Final Report Summary - REMAKE (REcovery of Motor functions After stroKE: exploiting and enhancing residual abilities of the upper body beyond compensatory strategies)
The REMAKE project (www.remake.dibris.unige.it) aims at developing adaptive/smart tools, based on Body-Machine Interfaces(BMI) and robotic technologies, which may help stroke survivors to recover functions of the upper body by exploiting/enhancing their residual capabilities, while avoiding the “easy shortcut" of stereotypical compensatory strategies. Specifically, stroke survivors face the dual problem of regaining independence in everyday tasks and recovering motor abilities. BMI's address the former problem and compliant robots the latter. Our rationale is to integrate them with the ultimate goal of breaking stereotypical compensatory strategies in favor of a gradual functional reorganization of upper body movements, obtained by continuously adapting the interface to the subject's status and physiological changes, such as aging, recovery, and progress of the illness.
The REMAKE concept. Following a stroke, in order to regain as much as possible the ability to perform tasks that once were straightforward, subjects undergo a profound reorganisation of their neural control. In their effort to quickly regain independence, impaired individuals focus on the recovery of functions that that are critical for activities of daily living (ADL), such as standing, walking, reaching, and grasping. This often leads to the development of compensatory strategies that, even when barely sufficient to carry out ADL' s, tend to be stereotypical and energetically inefficient. Furthermore, compensatory strategies often result in secondary complications like pain and muscle atrophy.
The work is organized in three general objectives:
(I) TO TRANSLATE BODY—DERIVED SIGNALS onto BMI commands, encoding Subjects’ state, impairment and residual abilities.
(ii) TO DESIGN AND IMPLEMENT ADAPTIVE BMIs for rehabilitation devices, based on the individual characteristic of each subject.
(iii) TO ENCODE INFORMATION of the subject's state of motion and interaction with the environment INTO APPROPRIATE SENSORY FEEDBACK.
This investigation provided us with a better understanding of the mechanisms underlying control of force and motion, as well as sensory-motor integration following stroke. Moreover, it generated the knowledge necessary for developing a new class of interfaces aimed at learning the subjects evolving abilities and adapting to their needs. These BMIs provide their users with both assistance and rehabilitation under a unified framework. The protocols and biomarkers for functional evaluation as well as the BMIs defined in this work were tested not only with stroke survivors, but also with subjects with spinal cord injury and multiple sclerosis and were used with different devices and sensors, demonstrating that the proposed approach could be extended to a large family of devices and a broader range of pathologies.
In this perspective, the project results provide guidance for further studies of efficient remapping of motor coordination for the control of assistive and rehabilitative devices and establish the basis for new training paradigms, in which the burden of learning is significantly removed from the impaired subjects and shifted to the devices.
The researcher obtained a stable position as associate professor at the host institution and she has building her independent research group. She has a strong focus on translating the research results into the clinical practice and with an international perspective, by maintaining and reinforcing collaborations of the host institution with both local and international research centers and clinical institutions.
The REMAKE concept. Following a stroke, in order to regain as much as possible the ability to perform tasks that once were straightforward, subjects undergo a profound reorganisation of their neural control. In their effort to quickly regain independence, impaired individuals focus on the recovery of functions that that are critical for activities of daily living (ADL), such as standing, walking, reaching, and grasping. This often leads to the development of compensatory strategies that, even when barely sufficient to carry out ADL' s, tend to be stereotypical and energetically inefficient. Furthermore, compensatory strategies often result in secondary complications like pain and muscle atrophy.
The work is organized in three general objectives:
(I) TO TRANSLATE BODY—DERIVED SIGNALS onto BMI commands, encoding Subjects’ state, impairment and residual abilities.
(ii) TO DESIGN AND IMPLEMENT ADAPTIVE BMIs for rehabilitation devices, based on the individual characteristic of each subject.
(iii) TO ENCODE INFORMATION of the subject's state of motion and interaction with the environment INTO APPROPRIATE SENSORY FEEDBACK.
This investigation provided us with a better understanding of the mechanisms underlying control of force and motion, as well as sensory-motor integration following stroke. Moreover, it generated the knowledge necessary for developing a new class of interfaces aimed at learning the subjects evolving abilities and adapting to their needs. These BMIs provide their users with both assistance and rehabilitation under a unified framework. The protocols and biomarkers for functional evaluation as well as the BMIs defined in this work were tested not only with stroke survivors, but also with subjects with spinal cord injury and multiple sclerosis and were used with different devices and sensors, demonstrating that the proposed approach could be extended to a large family of devices and a broader range of pathologies.
In this perspective, the project results provide guidance for further studies of efficient remapping of motor coordination for the control of assistive and rehabilitative devices and establish the basis for new training paradigms, in which the burden of learning is significantly removed from the impaired subjects and shifted to the devices.
The researcher obtained a stable position as associate professor at the host institution and she has building her independent research group. She has a strong focus on translating the research results into the clinical practice and with an international perspective, by maintaining and reinforcing collaborations of the host institution with both local and international research centers and clinical institutions.