Home-Based Telerehabilitation following Stroke David Reinkensmeyer, Ph.D., Robert Sanchez, M.S. Dept. of Mechanical and Aerospace Engineering University of California Irvine

The Stroke Rehabilitation Paradox There is increasing evidence that intensive sensory motor training can improve functional recovery.There is increasing evidence that intensive sensory motor training can improve functional recovery. However, stroke patients are getting less therapy and going home sooner due to economic pressures.However, stroke patients are getting less therapy and going home sooner due to economic pressures. There is little technology available to continue therapy at home in order to maintain, improve, or monitor recovery.There is little technology available to continue therapy at home in order to maintain, improve, or monitor recovery.

Web-Based Home Therapy: Java Therapy Reinkensmeyer DJ, Pang CT, Nessler CA, Painter CC (2002) Web-based telerehabilitation for the upper-extremity after stroke, IEEE Transactions on Neural Science and Rehabilitation Engineering, vol. 10, no. 2, pp

Java Therapy Results Improvement in Movement Time with Practice Improvement in Movement Trajectory with Practice

Java Therapy Results Demonstrates feasibility of using a web-based system to: – direct a therapy program –mechanically assist in movement –track improvements However, no functional improvements, using standard clinical scales Subjects likely get better at the movements they practice Improved input devices are needed to measure and assist in more functional movements

Current Work Develop large-workspace, instrumented orthosis for arm movementDevelop large-workspace, instrumented orthosis for arm movement –based on anti-gravity orthosis for children –WREX, Tariq Rahman, A.I. duPont Institute Develop integrated hand function measureDevelop integrated hand function measure –based on ShapeTape Test efficacy of the device in improving/maintaing recovery after termination of conventional therapyTest efficacy of the device in improving/maintaing recovery after termination of conventional therapy Project V: NIDRR RERC on Rehabilitation Robotics, Machines Assisting Rehabilitation after StrokeProject V: NIDRR RERC on Rehabilitation Robotics, Machines Assisting Rehabilitation after Stroke

Progress Developed complete CAD model of orthosisDeveloped complete CAD model of orthosis Fabricated adult-sized version of orthosisFabricated adult-sized version of orthosis Designed adjustable mount to generic chairDesigned adjustable mount to generic chair Instrumented with ShapetapeInstrumented with Shapetape Orthosis has excellent range of motionOrthosis has excellent range of motion Anti-gravity function appears adequateAnti-gravity function appears adequate Shapetape has poor repeatability for this applicationShapetape has poor repeatability for this application

Next Steps: Instrument Arm Movement Option 1: Develop external digitizing linkageOption 1: Develop external digitizing linkage Requires 3 sensorsRequires 3 sensors Sensors can be in a protected boxSensors can be in a protected box Separate piece of equipmentSeparate piece of equipment Use off the shelf equipment? ($3500)Use off the shelf equipment? ($3500) Option 2: Instrument joints themselvesOption 2: Instrument joints themselves Requires 5 sensorsRequires 5 sensors Sensors are exposedSensors are exposed Single piece of equipmentSingle piece of equipment Rotary sensor optionsRotary sensor options Relative: encoders, resolvers – require “zeroing”, impractical for home use?Relative: encoders, resolvers – require “zeroing”, impractical for home use? AbsoluteAbsolute Optical encoders ($350)Optical encoders ($350) Potentiometers ($60) (resolution questionable –1% linearity = 360 counts)Potentiometers ($60) (resolution questionable –1% linearity = 360 counts)

Next Steps: Instrument Hand Movement Option 1: Work with ShapetapeOption 1: Work with Shapetape Shorter lengths have better resolutionShorter lengths have better resolution Option 2: Dataglove (5DT) ($500)Option 2: Dataglove (5DT) ($500) Difficult to don – problematic for home useDifficult to don – problematic for home use Must be zeroedMust be zeroed Option 3: External goniometers ($600)Option 3: External goniometers ($600) Option 4: External WorkstationOption 4: External Workstation measure hand function rather than joint range of motionmeasure hand function rather than joint range of motion Example: “Box and balls” task: motor weighs balls and resets taskExample: “Box and balls” task: motor weighs balls and resets task

Next Steps: Develop Software for Functional Exercises Approach: Base exercises on standard clinical tests (e.g. Fugl-Meyer scale)Base exercises on standard clinical tests (e.g. Fugl-Meyer scale) Use external, physical landmarks as 3D targetsUse external, physical landmarks as 3D targets Example: “Touch your nose”Example: “Touch your nose” Example: Activities of Daily Living WorkstationExample: Activities of Daily Living Workstation Make Java Therapy software run off-lineMake Java Therapy software run off-line Provide video demonstration and video feedback to subjects?Provide video demonstration and video feedback to subjects?

Next Steps: Testing Years 1 and 2: Evaluate software/hardware interfaces and measure short-term motor learning with current PHANToM/Anti-gravity orthosis set-upYears 1 and 2: Evaluate software/hardware interfaces and measure short-term motor learning with current PHANToM/Anti-gravity orthosis set-up Years 3-5: Larger, controlled study:Years 3-5: Larger, controlled study: