Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients’ Rehabilitation: Systematic Review

Abstract

BackgroundRobot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications.ObjectiveThe goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors.MethodsA systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct & The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients’ condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients.ResultsThirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation.ConclusionsFuture studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies.

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“…Very few studies ( 25 , 26 ) have attempted to assess the additional benefits of this combination of technologies. Patients #1 and #5 in our study showed marginal motor improvements on the FM UE scale ( 27 , 28 ).…”

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“…• Helpful for the therapy of the patient suffering the mental health issues Riva et al, 2011 44 ; Valmaggia et al, 2016 45 ; Chirico et al, 2016 46 ; Mubin et al, 2019 47…”

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“…Robotic rehabilitation can reduce the burden of therapists by automating tedious and labor-intensive therapy [ 2 ] and by adapting to the specific needs of the targeted individuals [ 1 ]. Additionally, it can offer a multisensory rehabilitation experience [ 11 ] when combined with other technologies such as virtual and augmented reality (VR/AR) and gaming [ 12 ] or haptics [ 13 ]. This way it can provide additional sensory feedback to facilitate neuroplasticity and become more intuitive for individuals with cognitive deficiencies [ 13 ].…”