Robot-assisted therapy for upper limb impairments in cerebral palsy:A scoping review and suggestions for future research

A growing number of studies investigate the use of robotics therapy for motor (re)habilitation with children with cerebral palsy (CP). Most of these studies use functional robots in very repetitive sessions. While the therapy is effective, very few studies employ social robots, which appears to be a missed opportunity to design more compelling and enjoyable sessions for the children. In this article, we will review robot-assisted upper limb motor (re)habilitation for children with CP. Previous reviews of robot-assisted therapy for CP had mostly focused on lower limbs, or the review was made from a medical point of view, with the sole concern being the therapy's effectiveness. Here, we focus our review on robot-assisted upper limb (re)habilitation and address human-robot interaction considerations. We searched PubMed, Scopus, and IEEE databases and argue that although this area of research is promising and already effective, it would benefit from the inclusion of social robots for a more engaging and enjoyable experience. We suggest four scenarios that could be developed in this direction. The goal of this article is to highlight the relevance of the past work and encourage the development of new ideas where therapy will socially engage and motivate children.</p

Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study

Background: The past decade has seen the emergence of rehabilitation treatments using virtual reality. One of the advantages in using this technology is the potential to create positive motivation, by means of engaging environments and tasks shaped in the form of serious games. The aim of this study is to determine the efficacy of immersive Virtual Environments and weaRable hAptic devices (VERA) for rehabilitation of upper limb in children with Cerebral Palsy (CP) and Developmental Dyspraxia (DD). Methods: A two period cross-over design was adopted for determining the differences between the proposed therapy and a conventional treatment. Eight children were randomized into two groups: one group received the VERA treatment in the first period and the manual therapy in the second period, and viceversa for the other group. Children were assessed at the beginning and the end of each period through both the Nine Hole Peg Test (9-HPT, primary outcome) and Kinesiological Measurements obtained during the performing of similar tasks in a real setting scenario (secondary outcomes). Results: All subjects, not depending from which group they come from, significantly improved in both the performance of the 9-HPT and in the parameters of the kinesiological measurements (movement error and smoothness). No statistically significant differences have been found between the two groups. Conclusions: These findings suggest that immersive VE and wearable haptic devices is a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Trial registration ClinicalTrials, NCT03353623. Registered 27 November 2017-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03353623

Haptic induced motor learning and the extension of its benefits to stroke patients

In this research, the Haptic Master robotic arm and virtual environments are used to induce motor learning in subjects with no known musculoskeletal or neurological disorders. It is found in this research that both perception and performance of the subject are increased through the haptic and visual feedback delivered through the Haptic Master. These system benefits may be extended to enhance therapies for patients with loss of motor skills due to neurological disease or brain injury. Force and visual feedback were manipulated within virtual environment scenarios to facilitate learning. In one force feedback condition, the subject is required to maneuver a sphere through a haptic maze or linear channel. In the second feedback condition, the subject\u27s movement was stopped when the sphere came in contact with the haptic walls. To resume movement, the force vector had to be redirected towards the optimal trajectory. To analyze the efficiency of the various scenarios, the area between the optimal and actual trajectories was used as a measure of learning. The results from this research demonstrated that within more complex environments one type of force feedback was more successful in facilitating motor learning. In a simpler environment, two out of three subjects experienced a higher degree of motor learning with the same type of force feedback. Learning is not enhanced with the presence of visual feedback. Also, in nearly all studied cases, the primary limitation to learning is shoulder and attention fatigue brought on by the experimentation

Design and Evaluation of a Virtual Reality Game to Improve Physical and Cognitive Acuity

Physical and mental health are both integral to healthy living and ageing, and a causal-cum-symbiotic relationship has been observed between the two. Physical and cognitive activities such as exercise and board games are known to promote healthy ageing. In this regard, highly engaging lightboard games are known to improve hand-eye coordination, reflexes, and motor skills for individuals. Immersivity of virtual reality games can transform mundane and repetitive exercise routines into stimulating experiences, and they can be utilized by users to improve physical and cognitive performance from the comfort of their homes. In this study, we adopt design science framework to design, develop and evaluate a VR BATAK lightboard game to improve physical reaction, hand-eye coordination, visual memory and cognitive processing. Based on the findings from evaluation over three phases, we propose three design principles related to accessibility, sensory cueing and cognitive loading, as theoretical and practical contributions of this study

XR, music and neurodiversity: design and application of new mixed reality technologies that facilitate musical intervention for children with autism spectrum conditions

This thesis, accompanied by the practice outputs,investigates sensory integration, social interaction and creativity through a newly developed VR-musical interface designed exclusively for children with a high-functioning autism spectrum condition (ASC).The results aim to contribute to the limited expanse of literature and research surrounding Virtual Reality (VR) musical interventions and Immersive Virtual Environments (IVEs) designed to support individuals with neurodevelopmental conditions. The author has developed bespoke hardware, software and a new methodology to conduct field investigations. These outputs include a Virtual Immersive Musical Reality Intervention (ViMRI) protocol, a Supplemental Personalised, immersive Musical Experience(SPiME) programme, the Assisted Real-time Three-dimensional Immersive Musical Intervention System’ (ARTIMIS) and a bespoke (and fully configurable) ‘Creative immersive interactive Musical Software’ application (CiiMS). The outputs are each implemented within a series of institutional investigations of 18 autistic child participants. Four groups are evaluated using newly developed virtual assessment and scoring mechanisms devised exclusively from long-established rating scales. Key quantitative indicators from the datasets demonstrate consistent findings and significant improvements for individual preferences (likes), fear reduction efficacy, and social interaction. Six individual case studies present positive qualitative results demonstrating improved decision-making and sensorimotor processing. The preliminary research trials further indicate that using this virtual-reality music technology system and newly developed protocols produces notable improvements for participants with an ASC. More significantly, there is evidence that the supplemental technology facilitates a reduction in psychological anxiety and improvements in dexterity. The virtual music composition and improvisation system presented here require further extensive testing in different spheres for proof of concept

Wireless vibrotactile wireless optical device for motor activity assistance motor activities

This article describes the research that leads to the development of a wireless optical device capable of generating vibrotactile mechanical stimuli at different points on the skin and at desired frequencies by means of sixteen actuators contained in a portable bracelet designed for any extremity of the human body. This prototype allows control over each actuator used as a stimulation point, actuated independently by wirelessly transmitted commands to a rechargeable stand-alone control system in the bracelet. Usability tests were carried out, with respect to tactile perception, which proved the correct functioning of the device. In perspective, the development, after a variety of validation tests with a large sample of patients with and without neuropathy, aims at creating a database to be used as set point values in front of these patients with the expectation that the system will also be used in patients with movement deficits, and employing tactile perception as a psychomotor stimulant in the execution of motor activities