Home-based upper limb stroke rehabilitation mechatronics: challenges and opportunities

Abstract

Interest in home-based stroke rehabilitation mechatronics, which includes both robots and sensor mechanisms, has increased over the past 12 years. The COVID-19 pandemic has exacerbated the existing lack of access to rehabilitation for stroke survivors post-discharge. Home-based stroke rehabilitation devices could improve access to rehabilitation for stroke survivors, but the home environment presents unique challenges compared to clinics. The present study undertakes a scoping review of designs for at-home upper limb stroke rehabilitation mechatronic devices to identify important design principles and areas for improvement. Online databases were used to identify papers published 2010–2021 describing novel rehabilitation device designs, from which 59 publications were selected describing 38 unique designs. The devices were categorized and listed according to their target anatomy, possible therapy tasks, structure, and features. Twenty-two devices targeted proximal (shoulder and elbow) anatomy, 13 targeted distal (wrist and hand) anatomy, and three targeted the whole arm and hand. Devices with a greater number of actuators in the design were more expensive, with a small number of devices using a mix of actuated and unactuated degrees of freedom to target more complex anatomy while reducing the cost. Twenty-six of the device designs did not specify their target users’ function or impairment, nor did they specify a target therapy activity, task, or exercise. Twenty-three of the devices were capable of reaching tasks, 6 of which included grasping capabilities. Compliant structures were the most common approach of including safety features in the design. Only three devices were designed to detect compensation, or undesirable posture, during therapy activities. Six of the 38 device designs mention consulting stakeholders during the design process, only two of which consulted patients specifically. Without stakeholder involvement, these designs risk being disconnected from user needs and rehabilitation best practices. Devices that combine actuated and unactuated degrees of freedom allow a greater variety and complexity of tasks while not significantly increasing their cost. Future home-based upper limb stroke rehabilitation mechatronic designs should provide information on patient posture during task execution, design with specific patient capabilities and needs in mind, and clearly link the features of the design to users’ needs.

Designing for usability: development and evaluation of a portable minimally-actuated haptic hand and forearm trainer for unsupervised stroke rehabilitation

“…We refined the device's appearance, and also added a passive DoF for wrist pronosupination, a movement highly recommended by therapists (Rätz et al, 2021b ), by allowing the entire device to be tilted around its longitudinal axis. The combination of passive and active degrees of freedom is in line with the recommendations of Forbrigger et al ( 2023a ), who suggested this concept to reduce cost while still providing high functionality. We thus satisfied all the required device improvements that we defined based on the first concept (see Section 2.1.1).…”

“…However, both group therapy and at-home rehabilitation require adequate tools that deliver high-dosage training and ensure patient engagement in minimally supervised (group therapy) or unsupervised environments (home rehabilitation). Sensorized or robotic devices in combination with interactive gamified exercises are promising candidates to drive this paradigm shift (Chen et al, 2019 ; Handelzalts et al, 2021 ; Lambercy et al, 2021 ; Forbrigger et al, 2023a ). The effectiveness of robot-based group therapy in providing high dosage high-intensity therapy has already been demonstrated (e.g., Hesse et al, 2014 ), while the feasibility of sensorized or robotic devices to deliver high dosage in self-guided therapies at home has been largely endorsed, (e.g., Sivan et al, 2014 ; Wittmann et al, 2016 ; Hyakutake et al, 2019 ; McCabe et al, 2019 ; Rozevink et al, 2021 ).…”