The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation

Modelling and Design of Asymmetric Vibrations to Induce Bidirectional Force Sensation for Portable Rehabilitation Devices. IEEE Int Conf Rehabil Robot 2022;2022:1-6. [PMID: 36176088 DOI: 10.1109/icorr55369.2022.9896538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Assistive rehabilitation devices have been developed to help post-stroke patients to recover and live independently for a number of years. As a way to communicate with the physical world, force sensation is extremely helpful to rebuild neuroplasticity [1] during the rehabilitation process. This paper presents a model and design of asymmetric vibrations to provide bidirectional force sensation, which can be beneficial to design a portable rehabilitation haptic device. Users will feel a directional cue generated by asymmetric vibrations by holding the device. This directional cue can navigate users around in a rehabilitation training along with visual guidance and provide physical force sensations. The system consists of a current-drive single solenoid rigidly attached to a base. The system's model is verified through experiment at three different frequencies. Our analysis shows that by varying the signal's duty ratio, the direction of peak accelerations change from positive to negative. In addition, two other waveforms (saw-tooth and step-ramp) at several frequencies and different spring's stiffness are also discussed to determine the ideal characteristics of the input signal for rehabilitation applications.

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective

BACKGROUND

The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.

METHODS

A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.

RESULTS

Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.

CONCLUSIONS

Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.

TRIAL REGISTRATION

PROSPERO registration ref. CRD42021224141 .

Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge

Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention.

Technologies for Multimodal Interaction in Extended Reality—A Scoping Review

When designing extended reality (XR) applications, it is important to consider multimodal interaction techniques, which employ several human senses simultaneously. Multimodal interaction can transform how people communicate remotely, practice for tasks, entertain themselves, process information visualizations, and make decisions based on the provided information. This scoping review summarized recent advances in multimodal interaction technologies for head-mounted display-based (HMD) XR systems. Our purpose was to provide a succinct, yet clear, insightful, and structured overview of emerging, underused multimodal technologies beyond standard video and audio for XR interaction, and to find research gaps. The review aimed to help XR practitioners to apply multimodal interaction techniques and interaction researchers to direct future efforts towards relevant issues on multimodal XR. We conclude with our perspective on promising research avenues for multimodal interaction technologies.

VIRTUAL REALITY TRAINING THROUGH NINTENDO WII GAMES IN STROKE PATIENTS: A RANDOMISED CLINICAL TRIAL (Preprint)

Background

Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial.

Objective

The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke.

Methods

It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22.

Results

The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted.

Conclusions

VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability.

Trial Registration

Iranian Registry of Clinical Trials RCT20190715044216N1; https://www.irct.ir/user/trial/40898/view

Haptic-Enabled Hand Rehabilitation in Stroke Patients: A Scoping Review

There is a plethora of technology-assisted interventions for hand therapy, however, less is known about the effectiveness of these interventions. This scoping review aims to explore studies about technology-assisted interventions targeting hand rehabilitation to identify the most effective interventions. It is expected that multifaceted interventions targeting hand rehabilitation are more efficient therapeutic approaches than mono-interventions. The scoping review will aim to map the existing haptic-enabled interventions for upper limb rehabilitation and investigates their effects on motor and functional recovery in patients with stroke. The methodology used in this review is based on the Arksey and O’Malley framework, which includes the following stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. Results show that using three or four different technologies was more positive than using two technologies (one technology + haptics). In particular, when standardized as a percentage of outcomes, the combination of three technologies showed better results than the combination of haptics with one technology or with three other technologies. To conclude, this study portrayed haptic-enabled rehabilitation approaches that could help therapists decide which technology-enabled hand therapy approach is best suited to their needs. Those seeking to undertake research and development anticipate further opportunities to develop haptic-enabled hand telerehabilitation platforms.

Upper Limb Rehabilitation Tools in Virtual Reality Based on Haptic and 3D Spatial Recognition Analysis: A Pilot Study

With aging, cerebrovascular diseases can occur more often. Stroke cases involve hemiplegia, which causes difficulties in performing activities of daily living. Existing rehabilitation treatments are based on the subjective evaluation of the therapist as the need for non-contact care arises; it is necessary to develop a system that can self-rehabilitate and offer objective analysis. Therefore, we developed rehabilitation tools that enable self-rehabilitation exercises in a virtual space based on haptics. Thirty adults without neurological damage were trained five times in a virtual environment, and the time, number of collisions, and coordinates were digitized and stored in real time. An analysis of variance (ANOVA) of the time and distance similarity changes revealed that as the number of rounds increased, no changes or increases occurred (p ≥ 0.05), and the collisions and paths were stable as the training progressed (p < 0.05). ANOVA showed a high correlation (0.90) with a decrease in the number of crashes and time required. It was meaningful to users when performing rehabilitation training more than four times and significantly impacted the analysis. This study analyzed the upper limb and cognitive rehabilitation of able-boded people in three-dimensional space in a virtual environment; the performance difficulty could be controlled through variations in rehabilitation models.

Serious Game Platform with Haptic Feedback and EMG Monitoring for Upper Limb Rehabilitation and Smoothness Quantification on Spinal Cord Injury Patients

Cervical Spinal Cord injury (SCI) is a neurological disease that produces, as a consequence, impairments of the upper limb function. This paper illustrates a virtual reality platform based on three serious games for upper limb rehabilitation with electromyography monitoring, providing force feedback to the patient. In the rehabilitation process proposed, haptic feedback was provided to the patients to strength the arm muscles by means of the Novint Falcon device. This end-effector device was used to manipulate the serious games. During the therapy performance, the system recorded electromyography signals from the patient’s arm muscles, which may be used to monitor muscle contraction. The work presented a virtual reality system developed for spinal cord-injured patients. Each virtual reality environment could be modified in strength and duration according to the patients’ needs and was implemented for recording quantitative data about the motor performance. The platform was validated as a proof of concept in cervical spinal cord-injured patients. Results showed that this rehabilitation platform could be used for obtaining objective information in relation to motor control characteristics.

Localized Fretting-Vibrotactile Sensations for Large-Area Displays

Tactile perception in large-area displays is currently attracting substantial research attention since, in conjunction with visible and auditory sensations, it provides more immersive and realistic interactions with displayed contents. Here, a new vibrotactile display based on the fretting phenomenon is developed for the first time to provide localized tactile feedback on a large-area display. Normal pressure by a human fingertip activates a locally concentrated electric field in a relaxor ferroelectric polymer (RFP) film under the contact area, which produces a localized electrostrictive strain. The synergistic interplay among the localized electric field, electrostrictive deformation of the RFP film, and contact area dramatically amplifies acoustic vibrations near the contact edge of a human fingertip. A blend of poly(vinylidene fluoride-trifluoroethylene-chlorofluoroethylene) terpolymer and poly(vinylidene fluoride-trifluoroethylene) (55:45) copolymer is proposed for the RFP to provide an enhanced actuation performance even at elevated temperatures. The fretting-vibrotactile mechanism has several interesting properties, such as tactile feedback on a stationary fingertip, pressure-responsive simple on-off mechanism, multitouch interaction, excellent transparency, and easy integration with capacitive or resistive touch sensors and friction-based haptic-feedback mechanisms. An array of RFP film vibrators can provide addressable content-related multiple tactile feedback on large-area displays by modulating the frequency, amplitude, and profile of the driving voltage signals.

Investigating the feasibility and acceptability of real-time visual feedback in reducing compensatory motions during self-administered stroke rehabilitation exercises: A pilot study with chronic stroke survivors

INTRODUCTION

Homework-based rehabilitation programs can help stroke survivors restore upper extremity function. However, compensatory motions can develop without therapist supervision, leading to sub-optimal recovery. We developed a visual feedback system using a live video feed or an avatar reflecting users' movements so users are aware of compensations. This pilot study aimed to evaluate validity (how well the avatar characterizes different types of compensations) and acceptability of the system.

METHODS

Ten participants with chronic stroke performed upper-extremity exercises under three feedback conditions: none, video, and avatar. Validity was evaluated by comparing agreement on compensations annotated using video and avatar images. A usability survey was administered to participants after the experiment to obtain information on acceptability.

RESULTS

There was substantial agreement between video and avatar images for shoulder elevation and hip extension (Cohen's κ: 0.6-0.8) and almost perfect agreement for trunk rotation and flexion (κ: 0.80-1). Acceptability was low due to lack of corrective prompts and occasional noise with the avatar display. Most participants suggested that an automatic compensation detection feature with visual and auditory cuing would improve the system.

CONCLUSION

The avatar characterized four types of compensations well. Future work will involve increasing sensitivity for shoulder elevation and implementing a method to detect compensations.

Home-based transcranial direct current stimulation plus tracking training therapy in people with stroke: an open-label feasibility study

Background

Transcranial direct current stimulation (tDCS) is an effective neuromodulation adjunct to repetitive motor training in promoting motor recovery post-stroke. Finger tracking training is motor training whereby people with stroke use the impaired index finger to trace waveform-shaped lines on a monitor. Our aims were to assess the feasibility and safety of a telerehabilitation program consisting of tDCS and finger tracking training through questionnaires on ease of use, adverse symptoms, and quantitative assessments of motor function and cognition. We believe this telerehabilitation program will be safe and feasible, and may reduce patient and clinic costs.

Methods

Six participants with hemiplegia post-stroke [mean (SD) age was 61 (10) years; 3 women; mean (SD) time post-stroke was 5.5 (6.5) years] received five 20-min tDCS sessions and finger tracking training provided through telecommunication. Safety measurements included the Digit Span Forward Test for memory, a survey of symptoms, and the Box and Block test for motor function. We assessed feasibility by adherence to treatment and by a questionnaire on ease of equipment use. We reported descriptive statistics on all outcome measures.

Results

Participants completed all treatment sessions with no adverse events. Also, 83.33% of participants found the set-up easy, and all were comfortable with the devices. There was 100% adherence to the sessions and all recommended telerehabilitation.

Conclusions

tDCS with finger tracking training delivered through telerehabilitation was safe, feasible, and has the potential to be a cost-effective home-based therapy for post-stroke motor rehabilitation.

Trial registration

NCT02460809 (ClinicalTrials.gov).