Development and evaluation of a haptic framework supporting telerehabilitation robotics and group interaction

Telerehabilitation robotics has grown remarkably in the past few years. It can provide intensive training to people with special needs remotely while facilitating therapists to observe the whole process. Telerehabilitation robotics is a promising solution supporting routine care which can help to transform face-to-face and one-on-one treatment sessions that require not only intensive human resource but are also restricted to some specialised care centres to treatments that are technology-based (less human involvement) and easy to access remotely from anywhere. However, there are some limitations such as network latency, jitter, and delay of the internet that can affect negatively user experience and quality of the treatment session. Moreover, the lack of social interaction since all treatments are performed over the internet can reduce motivation of the patients. As a result, these limitations are making it very difficult to deliver an efficient recovery plan. This thesis developed and evaluated a new framework designed to facilitate telerehabilitation robotics. The framework integrates multiple cutting-edge technologies to generate playful activities that involve group interaction with binaural audio, visual, and haptic feedback with robot interaction in a variety of environments. The research questions asked were: 1) Can activity mediated by technology motivate and influence the behaviour of users, so that they engage in the activity and sustain a good level of motivation? 2) Will working as a group enhance users’ motivation and interaction? 3) Can we transfer real life activity involving group interaction to virtual domain and deliver it reliably via the internet? There were three goals in this work: first was to compare people’s behaviours and motivations while doing the task in a group and on their own; second was to determine whether group interaction in virtual and reala environments was different from each other in terms of performance, engagement and strategy to complete the task; finally was to test out the effectiveness of the framework based on the benchmarks generated from socially assistive robotics literature. Three studies have been conducted to achieve the first goal, two with healthy participants and one with seven autistic children. The first study observed how people react in a challenging group task while the other two studies compared group and individual interactions. The results obtained from these studies showed that the group interactions were more enjoyable than individual interactions and most likely had more positive effects in terms of user behaviours. This suggests that the group interaction approach has the potential to motivate individuals to make more movements and be more active and could be applied in the future for more serious therapy. Another study has been conducted to measure group interaction’s performance in virtual and real environments and pointed out which aspect influences users’ strategy for dealing with the task. The results from this study helped to form a better understanding to predict a user’s behaviour in a collaborative task. A simulation has been run to compare the results generated from the predictor and the real data. It has shown that, with an appropriate training method, the predictor can perform very well. This thesis has demonstrated the feasibility of group interaction via the internet using robotic technology which could be beneficial for people who require social interaction (e.g. stroke patients and autistic children) in their treatments without regular visits to the clinical centres

International Conference on NeuroRehabilitation 2012

This volume 3, number 2 gathers a set of articles based on the most outstanding research on accessibility and disability issues that was presented in the International Conference on NeuroRehabilitation 2012 (ICNR).The articles’ research present in this number is centred on the analysis and/or rehabilitation of body impairment most due to brain injury and neurological disorders.JACCES thanks the collaboration of the ICNR members and the research authors and reviewers that have collaborated for making possible that issue

Uma arquitetura de telerreabilitação baseada em realidade aumentada para apoiar o treinamento de usuários de cadeiras de rodas motorizadas

Many people worldwide have been experimenting a decrease in their mobility as a result of aging, accidents and degenerative diseases. In many cases, a Powered Wheelchair (PW) is an alternative help. Currently, in Brazil, patients can receive a PW from the Unified Health System, following prescription criteria. However, they do not have an appropriate previous training for driving the PW. Consequently, users might suffer accidents since a customized training protocol is not available. Nevertheless, due to financial and/or health limitations, many users are unable to attend a rehabilitation center. To overcome these limitations, we developed an Augmented Reality (AR) Telerehabilitation System Architecture based on the Power Mobility Road Test (PMRT), for supporting PW user’s training. In this system, the therapists can remotely customize and evaluate training tasks and the user can perform the training in safer conditions. Video stream and data transfer between each environment were made possible through UDP (User Datagram Protocol). To evaluate and present the system architecture potential, a preliminary test was conducted with 3 spinal cord injury participants. They performed 3 basic training protocols defined by a therapist. The following metrics were adopted for evaluation: number of control commands; elapsed time; number of collisions; biosignals and a questionary was used to evaluate system features by participants. Results demonstrate the specific needs of individuals using a PW, thanks to adopted (qualitative and emotional) metrics. Also, the results have shown the potential of the training system with customizable protocols to fulfill these needs. User’s evaluation demonstrates that the combination of AR techniques with PMRT adaptations, increases user’s well-being after training sessions. Furthermore, a training experience helps users to overcome their displacement problems, as well as for appointing challenges before large scale use. The proposed system architecture allows further studies on telerehabilitation of PW users.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)Muitas pessoas em todo o mundo estão vivenciando uma diminuição de sua mobili- dade como resultado de envelhecimento, acidentes e doenças degenerativas. Em muitos casos, uma cadeira de rodas motorizada (CRM) é uma ajuda alternativa. Atualmente, no Brasil, os pacientes podem receber uma CRM do Sistema Único de Saúde, seguindo os critérios de prescrição. No entanto, eles não têm um treinamento prévio apropriado para dirigir a CRM. Conseqüentemente, os usuários podem sofrer acidentes, pois um protocolo de treinamento personalizado não está disponível. Além disto, devido a limi- tações financeiras e / ou de saúde, muitos usuários não podem comparecer a um centro de reabilitação. Para superar essas limitações, desenvolvemos uma arquitetura de sistema de telereabilitação com Realidade Aumentada (RA) baseado no PMRT (Power Mobility Road Test), para apoiar o treinamento de usuários de CRM. Nesse sistema, os terapeutas podem personalizar e avaliar remotamente as tarefas de treinamento e o usuário pode realizar o treinamento em condições mais seguras. O fluxo de vídeo e a transferência de dados entre cada ambiente foram possíveis através do UDP (User Datagram Protocol). Para avaliar e apresentar o potencial da arquitetura do sistema, foi realizado um teste preliminar de três participantes com lesão medular. Eles realizaram três protocolos básicos de treinamento definidos por um terapeuta. As seguintes métricas adotadas para avaliação foram: número de comandos de controle; tempo decorrido; número de colisões e biossinais. Além disso, um questionário foi usado para avaliar os recursos do sistema. Os resultados demonstram as necessidades específicas dos indivíduos que usam uma CRM, graças às métricas adotadas (qualitativas e emocionais). Além disso, os resultados mostraram o potencial do sistema de treinamento com protocolos personalizáveis para atender a essas necessidades. A avaliação do usuário demonstra que a combinação de técnicas de RA com adaptações PMRT aumenta o bem-estar do usuário após as sessões de treinamento. Além disso, esta experiência de treinamento ajuda os usuários a superar seus problemas de deslocamento, bem como a apontar desafios antes do uso em larga escala. A arquitetura de sistema proposta, permite estudos adicionais sobre a telerreabilitação de usuários de CRM

Upper limb-rehabilitation service system for chinese mild-stroke patients at home

With the continuous growth in the popularity of stroke patients in China and the increasing demand for rehabilitation services, the existing traditional hospital rehabilitation model can no longer meet the patients’ needs. In recent years, the Chinese government has focused on promoting a new model of “Internet plus medical care” and home rehabilitation. Of all the symptoms of the stroke, upper limb motor dysfunction is the most common one that causes the decline of the patients’ self-care ability and quality of life. Therefore, continuous rehabilitation training plays a vital role in the recovery of limb motor function in stroke patients with hemiplegia and can also serve as a starting point for remote rehabilitation. This thesis first summarized the fundamental upper limb movements as well as theories, high technologies and assessment methods of upper limb rehabilitation. All the literature review assists designers in understanding the necessary medical knowledge of stroke and rehabilitation. Secondly, the existing products and services of upper limb rehabilitation in China and at abroad are compared and analyzed to explore more design opportunities. Furthermore, based on the observations and interviews, the author summarized the rehabilitation needs, information needs and emotional needs of stroke patients in Shanghai, investigated design pain points, and selected target users for remote rehabilitation. Finally, a support remote upper limb rehabilitation system concept was established by adopting service design approaches and tools. Furthermore, the concept of a home rehabilitation device and a digital platform, which were two main touchpoints in this system were designed in-depth and made into the prototype for user feedback. The home rehabilitation device integrated a variety of hand grasping exercises by modularization and integrated different upper limb movements through a point-to-line method to solve the problem of lacking multi-function and miniaturization in the home environment. The digital platform used visual interfaces to provide patients with clear instructions and incentive mechanisms which prevent them from giving up rehabilitation halfway. The findings of this thesis indicated the importance of service design approaches and tools on systemic thinking and creative ideas. The design results of this project can not only help stroke patients to perform active exercises at home and improve their upper limb motor function, but also provide new visions for the development of future remote rehabilitation service system in China

Remote constraint induced therapy of the upper extremity (ReCITE): A feasibility study protocol

Background: Difficulty using the upper extremity in everyday activities is common after stroke. Constraint-induced movement therapy (CIMT) has been shown to be effective in both sub-acute and chronic phases of stroke recovery and is recommended in clinical practice guidelines for stroke internationally. Despite reports of equivalence of outcome when stroke rehabilitation interventions are delivered using telehealth, there has been limited evaluation of CIMT when using this mode of delivery. ReCITE will (a) evaluate the feasibility and acceptability of CIMT when delivered via telehealth to stroke survivors (TeleCIMT) and (b) explore therapists' experiences and use of an online support package inclusive of training, mentoring and resources to support TeleCIMT delivery in clinical practice. / Methods: A prospective single-group, single blinded, study design with embedded process evaluation will be conducted. The study will be conducted at three outpatient services in Sydney, Australia. A multi-faceted therapist support package, informed by the Capabilities, Opportunity, Motivation- Behaviour model (COM-B), will be used to support occupational therapists to implement TeleCIMT as part of routine care to stroke survivors. Each service will recruit 10 stroke survivor participants (n = 30) with mild to moderate upper extremity impairment. Upper extremity and quality of life outcomes of stroke survivor participants will be collected at baseline, post-intervention and at a 4 week follow-up appointment. Feasibility of TeleCIMT will be evaluated by assessing the number of stroke participants who complete 80% of intensive arm practice prescribed during their 3 week program (i.e., at least 24 h of intensive arm practice). Acceptability will be investigated through qualitative interviews and surveys with stroke survivors, supporter surveys and therapist focus groups. Qualitative interviews with therapists will provide additional data to explore their experiences and use of the online support package. / Discussion: The COVID-19 pandemic resulted in a rapid transition to delivering telehealth. The proposed study will investigate the feasibility and acceptability of delivering a complex intervention via telehealth to stroke survivors at home, and the support that therapists and patients require for delivery. The findings of the study will be used to inform whether a larger, randomized controlled trial is feasible

Vibrotactile Sensory Augmentation and Machine Learning Based Approaches for Balance Rehabilitation

Vestibular disorders and aging can negatively impact balance performance. Currently, the most effective approach for improving balance is exercise-based balance rehabilitation. Despite its effectiveness, balance rehabilitation does not always result in a full recovery of balance function. In this dissertation, vibrotactile sensory augmentation (SA) and machine learning (ML) were studied as approaches for further improving balance rehabilitation outcomes. Vibrotactile SA provides a form of haptic cues to complement and/or replace sensory information from the somatosensory, visual and vestibular sensory systems. Previous studies have shown that people can reduce their body sway when vibrotactile SA is provided; however, limited controlled studies have investigated the retention of balance improvements after training with SA has ceased. The primary aim of this research was to examine the effects of supervised balance rehabilitation with vibrotactile SA. Two studies were conducted among people with unilateral vestibular disorders and healthy older adults to explore the use of vibrotactile SA for therapeutic and preventative purposes, respectively. The study among people with unilateral vestibular disorders provided six weeks of supervised in-clinic balance training. The findings indicated that training with vibrotactile SA led to additional body sway reduction for balance exercises with head movements, and the improvements were retained for up to six months. Training with vibrotactile SA did not lead to significant additional improvements in the majority of the clinical outcomes except for the Activities-specific Balance Confidence scale. The study among older adults provided semi-supervised in-home balance rehabilitation training using a novel smartphone balance trainer. After completing eight weeks of balance training, participants who trained with vibrotactile SA showed significantly greater improvements in standing-related clinical outcomes, but not in gait-related clinical outcomes, compared with those who trained without SA. In addition to investigating the effects of long-term balance training with SA, we sought to study the effects of vibrotactile display design on people’s reaction times to vibrational cues. Among the various factors tested, the vibration frequency and tactor type had relatively small effects on reaction times, while stimulus location and secondary cognitive task had relatively large effects. Factors affected young and older adults’ reaction times in a similar manner, but with different magnitudes. Lastly, we explored the potential for ML to inform balance exercise progression for future applications of unsupervised balance training. We mapped body motion data measured by wearable inertial measurement units to balance assessment ratings provided by physical therapists. By training a multi-class classifier using the leave-one-participant-out cross-validation method, we found approximately 82% agreement among trained classifier and physical therapist assessments. The findings of this dissertation suggest that vibrotactile SA can be used as a rehabilitation tool to further improve a subset of clinical outcomes resulting from supervised balance rehabilitation training. Specifically, individuals who train with a SA device may have additional confidence in performing balance activities and greater postural stability, which could decrease their fear of falling and fall risk, and subsequently increase their quality of life. This research provides preliminary support for the hypothesized mechanism that SA promotes the central nervous system to reweight sensory inputs. The preliminary outcomes of this research also provide novel insights for unsupervised balance training that leverage wearable technology and ML techniques. By providing both SA and ML-based balance assessment ratings, the smart wearable device has the potential to improve individuals’ compliance and motivation for in-home balance training.PHDMechanical EngineeringUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/143901/1/baotian_1.pd

An interactionist framework for understanding the acceptance, rejection and use of health and care technologies

My research makes an empirically informed, theoretical contribution to understanding how health and care technologies are accepted, rejected and used by older people and stroke survivors. Current research on health and care technologies such as telecare and telerehabilitation systems has not tended to investigate questions such as what the technologies mean to users, how users appropriate and interact with the technologies on a daily basis, and the significance that these technologies can have within the context of users' everyday lives. Drawing on key concepts from structural symbolic interactionism, the life course perspective and the domestication framework, my research explores the relationships between users and technologies in contexts. These relationships are negotiated through interaction, are meaningful and unfold over time as individuals navigate the life course. A collective case study research design is adopted focusing on how users appropriate and interact with telecare and telerehabilitation systems. Two cases are supported by data from qualitative interviews with older people (n=19) and stroke survivors (n=4), respectively. Data analysis is conducted in light of an analytical framework, which draws attention to users' interpretations of the technologies, and the processes of meaning making and social interaction. These processes shape a technology's acceptance, rejection and use. Findings suggest that individuals interpret health and care technologies in different ways and that meaning is constructed through processes of appropriation and interaction. It is through interaction, with technologies and with others, that meanings are negotiated. These meanings are shaped by individuals' identities and roles, and their agency and capacity to participate in situated action. I contribute an interactionist framework that conceptualises these complex relationships. The framework provides a means of exploring and understanding the acceptance, rejection and use of health and care technologies that does not under- or over-play individual agency or the affordances and 'scripts' of these technologies

Motion-Based Video Games for Stroke Rehabilitation with Reduced Compensatory Motions

Stroke is the leading cause of long-term disability among adults in industrialized nations, with 80% of people who survive strokes experiencing motor disabilities. Recovery requires daily exercise with a high number of repetitions, often without therapist supervision. Motion-based video games can help motivate people with stroke to perform the necessary exercises to recover. We explore the design space of video games for stroke rehabilitation using Wii remotes and webcams as input devices, and share the lessons we learned about what makes games therapeutically useful. We demonstrate the feasibility of using games for home-based stroke therapy with a six-week case study. We show that exercise with games can help recovery even 17 years after the stroke, and share the lessons that we learned for game systems to be used at home as a part of outpatient therapy. As a major issue with home-based therapy, we identify that unsupervised exercises lead to compensatory motions that can impede recovery and create new health issues. We reliably detect torso compensation in shoulder exercises using a custom harness, and develop a game that meaningfully uses both exercise and compensation as inputs. We provide in-game feedback that reduces compensation in a number of ways. We evaluate alternative ways for reducing compensation in controlled experiments and show that using techniques from operant conditioning are effective in significantly reducing compensatory behavior compared to existing approaches