Towards a platform for robot-assisted minimally-supervised therapy of hand function: design and pilot usability evaluation

Abstract

BackgroundRobot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home.MethodsWe implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist.ResultsParticipants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46(7.69-19.23)% of the tasks. They assigned good-to-excellent scores on the SUS to the user-interface and the exercises (85.00(75.63-86.88) and 73.75(63.13-83.75) out of 100, respectively). Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks.DiscussionOur findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platformcould complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.

Neurorehabilitation From a Distance: Can Intelligent Technology Support Decentralized Access to Quality Therapy?

“…Usability considerations (e.g., in the form of user-centered design involving patients in the development process (Meyer et al, 2019)) should be taken into account not only at the level of the hardware (e.g., how to turn it on/off, how to don/doff a device, etc.) but also at the level of the software and graphical user interface, which should be intuitive and easy to navigate for nonexperts in computer use, or patients with cognitive deficits (Ranzani et al, 2021). User archetypes created through data generated from actual target users might increase the potential for better design of technology-assisted interventions in stroke rehabilitation (Haldane et al, 2019).…”

“…A common digital therapy platform offers the unique advantage of sharing user-interaction features between devices, to improve usability and help seamlessly transition from one device to the other (e.g., within a therapy session, or over the course of rehabilitation). Figure 2 presents a possible set of selected user-friendly, mobile, complementary robotic systems targeting different components of the upper limb, that could be used as a basis to implement such a connected RehabGym concept (Chua et al, 2018;Butzer et al, 2020;Lambelet et al, 2020;Ranzani et al, 2020;Ranzani et al, 2021).…”

Design, characterization and preliminary usability testing of a portable robot for unsupervised therapy of hand function

“…However, the use of robotic devices is currently mainly limited to short therapy sessions in the clinics under constant supervision of specialized therapists, which limits their potential as a vector to increase therapy dose. One way to achieve this objective could be to use such technology within minimally supervised (i.e., therapy performed by a single patient or a group of patients with minimal external supervision or intervention [14,15]) or unsupervised (i.e., therapy performed without external supervision or intervention) robot-assisted therapy programs that could start in the clinic [14,16] and continue at home after discharge [6, [17][18][19][20]. Unfortunately, to make the step into the home environment of neurological subjects, current robotic devices should be rethought to guarantee simplicity of use, adaptability to different users and ergonomics, affordability and scalability, safety and portability [7,21,22].…”

“…As a result, only few robotic devices for upper limb rehabilitation have been proposed and tested for home use [18,19,[24][25][26], often without reporting their technical evaluation. Furthermore, little is known about their usability, which is fundamental to optimize the device development based on the user needs [27], as well as increase acceptance and user compliance to a therapy plan [15,21,[28][29][30], which is of key importance when targeting unsupervised use.…”

User-Centered Design and Spatially-Distributed Sequential Electrical Stimulation in Cycling for Individuals with Paraplegia

“…[7]. In the context of assistive devices, the SUS has been widely used as an evaluation tool for telerehabilitation systems [8] and robot-assisted devices [9].…”