Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Best Practices in Robot-assisted Radical Cystectomy and Urinary Reconstruction: Recommendations of the Pasadena Consensus Panel

CONTEXT Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. OBJECTIVE A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. EVIDENCE ACQUISITION A systematic review of the literature was performed in agreement with the PRISMA statement. EVIDENCE SYNTHESIS Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. CONCLUSIONS RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. PATIENT SUMMARY Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.

Fine Motor Skill Interventions for Teaching Handwriting

On my poster board I will display various samples of my student's writing to demonstrate their improved abilities due to my physical hand exercise.

Robotic Resection of Intraductal Neoplasm of the Pancreas

Background: Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional open surgery. Computer-assisted surgical devices have recently been approved for general surgical use. Aim: The aim of this study was to report the first known case of pancreatic resection with the use of a computer-assisted, or robotic, surgical device in Latin America. Patient and Methods: A 37-year-old female with a previous history of radical mastectomy for bilateral breast cancer due to a BRCA2 mutation presented with an acute pancreatitis episode. Radiologic investigation disclosed an intraductal pancreatic neoplasm located in the neck of the pancreas with atrophy of the body and tail. The main pancreatic duct was enlarged. The surgical decision was to perform a laparoscopic subtotal pancreatectomy, using the da Vinci (R) robotic system (Intuitive Surgical, Sunnyvale, CA). Five trocars were used. Pancreatic transection was achieved with vascular endoscopic stapler. The surgical specimen was removed without an additional incision. Results: Operative time was 240 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions: The subtotal laparoscopic pancreatic resection can safely be performed. The da Vinci robotic system allowed for technical refinements of laparoscopic pancreatic resection. Robotic assistance improved the dissection and control of major blood vessels due to three-dimensional visualization of the operative field and instruments with wrist-type end-effectors.

Hand-held robotic device for laparoscopic surgery and training

Laparoscopic surgery (LS) has revolutionized traditional surgical techniques introducing minimally invasive procedures for diagnosis and local therapies. LSs have undeniable advantages, such as small patient incisions, reduced postoperative pain and faster recovery. On the other hand, restricted vision of the anatomical target, difficult handling of the surgical instruments, restricted mobility inside the human body, need of dexterity to hand-eye coordination and inadequate and non-ergonomic surgical instruments may restrict LS only to more specialized surgeons. To overcome the referred limitations, this work presents a new robotic surgical handheld system – the EndoRobot. The EndoRobot was designed to be used in clinical practice or even as a surgical simulator. It integrates an electromechanical system with 3 degrees of freedom. Each degree can be manipulated independently and combined with different levels of sensitivity allowing fast and slow movements. As other features, the EndoRobot has battery power or external power supply, enables the use of bipolar radiofrequency to prevent bleeding while cutting and allows plug-and-play of the laparoscopic forceps for rapid exchange. As a surgical simulator, the system was also instrumented to measure and transmit, in real time, its position and orientation for a training software able to monitor and assist the trainee’s surgical movements.

Generic system for human-computer gesture interaction: applications on sign language recognition and robotic soccer refereeing

Hand gestures are a powerful way for human communication, with lots of potential applications in the area of human computer interaction. Vision-based hand gesture recognition techniques have many proven advantages compared with traditional devices, giving users a simpler and more natural way to communicate with electronic devices. This work proposes a generic system architecture based in computer vision and machine learning, able to be used with any interface for human-computer interaction. The proposed solution is mainly composed of three modules: a pre-processing and hand segmentation module, a static gesture interface module and a dynamic gesture interface module. The experiments showed that the core of visionbased interaction systems could be the same for all applications and thus facilitate the implementation. For hand posture recognition, a SVM (Support Vector Machine) model was trained and used, able to achieve a final accuracy of 99.4%. For dynamic gestures, an HMM (Hidden Markov Model) model was trained for each gesture that the system could recognize with a final average accuracy of 93.7%. The proposed solution as the advantage of being generic enough with the trained models able to work in real-time, allowing its application in a wide range of human-machine applications. To validate the proposed framework two applications were implemented. The first one is a real-time system able to interpret the Portuguese Sign Language. The second one is an online system able to help a robotic soccer game referee judge a game in real time.

Robotic, fluoroscopic or EMG assisted pedicle screw insertion. A CT based comparative study

Introduction: In order to improve safety of pedicle screw placement several techniques have been developed. More recently robotically assisted pedicle insertion has been introduced aiming at increasing accuracy. The aim of this study was to compare this new technique with the two main pedicle insertion techniques in our unit namely fluoroscopically assisted vs EMG aided insertion. Material and methods: A total of 382 screws (78 thoracic,304 lumbar) were introduced in 64 patients (m/f = 1.37, equally distributed between insertion technique groups) by a single experienced spinal surgeon. From those, 64 (10 thoracic, 54 lumbar) were introduced in 11 patients using a miniature robotic device based on pre operative CT images under fluoroscopic control. 142 (4 thoracic, 138 lumbar) screws were introduced using lateral fluoroscopy in 27 patients while 176 (64 thoracic, 112 lumbar) screws in 26 patients were inserted using both fluoroscopy and EMG monitoring. There was no difference in the distribution of scoliotic spines between the 3 groups (n = 13). Screw position was assessed by an independent observer on CTs in axial, sagittal and coronal planes using the Rampersaud A to D classification. Data of lumbar and thoracic screws were processed separately as well as data obtained from axial, sagittal and coronal CT planes. Results: Intra- and interobserver reliability of the Rampersaud classification was moderate, (0.35 and 0.45 respectively) being the least good on axial plane. The total number of misplaced screws (C&D grades) was generally low (12 thoracic and 12 lumbar screws). Misplacement rates were same in straight and scoliotic spines. The only difference in misplacement rates was observed on axial and coronal images in the EMG assisted thoracic screw group with a higher proportion of C or D grades (p <0.05) in that group. Recorded compound muscle action potentials (CMAP) values of the inserted screws were 30.4 mA for the robot and 24.9mA for the freehand technique with a CI of 3.8 of the mean difference of 5.5 mA. Discussion: Robotic placement did improve the placement of thoracic screws but not that of lumbar screws possibly because our misplacement rates in general near that of published navigation series. Robotically assisted spine surgery might therefore enhance the safety of screw placement in particular in training settings were different users at various stages of their learning curve are involved in pedicle instrumentation.

Tactile-Proprioceptive Robotic Grasping

Robotic grasping has been studied increasingly for a few decades. While progress has been made in this field, robotic hands are still nowhere near the capability of human hands. However, in the past few years, the increase in computational power and the availability of commercial tactile sensors have made it easier to develop techniques that exploit the feedback from the hand itself, the sense of touch. The focus of this thesis lies in the use of this sense. The work described in this thesis focuses on robotic grasping from two different viewpoints: robotic systems and data-driven grasping. The robotic systems viewpoint describes a complete architecture for the act of grasping and, to a lesser extent, more general manipulation. Two central claims that the architecture was designed for are hardware independence and the use of sensors during grasping. These properties enables the use of multiple different robotic platforms within the architecture. Secondly, new data-driven methods are proposed that can be incorporated into the grasping process. The first of these methods is a novel way of learning grasp stability from the tactile and haptic feedback of the hand instead of analytically solving the stability from a set of known contacts between the hand and the object. By learning from the data directly, there is no need to know the properties of the hand, such as kinematics, enabling the method to be utilized with complex hands. The second novel method, probabilistic grasping, combines the fields of tactile exploration and grasp planning. By employing well-known statistical methods and pre-existing knowledge of an object, object properties, such as pose, can be inferred with related uncertainty. This uncertainty is utilized by a grasp planning process which plans for stable grasps under the inferred uncertainty.

Four-arm single docking full robotic surgery for low rectal cancer: technique standardization

The authors present the four-arm single docking full robotic surgery to treat low rectal cancer. The eight main operative steps are: 1- patient positioning; 2- trocars set-up and robot docking; 3- sigmoid colon, left colon and splenic flexure mobilization (lateral-to-medial approach); 4-Inferior mesenteric artery and vein ligation (medial-to-lateral approach); 5- total mesorectum excision and preservation of hypogastric and pelvic autonomic nerves (sacral dissection, lateral dissection, pelvic dissection); 6- division of the rectum using an endo roticulator stapler for the laparoscopic performance of a double-stapled coloanal anastomosis (type I tumor); 7- intersphincteric resection, extraction of the specimen through the anus and lateral-to-end hand sewn coloanal anastomosis (type II tumor); 8- cylindric abdominoperineal resection, with transabdominal section of the levator muscles (type IV tumor). The techniques employed were safe and have presented low rates of complication and no mortality.

Performance evaluation of 3D computer vision techniques

This work presents the implementation and comparison of three different techniques of three-dimensional computer vision as follows: • Stereo vision - correlation between two 2D images • Sensorial fusion - use of different sensors: camera 2D + ultrasound sensor (1D); • Structured light The computer vision techniques herein presented took into consideration the following characteristics: • Computational effort ( elapsed time for obtain the 3D information); • Influence of environmental conditions (noise due to a non uniform lighting, overlighting and shades); • The cost of the infrastructure for each technique; • Analysis of uncertainties, precision and accuracy. The option of using the Matlab software, version 5.1, for algorithm implementation of the three techniques was due to the simplicity of their commands, programming and debugging. Besides, this software is well known and used by the academic community, allowing the results of this work to be obtained and verified. Examples of three-dimensional vision applied to robotic assembling tasks ("pick-and-place") are presented.

Chassis frame design of a mobile platform equipped with robotic arms

The overall objective of the thesis is to design a robot chassis frame which is a bearing structure of a vehicle supporting all mechanical components and providing structure and stability. Various techniques and scientific principles were used to design a chassis frame.Design principles were applied throughout the process. By using Solid-Works software,virtual models was made for chassis frame. Chassis frame of overall dimension 1597* 800*950 mm3 was designed. Center of mass lieson 1/3 of the length from front wheel at height 338mm in the symmetry plane. Overall weight of the chassis frame is 80.12kg. Manufacturing drawing is also provided. Additionally,structural analysis was done in FEMAP which gives the busting result for chassis design by taking into consideration stress and deflection on different kind of loading resembling real life case. On the basis of simulated result, selected material was verified. Resulting design is expected to perform its intended function without failure. As a suggestion for further research, additional fatigue analysis and proper dynamic analysis can be conducted to make the study more robust.

Gradient-based reinforcement learning techniques for underwater robotics behavior learning

Darrerament, l'interès pel desenvolupament d'aplicacions amb robots submarins autònoms (AUV) ha crescut de forma considerable. Els AUVs són atractius gràcies al seu tamany i el fet que no necessiten un operador humà per pilotar-los. Tot i això, és impossible comparar, en termes d'eficiència i flexibilitat, l'habilitat d'un pilot humà amb les escasses capacitats operatives que ofereixen els AUVs actuals. L'utilització de AUVs per cobrir grans àrees implica resoldre problemes complexos, especialment si es desitja que el nostre robot reaccioni en temps real a canvis sobtats en les condicions de treball. Per aquestes raons, el desenvolupament de sistemes de control autònom amb l'objectiu de millorar aquestes capacitats ha esdevingut una prioritat. Aquesta tesi tracta sobre el problema de la presa de decisions utilizant AUVs. El treball presentat es centra en l'estudi, disseny i aplicació de comportaments per a AUVs utilitzant tècniques d'aprenentatge per reforç (RL). La contribució principal d'aquesta tesi consisteix en l'aplicació de diverses tècniques de RL per tal de millorar l'autonomia dels robots submarins, amb l'objectiu final de demostrar la viabilitat d'aquests algoritmes per aprendre tasques submarines autònomes en temps real. En RL, el robot intenta maximitzar un reforç escalar obtingut com a conseqüència de la seva interacció amb l'entorn. L'objectiu és trobar una política òptima que relaciona tots els estats possibles amb les accions a executar per a cada estat que maximitzen la suma de reforços totals. Així, aquesta tesi investiga principalment dues tipologies d'algoritmes basats en RL: mètodes basats en funcions de valor (VF) i mètodes basats en el gradient (PG). Els resultats experimentals finals mostren el robot submarí Ictineu en una tasca autònoma real de seguiment de cables submarins. Per portar-la a terme, s'ha dissenyat un algoritme anomenat mètode d'Actor i Crític (AC), fruit de la fusió de mètodes VF amb tècniques de PG.

Investigating novel point-select techniques for older people

As the number and proportion of older people worldwide continues to grow, robotic devices can play a role in helping older people continue to live independent and active lives. Graphical user interfaces (GUIs) and interactions that involve pointing to items and selecting them are becoming more common in assistive robots. The authors are currently working on a project investigating techniques to improve point-select interactions for older people. In particular, the project studies how older people respond to expanding and moving targets. The research is ongoing, and this paper describes the methods that will be used in upcoming experiments.

On nonlinear dynamics and control of a robotic arm with chaos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fog- and cloud-induced aerosol modification observed by the Aerosol Robotic Network (AERONET)

Large fine mode-dominated aerosols (submicron radius) in size distributions retrieved from the Aerosol Robotic Network (AERONET) have been observed after fog or low-altitude cloud dissipation events. These column-integrated size distributions have been obtained at several sites in many regions of the world, typically after evaporation of low-altitude cloud such as stratocumulus or fog. Retrievals with cloud-processed aerosol are sometimes bimodal in the accumulation mode with the larger-size mode often similar to 0.4-0.5 mu m radius (volume distribution); the smaller mode, typically similar to 0.12 to similar to 0.20 mu m, may be interstitial aerosol that were not modified by incorporation in droplets and/or aerosol that are less hygroscopic in nature. Bimodal accumulation mode size distributions have often been observed from in situ measurements of aerosols that have interacted with clouds, and AERONET size distribution retrievals made after dissipation of cloud or fog are in good agreement with particle sizes measured by in situ techniques for cloud-processed aerosols. Aerosols of this type and large size range (in lower concentrations) may also be formed by cloud processing in partly cloudy conditions and may contribute to the "shoulder" of larger-size particles in the accumulation mode retrievals, especially in regions where sulfate and other soluble aerosol are a significant component of the total aerosol composition. Observed trends of increasing aerosol optical depth (AOD) as fine mode radius increased suggests higher AOD in the near-cloud environment and higher overall AOD than typically obtained from remote sensing owing to bias toward sampling at low cloud fraction.