A haptic-robotic platform for upper-limb reaching stroke therapy: preliminary design and evaluation results

Paul Lam, Debbie Hebert, Jennifer Boger, Hervé Lacheray, Don Gardner, Jacob Apkarian, Alex Mihailidis, Paul Lam, Debbie Hebert, Jennifer Boger, Hervé Lacheray, Don Gardner, Jacob Apkarian, Alex Mihailidis

Abstract

Background: It has been shown that intense training can significantly improve post-stroke upper-limb functionality. However, opportunities for stroke survivors to practice rehabilitation exercises can be limited because of the finite availability of therapists and equipment. This paper presents a haptic-enabled exercise platform intended to assist therapists and moderate-level stroke survivors perform upper-limb reaching motion therapy. This work extends on existing knowledge by presenting: 1) an anthropometrically-inspired design that maximizes elbow and shoulder range of motions during exercise; 2) an unobtrusive upper body postural sensing system; and 3) a vibratory elbow stimulation device to encourage muscle movement.

Methods: A multi-disciplinary team of professionals were involved in identifying the rehabilitation needs of stroke survivors incorporating these into a prototype device. The prototype system consisted of an exercise device, postural sensors, and a elbow stimulation to encourage the reaching movement. Eight experienced physical and occupational therapists participated in a pilot study exploring the usability of the prototype. Each therapist attended two sessions of one hour each to test and evaluate the proposed system. Feedback about the device was obtained through an administered questionnaire and combined with quantitative data.

Results: Seven of the nine questions regarding the haptic exercise device scored higher than 3.0 (somewhat good) out of 4.0 (good). The postural sensors detected 93 of 96 (97%) therapist-simulated abnormal postures and correctly ignored 90 of 96 (94%) of normal postures. The elbow stimulation device had a score lower than 2.5 (neutral) for all aspects that were surveyed, however the therapists felt the rehabilitation system was sufficient for use without the elbow stimulation device.

Conclusion: All eight therapists felt the exercise platform could be a good tool to use in upper-limb rehabilitation as the prototype was considered to be generally well designed and capable of delivering reaching task therapy. The next stage of this project is to proceed to clinical trials with stroke patients.

Figures

Figure 1
Figure 1
Upper-limb post-stroke rehabilitation system in use. The system consists of a (A) visual display, (B) end-effector with wrist sensor, (C) power amplifier, (D) terminal board, (E) computer, (F) haptic-robotic system, and (G) trunk sensors on chair back.
Figure 2
Figure 2
Schematic of the final design concept. Features include the (A) end-effector, (B) linear track, (C) traverse motion, (D) pitch adjustment, and (E) height adjustment.
Figure 3
Figure 3
Common compensatory strategies during the reaching exercise. Stroke survivors often exhibit abnormal shoulder abduction/internal rotation and trunk rotation during the reaching task. (a) Front view of normal reaching, (b) front view of abnormal reaching, (c) side view of normal reaching, and (d) side view of abnormal reaching.
Figure 4
Figure 4
Sensors used to detect abnormal trunk movement. Photo-sensitive resistors were used to detect when a the user had abnormal trunk movement. (a) Placement of sensors on the chair back and (b) specifications of the photo-resistor.
Figure 5
Figure 5
Design of the end-effector used in prototype trials. The (A) end-effector was designed to rotate freely, placing the challenge on the user to practice controlling their upper-limb. The amount of rotation of the end-effector can be translated into amount of shoulder abduction and internal rotation.
Figure 6
Figure 6
Elbow stimulator. (a) Eight vibration cells were positioned along (b) the posterior side of the elbow with four cells lined above and four cells lined below the elbow. For the prototype, the cells were (c) attached to the user with a lightly-bound compression bandage.
Figure 7
Figure 7
Interfaces for rehabilitation prototype. Screen-shots of the display for the (a) virtual stool and (b) rabbit-catching game interfaces.

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Source: PubMed

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