H. F. Machiel Van der Loos

Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy

Background The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). Methods MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). Results Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. Discussion VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. Trial Registration Prospero CRD42013004338

Robot-Assisted Upper-Limb Therapy in Acute Rehabilitation Setting Following Stroke: Department of Veterans Affairs Multisite Clinical Trial

This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains.

Video games and rehabilitation: using design principles to enhance engagement in physical therapy.

Patient nonadherence with therapy is a major barrier to rehabilitation. Recovery is often limited and requires prolonged, intensive rehabilitation that is time-consuming, expensive, and difficult. We review evidence for the potential use of video games in rehabilitation with respect to the behavioral, physiological, and motivational effects of gameplay. In this Special Interest article, we offer a method to evaluate effects of video game play on motor learning and their potential to increase patient engagement with therapy, particularly commercial games that can be interfaced with adapted control systems. We take the novel approach of integrating research across game design, motor learning, neurophysiology changes, and rehabilitation science to provide criteria by which therapists can assist patients in choosing games appropriate for rehabilitation. Research suggests that video games are beneficial for cognitive and motor skill learning in both rehabilitation science and experimental studies with healthy subjects. Physiological data suggest that gameplay can induce neuroplastic reorganization that leads to long-term retention and transfer of skill; however, more clinical research in this area is needed. There is interdisciplinary evidence suggesting that key factors in game design, including choice, reward, and goals, lead to increased motivation and engagement. We maintain that video game play could be an effective supplement to traditional therapy. Motion controllers can be used to practice rehabilitation-relevant movements, and well-designed game mechanics can augment patient engagement and motivation in rehabilitation. We recommend future research and development exploring rehabilitation-relevant motions to control games and increase time in therapy through gameplay. Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A61) for more insights from the authors.

Robotic stroke therapy assistant

The Rehabilitation Technologies Division of Applied Resources Corp. (RTD-ARC) has engaged in a Phase I effort to commercialize a robotic bi-manual therapy machine for use in stroke rehabilitation, in cooperation with the VA Rehabilitation R&D Center in Palo Alto. The robotic therapy device, called ARCMIME here in order to differentiate it from its clinical predecessor, has the potential to improve rehabilitation outcomes significantly for individuals who have upper limb impairments due to stroke and other brain injuries.This paper describes design considerations and clinical outcomes with regards to the Phase I system. It was found that the kinematically simpler system adequately replicated the data outcomes of the more sophisticated PUMA-based experimental test rig.

Development of Sensate and Robotic Bed Technologies for Vital Signs Monitoring and Sleep Quality Improvement

More than 50 million people in the U.S. suffer from chronic sleep disorders, including snoring, bruxism, restless legs syndrome, and obstructive sleep apnea. Clinical diagnosis of severe cases often requires expensive, hospital-based polysomnography testing, while less severe cases may benefit from lower-cost in-home sensor systems to collect physiological data over multiple nights. Remedies for sleep disorders, depending on the diagnosis, range from life style modification and medication prescription to throat surgery. There is a need for unobtrusive, in-bed sensing systems as well as robotic devices to alleviate certain sleep disorder symptoms. Two companion devices are presented. The SleepSmart device is a multi-sensor mattress pad controlled by software to detect heart rate, breathing rate, body orientation and index of restlessness. A spectral analysis module is combined with an event detection module to accumulate nightly reports, signal alarms when appropriate and, in future iterations, modify ambient conditions in the bedroom. A companion project has developed Morpheus, a mattress actuation system to encourage a person to roll over in bed to alleviate snoring based on acoustic sensor data analysis. The combination of the two systems is expected to lead to novel, in-home consumer devices to aid persons affected by mild forms of sleep disorders.

Grip forces and load forces in handovers: implications for designing human-robot handover controllers

In this study, we investigate and characterize haptic interaction in human-to-human handovers and identify key features that facilitate safe and efficient object transfer. Eighteen participants worked in pairs and transferred weighted objects to each other while we measured their grip forces and load forces. Our data show that during object transfer, both the giver and receiver employ a similar strategy for controlling their grip forces in response to changes in load forces. In addition, an implicit social contract appears to exist in which the giver is responsible for ensuring object safety in the handover and the receiver is responsible for maintaining the efficiency of the handover. Compared with prior studies, our analysis of experimental data show that there are important differences between the strategies used by humans for both picking up/placing objects on table and that used for handing over objects, indicating the need for specific robot handover strategies as well. The results of this study will be used to develop a controller for enabling robots to perform object handovers with humans safely, efficiently, and intuitively.

Human standing is modified by an unconscious integration of congruent sensory and motor signals

•  Electrical vestibular stimulation delivered at the mastoid processes evokes a reflex response in the appendicular muscles only when they are actively involved in keeping the unsupported head and body balanced. •  We show that the vestibular‐evoked muscle response was present during a task that simulated the control of standing where sensory feedback was congruent with the motor‐generated expectation to balance the body, and absent when sensory feedback did not match. •  The present results indicate that the task dependency of the vestibular‐evoked muscle response relies on congruent sensory and motor signals, and that this is organised in the absence of a conscious perception of postural control. •  These findings help us understand how our brain combines sensory and motor signals to provide an internal representation of standing balance that can be used to assess whether a perturbation poses a postural threat.

Rehabilitation and Health Care Robotics

The field of rehabilitation robotics considers robotic systems that 1) provide therapy for persons seeking to recover their physical, social, communication, or cognitive function, and/or that 2) assist persons who have a chronic disability to accomplish activities of daily living. This chapter will discuss these two main domains and provide descriptions of the major achievements of the field over its short history and chart out the challenges to come. Specifically, after providing background information on demographics (Sect. 64.1.2) and history (Sect. 64.1.3) of the field, Sect. 64.2 describes physical therapy and exercise training robots, and Sect. 64.3 describes robotic aids for people with disabilities. Section 64.4 then presents recent advances in smart prostheses and orthoses that are related to rehabilitation robotics. Finally, Sect. 64.5 provides an overview of recent work in diagnosis and monitoring for rehabilitation as well as other health-care issues. The reader is referred to Chap. 73 for cognitive rehabilitation robotics and to Chap. 65 for robotic smart home technologies, which are often considered assistive technologies for persons with disabilities. At the conclusion of the present chapter, the reader will be familiar with the history of rehabilitation robotics and its primary accomplishments, and will understand the challenges the field may face in the future as it seeks to improve health care and the well being of persons with disabilities.

Survey-Based Discussions on Morally Contentious Applications of Interactive Robotics

Introduction: As applications of robotics extend to areas that directly impact human life, such as the military and eldercare, the deployment of autonomous and semi-autonomous robots increasingly requires the input of stakeholder opinions. Up to now, technological deployment has been relying on the guidance of government/military policy and the healthcare system without specific incorporation of professional and lay opinion. Methods: This paper presents results from a roboethics study that uses the unique N-Reasons scenario-based survey instrument. The instrument collected Yes, No, Neutral responses from more than 250 expert and lay responders via the Internet along with their ethics-content reasons for the answers, allowing the respondents to agree to previously-provided reasons or to write their own. Data from three questions relating to military and eldercare robots are analyzed qualitatively and quantitatively. Results: The survey reveals that respondents weigh the appropriateness of robotics technology deployment in concert with the level of autonomy conferred upon it. The accepted level of robot autonomy does not appear to be solely dependent on the perceived efficiency and effectiveness of the technology, but is subject to the robot’s relationship with the public’s principle-based reasons and the application field in focus. Conclusion: The N-Reasons instrument was effective in eliciting ethical commentary in a simple, on-line survey format and provides insights into the interactions between the issues that respondents consider across application and technology boundaries.

Did you see it hesitate? - Empirically grounded design of hesitation trajectories for collaborative robots

Unwanted conflicts are inevitable between collaborating agents that share spaces and resources. Motivated by the use of nonverbal communications as a conflict resolution mechanism by humans, this study investigates the communicative capabilities reflected in the trajectory characteristics of hesitation gestures during human-robot collaboration. Hesitation gestures and non-hesitation human arm motions were recorded from a series of reach-and-retract tasks and embodied on a 6-DOF robot arm. A total of 86 survey respondents watched and scored recordings of these motions according to whether they recognized hesitation gestures as exhibited by both the human and the robot. Using the surveys statistical evidence indicating that hesitation trajectories embodied in an articulated robot arm can be recognized by human observers, we identified trajectory characteristics of hesitation gestures. The contribution of our work is an empirically grounded robot trajectory specification that provides communicative cues for conflict resolution during collaborative reaching scenarios.