Abstract
Hand neurorehabilitation involves training movements at the forearm, wrist, fingers, and thumb joints. Assisted training of all these joints requires either one complex multiple degree-of-freedom (DOF) robot or a set of simple robots with one or two DOF. Neither of these is economic or clinically viable. This paper addresses this problem with the PLUg and train rObot (PLUTO)- a single DOF robot that can train multiple joints one at a time. PLUTO has a single actuator with a set of passive attachments/mechanisms that can be easily attached/detached to train for wrist flexion-extension, wrist ulnar-radial deviation, forearm pronation-supination, and gross hand opening-closing. The robot can provide training in active and assisted regimes. PLUTO is linked to performance adaptive computer games to provide feedback to the patients and motivate them during training. As the first step towards clinical validation, the device usability was evaluated by 45 potential stakeholders/end-users of the device, including 15 patients, 15 caregivers, and 15 clinicians with standardized questionnaires: System Usability Scale (SUS) and User Experience Questionnaire (UEQ). Patients and caregivers were administered the questionnaire after a two-session training with the robot. Clinicians, on the other hand, had a single session demo, after which feedback was obtained. The total SUS score obtained from patients, clinicians, and caregivers was 73.3 ± 14.6 (n = 45), indicating good usability. The UEQ score was rated positively in all subscales by both patients and clinicians, indicating that the features of PLUTO match their expectations. The positive response from the preliminary testing and the feedback from the stakeholders indicate that with additional passive mechanisms, assessment features, and optimized ergonomics, PLUTO will be a versatile, affordable, and useful system for hand rehabilitation.
Highlights
Hand impairments resulting from a multitude of neurological and musculoskeletal conditions can significantly affect ADL such as feeding, self-care, etc., and have a debilitating effect on a person's quality of life
It is reported that 48.7% of the people with tetraplegia indicated that regaining hand functions is essential and of greatest priority to improve their quality of life [4]
This study evaluated the: (a) perceived experience by patients and clinicians when using the device as measured by the user experience questionnaire (UEQ) [57], and (b) perceived usability of PLUg and train rObot (PLUTO) as measured by the system usability scale (SUS)
Summary
Hand impairments resulting from a multitude of neurological and musculoskeletal conditions can significantly affect ADL such as feeding, self-care, etc., and have a debilitating effect on a person's quality of life. 15 million people are affected by stroke worldwide and 1.5 million people in India [1], about 80% of stroke survivors need some form of hand rehabilitation [2]. Incomplete tetraplegia is second only to stroke; the incidence of spinal cord injury (SCI) is estimated at 10 to 83 per million per year worldwide, with a significant proportion of those under the age of 25 years [3]. It is reported that 48.7% of the people with tetraplegia indicated that regaining hand functions is essential and of greatest priority to improve their quality of life [4]. Almost 50% of children with CP present a hand dysfunction [6]
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