Serious Games Strategies With Cable-Driven Robots for Bimanual Rehabilitation: A Randomized Controlled Trial With Post-Stroke Patients

Using immersive virtual reality to remotely examine performance differences between dominant and non-dominant hands

Circle drawing may be a useful task to study upper-limb function in patient populations. However, previous studies rely on expensive and bulky robotics to measure performance. For clinics or hospitals with limited budgets and space, this may be unfeasible. Virtual reality (VR) provides a portable and low-cost tool with integrated motion capture. It offers potentially a more feasible medium by which to assess upper-limb motor function. Prior to use with patient populations, it is important to validate and test the capabilities of VR with healthy users. This study examined whether a VR-based circle drawing task, completed remotely using participant's own devices, could capture differences between movement kinematics of the dominant and non-dominant hands in healthy individuals. Participants (n = 47) traced the outline of a circle presented on their VR head-mounted displays with each hand, while the positions of the hand-held controllers were continuously recorded. Although there were no differences observed in the size or roundness of circles drawn with each hand, consistent with prior literature our results did show that the circles drawn with the dominant hand were completed faster than those with the non-dominant hand. This provides preliminary evidence that a VR-based circle drawing task may be a feasible method for detecting subtle differences in function in clinical populations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00794-z.

A User-Friendly Nonmotorized Device for Ankle Rehabilitation

The ankle is formed by several joints, and it is the union of the lower leg with the foot. Its main function is to perform dorsiflexion and plantar flexion movements. Many people are affected by ankle problems. These problems can be due to simple factors, but they can also be a sign of a more serious impairment that can lead to the need for ankle rehabilitation. Thus, this paper presents a novel, fairly simple nonmotorized device for ankle rehabilitation. The design of the novel device is based on the crank–rocker mechanism, activated by the patient’s upper limb, allowing the execution of the ankle flexion range. The dimensions of the device were found using a differential evolution algorithm considering the ankle movement limits, the link stress, and singularity configurations. Graphic simulations were performed to validate the mathematical model. A prototype was constructed, and the angular ankle movement was verified. The device is easy to operate and low-cost, and in the future, it may be a tool for ankle rehabilitation.

Results of a 2-week novel robotic rehabilitation program in 18 children with prior hemispherectomy

BACKGROUND

Partial preservation of sensory and motor functions in the contralateral extremities after hemispherectomy is likely secondary to cortical reorganization of the remaining hemisphere and can be improved by rehabilitation. This study aims to investigate behavioral changes that may occur after a 2-week novel robotic rehabilitation program in 18 children with prior anatomic hemispherectomy. Other conventional rehabilitation methods were also reviewed and compared.

METHODS

This study examined the impact of a novel robotic rehabilitation 2-week program on 18 hemispherectomy patients (average age 14.3 ± 3.9 years; age at hemispherectomy 5.6 ± 4.5 years).

RESULTS

Statistically significant improvements were seen in the six-minute walk test (29 m, p < 0.001), Canadian Occupational Performance Measure performance (1.64 points, p = 0.002) and satisfaction (2.49 points, p = 0.001), and individual perceived performance on survey (1.72 points, p = 0.042). Fifteen patients showed improvement in the upper extremity Fugl-Meyer scores with an average increase of 3 points (p = 0.006).

CONCLUSION

This study demonstrates clinically meaningful and statistically significant improvements in motor function and behavior following a novel robotic rehabilitation two-week program.

Comparison of theoretical and experimental models for knee flexion/extension using a cable-driven robot

To support and facilitate the rehabilitation of patients with physical limitations and aid the therapist, several robotic structures are being studied. Among the structures, the cable-driven robots stand out. The cable-driven robots are structures actuated by cables and have the advantages of being flexible and reconfigurable for each patient. The objective of this paper is to develop a theoretical model for knee flexion/extension force and moment using a cable-driven robot. The proposed model is necessary for elaborating a referential to which diagnosis can be made and the improvement of the patient evaluated. The presented theoretical model was validated through experiments with twelve sedentary and healthy volunteers. The first procedure tested ten subjects in three thigh angles for knee flexion motion; the second procedure tested two subjects in flexion and extension for the same thigh angle. The results show the validity of the model for 88.58% of the tests in an ANOVA analysis with a 99% confidence interval. The similarity of data for different gender, ages, and intrinsic factors was noted, implying that the model is representative and independent of the subject’s individuality. Differences between flexion and extension values were observed, which need to be studied in the future.

Development of a novel body weight support system for gait rehabilitation

Modern rehabilitation processes for neurological patients have been widely assisted by robotic structures, with continuous research and improvements. The use of robotic assistance in rehabilitation is a consolidated technique for upper limb training sessions. However, human gait robotic rehabilitation still needs further research and development. Based on that, this paper deals with the development of a novel active body weight support (BWS) system integrated with a serious game for poststroke patients. This paper starts with a brief review of the state of the art of applied technologies for gait rehabilitation. Next, it presents the obtained mathematical model followed by multibody synthesis techniques and meta-heuristic optimization to the proposed device. The control of the structure is designed using proportional integral derivative (PID) controllers tuned with meta-heuristic optimization and associated with a suppression function to perform assist-as-needed actions. Then, the prototype is integrated with a serious game designed specifically for this application. Finally, a pilot study is conducted with the structure and healthy volunteers. The results obtained show that the mobility of the novel BWS is as expected and the proposed system potentially offers a novel tool for gait training.