Spasticity is a common movement disorder symptom in individuals with cerebral palsy, hereditary spastic paraplegia, spinal cord injury and stroke, being one of the most disabling features in the progression of these diseases. Despite the potential benefit of using wearable robots to treat spasticity, their use is not currently recommended to subjects with a level of spasticity above ${1^+}$ on the Modified Ashworth Scale. The varying dynamics of this velocity-dependent tonic stretch reflex make it difficult to deploy safe personalized controllers. Here, we describe a novel adaptive torque controller via deep reinforcement learning (RL) for a knee exoskeleton under joint spasticity conditions, which accounts for task performance and interaction forces reduction. To train the RL agent, we developed a digital twin, including a musculoskeletal-exoskeleton system with joint misalignment and a differentiable spastic reflexes model for the muscles activation. Results for a simulated knee extension movement showed that the agent learns to control the exoskeleton for individuals with different levels of spasticity. The proposed controller was able to reduce maximum torques applied to the human joint under spastic conditions by an average of 10.6\% and decreases the root mean square until the settling time by 8.9\% compared to a conventional compliant controller.

Robotic devices hold great potential for efficient and reliable assessment of neuromotor abnormalities in post-stroke patients. However, spasticity caused by stroke is still assessed manually in clinical settings. The limited and variable nature of data collected from patients has long posed a major barrier to quantitatively modelling spasticity with robotic measurements and fully validating robotic assessment techniques. This paper presents a simulation framework developed to support the design and validation of elbow spasticity models and mitigate data problems. The framework consists of a simulation environment of robot-assisted spasticity assessment, two motion controllers for the robot and human models, and a stretch reflex controller. Our framework allows simulation based on synthetic data without experimental data from human subjects. Using this framework, we replicated the constant-velocity stretch experiment typically used in robot-assisted spasticity assessment and evaluated four types of spasticity models. Our results show that a spasticity reflex model incorporating feedback on both muscle fibre velocity and length more accurately captures joint resistance characteristics during passive elbow stretching in spastic patients than a force-dependent model. When integrated with an appropriate spasticity model, this simulation framework has the potential to generate extensive datasets of virtual patients for future research on spasticity assessment.

Survivors of central nervous system injury commonly present with spastic hypertonia. The affected muscles are hyperexcitable and can display involuntary static muscle tone and an exaggerated stretch reflex. These symptoms affect posture and disrupt activities of daily living. Symptoms are typically measured using subjective manual tests such as the Modified Ashworth Scale; however, more quantitative measures are necessary to evaluate potential treatments. The hands are one of the most common targets for intervention, but few investigators attempt to quantify symptoms of spastic hypertonia affecting the fingers. We present the isometric force pillow (IFP) to quantify involuntary grip force. This lightweight, computerized tool provides a holistic measure of finger flexion force and can be used in various orientations for clinical testing and to measure the impact of assistive devices.

In this paper, we discuss the implementation of a rule based expert system for diagnosing neuromuscular diseases. The proposed system is implemented as a rule based expert system in JESS for the diagnosis of Cerebral Palsy, Multiple Sclerosis, Muscular Dystrophy and Parkinson's disease. In the system, the user is presented with a list of questionnaires about the symptoms of the patients based on which the disease of the patient is diagnosed and possible treatment is suggested. The system can aid and support the patients suffering from neuromuscular diseases to get an idea of their disease and possible treatment for the disease.