Abstract-A personal computer (PC)-based desktop virtual reality (VR) system was developed for rehabilitating hand function in stroke patients. The system uses two input devices, a CyberGlove and a Rutgers Master II-ND (RMII) force feedback glove, allowing user interaction with a virtual environment. This consists of four rehabilitation routines, each designed to exercise one specific parameter of hand movement: range, speed, fractionation or strength. The use of performance-based target levels is designed to increase patient motivation and individualize exercise difficulty to a patient's current state. Pilot clinical trials have been performed using the above system combined with noncomputer tasks, such as pegboard insertion or tracing of two-dimensional (2-D) patterns. Three chronic stroke patients used this rehabilitation protocol daily for two weeks. Objective measurements showed that each patient showed improvement on most of the hand parameters over the course of the training. Subjective evaluation by the patients was also positive. This technical report focuses on this newly developed technology for VR rehabilitation.

Abstract-The Rutgers Master II-ND glove is a haptic interface designed for dextrous interactions with virtual environments. The glove provides force feedback up to 16 N each to the thumb, index, middle, and ring fingertips. It uses custom pneumatic actuators arranged in a direct-drive configuration in the palm. Unlike commercial haptic gloves, the direct-drive actuators make unnecessary cables and pulleys, resulting in a more compact and lighter structure. The force-feedback structure also serves as position measuring exoskeleton, by integrating noncontact Hall-effect and infrared sensors. The glove is connected to a haptic-control interface that reads its sensors and servos its actuators. The interface has pneumatic servovalves, signal conditioning electronics, A/D/A boards, power supply and an imbedded Pentium PC. This distributed computing assures much faster control bandwidth than would otherwise be possible. Communication with the host PC is done over an RS232 line. Comparative data with the CyberGrasp commercial haptic glove is presented.

Background and Purpose. Recent evidence indicates that intensive massed practice may be necessary to modify neural organization and effect recovery of motor skills in patients following stroke. Virtual reality (VR) technology has the capability of creating an interactive, motivating environment in which practice intensity and feedback can be manipulated to create individualized treatments to retrain movement. Case Description. Three patients (ML, LE, and DK), who were in the chronic phase following stroke, participated in a 2-week training program (3½ hours a day) including dexterity tasks on real objects and VR exercises. The VR simulations were targeted for range of motion, movement speed, fractionation, and force production. Outcomes. ML's function was the most impaired at the beginning of the intervention, but showed improvement in the thumb and fingers in range of motion and speed of movement. LE improved in fractionation and range of motion of his thumb and fingers. DK made the greatest gains, showing improvement in range of motion and strength of the thumb, velocity of the thumb and fingers, and fractionation. Two of the 3 patients improved on the Jebsen Test of Hand Function. Discussion. The outcomes suggest that VR may be useful to augment rehabilitation of the upper limb in patients in the chronic phase following stroke.

It is difficult in current service delivery models to provide the intensity of practice that appears to be needed to effect neural reorganization and functional changes poststroke. Computerized exercise systems may be a way to maximize both the patients' and the clinicians' time. The data in this study add support to the proposal to explore novel technologies for incorporation into current practice.

This paper presents preliminary results from a virtual reality (VR)-based system for hand rehabilitation that uses a CyberGlove and a Rutgers Master II-ND haptic glove. This computerized system trains finger range of motion, finger flexion speed, independence of finger motion, and finger strength using specific VR simulation exercises. A remote Web-based monitoring station was developed to allow telerehabilitation interventions. The remote therapist observes simplified versions of the patient exercises that are updated in real time. Patient data is stored transparently in an Oracle database, which is also Web accessible through a portal GUI. Thus the remote therapist or attending physician can graph exercise outcomes and thus evaluate patient outcomes at a distance. Data from the VR simulations is complemented by clinical measurements of hand function and strength. Eight chronic post-stroke subjects participated in a pilot study of the above system. In keeping with variability in both their lesion size and site and in their initial upper extremity function, each subject showed improvement on a unique combination of movement parameters in VR training. Importantly, these improvements transferred to gains on clinical tests, as well as to significant reductions in task-completion times for the prehension of real objects. These results are indicative of the potential feasibility of this exercise system for rehabilitation in patients with hand dysfunction resulting from neurological impairment.

The "Rutgers Ankle" is a Stewart platform-type haptic interface designed for use in rehabilitation. The system supplies six-degree-of-freedom (DOF) resistive forces on the patient's foot, in response to virtual reality-based exercises. The Rutgers Ankle controller contains an embedded Pentium board, pneumatic solenoid valves, valve controllers, and associated signal conditioning electronics. The rehabilitation exercise used in our case study consists of piloting a virtual airplane through loops. The exercise difficulty can be selected based on the number and placement of loops, the airplane speed in the virtual environment, and the degree of resistance provided by the haptic interface. Exercise data is stored transparently, in real time, in an Oracle database. These data consist of ankle position, forces, and mechanical work during an exercise, and over subsequent rehabilitation sessions. The number of loops completed and the time it took to do that are also stored online. A case study is presented of a patient nine months post-stroke using this system. Results showed that, over six rehabilitation sessions, the patient improved on clinical measures of strength and endurance, which corresponded well with torque and power output increases measured by the Rutgers Ankle. There were also substantial improvements in task accuracy and coordination during the simulation and the patient's walking and stair-climbing ability.

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We present preliminary results from a virtual reality (VR)-based system for hand rehabilitation that uses a CyberGlove and a Rutgers Master II-ND haptic glove. This system trains finger range of motion, finger flexion speed, independence of finger motion and finger strength. Eight chronic post-stroke subjects participated. In keeping with variability in both the lesion site and in initial upper extremity function, each subject showed improvement on a unique combination of movement parameters in VR training. These improvements transferred to gains on clinical tests, as well as to significant reductions in task completion times for the prehension of real objects. These results are indicative of the potential feasibility of this exercise system for rehabilitation in patients with hand dysfunction resulting from neurological impairment.