Desenvolvimento da estrutura robótica atuada por cabos com um sistema de medição de compensação para reabilitação bimanual e cognitiva do AVC

Abstract

Despite contemporary rehabilitation strategies, stroke remains the leading cause of disability in adults worldwide, leaving a significant number of individuals with motor and cognitive deficits such as function and memory loss. Functional recovery after stroke is based on the neuroplasticity mechanism, in which another part of the brain assumes functions of the damaged areas. The use of bimanual robotic devices stimulates hemispheric activation, promoting a more neuroplastic environment and contributing to motor and functional recovery. Thus, in this thesis, a cable-driven robot and several serious games were developed to be applied in bimanual and cognitive (memory) rehabilitation of stroke. A compensation measurement system with six inertial sensors was developed to distinguish motor recovery from postural adjustments/compensations. The validation results indicated the accuracy of the developed devices and sensors compatible with the compensations amplitudes. Two developed software programs (BiEval and CADS) evaluate the patient's performance and progress based on quantifiable measures. Ten healthy volunteers and two stroke groups (10 and 3 patients) received bimanual exercises with the MineCart game and/or reaching exercises with the Color4Memory game, total of 30 minutes. An IMI was applied to both groups and indicated positive ratings in the dimensions: high interest, high competence, and low pressure. There was a significant improvement (p < 0.05) in several performance parameters during bimanual therapy with the MineCart game. During the reach tests with the Color4Memory game, patients started to give greater preference to the more affected upper extremity to perform the movement. Additionally, improvement was observed in all game parameters, as represented by an improvement in weighted score (p < 0.05). Furthermore, there was an improvement in clinical scales FM (51.7 to 63.0) and quantitative/qualitative MAL (62%/66%) applied to the second stroke group.