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

Abstract

Background and Purpose A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. Others utilize interventions tailored to patients but don't describe the clinical decision making process utilized to develop and modify interventions. This case report will describe a robot-based intervention customized to match the goals and clinical presentation of a gentleman with upper extremity hemiparesis secondary to stroke. Methods PM is an 85 year-old man with left hemiparesis secondary to an intracerebral hemorrhage five years prior to examination. Outcomes were measured before and after a one month period of home therapy and after a one month robotic intervention. The intervention was designed to address specific impairments identified during his PT examination. When necessary, activities were modified based on the patient's response to his first week of treatment. Outcomes PM trained twelve sessions using six virtually simulated activities. Modifications to original configurations of these activities resulted in performance improvements in five of these activities. PM demonstrated a 35 second improvement in Jebsen Test of Hand Function time and a 44 second improvement in Wolf Motor Function Test time subsequent to the robotic training intervention. Reaching kinematics, 24 hour activity measurement and the Hand and Activities of Daily Living scales of the Stroke Impact Scale all improved as well. Discussion A customized program of robotically facilitated rehabilitation resulted in large short-term improvements in several measurements of upper extremity function in a patient with chronic hemiparesis.

Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study

“…AD demonstrated motor skill development when performing the piano training simulation as measured by fractionation changes (see Figure 1(b)) in a pattern comparable to our subjects with chronic stroke [15,18] despite her lower level of active finger movement at the beginning of the study. She demonstrated comparable improvements in accuracy when performing the Monkey Business simulation as well.…”

“…[15] Our approach to initiating training with facilitation from the Cybergrasp and weaning this facilitation over the course of the intervention is described in detail in our case report on a patient with chronic stroke. [18] Space Pong targets the control of mass finger flexion and extension. The subjects control a pong paddle using flexion and extension of the fingers measured with a CyberGlove, playing a game against the computer.…”

Exploring the impact of visual and movement based priming on a motor intervention in the acute phase post-stroke in persons with severe hemiparesis of the upper extremity

“…The advantage of this task is that the instrumentation allows for calibrating the force demands to accommodate minimal voluntary movements available to the subjects while still preserving meaningful visual feedback. [32] This incorporates principles of motor learning to enhance its efficacy as a training tool. This task was used as both a training task and an outcome measure (see below).…”

Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke

“…Interest in rehabilitation technology is related to the potential for VR to provide more intensive training environments than are usually available during post-stroke Submitted rehabilitation to promote better motor recovery [2], [3]. Advantages of using VR technology include the ability to create training opportunities incorporating salient motor tasks that need to be re-acquired post-stroke and to manipulate task difficulty and feedback for effective, individualized motor learning paradigms [4]- [6].…”