk of seizures (rare) Limited to superficial brain areas Can result in transient headaches No good sham condition

68 Contact International Industry Society in Advanced Rehabilitation Technology (IISART) General Information info@iisartonline.org www.iisartonline.org www.iisartonline.org Principles of New Technologies 68

69 Literature [1] Poli et al. 2013, Robotic Technologies and Rehabilitation: New Tools for Stroke Patients’ Therapy. [2] Diaz et al. 2011, Lower-Limb Robotic Rehabilitation: Literature Review and Challenges. Principles of New Technologies 69

70 Image sources Slide 2 – Audience Background:http://www.iisd.ca/ymb/climate/wcc3/pix/1sept/DSC_6266%20full%20room.jpghttp://www.iisd.ca/ymb/climate/wcc3/pix/1sept/DSC_6266%20full%20room.jpg Slide 3 – Reasons for New Technologies Left:http://www.unece.org/typo3temp/pics/8346dcaa95.jpg Middle (upper):http://emergingtech.tbr.edu/sites/default/files/styles/flexslider_full/public/NewTech_0.jpg?itok=WghHlgJO Middle (lower):http://timpexelectronics.com/wp-content/uploads/2014/03/Electronics-0000166421891-1100x732.jpg Right:http://www.nature.com/sc/journal/v41/n12/fig_tab/3101518f1.htmlhttp://www.unece.org/typo3temp/pics/8346dcaa95.jpghttp://emergingtech.tbr.edu/sites/default/files/styles/flexslider_full/public/NewTech_0.jpg?itok=WghHlgJOhttp://timpexelectronics.com/wp-content/uploads/2014/03/Electronics-0000166421891-1100x732.jpghttp://www.nature.com/sc/journal/v41/n12/fig_tab/3101518f1.html Slide 4 – Usage of New Technologies 1st image (motor learning):http://www.vi-hotels.com/typo3temp/pics/s_1ad5acb5b7.jpg 2ndimage (brain injury):http://www.eusi.org/wp-content/uploads/2012/11/stroke.jpg 3rd image (therapy):Hocoma 4th image (assessments):http://www.hopkinsmedicine.org/healthlibrary/GetImage.aspx?ImageId=268329 5th image (daily activities):http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2013/10/28/1382979259350/Gardening-and-DIY-can-pro- 011.jpghttp://www.vi-hotels.com/typo3temp/pics/s_1ad5acb5b7.jpghttp://www.eusi.org/wp-content/uploads/2012/11/stroke.jpghttp://www.hopkinsmedicine.org/healthlibrary/GetImage.aspx?ImageId=268329http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2013/10/28/1382979259350/Gardening-and-DIY-can-pro- 011.jpg Slide 9 – Rehabilitation Robotics Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light Robot:http://bsiswoyo.lecture.ub.ac.id/files/2011/12/puma560-1.png Arm/leg orthosis:http://www.broadenedhorizons.com/powergrip-add-on-kit Therapeutic robot:From Lum et al. 2006, MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study.http://theosophy.net/forum/topics/theosophists-and-the-lighthttp://bsiswoyo.lecture.ub.ac.id/files/2011/12/puma560-1.pnghttp://www.broadenedhorizons.com/powergrip-add-on-kit Principles of New Technologies 70

71 Image sources Slide 10 – Robotic Therapy: Elements Image (Lokomat):Hocoma Slide 11 – Robotic Therapy: Devices 1st image (Lopes):http://www.blogcdn.com/www.engadget.com/media/2011/02/lopesexoskeletontwente-1298501841.jpg 2nd image (Armeo Power):Hocoma 3rd image (InMotion):http://imt.lynxdesign.com/wp-content/uploads/2012/11/HandRobotTherapy.png 4rd image (Lokomat):Hocoma 5th image (Gentle/S):http://www.reading.ac.uk/AcaDepts/si/gentle/103-0325_IMG.JPG 6th image (Mime): http://www.rehab.research.va.gov/jour/00/37/6/images/BURG-F03.JPG 7th image (G-EO System):http://www.skoutasmedical.gr/portal/components/com_virtuemart/shop_image/product/G_EO_System_Evol_4f4767f5b831c.jpg 8th image (Gait Trainer):http://www.reha-stim.de/cms/assets/images/GT-I-mit-Person 9th image (Bi-Manu-Track):http://www.reha-stim.de/cms/assets/images/Bi-Manu-Track-09.jpg 10th image (Lokohelp):http://www.woodway.de/images/productimages/LokoHelp_with_PPS.pnghttp://www.blogcdn.com/www.engadget.com/media/2011/02/lopesexoskeletontwente-1298501841.jpghttp://imt.lynxdesign.com/wp-content/uploads/2012/11/HandRobotTherapy.pnghttp://www.reading.ac.uk/AcaDepts/si/gentle/103-0325_IMG.JPG http://www.rehab.research.va.gov/jour/00/37/6/images/BURG-F03.JPGhttp://www.skoutasmedical.gr/portal/components/com_virtuemart/shop_image/product/G_EO_System_Evol_4f4767f5b831c.jpghttp://www.reha-stim.de/cms/assets/images/GT-I-mit-Personhttp://www.reha-stim.de/cms/assets/images/Bi-Manu-Track-09.jpghttp://www.woodway.de/images/productimages/LokoHelp_with_PPS.png Slide 12 – Robotic Therapy: Exoskeletons Images:Created for slide pool Slide 13 – Robotic Therapy: End-Effector Devices Images:Created for slide pool Slide 14 – Exoskeletons vs. End-Effector Devices Images:Created for slide pool Principles of New Technologies 71

72 Image sources Slide 15 – Robotic Therapy: Upper Limbs Left images (unilateral):http://imt.lynxdesign.com/wp-content/uploads/2012/11/HandRobotTherapy.png Left images (bilateral):From van Delden 2012, A Systematic Review of Bilateral Upper Limb Training Devices for Poststroke Rehabilitation. Middle images (2 Dof):From Metzger et al. 2012, High-Fidelity Rendering of Virtual Objects with the ReHapticKnob – Novel Avenues in Robot- Assisted Rehabilitation of Hand Function. Middle images (6+1 Dof):Hocoma Right images (elbow):http://nyp.org/img/enewsletters/e100_patient_balls.jpg Right images (fingers):http://tyromotion.com/wp-content/uploads/2013/02/Amadeo_1.pnghttp://imt.lynxdesign.com/wp-content/uploads/2012/11/HandRobotTherapy.pnghttp://nyp.org/img/enewsletters/e100_patient_balls.jpghttp://tyromotion.com/wp-content/uploads/2013/02/Amadeo_1.png Slide 16 – Robotic Therapy: Lower Limbs Treadmill:Hocoma Foot-plates:http://www.rehatechnology.com/upload/cms/user/G-EO_System_brochure_EN.pdf, page 4 Overground:http://c1.staticflickr.com/5/4083/5169846467_b25ee3cc73_n.jpg Active foot orthoses:http://www.mdpi.com/robotics/robotics-03-00120/article_deploy/html/images/robotics-03-00120-g007-1024.pnghttp://www.rehatechnology.com/upload/cms/user/G-EO_System_brochure_EN.pdfhttp://c1.staticflickr.com/5/4083/5169846467_b25ee3cc73_n.jpghttp://www.mdpi.com/robotics/robotics-03-00120/article_deploy/html/images/robotics-03-00120-g007-1024.png Slide 17 – Robotic Therapy: Control Strategies Images:Adapted from Teasell and Hussein 2013, Evidence-Based Review of Stroke Rehabilitation: Background Concepts in Stroke Rehabilitation Slide 18-20 – Advantages and Limitations Icons:Created for slide pool Principles of New Technologies 72

73 Image sources Slide 21 – Linkage to Neural Principles and Learning Left image (repetitions):Hocoma Middle image (pract. time):http://cms.birdinhand.com.au/bird/wp-content/uploads/sites/2/2014/10/hour-glass.jpg Right image (difficulty):Existing presentationhttp://cms.birdinhand.com.au/bird/wp-content/uploads/sites/2/2014/10/hour-glass.jpg Slide 22 – Linkage to Neural Principles and Learning Left image (segmentation):Created for slide pool Middle image (motivation):Created for slide pool Right image (feedback):Existing presentation Slide 24 – Non-Actuator Devices Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light Left image:From Lum et al. 2006, MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. Middle image (actuator):http://www.intelligentactuator.com/images/rcp2_ra10c.jpg Right image:http://cdn.shopify.com/s/files/1/0251/9611/files/BOOM_small.jpg?15468http://theosophy.net/forum/topics/theosophists-and-the-lighthttp://www.intelligentactuator.com/images/rcp2_ra10c.jpghttp://cdn.shopify.com/s/files/1/0251/9611/files/BOOM_small.jpg?15468 Slide 25 – Non-Actuator Devices: Elements Left Image: Hocoma Slide 26 – Non-Actuator Devices: Upper/Lower Limbs 1st image:Hocoma 2nd image (handSOME):http://cabrr.cua.edu/res/images/research/Handsomepic6.jpg 3rd image (GBO):http://roar.me.columbia.edu/projects/gbo/figures/gbo.jpghttp://cabrr.cua.edu/res/images/research/Handsomepic6.jpghttp://roar.me.columbia.edu/projects/gbo/figures/gbo.jpg Principles of New Technologies 73

74 Image sources Slide 26 – Non-Actuator Devices: Upper/Lower Limbs 4th image (ZeroG): http://www.aretechllc.com/img/passive/zgp1-n.jpghttp://www.aretechllc.com/img/passive/zgp1-n.jpg Slide 27 – Non-Actuator vs. Robotic Devices Images:Created for slide pool Slide 28-30 – Advantages and Limitations Icons:Created for slide pool Slide 31 – Functional Electrical Stimulation Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light Muscle:http://cdn.inquisitr.com/wp-content/uploads/2011/06/build-leg-muscle.jpeg Electricity pattern:http://i.kinja-img.com/gawker-media/image/upload/s--v9hJqgOH--/c_fit,fl_progressive,q_80,w_636/187bzswqhpil0jpg.jpg FES:http://www.walkaide.com/en-US/news/PublishingImages/productimages/Bi-Flex-Production-4_tn.jpghttp://theosophy.net/forum/topics/theosophists-and-the-lighthttp://cdn.inquisitr.com/wp-content/uploads/2011/06/build-leg-muscle.jpeghttp://i.kinja-img.com/gawker-media/image/upload/s--v9hJqgOH--/c_fit,fl_progressive,q_80,w_636/187bzswqhpil0jpg.jpghttp://www.walkaide.com/en-US/news/PublishingImages/productimages/Bi-Flex-Production-4_tn.jpg Slide 32 – FES: Elements Image:IISART Techindex Slide 33 – FES: Stimulation Parameters Upper image:From Fuglevand et al. 1999, Force-frequency and fatigue properties of motor units in muscles that control digits of the human hand. Lower image:From Kesar et al. 2008, Effects of stimulation frequency versus pulse duration modulation on muscle fatigue. Principles of New Technologies 74

75 Image sources Slide 34 – FES: Electrodes Images (surface & subcut.):Present. from Finetech Medical Ltd.: http://www.healthyaims.org/presentations06/Functional%20Electrical%20Stimulation% 20-%20Salisbury%20presentation%20March%203rd%2006.pdf http://www.healthyaims.org/presentations06/Functional%20Electrical%20Stimulation% Slide 35-36 – Electrode Types Icons:Created for slide pool Slide 38 – Advantages and Limitations Icons:Created for slide pool Slide 40 – Sensor Technology Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light Sensor:Hocoma Display:http://clipartist.net/svg/monitor-screen-may-2011/ Sensor technology:Hocomahttp://theosophy.net/forum/topics/theosophists-and-the-light Slide 41 – Sensor Technology: Elements Image:Hocoma Slide 43 – Sensor Technology: Field of Application Icons:Created for slide pool Principles of New Technologies 75

76 Image sources Slide 44 – Sensor Technology in Rehabilitation I Images:Presentation from Clemens Slide 45 – Sensor Technology in Rehabilitation II Icons:Created for slide pool Slide 46 – Sensor Technology: Advantages and Limitations Icons:Created for slide pool Slide 48 – Virtual Reality Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light User input/tracking device:http://i-am-fast.com/Pictures/data-glove.jpg Display:http://clipartist.net/svg/monitor-screen-may-2011/ Virtual reality:IISART Techindexhttp://theosophy.net/forum/topics/theosophists-and-the-lighthttp://i-am-fast.com/Pictures/data-glove.jpg Slide 50 – Virtual Reality: Principles Original slide:Prof. Dr.-Ing. Robert Riener, ETH Zurich Slide 51 – Virtual Reality: Elements Image:IISART Techindex Slide 52 – Virtual Reality: Hardware HMD:http://www.geeky-gadgets.com/wp-content/uploads/2012/10/Carl-Zeiss-OLED-Head-Mounted-Display.jpg BOOM:http://www.macs.hw.ac.uk/~hamish/9ig2/graphics/f3boomhf.GIFhttp://www.geeky-gadgets.com/wp-content/uploads/2012/10/Carl-Zeiss-OLED-Head-Mounted-Display.jpghttp://www.macs.hw.ac.uk/~hamish/9ig2/graphics/f3boomhf.GIF Principles of New Technologies 76

77 Image sources Slide 52 – Virtual Reality: Hardware CAVE:http://www.jvrb.org/past-issues/3.2006/589/figure03.jpg Data glove:http://i-am-fast.com/Pictures/data-glove.jpg Control devices:http://cdn2.sbnation.com/assets/3757533/hydra-theverge-1_560.jpghttp://www.jvrb.org/past-issues/3.2006/589/figure03.jpghttp://i-am-fast.com/Pictures/data-glove.jpghttp://cdn2.sbnation.com/assets/3757533/hydra-theverge-1_560.jpg Slide 53 – Virtual Reality: Software (Architecture) Icons:Created for slide pool Slide 54 – Virtual Reality: Field of Application Icons:Created for slide pool Slide 55 – Virtual Reality: Devices Icons:Created for slide pool Slide 56 – Virtual Reality: Immersive Devices Image:Created for slide pool Slide 57 – Virtual Reality: Non-Immersive Devices Image:Created for slide pool Slide 58-59 – Advantages and Limitations Icons:Created for slide pool Principles of New Technologies 77

78 Image sources Slide 60 – Linkage to Neural Principles and Learning Motivation:Created for slide pool Feedback:http://lermagazine.com/wp-content/uploads/2014/01/1ITM-diabetes-iStock_13540.jpg Repetitions:Hocomahttp://lermagazine.com/wp-content/uploads/2014/01/1ITM-diabetes-iStock_13540.jpg Slide 62 – Brain Stimulation Light bulb:http://theosophy.net/forum/topics/theosophists-and-the-light Brain:Created for slide pool by Gokcen Akcali Electricity:http://i.kinja-img.com/gawker-media/image/upload/s--v9hJqgOH--/c_fit,fl_progressive,q_80,w_636/187bzswqhpil0jpg.jpg Brain stimulation: http://brainmodulation.com/wp-content/uploads/2014/06/brain-mod-assfn.jpghttp://theosophy.net/forum/topics/theosophists-and-the-lighthttp://i.kinja-img.com/gawker-media/image/upload/s--v9hJqgOH--/c_fit,fl_progressive,q_80,w_636/187bzswqhpil0jpg.jpghttp://brainmodulation.com/wp-content/uploads/2014/06/brain-mod-assfn.jpg Slide 63 – Brain Stimulation: Elements Magnetic coil:http://www.magstim.com/img/imagecache/8/e/1/d/cache_8e1deb172df266220a30b367e3b279d3.png Stimulator:http://www.rogue-resolutions.com/wp-content/uploads/2012/07/Rogue-Resolutions-DC-STIMULATOR-PLUS.jpg Electrodes:http://www.wired.com/wp-content/uploads/2014/05/brainstim-figure.jpghttp://www.magstim.com/img/imagecache/8/e/1/d/cache_8e1deb172df266220a30b367e3b279d3.pnghttp://www.rogue-resolutions.com/wp-content/uploads/2012/07/Rogue-Resolutions-DC-STIMULATOR-PLUS.jpghttp://www.wired.com/wp-content/uploads/2014/05/brainstim-figure.jpg Slide 64 – Brain Stimulation: Methods TMS:http://www.brainclinics.com/dynamic/media/1/images/rTMS_Figure1.png tDCS:http://www.drmueller-healthpsychology.com/i//tDCS_Device.jpg DBS:http://www.extremetech.com/wp-content/uploads/2013/07/Deep-brain-stimulation-640x353.jpghttp://www.brainclinics.com/dynamic/media/1/images/rTMS_Figure1.pnghttp://www.drmueller-healthpsychology.com/i//tDCS_Device.jpghttp://www.extremetech.com/wp-content/uploads/2013/07/Deep-brain-stimulation-640x353.jpg Slide 65 – Brain Stimulation: TMS Image:http://2012books.lardbucket.org/books/beginning-psychology/section_17/5031a470f57cb20752c42fb4956e7c3f.jpghttp://2012books.lardbucket.org/books/beginning-psychology/section_17/5031a470f57cb20752c42fb4956e7c3f.jpg Principles of New Technologies 78

79 Image sources Slide 66 – Brain Stimulation: tDCS image:http://davidileitman.com/wp-content/uploads/2014/04/tdcs.jpghttp://davidileitman.com/wp-content/uploads/2014/04/tdcs.jpg Slide 67 – TMS vs. tDCS TMS:http://www.brainclinics.com/dynamic/media/1/images/rTMS_Figure1.png tDCS:http://www.drmueller-healthpsychology.com/i//tDCS_Device.jpghttp://www.brainclinics.com/dynamic/media/1/images/rTMS_Figure1.pnghttp://www.drmueller-healthpsychology.com/i//tDCS_Device.jpg Principles of New Technologies 79


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