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Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of [...]

Abstract Background It is common for individuals with chronic disabilities to continue using the compensatory movement coordination due to entrenched habits, increased perception of task difficulty, or personality variables such as low self-efficacy or a fear of failure. Following our previous work using feedback distortion in a virtual rehabilitation environment to increase strength and range of motion, we address the use of visual feedback distortion environment to alter movement coordination patterns. Methods Fifty-one able-bodied subjects participated in the study. During the experiment, each subject learned to move their index finger and thumb in a particular target pattern while receiving visual feedback. Visual distortion was implemented as a magnification of the error between the thumb and/or index finger position and the desired position. The error reduction profile and the effect of distortion were analyzed by comparing the mean total absolute error and a normalized error that measured performance improvement for each subject as a proportion of the baseline error. Results The results of the study showed that (1) different coordination pattern could be trained with visual feedback and have the new pattern transferred to trials without visual feedback, (2) distorting individual finger at a time allowed different error reduction profile from the controls, and (3) overall learning was not sped up by distorting individual fingers. Conclusion It is important that robotic rehabilitation incorporates multi-limb or finger coordination tasks that are important for activities of daily life in the near future. This study marks the first investigation on multi-finger coordination tasks under visual feedback manipulation.

Effective clinical trials for neuroprotective interventions for Parkinson's disease (PD) require a way to quantify an individual's motor symptoms and analyze the change in these symptoms over time. Clinical scales provide a global picture of funclion but cannot precisely measure specific aspects of motor control. We have used commercially available sensors to create a protocol called Advanced Sensing for Assessment of Parkinson's disease (ASAP) to obtain a quantitative and reliable measure of motor impairment in early to moderate PD. The ASAP protocol measures grip force as an individual tracks a sinusoidal or pseudorandom target force under three conditions of increasing cognitive load. Thirty individuals with PD have completed the ASAP protocol. The ASAP data for 26 of these individuals were summarized in terms of 36 variables, and modified regression techniques were used to predict an individual's score on the Unified Parkinson Disease Rating Scale based on ASAP data. We observed a mean prediction error of approximately 3.5 UPDRS points, and the predicted score accounted for approximately 76% of the variability of the UPDRS. These results demonstrate that the ASAP protocol can measure differences for individuals who are clinically different. This indicates that the ASAP protocol may be able to measure changes with time in the motor signs of an individual with PD. [ABSTRACT FROM AUTHOR]

We create a robotic rehabilitation environment that distorts the visual feedback of a movement representation to restore lost movements. The use of visual-feedback distortion produces a perceptual gap between the perceived (visual) and actual somatosensory experiences, in which movements can be manipulated without patients' knowledge. Previously, we reported the smallest amount of distortion that is imperceptible by measuring just noticeable difference (JND), the distortion size that is tolerable without detection, and the invariance of perceived physical effort under visual-feedback distortion. In this paper, we report the performance changes under visual-feedback distortion in a robotic rehabilitation environment. By interleaving trials with no visual feedback, we showed that the internal somatosensory representation of the movement goal changed along with visual distortion for unimpaired and motor-impaired subjects. In addition, a gradual change of visual-feedback distortion within one experiment allowed movement changes significantly larger than the JND. These changes were robust under sudden lack of visual feedback and even when subjects were informed of possible distortion ahead of time. Finally, preliminary results of a six-week rehabilitation paradigm are reported. Improvements in the patient's hand condition were found, particularly in the range of motion of the index and middle fingers. [ABSTRACT FROM AUTHOR]

Imperceptible visual distortion, in the form of a disguised progression of performance goals, may be a helpful addition to rehabilitation after stroke and other brain injuries. This paper describes work that has been done to lay the groundwork for testing this hypothesis. We have constructed and validated an experimental environment that provides controllable visual distortion and allows precise force and position measurements. To estimate the amount of visual distortion that should be imperceptible, we measured the limits for force and distance/position perception in our rehabilitation environment for young and elderly unimpaired subjects and for a single traumatic brain injury (TBI) patient. We found the Just Noticeable Difference (JND) for produced force to be 19.7% (0.296 N) and the JND for movement distance/finger position to be 13.0% (3.99 mm) for young subjects (ages 18–35). For elderly subjects (ages 61–80), the JND for force was measured to be 31.0% (0.619 N) and the JND for distance/position was 16.1% (5.01 mm). JNDs of 46.0% (0.920 N) and 45.0% (14.8 mm) were found for the motor-impaired individual. In addition, a subject's rating of effort was found to be profoundly influenced by visual feedback concerning the force magnitude. Even when this feedback was distorted, it accounted for 99% of the variance of the effort rating. These results indicate that substantial visual distortions should be imperceptible to the subject, and that visual feedback can be used to influence the subject's perceived experience in our robotic environment. This means that we should be able to use imperceptible visual distortion to alter a patient's perception of therapeutic exercise in a robotic environment. [ABSTRACT FROM AUTHOR]

Abnormal kinematics and the use of compensation strategies during training limit functional improvement from therapy. The Kinect is a low cost ($100) sensor that does not require any markers to be placed on the user. Integration of this sensor into currently used therapy systems can provide feedback about the user's movement quality, and the use of compensatory strategies to complete tasks. This paper presents a novel technique of adding the Kinect to an end effector robot to limit compensation strategies and to train normal joint coordination during movements with an end effector robot. This methodology has wider implications for other robotic and passively actuated end effector rehabilitation devices.

Many robotic systems have been developed to provide assistance to individuals with disabilities. Most of these systems require the individual to interact with the robot via a joystick or keypad, though some utilize techniques such as speech recognition or selection of objects with a laser pointer. In this paper, we describe a prototype system using a novel method of interaction with an assistive robot. A touch-sensitive skin enables the user to directly guide a robotic arm to a desired position. When the skin is released, the robot remains fixed in position. The target population for this system is individuals with hemiparesis due to chronic stroke. The system can be used as a substitute for the paretic arm and hand in bimanual tasks such as holding a jar while removing the lid. This paper describes the hardware and software of the prototype system, which includes a robotic arm, the touch-sensitive skin, a hook-style prehensor, and weight compensation and speech recognition software.

In this study, a robotic orthotic device with one degree of freedom was used for assessment of individuals with chronic stroke and resultant hemiparesis. The specific aim was to investigate the effect of visual feedback distortion on range of motion (ROM) at the elbow and wrist joints as measured by the Arm IntelliStretch platform from Rehabtek LLC. It was hypothesized that introducing visual feedback distortion in increments under the just noticeable difference of two degrees would directly correspond to an increase in ROM at both the wrist and elbow joints when compared to ROM measured by the IntelliStretch system without visual feedback distortion. Ten individuals an average of 11 years post stroke (SD: 9.7) participated in this study. At the elbow joint, repeated measures ANOVA showed a significant effect of distortion (F(4, 36) = 2.69, p < 0.047). Similar trends were seen at the wrist joint, though these results were not statistically significant.

Assistive robots for persons with physical limitations need to interact with humans in a manner that is safe to the user and the environment. Early work in this field centered on task specific robots. Recent work has focused on the use of the MANUS ARM and the development of different interfaces. The most intuitive interaction with an object is through touch. By creating a skin for the robot arm which will directly control its movement compliance, we have developed a novel and intuitive method of interaction. This paper describes the development of a skin which acts as a switch. When activated through touch, the skin will put the arm into compliant mode allowing it to be moved to the desired location safely, and when released will put the robot into non-compliant mode thereby keeping it in place. We investigated four conductive materials and four insulators, selecting the best combination based on our design goals of the need for a continuous activation surface, the least amount of force required for skin activation, and the most consistent voltage change between the conductive surfaces measured during activation.