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Proceedings of The National Conference on Man Machine Interaction 2014 [NCMMI 2014]

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APatientRehabilitationSystemusingaManǦ MachineInterfaceDesign BinsonVA,JoJoy,AnishThomas

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AssistantProfessor,DepartmentofAEI,Saintgitscollege,Kottayam,India AssistantProfessor,DepartmentofEEE,Saintgitscollege,Kottayam,India

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AssistantProfessor,DepartmentofAEI,Saintgitscollege,Kottayam,India  Abstract: This paper presents the design of a man machine interface for controlling of a rehabilitation robotthatcanperformactiveandpassiveexercisesforlowerlimbs.Thesystemwithmanmachineinterface and robot manipulator can learn physiotherapist manual exercises and perform them by itself like a physiotherapist. Thus the rehabilitation capability is conveyed to the patient directly. The System also provides a graphical user Interface by which the treatment period can be observed and recorded. This interfacecanalsobeusedforwebǦbasedremotetherapy.Rehabilitationofkneeandhiparecarriedoutand thetestresultsarepresented.

I.Introduction

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The role of the rehabilitation process is to restore functionality of previously damaged limbs. It is most importanttoreturnpatientstosociety,reintegratethemintosociallifeandthereforeimprovethepatients' qualityoflife.Throughouttherapy,physicalexercisesforextremitieslikearmsandlegshaveakeyǦrolein the recovery of the patient. Therapeutic exercises consist of active or passive physical movements of the patient,carriedoutthroughthetherapist,orofmovementscarriedoutofthepatientwiththeassistanceof thephysiotherapist,dependingontheconditionofthepatient.Forrehabilitationeitherthepatienthasto go to a healthcare center, or the physiotherapist has to come to the patient. Studies for robots in rehabilitationhavebeenincreasedduetothetimeǦconsumingprocessofrehabilitation.

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Studies carried out in the closer past have proved many advantages of rehabilitation robots compared to classic therapy methods [2]. In addition robotic therapy provides better possibilities to acquire and store information such as the therapy response of the patient [3]. Thereare several studies that use intelligent techniquesandtheiraimsaretotransferphysiotherapistrehabilitationcapacitytopatientdirectly.Inthis study, a man machine interface (MMI) has been designed in order to control a designed and produced rehabilitation robot. Unlike other existing projects the robot manipulator (RM) that is usedin this study can perform active and passive exercises for lower limbs and it can perform knee flexionǦextension, hip extensionǦflexionandhipabductionǦadductionmovements.Alsotherehabilitationsystemthatconsistsof humanmachineinterfaceandrobotmanipulatorcanlearnphysiotherapistmanualexercisesandperform them by itself like a physiotherapist. So this rehabilitation capability is conveyed to patient directly. So, singlephysiotherapistrehabilitatesmorethanonepatientatthesametimewiththissystem.ThehumanǦ machineinterfaceincludesaneasyǦtoǦusegraphicaluserinterface.Withthisinterface,thetreatmentperiod can be observed andsaved. Furthermore, the interface has been designed to be fit for webǦbased remote therapy. Thus, difficulties of transferring patients to medical centers can be eradicated. Test results are presentedfordirectrehabilitationofkneeandhip.

II.SystemDescription Thesystemconsistsof threebasiccomponents(SeeFigure1)Physiotherapist,themanmachineinterface androbotmanipulator(RM).ThesystemcanperformPhysiotherapist’smanualexercisesaswellastocarry out all standard active and passive exercises. The modeling of the manual exercises has been named



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Proceedings of The National Conference on Man Machine Interaction 2014 [NCMMI 2014]

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“robotheerapy”. In thee robotherap py mode, thee system opeerates in two o different m modes. These modes are directth herapy andreeactive therap py. Indirect therapymod de, thesystem mcanrepeatt movementsstaughtby thePhyssiotherapistfo foranyrequirredduration..Inreactivet therapymode,thesystem mrespondsacccordingto thepatieent’sreaction ns,theboundarycondition nsoftheexerrcisecarriedo outkeepchangingoverth heduration ofthetherapy.Inthisspaper,onlythedirecttherapymodet testresultshaavebeensho own.  Figure1.Basiccompo onentsofthesystem.  Thegraaphicaluseri  nterfaceenab blesthePT access to all inform mation conccerning the patient and therapyy mode, exeercise type etc. Th he standard d active an nd passive exercisees are carried d out throug gh the RM. Howeveer, for d direct therrapy the physioth herapist carrries out m movements while the t patient iis on the R RM. In the meantim me, the HM MI monitors and stores position n and forcee values. A All process paramettersarestoreedinthedatabase.This mode h has been n named “direcct therapy teaching g”mode. Thenext stepi istoswitch overto“directtheraapyǦtherapy”mode.The RMisn nowreproduccingthesam mepositions and forces applied tto the patien nt as in the previou usteachingm mode.

A.Physiiotherapistt

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 ndesignedto obeanaid Thesystemhasbeen for the physiotherap pist considerring a fixed numberrofphysiotherapistinsocciety,more patientss could be h helped in a better way using this techn nology. Fu urthermore, rehabiliitation sessiions could be held longer, which is an n additional advantage. The syystem's aim isn't to reeplace the physioth herapist,itisstosupporth himorher. Thephyysiotherapistdecidesont thespecific exercisees to be carrried out by tthe patient andteacchesthoseto otheRM.TheRMisfed with in nformation ab bout the paatient (ageǦ weight body length)) and detailss about the exercisee to be carried out. The physioth herapist th hen carries out the exercisees together w with the patiient. In the p, the RM caarries out th he exercises w with the pattient in the same way ass done beforre with the next step physioth herapist.

B.Man nMachineI Interface

 TheMM MIisthecentrralunitbetw weenphysioth herapistandtheRM.Itco onsistsoftheeimpedancecontroller, rule basee, data base, graphical usser interface and central interface uniits. A detaileed block diag gram of the



NCMMI '14



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Proceedings of The National Conference on Man Machine Interaction 2014 [NCMMI 2014]

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MMIisg giveninFigurre2whichisalsoknowna asHumanmaachineinterfaace(HMI).Th heMMIprogrrammingis realizedi inMatlab/Sim mulink.



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MI/MMI Figurre2.DetailedBlockDiagraamoftheHM Central Interface Unit: The central inteerface unit provides communication n between all system componeents.

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Graphiccal User Inte erface (GUI): Enables th he user to co ommunicate with the HM MI. The maiin menu as shownin nFigure3isusedtoinpu utthepatientts'data.Thessedataisuseedinorderto ocalculateanumberof mechanicalparameteers.Thebodyylimbwhichistobeexercisedandtheeexercisetyp peareselecteedfromthe mainmeenuaswell.R Resultsfromp previouslycaarriedoutexeercisescanbeeaccessedfromthemain nmenuand aredispllayedgraphiccallyasshow wninFigure4 4.Thegraph hicsdisplayth hepatients'r rangeofmottion(ROM) andcorrrespondingfo orces. These resultsaresttoredinthedatabasefordocumentattionand can beprinted outoptio onally. Impedan nce Controller: Impedaance controll aims at co ontrolling po osition and fforce by adjjusting the mechanicalimpedancceoftheend dnjeffectorto external forcces generated dby contact with themaanipulator’s environm ment. Mechaanical impedance is roug ghly an exten nded concep pt of the stiffness of a m mechanism against aa force appllied to it. It is accepteed to be thee most apprropriate conttrol techniqu ue for the physioth herapyandisusedinman nyrehabilitattionrobotap pplications[5,6][8][11,12])).Becauseof fthisitwas usedint thisapplicatiionasmainc controlmeth hod.Fordirecctrehabilitattion,itsparam meterswereselectedas appropriiate for PT m moves patien nt limbs smo oothly and eaasily. In ordeer to select appropriate impedance parameteersvalues,so omeexperimeentswerereaalizedwithdiffferentparam metersindiffe ferentspeeds.. Data an nd Rule Basse: All data rrelevant to tthe patient iss stored in tthe data and d rule base. The stored informattion containss personal daata, impedan nce controllerr parameters, saved exerccises from th he teaching modean ndexerciseresults.



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Proceedings of The National Conference on Man Machine Interaction 2014 [NCMMI 2014]

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Figure5.RobotManip pulator



I III.Results sandDiscu ussion

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IIn the experriments with h the RM, h healthy test persons are used. Each t testperson's legisconnectedtothe R RM with tw wo points, thigh and a ankle. “Direcct therapy ǦǦ teaching” m modeisselec ctedfromtheGUI.The e experiments  carried out cover knee f flexionǦexten nsion, hip flexionǦ e extensionan dabductionǦǦadduction. T The physiottherapist teeaches the e exercises together with h the test p persondirect tlyontheRM M. Position a andforceme easurementresultsfrom t taught exerccises are stored in the d database. In n the following step “ “direct theraapy – therapyy” mode is s selectedfrom mtheGUI.Th heRMnow c carries out evvery stored eexercise for t patient independentlly from the the p physiotherap pist. Figure 6 shows e exemplary ttest results for knee e extensionǦfle xion.Inthisfigure,first g graphic shows physio otherapist’s e exercise traajectory in teaching m mode, secon nd graphic sshows RM’ exercisetrajectoryintherapymod deandthelasstgraphicsho owstrajectorryerrorbetweeenphysioth herapistand RM exerrcises. The reesults show a very much h accurate reepetition of the PT's mo ovements as learned in teaching gmode.InFigure7,teach hingandtherrapyresultsa areshownfo orhipflexion nǦextensionm movements. RM’sLin nk1isthehip plink,Link2 2isthekneeelink. Forhipflexionand dextensionb bothhipjoin ntandknee joint aree moving sim multaneouslyy. Every graaph shows th he teaching trajectory as a well as th he therapy trajectoryy.AsforFigu ure8,abducttionǦadductio onmovementtsareshown.AbductionǦadductionm movementis realized bythedrive mountedun nderneathth hepatient,byy movingtheehip aboutth heverticalzǦǦaxisofthe



NCMMI '14



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Proceedings of The National Conference on Man Machine Interaction 2014 [NCMMI 2014]

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RM. Botth Figures 7 7 and 8 sh how successfful realizatio on of hip m movement previously tau ught by a physioth herapist.



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Figure6.TeeachingPosittion,DirectT TherapyPosittionandErro or





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IV.Conclusion

References

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Krebs, H. 2006. An Overview of Rehabilitation Robotic Technologies, American Spinal Injury AssociationSymposium. Lum, P.S., Burgar, CG., Shor, PC., Majmundar, M., Van der Loos, M. 2002. Robot assisted Movement Training Compared with Conventional Therapy Techniques for The Rehabilitation of Upper–LimbMotorFunctionAfterStroke.PhysicalMedicineandRehabilitation,83(7),952Ǧ959. Richardson,R.;Brown,M.;Plummer,A.R.2000.PneumaticImpedanceControlforPhysiotherapy. EuropeanAdvancedRoboticsSystemConference. Khalili D., Zomlefer M. 1988. An Intelligent System for Rehabilitation of Joints and Estimation of BodySegmentParameters.IEEETransactiononBiomedicalEngineering,vol.35,num.2,138Ǧ146. Krebs H.I., Hogan N., Aisen M.L., Volpe B.T. 1998. Robot Aided Neurorehabilitation. IEEE Trans. OnRehabilitationEngineering,vol.6,num.1,75Ǧ87. Krebs HI, Palazzolo JJ, Volpe BT,Hogan N. 2003. Rehabilitation Robotics: Performance Based ProgressiveRobotAssistedTherapy.AutonomousRobots,KluwerAcademicPublishers,7Ǧ20. LumP.S.,BurgarG.,VanDerLoosM.1997.TheUseofRoboticDeviceForPostStrokeMovement Therapy.ProceedingsofTheInt.ConfonRehabilitationRobotics,79Ǧ82. RaoR.,AgrawalS.K.,ScholzJ.P.1999.Proc.Int.ConfonRehabilitationRobotics,187Ǧ200. RichardsonR,AustinME,PlummerAR.1999.Developmentofaphysiotherapyrobot.Proceedings oftheInternationalBiomechatronicsWorkshop,Enshede,116Ǧ120. Richardson R., Brown M., Plummer A.R. 2000. Pneumatic Impedance Control for Physiotherapy. ProceedingsoftheEURELInt.Conf.Robotics,vol.2. TanakaY.,TsujiT.,KanekoM.2000.ABioǦMimeticRehabilitationAidforMotorǦControlTraining usingTimeBaseGenerator.IndustrialElectronicsSociety,IECON2000.26thAnnualConferenceof theIEEE,vol.1,114Ǧ119. Culmer P., Jackson A., Levesley M.C. et. al. 2005. An Admittance Control Scheme for a Robotic UpperǦLimbStrokeRehabilitationSystem.Proceedingsofthe2005IEEEEngineeringinMedicine andBiology27thAnnualConference. Reinkensmeyer DJ, Kahn LE, Averbuch M, McKennaǦCole AN, Schmit BD, Rymer WZ. (2000). Understanding and treating arm movement impairment after chronic brain injury. Progress with theARMGuide,JournalofRehabilitationResearchandDevelopment,vol.37,num.6,653Ǧ662.

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ThepaperdescribesaManǦmachineǦinterfacetotranslatethecapabilitiesofaphysiotherapistdirectlytoa robotmanipulator.Furthermore,standardactiveandpassiveexercisescanbeperformedbythisHMI.The graphicaluserinterfacecreatedfortheHMIgivestheuseraneasyaccesstoallfunctionsoftheHMI.Using thedevelopedHMIthephysiotherapistcanteachexercisesintoRMthroughperformingexercisesdirectly on the patient. The exercises covered are knee and hip flexionǦextension as well as hip abductionǦ adduction.ThepreviouslytaughtexercisescanberepeatedeffectivelybytheRMitself.Theexerciseresults are evaluated automatically and displayed by numerical and graphical means. The results are stored in a database for later use. The realized interfacing system is made of flexible nature to be fit for webǦbased application.

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