BackgroundSeveral strategies have been proposed to improve patient motivation and exercise intensity during robot-aided stroke rehabilitation. One relatively unexplored possibility is two-player gameplay, allowing subjects to compete or cooperate with each other to achieve a common goal. In order to explore the potential of such games, we designed a two-player game played using two ARMin arm rehabilitation robots.MethodsThe game was an air-hockey task displayed on a computer monitor and controlled using shoulder movements in the ARMin robot. Three game modes were tested: single-player (competing against computer), competitive (competing against human), and cooperative (cooperating with human against computer). All modes were played by 30 unimpaired subjects and 8 impaired chronic stroke subjects. The subjects filled out the Intrinsic Motivation Inventory questionnaire after each game mode, as well as a final questionnaire about game preferences and their personality.ResultsNearly all unimpaired subjects preferred playing the two-player game modes to the single-player one, as they enjoyed talking and interacting with another person. However, there were two distinct player groups: one liked the competitive mode but not the cooperative mode while the other liked the cooperative but not the competitive mode. Unimpaired subjects who liked the competitive mode also put significantly more effort into it than into the other modes. Results from impaired subjects were similar, with even impaired subjects over 60 years old enjoying competitive gameplay. The subjects’ personalities roughly predicted which mode they would prefer, which was especially evident in a poorly-matched impaired pair that preferred the single-player mode.ConclusionsResults indicate great potential for two-player rehabilitation games, in the form of greater enjoyment as well as potentially more intensive exercise compared to single-player games. However, the right game type needs to be chosen for each subject depending on skill and personality, along with selecting an appropriate co-player. Further studies with patients that are currently enrolled in rehabilitation programs are recommended, and the subjective measures used in our study should be augmented with objective measures such as electromyography.

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Gait analysis has traditionally been carried out in a laboratory environment using expensive equipment, but, recently, reliable, affordable, and wearable sensors have enabled integration into clinical applications as well as use during activities of daily living. Real-time gait analysis is key to the development of gait rehabilitation techniques and assistive devices such as neuroprostheses. This article presents a systematic review of wearable sensors and techniques used in real-time gait analysis, and their application to pathological gait. From four major scientific databases, we identified 1262 articles of which 113 were analyzed in full-text. We found that heel strike and toe off are the most sought-after gait events. Inertial measurement units (IMU) are the most widely used wearable sensors and the shank and foot are the preferred placements. Insole pressure sensors are the most common sensors for ground-truth validation for IMU-based gait detection. Rule-based techniques relying on threshold or peak detection are the most widely used gait detection method. The heterogeneity of evaluation criteria prevented quantitative performance comparison of all methods. Although most studies predicted that the proposed methods would work on pathological gait, less than one third were validated on such data. Clinical applications of gait detection algorithms were considered, and we recommend a combination of IMU and rule-based methods as an optimal solution.

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Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the “Graded and Redefined Assessment of Strength, Sensibility and Prehension” (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

Adults and children with neurological disorders often require rehabilitation therapy to improve their arm motor functions. Complementary to conventional therapy, robotic therapy can be applied. Such robots should support arm movements while assisting only as much as needed to ensure an active participation of the patient. Different control strategies are known to provide arm support to the patient. The path controller is a strategy that helps the patient's arm to stay close to a given path while allowing for temporal and spatial freedom. In this paper, an assist-as-needed path controller is presented that is implemented in the end-effector-based robot PASCAL, which was designed for children with cerebral palsy. The new control approach is a combination of an existing path controller with additional speed restrictions to support, when the arm speed is too slow, and to resist, when the speed is too fast. Furthermore, a target position gain scheduling is introduced in order to reach a target position with a predefined precision as well as an adaptable direction-dependent supportive flux that supports along the path. These path control features were preliminarily tested with a healthy adult volunteer in different conditions. The presented controller covers the range from a completely passive user, who needs full support to an actively performed movement that needs no assistance. In close future, the controller is planned to be used to enable reaching in children as well as in adults and help to increase the intensity of the rehabilitation therapy by assisting the hand movement and by provoking an active participation.

B ODY weight support (BWS) systems are widely used in gait research and rehabilitation. This paper introduces a new 3D overground BWS system, called the RYSEN 7. The RYSEN is designed to be intrinsically safe and low power consuming, while still performing at least as well as existing BWS systems regarding human-robot interaction. These features are mainly achieved by decoupling degrees of freedom between motors: slow/high-torque motors for vertical motion and fast/low-torque motors for horizontal motion. This paper explains the design and evaluates its performance on power consumption and safety. Power consumption is expressed in terms of the sum of the positive mechanical output power of all motor axes. Safety is defined as the difference between the mechanical power available for horizontal and vertical movements and the mechanical power that is needed to perform its task. The results of the RYSEN are compared to the performance of three similar systems: a gantry, the FLOAT and a classic cable robot. The results show that the RYSEN and a gantry consume approximately the same amount of power. The amount is approximately half the power consumed by the next best system. For the safety, the gantry is taken as the benchmark, because of its perfect decoupling of directions. The RYSEN has a surplus of 268 W and 126 W for horizontal and vertical movements respectively. This is significantly lower than the next best system, which has a surplus of 1088 W and 1967 W respectively.

The question whether novel rehabilitation interventions can exploit restorative rather than compensatory mechanisms has gained momentum in recent years. Assessments measuring selective voluntary motor control could answer this question. However, while current clinical assessments are ordinal-scaled, which could affect their sensitivity, lab-based assessments are costly and time-consuming. We propose a novel, interval-scaled, computer-based assessment game using low-cost accelerometers to evaluate selective voluntary motor control. Participants steer an avatar owl on a star-studded path by moving the targeted joint of the upper or lower extremities. We calculate a target joint accuracy metric, and an outcome score for the frequency and amplitude of involuntary movements of adjacent and contralateral joints as well as the trunk. We detail the methods and, as a first proof of concept, relate the results of select children with upper motor neuron lesions (n = 48) to reference groups of neurologically intact children (n = 62) and adults (n = 64). Linear mixed models indicated that the cumulative therapist score, rating the degree of selectivity, was a good predictor of the involuntary movements outcome score. This highlights the validity of this assessgame approach to quantify selective voluntary motor control and warrants a more thorough exploration to quantify changes induced by restorative interventions.