126 research outputs found

    Feasibility of a second iteration wrist and hand supported training system for self-administered training at home in chronic stroke

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    Telerehabilitation allows continued rehabilitation at home after discharge. The use of rehabilitation technology supporting wrist and hand movements within a motivational gaming environment could enable patients to train independently and ultimately serve as a way to increase the dosage of practice. This has been previously examined in the European SCRIPT project using a first prototype, showing potential feasibility, although several usability issues needed further attention. The current study examined feasibility and clinical changes of a second iteration training system, involving an updated wrist and hand supporting orthosis and larger variety of games with respect to the first iteration. Nine chronic stroke patients with impaired arm and hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility and arm and hand function were assessed before and after training. Median weekly training duration was 113 minutes. Participants accepted the six weeks of training (median Intrinsic Motivation Inventory = 4.4 points and median System Usability Scale = 73%). After training, significant improvements were found for the Fugl Meyer assessment, Action Research Arm Test and self-perceived amount of arm and hand use in daily life. These findings indicate that technology-supported arm and hand training can be a promising tool for self-administered practice at home after stroke.Final Accepted Versio

    Design, development and deployment of a hand/wrist exoskeleton for home-based rehabilitation after stroke - SCRIPT project

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    YesChanges in world-wide population trends have provided new demands for new technologies in areas such as care and rehabilitation. Recent developments in the the field of robotics for neurorehabilitation have shown a range of evidence regarding usefulness of these technologies as a tool to augment traditional physiotherapy. Part of the appeal for these technologies is the possibility to place a rehabilitative tool in one’s home, providing a chance for more frequent and accessible technologies for empowering individuals to be in charge of their therapy. Objective: this manuscript introduces the Supervised Care and Rehabilitation Involving Personal Tele-robotics (SCRIPT) project. The main goal is to demonstrate design and development steps involved in a complex intervention, while examining feasibility of using an instrumented orthotic device for home-based rehabilitation after stroke. Methods: the project uses a user-centred design methodology to develop a hand/wrist rehabilitation device for home-based therapy after stroke. The patient benefits from a dedicated user interface that allows them to receive feedback on exercise as well as communicating with the health-care professional. The health-care professional is able to use a dedicated interface to send/receive communications and remote-manage patient’s exercise routine using provided performance benchmarks. Patients were involved in a feasibility study (n=23) and were instructed to use the device and its interactive games for 180 min per week, around 30 min per day, for a period of 6 weeks, with a 2-months follow up. At the time of this study, only 12 of these patients have finished their 6 weeks trial plus 2 months follow up evaluation. Results: with the “use feasibility” as objective, our results indicate 2 patients dropping out due to technical difficulty or lack of personal interests to continue. Our frequency of use results indicate that on average, patients used the SCRIPT1 device around 14 min of self-administered therapy a day. The group average for the system usability scale was around 69% supporting system usability. Conclusions: based on the preliminary results, it is evident that stroke patients were able to use the system in their homes. An average of 14 min a day engagement mediated via three interactive games is promising, given the chronic stage of stroke. During the 2nd year of the project, 6 additional games with more functional relevance in their interaction have been designed to allow for a more variant context for interaction with the system, thus hoping to positively influence the exercise duration. The system usability was tested and provided supporting evidence for this parameter. Additional improvements to the system are planned based on formative feedback throughout the project and during the evaluations. These include a new orthosis that allows a more active control of the amount of assistance and resistance provided, thus aiming to provide a more challenging interaction.This work has been partially funded under Grant FP7-ICT-288698(SCRIPT) of the European Community Seventh Framework Programme

    Formative Usability Evaluation of WiGlove - A Home-based Rehabilitation Device for Hand andWrist Therapy after Stroke

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    © 2023 Copyright held by the owner/author(s). Publication rights licensed to ACM.WiGlove is a passive dynamic orthosis aimed at home-based poststroke rehabilitation of the hand and wrist. This paper highlights results from WiGlove's formative evaluation as the first step towards its deployment. In this study, twenty healthy participants evaluated the usability and safety of the WiGlove compared to its predecessor, the state-of-the-art SCRIPT Passive Orthosis (SPO). In this within-subject experiment, they performed various tasks such as donning/doffing, adjusting the tension, grasping, etc., with both gloves and rated them using a Likert scale-based questionnaire. The results showed improvements in several aspects of usability and safety. This study provides preliminary evidence of WiGlove's fitness for the next assessment with its intended users, people recovering from stroke with sustained hand and wrist impairment

    Feasibility study into self-administered training at home using an arm and hand device with motivational gaming environment in chronic stroke

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    © 2015 Nijenhuis et al. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke. METHODS: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up. RESULTS: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log. CONCLUSIONS: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings. TRIAL REGISTRATION: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .Peer reviewe

    WiGlove : A Passive Dynamic Orthosis for Home-based Post-stroke Rehabilitation of Hand and Wrist

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    Stroke survivors often experience varying levels of motor function deficits in their hands affecting their ability to perform activities of daily life. Recovering their hand functions through neurorehabilitation is a significant step in their recovery towards independent living. Home-based rehabilitation using robotic devices allows stroke survivors to train at their convenience independent of factors such as the availability of therapists’ appointments and the need for frequent travel to outpatient clinics. While many robotic solutions have been proposed to address the above concerns, most focus on training only the wrist or the fingers, neglecting the synergy between the two. To address this, the WiGlove was co-designed to allow hemiparetic stroke survivors to train both the wrist and fingers in the comfort of their homes. The central hypothesis of this work is to investigate if a device designed using user-centred methods featuring aspects of usability such as easy donning and doffing and wireless operation, can act as a feasible tool for home-based rehabilitation of the hand and wrist following stroke. In order to aid this investigation, we tackled this task in three stages of usability and feasibility evaluations. Firstly, healthy participants tried the current state of the art, the SCRIPT Passive Orthosis, as well as the WiGlove, in a counterbalanced, within-subject experiment and attested to WiGlove’s improvement in several aspects of usability such as ease of don/doffing, suitability for ADL, unblocked natural degrees of freedom, safety and aesthetic appeal. Subsequently, a heuristic evaluation with six stroke therapists validated these improvements and helped identify issues they perceived to potentially affect the device’s acceptance. Integrating this feedback, the updated WiGlove was subjected to a six-week summative feasibility evaluation with two stroke survivors, with varying levels of impairment, in their homes without supervision from the therapists. Results from this study were overwhelmingly positive on the usability and acceptance of the WiGlove. Furthermore, in the case of the first participant who trained with it for a total of 39 hours, notable improvements were observed in the participant’s hand functions. It showed that even without a prescribed training protocol, both participants were willing to train regularly with the WiGlove and its games, sometimes several times a day. These results demonstrate that WiGlove can be a promising tool for home-based rehabilitation for stroke survivors and serve as evidence for a larger user study with more participants with varying levels of motor impairments due to stroke. The findings of this study also offer preliminary evidence supporting the effectiveness of training with the WiGlove, particularly in the case of the first participant, who exhibited a significant reduction of tone in the hand as a result of increased training intensity. Owing to the participant’s satisfaction with the device, it was requested by him to extend his involvement in the study by using the WiGlove for a longer duration which was facilitated

    Training modalities in robot-mediated upper limb rehabilitation in stroke : A framework for classification based on a systematic review

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    © 2014 Basteris et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The work described in this manuscript was partially funded by the European project ‘SCRIPT’ Grant agreement no: 288698 (http://scriptproject.eu). SN has been hosted at University of Hertfordshire in a short-term scientific mission funded by the COST Action TD1006 European Network on Robotics for NeuroRehabilitationRobot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.Peer reviewedFinal Published versio

    Evaluation of an Actuated Wrist Orthosis for Use in Assistive Upper Extremity Rehabilitation

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    Cerebral palsy (CP) is a neurological condition caused by damage to motor control centers of the brain. This leads to physical and cognitive deficiencies that can reduce an individual’s quality of life. Specifically, motor deficiencies of the upper extremity can make it difficult for an individual to complete everyday tasks, including eating, drinking, getting dressed, or combing their hair. Physical therapy, involving repetitive tasks, has been shown to be effective in training normal motion of the limb by invoking the neuroplasticity of the brain and its ability to adapt in order to facilitate motor learning. Creating a device for use with Activities of Daily Living (ADLs) provides an additional tool for task-based therapy with the goal of improving functional outcome. A custom wrist orthotic has been designed and developed that assists flexion/extension of the wrist and rotation of the forearm, while leaving the hand open for the grasp and manipulation of objects. Actuated joints are driven with geared brushless DC motors on a lightweight, exoskeleton frame coupled to a passive arm that tracks positional changes within the task space. Control of actuation is accomplished with a custom mapping strategy, created from nominal movement profiles for 5 ADLs collected from healthy subjects. A simple relationship was created between position within the workspace and orientation necessary for task completion to determine needed assistance. Validation of the design subjected the device to three different conditions, including robot guidance of the limb, co-contraction of the forearm, and the use of alternate approaches to complete the task. Co-contraction and alternate approach conditions were used to simulate characteristics of impaired subjects, including rigidity spasticity, and lack of muscle control. Robot guidance achieved an average orientation error of 5° or less in at least 75% of iterations across all tasks, while co-contraction and alternate approach was able to do this in flexion/extension, but saw much higher errors in forearm rotation. Causes for performance deficiencies were attributed to lack of torque bandwidth at the motor and response delay due to signal filtering, aspects that will be corrected in the next iteration of the design

    Mechanical Redesign and Implementation of Intuitive User Input Methods for a Hand Exoskeleton Informed by User Studies on Individuals with Chronic Upper Limb Impairments

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    Individuals with upper limb motor deficits due to neurological conditions, such as stroke and traumatic brain injury, may exhibit hypertonia and spasticity, which makes it difficult for these individuals to open their hand. The Hand Orthosis with Powered Extension (HOPE) Hand was created in 2018. The performance of the HOPE Hand was evaluated by conducting a Box and Blocks test with an impaired subject. Improvements were identified and the HOPE Hand was mechanically redesigned to increase the functionality in performing grasps. The original motor configuration was reorganized to include active thumb flexion and extension, as well as thumb abduction/adduction. An Electromyography (EMG) study was conducted on 19 individuals (10 healthy, 9 impaired) to evaluate the viability of EMG device control for the specified user group. EMG control, voice control, and manual control were implemented with the HOPE Hand 2.0 and the exoskeleton system was tested for usability during a second Box and Blocks test
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