Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of clinical study of the devices make it difficult to follow and interpret the results in this new field. This article is a review of the current state-of-the-art in robotic applications in poststroke therapy for the upper extremity, written specifically to help clinicians determine the differences between various systems. We concentrate primarily on systems that have been tested clinically. Robotic systems are grouped by rehabilitation application (e.g., gross motor movement, bilateral training, etc.), and, where possible, the neurorehabilitation strategies employed by each system are described. We close with a discussion of the benefits and concerns of using robotics in rehabilitation and an indication of challenges that must be addressed for therapeutic robots to be applied practically in the clinic.

Abstract-Imperceptible visual distortion, in the form of a disguised progression of performance goals, may be a helpful addition to rehabilitation after stroke and other brain injuries. This paper describes work that has been done to lay the groundwork for testing this hypothesis. We have constructed and validated an experimental environment that provides controllable visual distortion and allows precise force and position measurements. To estimate the amount of visual distortion that should be imperceptible, we measured the limits for force and distance/position perception in our rehabilitation environment for young and elderly unimpaired subjects and for a single traumatic brain injury (TBI) patient. We found the Just Noticeable Difference (JND) for produced force to be 19.7% (0.296 N) and the JND for movement distance/finger position to be 13.0% (3.99 mm) for young subjects (ages 18-35). For elderly subjects (ages 61-80), the JND for force was measured to be 31.0% (0.619 N) and the JND for distance/position was 16.1% (5.01 mm). JNDs of 46.0% (0.920 N) and 45.0% (14.8 mm) were found for the motor-impaired individual. In addition, a subject's rating of effort was found to be profoundly influenced by visual feedback concerning the force magnitude. Even when this feedback was distorted, it accounted for 99% of the variance of the effort rating. These results indicate that substantial visual distortions should be imperceptible to the subject, and that visual feedback can be used to influence the subject's perceived experience in our robotic environment. This means that we should be able to use imperceptible visual distortion to alter a patient's perception of therapeutic exercise in a robotic environment.

BACKGROUND: Continued and frequent use of the affected arm can result in increased function after stroke. However, long-term access to therapy is often limited, and home exercise compliance is low. While rehabilitation gaming is becoming increasingly prevalent, concerns about therapeutic method, safety, and usability for independent home use remain largely unaddressed. OBJECTIVE: The following paper presents usability evaluation of a game based home therapy program called Home Arm Movement Stroke Training Environment (HAMSTER), which is focused on retraining normal arm kinematics and preventing compensation strategies that limit recovery. METHODS: Kinect games were created with special consideration for the stroke population and retraining normal movement kinematics. Ten individuals with stroke evaluated the games in focused interviews and one individual with chronic stroke completed one month of independent HAMSTER use in the home. RESULTS: The focused interviews showed the need for motivational upper extremity home interventions. Usability evaluation showed the ability for individuals with stroke to interact with the kinematics focused Kinect games after a short exposure time. The single participant evaluation of home use showed good compliance and improvement on all of the clinical outcome measures after the one month of HAMSTER use. CONCLUSIONS: These positive results merit further evaluation of kinematic-focused home gaming interventions like HAM-STER to reduce the use of compensation strategies during home exercise and provide a supplement to conventional care to improve exercise compliance and upper extremity function after stroke.

No abstract