Robotically Facilitated Virtual Rehabilitation of Arm Transport Integrated With Finger Movement in Persons with Hemiparesis

Abstract

BackgroundRecovery of upper extremity function is particularly recalcitrant to successful rehabilitation. Robotic-assisted arm training devices integrated with virtual targets or complex virtual reality gaming simulations are being developed to deal with this problem. Neural control mechanisms indicate that reaching and hand-object manipulation are interdependent, suggesting that training on tasks requiring coordinated effort of both the upper arm and hand may be a more effective method for improving recovery of real world function. However, most robotic therapies have focused on training the proximal, rather than distal effectors of the upper extremity. This paper describes the effects of robotically-assisted, integrated upper extremity training.MethodsTwelve subjects post-stroke were trained for eight days on four upper extremity gaming simulations using adaptive robots during 2-3 hour sessions.ResultsThe subjects demonstrated improved proximal stability, smoothness and efficiency of the movement path. This was in concert with improvement in the distal kinematic measures of finger individuation and improved speed. Importantly, these changes were accompanied by a robust 16-second decrease in overall time in the Wolf Motor Function Test and a 24-second decrease in the Jebsen Test of Hand Function.ConclusionsComplex gaming simulations interfaced with adaptive robots requiring integrated control of shoulder, elbow, forearm, wrist and finger movements appear to have a substantial effect on improving hemiparetic hand function. We believe that the magnitude of the changes and the stability of the patient's function prior to training, along with maintenance of several aspects of the gains demonstrated at retention make a compelling argument for this approach to training.

Correlations between statistical models of robotically collected kinematics and clinical measures of upper extremity function

“…The training period was 8 days, 2–3 hours with subjects performing four simulations that train the hand, arm and fingers as an integrated functional unit each day. The protocol is described in detail elsewhere [7]. …”

Robots Integrated With Virtual Reality Simulations for Customized Motor Training in a Person With Upper Extremity Hemiparesis

“…5 Robotics and virtual environments have been utilized to facilitate the intensity and volume requirements of RTP. 6, 7 To date, the majority of the interventions using these robotic systems have been studied using standardized experimental protocols in groups of patients, using a uniform set of impairment based upper arm movements. Two studies describe attempts at customizing interventions, one utilized custom force fields to shape reaching trajectories f individual patients to conform to a goal trajectory, 8, 9 a second combined standardized, impairment based robotic activities with a customized, traditional inpatient rehabilitation program.…”

“…In previously published studies using the NJIT-RAVR and Track-Glove systems, the experimental protocols used a standardized approach to test the capabilities of this system to train patients on activities that integrate arm and finger movement and compare this approach to training the arm and hand in isolation. 6 The virtual reality simulations used, feedback provided to the patient, the progression of difficulty, and positioning of the patients in relation to the robot were applied uniformly to all patients that met inclusion criteria, without regard to individual therapeutic goals, specific impairments or responses to the intervention. 6, 13 This case report describes a clinically relevant use of the system that was designed specifically for an individual patient.…”

“…6 The virtual reality simulations used, feedback provided to the patient, the progression of difficulty, and positioning of the patients in relation to the robot were applied uniformly to all patients that met inclusion criteria, without regard to individual therapeutic goals, specific impairments or responses to the intervention. 6, 13 This case report describes a clinically relevant use of the system that was designed specifically for an individual patient. Therefore, this case report adds a new dimension to the body of work previously published on robotically-assisted interventions.…”

Out of reach? — A novel AR interface approach for motor rehabilitation

“…A recent study with twelve post-stroke patients used a virtual reality gaming system and reported an "improved proximal stability, smoothness and efficiency of the movement path". [40] Given the technological possibilities of VR and AR and the ethos of gaming to help motivate stroke rehabilitation, we began to develop the TheraMem system, which is described in the following section.…”