Towards a Platform for Robot-Assisted Minimally-Supervised Therapy of Hand Function: Design and Pilot Usability Evaluation

BackgroundRobot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home.MethodsWe implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist.ResultsParticipants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46 (7.69–19.23)% of the tasks. They assigned good-to-excellent scores on the System Usability Scale to the user-interface and the exercises [85.00 (75.63–86.88) and 73.75 (63.13–83.75) out of 100, respectively]. Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks.DiscussionOur findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platform could complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.

Towards a platform for robot-assisted minimally-supervised therapy of hand function: design and pilot usability evaluation

BackgroundRobot-assisted therapy can increase therapy dose after stroke, which is often considered insufficient in clinical practice and after discharge, especially with respect to hand function. Thus far, there has been a focus on rather complex systems that require therapist supervision. To better exploit the potential of robot-assisted therapy, we propose a platform designed for minimal therapist supervision, and present the preliminary evaluation of its immediate usability, one of the main and frequently neglected challenges for real-world application. Such an approach could help increase therapy dose by allowing the training of multiple patients in parallel by a single therapist, as well as independent training in the clinic or at home.MethodsWe implemented design changes on a hand rehabilitation robot, considering aspects relevant to enabling minimally-supervised therapy, such as new physical/graphical user interfaces and two functional therapy exercises to train hand motor coordination, somatosensation and memory. Ten participants with chronic stroke assessed the usability of the platform and reported the perceived workload during a single therapy session with minimal supervision. The ability to independently use the platform was evaluated with a checklist.ResultsParticipants were able to independently perform the therapy session after a short familiarization period, requiring assistance in only 13.46(7.69-19.23)% of the tasks. They assigned good-to-excellent scores on the SUS to the user-interface and the exercises (85.00(75.63-86.88) and 73.75(63.13-83.75) out of 100, respectively). Nine participants stated that they would use the platform frequently. Perceived workloads lay within desired workload bands. Object grasping with simultaneous control of forearm pronosupination and stiffness discrimination were identified as the most difficult tasks.DiscussionOur findings demonstrate that a robot-assisted therapy device can be rendered safely and intuitively usable upon first exposure with minimal supervision through compliance with usability and perceived workload requirements. The preliminary usability evaluation identified usability challenges that should be solved to allow real-world minimally-supervised use. Such a platformcould complement conventional therapy, allowing to provide increased dose with the available resources, and establish a continuum of care that progressively increases therapy lead of the patient from the clinic to the home.

A Plug-and-Train Robot (PLUTO) for Hand Rehabilitation: Design and Preliminary Evaluation

Hand neurorehabilitation involves the training of movements at various joints of the forearm, wrist, fingers, and thumb. Assisted training of all these joints either requires either one complex multiple degree-of-freedom (DOF) robot or a set of simple robots with one or two DOF. Both of these are not economically or clinically viable solutions. The paper presents work that addresses this problem with a single DOF robot that can train multiple joints one at a time – the plug and train robot (PLUTO). 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-closings. 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 toward clinical validation, the device's usability was evaluated in 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. Clinicians, on the other hand, had a single session demo after which feedback was obtained. The total SUS score obtained from the patients, clinicians, and healthy subjects was 73.3 ± 14.6 (n = 45), indicating good usability. The UEQ score was rated positively in all subscales by both the 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 indicates that with additional passive mechanisms, assessment features, and optimized ergonomics, PLUTO will be a versatile, affordable, and useful system for routine use in clinics and also patients’ homes for delivering minimally supervised hand therapy.