Abstract
BackgroundWe present a robot-assisted telerehabilitation system that allows for haptic interaction between therapist and patient over distance. It consists of two arm therapy robots. Attached to one robot the therapists can feel on their own arm the limitations of the patient’s arm which is attached to the other robot. Due to the exoskeleton structure of the robot, movements can be performed in the three-dimensional space.MethodsFifteen physical and occupational therapists tested this strategy, named “Beam-Me-In”, while using an exoskeleton robot connected to a second exoskeleton robot in the same room used by the study experimenter. Furthermore, the therapists assessed the level of impairment of recorded and simulated arm movements. They quantified four typical impairments of stroke patients: reduced range of motion (active and passive), resistance to passive movement, a lack of ability to fractionate a movement, and disturbed quality of movement.ResultsOn a Likert Scale (0 to 5 points) therapists rated the “Beam-Me-In” strategy as a very useful medium (mode: 4 points) to evaluate a patient’s progress over time. The passive range of motion of the elbow joint was assessed with a mean absolute error of 4.9∘ (absolute precision error: 6.4∘). The active range of motion of the elbow was assessed with a mean absolute error of 4.9∘ (absolute precision error: 6.5∘). The resistance to passive movement (i.e. modified Tardieu Scale) and the lack of ability to fractionate a movement (i.e. quantification of pathological muscle synergies) was assessed with an inter-rater reliability of 0.930 and 0.948, respectively.ConclusionsThe “Beam-Me-In” strategy is a promising approach to complement robot-assisted movement training. It can serve as a platform to assess and identify abnormal movement patterns in patients. This is the first application of remote three-dimensional haptic assessmen t applied to telerehabilitation. Furthermore, the “Beam-Me-In” strategy has a potential to overcome barriers for therapists regarding robot-assisted telerehabilitation.
Highlights
Typical upper limb impairments after stroke are muscle weakness with reduced range of motion (ROM), spasticity, reduced ability to fractionate movements, reduced movement smoothness and deviation from an intended movement path [1,2,3]
Robotic devices can assess abnormal movement patterns related to the impairment of an individual [9,10,11,12]
Notwithstanding, a physical or occupational therapist is indispensable for neurorehabilitation therapy as the therapist determines the course of the treatment and surveys the course of recovery
Summary
Typical upper limb impairments after stroke are muscle weakness with reduced range of motion (ROM), spasticity, reduced ability to fractionate movements, reduced movement smoothness and deviation from an intended movement path [1,2,3]. Rehabilitation robots support and enhance physical or occupational therapy. They can deliver therapy with high intensity and provide quantitative assessments [4,5,6,7,8]. More and more clinics implement rehab gyms where several devices are provided and allow several individuals to train in one room. We present a robot-assisted telerehabilitation system that allows for haptic interaction between therapist and patient over distance. It consists of two arm therapy robots. Due to the exoskeleton structure of the robot, movements can be performed in the three-dimensional space
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