A usability study in patients with stroke using MERLIN, a robotic system based on serious games for upper limb rehabilitation in the home setting

Neuroscience and neurotechnology are transforming stroke rehabilitation. Robotic devices, in addition to telerehabilitation, are increasingly being used to train the upper limbs after stroke, and their use at home allows us to extend institutional rehabilitation by increasing and prolonging therapy. The aim of this study is to assess the usability of the MERLIN robotic system based on serious games for upper limb rehabilitation in people with stroke in the home environment.This research is part of a MERLIN project, which has received funding from EIT Health (Grant no. 20649). EIT Health is supported by the European Institute of Innovation and Technology (EIT), a body of the European Union which receives support from the European Union’s Horizon 2020 Research and innovation programme

An investigation into the implementation of robot-assisted upper limb therapy within an Australian rehabilitative setting

Background: Robot-assisted upper limb therapy (RT-UL) is an emerging intervention for stroke survivors with upper limb (UL) impairments. Research into RT-UL has concentrated on investigating the clinical efficacy but implementation and use of RT-UL in routine practice has not yet been adequately explored. This is a notable gap in the field when considering that non-adoption and abandonment is common for health technologies in the clinical setting. The aim of this doctoral research program was to investigate the implementation and use of the InMotion, RT-UL device, for the first time in an Australian clinical setting. Methods: A multiple methods approach was used in this program of research involving four studies, two qualitative and two quantitative. Study 1 explored therapists’ perceptions of RT-UL prior to the implementation through discipline specific focus groups. Study 2 was an observational study that investigated the amount of UL practice performed by subacute stroke survivors pre and post RT-UL implementation. Study 3 involved audits of RT-UL computer data to investigate the sustainability of RT-UL as part of routine practice over a two-year period. Study 4 explored therapist perceptions of the RT-UL post implementation through discipline specific focus groups. Results: Study 1 identified therapists were positive towards the implementation of RT-UL perceiving the device would provide opportunity for increased UL practice for strokes survivors in their clinical setting. The availability of a single RT-UL device may however create unique logistical challenges. Study 2 observed a significant increase in UL practice for stroke survivors including those with severe UL impairment following the implementation of RT-UL as part of routine practice. Study 3 discovered that RT-UL was in continued and regular use with stroke survivors two years after implementation. Study 4 found both disciplines continued to be accepting of RT-UL post implementation but it was physiotherapists who predominantly prescribed RT-UL. Implementation of RT-UL had been largely successful due to an increased level of UL practice for patients, the ease of using the device as part of routine practice and positive reception from patients. The implementation process was also clinician initiated and led. Conclusion: This research program was the first to evaluate the implementation of RT-UL into the routine practices of an Australian rehabilitation setting. New knowledge was acquired about RT-UL use with stroke survivors including occupational therapists and physiotherapists perceptions, impact on the amount of UL practice able to be delivered, sustainability of RT-UL within the inpatient rehabilitation setting and barriers and facilitator to RT-UL implementation

Perseverance with technology-facilitated home-based upper limb practice after stroke: a systematic mixed studies review

Background: Technology is being increasingly investigated as an option to allow stroke survivors to exploit their full potential for recovery by facilitating home-based upper limb practice. This review seeks to explore the factors that influence perseverance with technology-facilitated home-based upper limb practice after stroke. Methods: A systematic mixed studies review with sequential exploratory synthesis was undertaken. Studies investigating adult stroke survivors with upper limb disability undertaking technology-facilitated home-based upper limb practice administered ≥ 3 times/week over a period of ≥ 4 weeks were included. Qualitative outcomes were stroke survivors’ and family members’ perceptions of their experience utilising technology to facilitate home-based upper limb practice. Quantitative outcomes were adherence and dropouts, as surrogate measures of perseverance. The Mixed Methods Appraisal Tool was used to assess quality of included studies. Results: Forty-two studies were included. Six studies were qualitative and of high quality; 28 studies were quantitative and eight were mixed methods studies, all moderate to low quality. A conceptual framework of perseverance with three stages was formed: (1) getting in the game; (2) sticking with it, and; (3) continuing or moving on. Conditions perceived to influence perseverance, and factors mediating these conditions were identified at each stage. Adherence with prescribed dose ranged from 13 to 140%. Participants were found to be less likely to adhere when prescribed sessions were more frequent (6–7 days/week) or of longer duration (≥ 12 weeks). Conclusion: From the mixed methods findings, we propose a framework for perseverance with technology-facilitated home-based upper limb practice. The framework offers opportunities for clinicians and researchers to design strategies targeting factors that influence perseverance with practice, in both the clinical prescription of practice and technology design. To confirm the clinical utility of this framework, further research is required to explore perseverance and the factors influencing perseverance

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

During the COVID-19 pandemic, the higher susceptibility of post-stroke patients to infection calls for extra safety precautions. Despite the imposed restrictions, early neurorehabilitation cannot be postponed due to its paramount importance for improving motor and functional recovery chances. Utilizing accessible state-of-the-art technologies, home-based rehabilitation devices are proposed as a sustainable solution in the current crisis. In this paper, a comprehensive review on developed home-based rehabilitation technologies of the last 10 years (2011–2020), categorizing them into upper and lower limb devices and considering both commercialized and state-of-the-art realms. Mechatronic, control, and software aspects of the system are discussed to provide a classified roadmap for home-based systems development. Subsequently, a conceptual framework on the development of smart and intelligent community-based home rehabilitation systems based on novel mechatronic technologies is proposed. In this framework, each rehabilitation device acts as an agent in the network, using the internet of things (IoT) technologies, which facilitates learning from the recorded data of the other agents, as well as the tele-supervision of the treatment by an expert. The presented design paradigm based on the above-mentioned leading technologies could lead to the development of promising home rehabilitation systems, which encourage stroke survivors to engage in under-supervised or unsupervised therapeutic activities

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Development of a home-based Computer Assisted Arm Rehabilitation (hCAAR) device for upper limb exercises in stroke patients

Home-based robotic technologies may offer the possibility of self-directed upper limb exercise after stroke as a means of increasing the intensity of rehabilitation treatment. The aim of this research project was to develop and evaluate a robotic device hCAAR that can be used independently at home by stroke survivors with upper limb weakness. The project had two stages: Stage 1, hCAAR development using a user-centred design process; Stage 2, A feasibility clinical study in the home setting. Stage 1: Nine stroke survivors with upper limb weakness and six healthcare professionals were involved in the concept and design stages of device development. hCAAR consists of a powered joystick with a computer interface, which is used to direct the movement of the upper limb to perform therapeutic movements as directed by tasks on the screen. hCAAR also provides controlled assistance when the user’s voluntary upper limb movement is insufficient to complete the prescribed task. Stage 2: In the feasibility study, 19 participants (stroke survivors with upper limb weakness) were recruited and 17 participants used hCAAR in their homes for eight weeks. No serious adverse events were reported. All 17 participants were able to use the device independently. A statistically significant improvement was observed in the kinematic and clinical outcomes. Three participants showed clinically significant improvement in all clinical outcomes. Five participants reported improvement in functional ability in daily activities. Participants, family members and therapists were satisfied with the usability of hCAAR in the home setting. This research project also demonstrated that the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for stroke provides a useful basis to structure interviews to gather feedback from end-users and healthcare professionals in different stages of the rehabilitation device development. In summary, hCAAR is a home-based rehabilitation robotic device that can be independently used by stroke survivors with upper limb weakness and has the potential to improve upper limb movement and function

Mutual shaping in the design of socially assistive robots: A case study on social robots for therapy

This paper offers a case study in undertaking a mutual shaping approach to the design of socially assistive robots. We consider the use of social robots in therapy, and we present our results regarding this application, but the approach is generalisable. Our methodology combines elements of user-centered and participatory design with a focus on mutual learning. We present it in full alongside a more general guide for application to other areas. This approach led to valuable results concerning mutual shaping effects and societal factors regarding the use of such robots early in the design process. We also measured a significant shift in participant robot acceptance pre-/post-study, demonstrating that our approach led to the two-way sharing and shaping of knowledge, ideas and acceptance