Anne-Marie Hughes

Iterative Learning Control in Health Care: Electrical Stimulation and Robotic-Assisted Upper-Limb Stroke Rehabilitation

Annually, 15 million people worldwide suffer a stroke, and 5 million are left permanently disabled. A stroke is usually caused when a blood clot blocks a vessel in the brain and acts like a dam, stopping the blood reaching the regions downstream. Alternatively, it may be caused by a hemorrhage, in which a vessel ruptures and leaks blood into surrounding areas. As a result, some of the connecting nerve cells die, and the person commonly suffers partial paralysis on one side of the body, termed hemiplegia. Cells killed in this way cannot regrow, but the brain has some spare capacity and, hence, new connections can be made. The brain is continually and rapidly changing as new skills are learned, new connections are formed, and redundant ones disappear. A person who relearns skills after a stroke goes through the same process as someone learning to play tennis or a baby learning to walk, requiring sensory feedback during the repeated practice of a task. Unfortunately, the problem is that they can hardly move and, therefore, do not receive feedback on their performance.

Design & control of a 3D stroke rehabilitation platform

An upper limb stroke rehabilitation system is developed which combines electrical stimulation with mechanical arm support, to assist patients performing 3D reaching tasks in a virtual reality environment. The Stimulation Assistance through Iterative Learning (SAIL) platform applies electrical stimulation to two muscles in the arm using model-based control schemes which learn from previous trials of the task. This results in accurate movement which maximises the therapeutic effect of treatment. The principal components of the system are described and experimental results confirm its efficacy for clinical use in upper limb stroke rehabilitation.

A qualitative study exploring views and experiences of people with stroke undergoing transcranial direct current stimulation and upper limb robot therapy

Abstract Background: Neurorehabilitation technologies used mainly in research such as robot therapy (RT) and transcranial direct current stimulation (tDCS) can promote upper limb motor recovery after stroke. Understanding the feasibility and efficacy of stroke rehabilitation technologies for upper limb impairments is crucial for effective implementation in practice. Small studies have explored views of RT by people with stroke; however experiences of people receiving tDCS in combination with RT have never been explored. Objective: To explore views and experiences of people with sub-acute and chronic stroke that had previously taken part in a randomised controlled trial involving tDCS and RT for their impaired upper limb. Methods: An interview study includes open and closed questions. Face-to-face interviews were audio recorded. Open-ended question responses were transcribed and analyzed using thematic analysis; closed questions were analyzed using descriptive analysis. Results: Participants felt that RT was enjoyable (90%) and beneficial for their affected arm (100%). From the open question data, it was found that the intervention was effective for the impaired arm especially in the sub-acute stage. Main reported concerns were that tDCS caused painful, itching and burning sensations and RT was sometimes tiring and difficult. Participants recommended that future research should focus on designing a more comfortable method of tDCS and develop a robot that promotes hand movements. Conclusions: This study provides new knowledge about the benefits and barriers associated with these technologies which are crucial to the future effective implementation of these tools in practice.