Synthesis of Hand Exoskeletons for the Rehabilitation of Post-Stroke Patients

This dissertation presents the synthesis of a hand exoskeleton (HE) for the rehabilitation of post-stroke patients. Through the analysis of state-of-the-art, a topological classification was proposed. Based on the proposed classification principles, the rehabilitation HEs were systematically analyzed and classified. This classification is helpful to both understand the reason of proposing certain solutions for specific applications and provide some useful guidelines for the design of a new HE, that was actually the primary motivation of this study. Further to this classification, a novel rehabilitation HE was designed to support patients in cylindrical shape grasping tasks with the aim of recovering the basic functions of manipulation. The proposed device comprises five planar mechanisms, one per finger, globally actuated by two electric motors. Indeed, the thumb flexion/extension movement is controlled by one actuator whereas a second actuator is devoted to the control of the flexion/extension of the other four fingers. By focusing on the single finger mechanism, intended as the basic model of the targeted HE, the feasibility study of three different 1 DOF mechanisms are analyzed: a 6-link mechanism, that is connected to the human finger only at its tip, an 8-link and a 12-link mechanisms where phalanges and articulations are part of the kinematic chain. The advantages and drawbacks of each mechanism are deeply analyzed with respect to targeted requirements: the 12-link mechanism was selected as the most suitable solution. The dimensional synthesis based on the Burmester theory as well as kinematic and static analyses were separately done for all fingers in order to satisfy the desired specifications. The HE was finally designed and a prototype was built. The experimental results of the first tests are promising and demonstrate the potential for clinical applications of the proposed device in robot-assisted training of the human hand for grasping functions.

Robotic Approach in the Treatment of Locally Advanced (Stage IIIA-pN2) non Small Cell Lung Cancer after Induction Therapy

Introduction: Despite there are already many studies on robotic surgery as minimally invasive approach for non-small cell lung cancer (NSCLC) patients, the use of this technique for stage III disease is still poorly described. These are the preliminary results of our prospective study on safety and effectiveness of robotic approach in patients with locally advanced NSCLC, in terms of postoperative complications and oncological outcome. Methods: Since 2016, we prospectively investigated, using standardized questionnaire and protocol, 21 consecutive patients with NSCLC stage IIIA-pN2 (diagnosed by EBUS-TBNA) who underwent lobectomy and radical lymph node dissection with robotic approach after induction treatment. Then, we performed a matched case-control study with 54 patients treated with open surgery during the same period of time, with similar age, clinical and pathological tumor stage. Results: The individual matched population was composed of 14 robot-assisted thoracic surgery and 14 patients who underwent open surgery. The median time range of resection was inferior in the open group compared to robotic lobectomy (148 vs 229 minutes; P=0.002). Lymph nodes resection and positivity were not statistically significantly different (p=0.66 and p=0.73 respectively). No difference was observed also for PFS (P=0.99) or OS (P=0.94). Conclusions: Our preliminary results demonstrated that the early outcomes and oncological results of N2-patients after robotic lobectomy were similar to open surgery. Considering the advantages of minimally invasive surgery, robotic assisted lobectomy should be a safe approach also to patients with local advanced disease.

Nonlinear Control Strategies for Cooperative Control of Multi-Robot Systems

This thesis deals with distributed control strategies for cooperative control of multi-robot systems. Specifically, distributed coordination strategies are presented for groups of mobile robots. The formation control problem is initially solved exploiting artificial potential fields. The purpose of the presented formation control algorithm is to drive a group of mobile robots to create a completely arbitrarily shaped formation. Robots are initially controlled to create a regular polygon formation. A bijective coordinate transformation is then exploited to extend the scope of this strategy, to obtain arbitrarily shaped formations. For this purpose, artificial potential fields are specifically designed, and robots are driven to follow their negative gradient. Artificial potential fields are then subsequently exploited to solve the coordinated path tracking problem, thus making the robots autonomously spread along predefined paths, and move along them in a coordinated way. Formation control problem is then solved exploiting a consensus based approach. Specifically, weighted graphs are used both to define the desired formation, and to implement collision avoidance. As expected for consensus based algorithms, this control strategy is experimentally shown to be robust to the presence of communication delays. The global connectivity maintenance issue is then considered. Specifically, an estimation procedure is introduced to allow each agent to compute its own estimate of the algebraic connectivity of the communication graph, in a distributed manner. This estimate is then exploited to develop a gradient based control strategy that ensures that the communication graph remains connected, as the system evolves. The proposed control strategy is developed initially for single-integrator kinematic agents, and is then extended to Lagrangian dynamical systems.

Distributed Large-scale Mixed-Integer Optimization with Application to Energy and Multi-robot Networks

Several decision and control tasks in cyber-physical networks can be formulated as large- scale optimization problems with coupling constraints. In these "constraint-coupled" problems, each agent is associated to a local decision variable, subject to individual constraints. This thesis explores the use of primal decomposition techniques to develop tailored distributed algorithms for this challenging set-up over graphs. We first develop a distributed scheme for convex problems over random time-varying graphs with non-uniform edge probabilities. The approach is then extended to unknown cost functions estimated online. Subsequently, we consider Mixed-Integer Linear Programs (MILPs), which are of great interest in smart grid control and cooperative robotics. We propose a distributed methodological framework to compute a feasible solution to the original MILP, with guaranteed suboptimality bounds, and extend it to general nonconvex problems. Monte Carlo simulations highlight that the approach represents a substantial breakthrough with respect to the state of the art, thus representing a valuable solution for new toolboxes addressing large-scale MILPs. We then propose a distributed Benders decomposition algorithm for asynchronous unreliable networks. The framework has been then used as starting point to develop distributed methodologies for a microgrid optimal control scenario. We develop an ad-hoc distributed strategy for a stochastic set-up with renewable energy sources, and show a case study with samples generated using Generative Adversarial Networks (GANs). We then introduce a software toolbox named ChoiRbot, based on the novel Robot Operating System 2, and show how it facilitates simulations and experiments in distributed multi-robot scenarios. Finally, we consider a Pickup-and-Delivery Vehicle Routing Problem for which we design a distributed method inspired to the approach of general MILPs, and show the efficacy through simulations and experiments in ChoiRbot with ground and aerial robots.

Sviluppo di un sistema di Realta Aumentata applicato a un modello 3D della prostata, sviluppato a partire da immagini RM, al fine di facilitare la dissezione del tumore e la conservazione dei fasci neuro vascolari durante l'intervento chirurgico di prostatectomia radicale robot-assistita

La realtà aumentata (AR) è una nuova tecnologia adottata in chirurgia prostatica con l'obiettivo di migliorare la conservazione dei fasci neurovascolari (NVB) ed evitare i margini chirurgici positivi (PSM). Abbiamo arruolato prospetticamente pazienti con diagnosi di cancro alla prostata (PCa) sul base di biopsia di fusione mirata con mpMRI positiva. Prima dell'intervento, i pazienti arruolati sono stati indirizzati a sottoporsi a ricostruzione del modello virtuale 3D basato su mpMRI preoperatoria immagini. Infine, il chirurgo ha eseguito la RARP con l'ausilio del modello 3D proiettato in AR all'interno della console robotica (RARP guidata AR-3D). I pazienti sottoposti a AR RARP sono stati confrontati con quelli sottoposti a "RARP standard" nello stesso periodo. Nel complesso, i tassi di PSM erano comparabili tra i due gruppi; I PSM a livello della lesione indice erano significativamente più bassi nei pazienti riferiti al gruppo AR-3D (5%) rispetto a quelli nel gruppo di controllo (20%; p = 0,01). La nuova tecnica di guida AR-3D per l'analisi IFS può consentono di ridurre i PSM a livello della lesione dell'indice

Preventing worker’s musculoskeletal disorders with wearable inertial sensors: ergonomics and modelling of physical human-robot interactions

The most widespread work-related diseases are musculoskeletal disorders (MSD) caused by awkward postures and excessive effort to upper limb muscles during work operations. The use of wearable IMU sensors could monitor the workers constantly to prevent hazardous actions, thus diminishing work injuries. In this thesis, procedures are developed and tested for ergonomic analyses in a working environment, based on a commercial motion capture system (MoCap) made of 17 Inertial Measurement Units (IMUs). An IMU is usually made of a tri-axial gyroscope, a tri-axial accelerometer, and a tri-axial magnetometer that, through sensor fusion algorithms, estimates its attitude. Effective strategies for preventing MSD rely on various aspects: firstly, the accuracy of the IMU, depending on the chosen sensor and its calibration; secondly, the correct identification of the pose of each sensor on the worker’s body; thirdly, the chosen multibody model, which must consider both the accuracy and the computational burden, to provide results in real-time; finally, the model scaling law, which defines the possibility of a fast and accurate personalization of the multibody model geometry. Moreover, the MSD can be diminished using collaborative robots (cobots) as assisted devices for complex or heavy operations to relieve the worker's effort during repetitive tasks. All these aspects are considered to test and show the efficiency and usability of inertial MoCap systems for assessing ergonomics evaluation in real-time and implementing safety control strategies in collaborative robotics. Validation is performed with several experimental tests, both to test the proposed procedures and to compare the results of real-time multibody models developed in this thesis with the results from commercial software. As an additional result, the positive effects of using cobots as assisted devices for reducing human effort in repetitive industrial tasks are also shown, to demonstrate the potential of wearable electronics in on-field ergonomics analyses for industrial applications.