A Virtual Reality—Based Exercise System for Hand Rehabilitation Post-Stroke

Abstract

This paper presents preliminary results from a virtual reality (VR)-based system for hand rehabilitation that uses a CyberGlove and a Rutgers Master II-ND haptic glove. This computerized system trains finger range of motion, finger flexion speed, independence of finger motion, and finger strength using specific VR simulation exercises. A remote Web-based monitoring station was developed to allow telerehabilitation interventions. The remote therapist observes simplified versions of the patient exercises that are updated in real time. Patient data is stored transparently in an Oracle database, which is also Web accessible through a portal GUI. Thus the remote therapist or attending physician can graph exercise outcomes and thus evaluate patient outcomes at a distance. Data from the VR simulations is complemented by clinical measurements of hand function and strength. Eight chronic post-stroke subjects participated in a pilot study of the above system. In keeping with variability in both their lesion size and site and in their initial upper extremity function, each subject showed improvement on a unique combination of movement parameters in VR training. Importantly, these improvements transferred to gains on clinical tests, as well as to significant reductions in task-completion times for the prehension of real objects. These results are indicative of the potential feasibility of this exercise system for rehabilitation in patients with hand dysfunction resulting from neurological impairment.

Exoskeleton-Based Exercisers for the Disabilities of the Upper Arm and Hand

“…To determine whether the skills gained in the VR environment transferred to real-world movements, two generalization tests were utilized, a clinical evaluation using the Jebsen Test of Hand Function and kinematic analysis of prehension movements. On average, the task was performed 22% faster after the intervention, illustrating transfer of their improvement in VR to a functional task (Adamovich et al 2005).…”

“…Lightweight custom pneumatic actuators are attached to the tips of the thumb, index, middle, and ring fingers with force output up to 16N (Bouzit et al, 2002). In 2001 Jack et al proposed a hand rehabilitation system for stroke survivors (Jack et al, 2001;Boian et al, 2002;Adamovich et al, 2005). The aim of the proposed system was to offer dedicated exercises for finger range of motion, speed, fractionation and strength.…”

“…During exercise the patients receive auditory, visual, and numerical feedback about their target goal and their current performance. The target goals of the VR exercises are calculated automatically by the system, based on the patient's previous results (Adamovich et al, 2005). To determine whether the skills gained in the VR environment transferred to real-world movements, two generalization tests were utilized, a clinical evaluation using the Jebsen Test of Hand Function and kinematic analysis of prehension movements.…”

“…In an effort to minimise this cost and to make VR therapy attractive for a more generalised use, (Morrow et al, 2006) proposed a system built around commercial video gaming equipment. After successfully testing VR rehabilitation using high-end equipment in a clinical environment (Adamovich et al, 2005), the Rutgers group proceeded into applying the same therapeutic principles and exercises via alternative, more economical hardware. The CyberGlove was replaced by a P5 game glove while the PC formally responsible for graphics processing was substituted by an Xbox game console.…”

“…In this application tracking was limited to finger flexion while hand position and orientation in space was not implemented. The aim of this project was to replicate the same finger velocity and range of motion exercises previously applied through a superior and more expensive system (Adamovich et al, 2005). Java 3D simulations were chosen to emulate the exercises initially developed with WorldToolKit graphics development platform alleviating the high cost of the latter.…”