A robot goes to rehab: a novel gamified system for long-term stroke rehabilitation using a socially assistive robot-methodology and usability testing

Abstract

Background: Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Yet, to date, there are no data on the motivating benefit of SARs in a long-term interaction with post-stroke patients.

Methods: Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 24 post-stroke patients were randomly allocated to exercise with this platform-either with the robot or the computer configuration-over a 5-7 week period, 3 times per week, for a total of 306 sessions.

Results: The participants in both groups reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with it even after the study ended. We found a trend for higher acceptance of the system by the participants in the robot group on all parameters; however, this difference was not significant. We found that system failures did not affect the long-term trust that users felt towards the system.

Conclusions: We demonstrated the usability of using this platform for a long-term rehabilitation with post-stroke patients in a clinical setting. We found high levels of acceptance of both platform configurations by patients following this interaction, with higher ratings given to the SAR configuration. We show that it is not the mere use of technology that increases the motivation of the person to practice, but rather it is the appreciation of the technology's effectiveness and its perceived contribution to the rehabilitation process. In addition, we provide a list of guidelines that can be used when designing and implementing other technological tools for rehabilitation.

Trial registration: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://ichgcp.net/clinical-trials-registry/NCT03651063 .

Keywords: Co-design; Exergames; In-the-wild-study; Participatory design; Rehabilitation; Socially assistive robots; Stroke; Trust.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

The two implementations of the stroke rehabilitation system. Left: the social robot Pepper gives instructions and feedback to the patient (ROBOT). Right: the instructions and feedback are presented on a computer screen (COMPUTER)

Fig. 2

The Target and the Cup Games. Left: A patient playing the Target Game with the instructions provided by the robot. Inset: an example of instruction in this game, where three colored cups should be placed along a circle; white circles denote empty spaces. Top right: an illustration of the Target Game with all seven cup locations occupied. Bottom right: an illustration of the Cup Game with four occupied cup locations, out of the possible six

Fig. 3

The Keys and the Purse Games. A patient playing the Keys Game with the instructions provided by the robot. Large inset: an illustration of the Purse Game, showing the keys, taken out of color-matched zipped purses, to be placed on the sensorized key hanger. Small inset: an example of instruction in either of these two games, where four colored keys should be placed on the key hanger; white circles denote empty spaces

Fig. 4

The Kitchen Game. Left: A patient playing the Kitchen Game with the instructions provided by the robot. Top right: an illustration of the Kitchen Game, with all nine shelf locations occupied. The white text above each jar/bottle indicates the content of each item, which is also printed on the item itself; “½” indicates that the jar or bottle is half full. Bottom right: The variety of kitchen items that are used in this exercise game

Fig. 5

The Black Jack Game. A patient playing the Black Jack Game in the role of the dealer, with the robot in the role of the player. The cards, custom-printed on RFID tags, are placed on the sensorized table by the patient

Fig. 6

The Escape-Room Game. A–E some of the tasks of the exercise, including opening drawers to a specific distance, identifying a key or a card among distractors, punching numbers on a keypad, turning a lock, etc. F, G a patient performing the tasks in this exercise, corresponding to instructions 5 and 6 in the text

Fig. 7

Results of the user satisfaction evaluation questionnaire (USEQ), mean ± SD. A score of 1 denotes "not at all" and 5 denotes "very much". The green bars denote the responses to the questions for which a higher rating indicates a more positive experience with the platform, and the red bars denote the responses to the question for which a lower rating indicates a more positive experience with the platform