The effect of the GENTLE/s robot-mediated therapy system on arm function after stroke

Objective: To evaluate the effect of robot-mediated therapy on arm dysfunction post stroke. Design: A series of single-case studies using a randomized multiple baseline design with ABC or ACB order. Subjects (n = 20) had a baseline length of 8, 9 or 10 data points. They continued measurement during the B - robot-mediated therapy and C - sling suspension phases. Setting: Physiotherapy department, teaching hospital. Subjects: Twenty subjects with varying degrees of motor and sensory deficit completed the study. Subjects attended three times a week, with each phase lasting three weeks. Interventions: In the robot-mediated therapy phase they practised three functional exercises with haptic and visual feedback from the system. In the sling suspension phase they practised three single-plane exercises. Each treatment phase was three weeks long. Main measures: The range of active shoulder flexion, the Fugl-Meyer motor assessment and the Motor Assessment Scale were measured at each visit. Results: Each subject had a varied response to the measurement and intervention phases. The rate of recovery was greater during the robot-mediated therapy phase than in the baseline phase for the majority of subjects. The rate of recovery during the robot-mediated therapy phase was also greater than that during the sling suspension phase for most subjects. Conclusion: The positive treatment effect for both groups suggests that robot-mediated therapy can have a treatment effect greater than the same duration of non-functional exercises. Further studies investigating the optimal duration of treatment in the form of a randomized controlled trial are warranted.

Eye tracking and gaze based interaction within immersive virtual environments

Our eyes are input sensors which Provide our brains with streams of visual data. They have evolved to be extremely efficient, and they will constantly dart to-and-fro to rapidly build up a picture of the salient entities in a viewed scene. These actions are almost subconscious. However, they can provide telling signs of how the brain is decoding the visuals and call indicate emotional responses, prior to the viewer becoming aware of them. In this paper we discuss a method of tracking a user's eye movements, and Use these to calculate their gaze within an immersive virtual environment. We investigate how these gaze patterns can be captured and used to identify viewed virtual objects, and discuss how this can be used as a, natural method of interacting with the Virtual Environment. We describe a flexible tool that has been developed to achieve this, and detail initial validating applications that prove the concept.

Challenges and opportunities for robot-mediated neurorehabilitation

Robot-mediated neurorehabilitation is a rapidly advancing field that seeks to use advances in robotics, virtual realities, and haptic interfaces, coupled with theories in neuroscience and rehabilitation to define new methods for treating neurological injuries such as stroke, spinal cord injury, and traumatic brain injury. The field is nascent and much work is needed to identify efficient hardware, software, and control system designs alongside the most effective methods for delivering treatment in home and hospital settings. This paper identifies the need for robots in neurorehabilitation and identifies important goals that will allow this field to advance.

Case studies to demonstrate the range of applications of the Southampton Hand Assessment Procedure

The Southampton Hand Assessment Procedure (SHAP) was devised to assess quantitatively the functional range of injured and healthy adult hands. It was designed to be a practical tool for use in a busy clinical setting; thus, it was made simple to use and easy to interpret. This paper describes four examples of its use: before and after a surgical procedure, to observe the impact of an injury, use with prostheses, and during recovery following a fracture. The cases show that the SHAP is capable of monitoring progress and recovery, identifying functional abilities in prosthetic hands and comparing the capabilities of different groups of injuries.

A Gentle/S approach to robot assisted neuro-rehabilitation

Movement disorders (MD) include a group of neurological disorders that involve neuromotor systems. MD can result in several abnormalities ranging from an inability to move, to severe constant and excessive movements. Strokes are a leading cause of disability affecting largely the older people worldwide. Traditional treatments rely on the use of physiotherapy that is partially based on theories and also heavily reliant on the therapists training and past experience. The lack of evidence to prove that one treatment is more effective than any other makes the rehabilitation of stroke patients a difficult task. UL motor re-learning and recovery levels tend to improve with intensive physiotherapy delivery. The need for conclusive evidence supporting one method over the other and the need to stimulate the stroke patient clearly suggest that traditional methods lack high motivational content, as well as objective standardised analytical methods for evaluating a patient's performance and assessment of therapy effectiveness. Despite all the advances in machine mediated therapies, there is still a need to improve therapy tools. This chapter describes a new approach to robot assisted neuro-rehabilitation for upper limb rehabilitation. Gentle/S introduces a new approach on the integration of appropriate haptic technologies to high quality virtual environments, so as to deliver challenging and meaningful therapies to people with upper limb impairment in consequence of a stroke. The described approach can enhance traditional therapy tools, provide therapy "on demand" and can present accurate objective measurements of a patient's progression. Our recent studies suggest the use of tele-presence and VR-based systems can potentially motivate patients to exercise for longer periods of time. Two identical prototypes have undergone extended clinical trials in the UK and Ireland with a cohort of 30 stroke subjects. From the lessons learnt with the Gentle/S approach, it is clear also that high quality therapy devices of this nature have a role in future delivery of stroke rehabilitation, and machine mediated therapies should be available to patient and his/her clinical team from initial hospital admission, through to long term placement in the patient's home following hospital discharge.

Upper limb robot mediated stroke therapy - GENTLE/s approach

Stroke is a leading cause of disability in particular affecting older people. Although the causes of stroke are well known and it is possible to reduce these risks, there is still a need to improve rehabilitation techniques. Early studies in the literature suggest that early intensive therapies can enhance a patient's recovery. According to physiotherapy literature, attention and motivation are key factors for motor relearning following stroke. Machine mediated therapy offers the potential to improve the outcome of stroke patients engaged on rehabilitation for upper limb motor impairment. Haptic interfaces are a particular group of robots that are attractive due to their ability to safely interact with humans. They can enhance traditional therapy tools, provide therapy "on demand" and can present accurate objective measurements of a patient's progression. Our recent studies suggest the use of tele-presence and VR-based systems can potentially motivate patients to exercise for longer periods of time. The creation of human-like trajectories is essential for retraining upper limb movements of people that have lost manipulation functions following stroke. By coupling models for human arm movement with haptic interfaces and VR technology it is possible to create a new class of robot mediated neuro rehabilitation tools. This paper provides an overview on different approaches to robot mediated therapy and describes a system based on haptics and virtual reality visualisation techniques, where particular emphasis is given to different control strategies for interaction derived from minimum jerk theory and the aid of virtual and mixed reality based exercises.

An assessment of eye-gaze potential within immersive virtual environments

In collaborative situations, eye gaze is a critical element of behavior which supports and fulfills many activities and roles. In current computer-supported collaboration systems, eye gaze is poorly supported. Even in a state-of-the-art video conferencing system such as the access grid, although one can see the face of the user, much of the communicative power of eye gaze is lost. This article gives an overview of some preliminary work that looks towards integrating eye gaze into an immersive collaborative virtual environment and assessing the impact that this would have on interaction between the users of such a system. Three experiments were conducted to assess the efficacy of eye gaze within immersive virtual environments. In each experiment, subjects observed on a large screen the eye-gaze behavior of an avatar. The eye-gaze behavior of that avatar had previously been recorded from a user with the use of a head-mounted eye tracker. The first experiment was conducted to assess the difference between users' abilities to judge what objects an avatar is looking at with only head gaze being viewed and also with eye- and head-gaze data being displayed. The results from the experiment show that eye gaze is of vital importance to the subjects, correctly identifying what a person is looking at in an immersive virtual environment. The second experiment examined whether a monocular or binocular eye-tracker would be required. This was examined by testing subjects' ability to identify where an avatar was looking from their eye direction alone, or by eye direction combined with convergence. This experiment showed that convergence had a significant impact on the subjects' ability to identify where the avatar was looking. The final experiment looked at the effects of stereo and mono-viewing of the scene, with the subjects being asked to identify where the avatar was looking. This experiment showed that there was no difference in the subjects' ability to detect where the avatar was gazing. This is followed by a description of how the eye-tracking system has been integrated into an immersive collaborative virtual environment and some preliminary results from the use of such a system.

Eye gaze in virtual environments: evaluating the need and initial work on implementation

For efficient collaboration between participants, eye gaze is seen as being critical for interaction. Video conferencing either does not attempt to support eye gaze (e.g. AcessGrid) or only approximates it in round table conditions (e.g. life size telepresence). Immersive collaborative virtual environments represent remote participants through avatars that follow their tracked movements. By additionally tracking people's eyes and representing their movement on their avatars, the line of gaze can be faithfully reproduced, as opposed to approximated. This paper presents the results of initial work that tested if the focus of gaze could be more accurately gauged if tracked eye movement was added to that of the head of an avatar observed in an immersive VE. An experiment was conducted to assess the difference between user's abilities to judge what objects an avatar is looking at with only head movements being displayed, while the eyes remained static, and with eye gaze and head movement information being displayed. The results from the experiment show that eye gaze is of vital importance to the subjects correctly identifying what a person is looking at in an immersive virtual environment. This is followed by a description of the work that is now being undertaken following the positive results from the experiment. We discuss the integration of an eye tracker more suitable for immersive mobile use and the software and techniques that were developed to integrate the user's real-world eye movements into calibrated eye gaze in an immersive virtual world. This is to be used in the creation of an immersive collaborative virtual environment supporting eye gaze and its ongoing experiments. Copyright (C) 2009 John Wiley & Sons, Ltd.