Home-Based Telerehabilitation Home-Based Telerehabilitation

following Strokefollowing Stroke

David Reinkensmeyer, Ph.D., Robert Sanchez, M.S.David Reinkensmeyer, Ph.D., Robert Sanchez, M.S.

Dept. of Mechanical and Aerospace EngineeringDept. of Mechanical and Aerospace Engineering

University of California IrvineUniversity of California Irvine

The Stroke Rehabilitation ParadoxThe Stroke Rehabilitation Paradox

• There is increasing evidence that intensive sensory There is increasing evidence that intensive sensory motor training can improve functional recovery.motor training can improve functional recovery.

• However, stroke patients are getting less therapy and However, stroke patients are getting less therapy and going home sooner due to economic pressures.going home sooner due to economic pressures.

• There is little technology available to continue therapy at There is little technology available to continue therapy at home in order to maintain, improve, or monitor recovery.home in order to maintain, improve, or monitor recovery.

Web-Based Home Therapy: Java TherapyWeb-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. 102-108

Java Therapy ResultsJava Therapy Results

Improvement in Movement Time Improvement in Movement Time with Practicewith Practice

Improvement in Movement Improvement in Movement Trajectory with PracticeTrajectory with Practice

Java Therapy ResultsJava Therapy Results

Demonstrates feasibility of using a web-based system to:Demonstrates feasibility of using a web-based system to:– direct a therapy programdirect a therapy program

– mechanically assist in movementmechanically assist in movement

– track improvementstrack improvements

However, no functional improvements, using standard clinical scalesHowever, no functional improvements, using standard clinical scales

Subjects likely get better at the movements they practiceSubjects likely get better at the movements they practice

Improved input devices are needed to measure and assist in more Improved input devices are needed to measure and assist in more functional movementsfunctional movements

Current WorkCurrent Work• Develop large-workspace, instrumented Develop large-workspace, instrumented

orthosis for arm movementorthosis for arm movement– based on anti-gravity orthosis for childrenbased on anti-gravity orthosis for children– WREX, Tariq Rahman, A.I. duPont InstituteWREX, Tariq Rahman, A.I. duPont Institute

• Develop integrated hand function measureDevelop integrated hand function measure– based on ShapeTapebased on ShapeTape

• Test efficacy of the device in Test efficacy of the device in improving/maintaing recovery after improving/maintaing recovery after termination of conventional therapytermination of conventional therapy

• Project V: NIDRR RERC on Rehabilitation Project V: NIDRR RERC on Rehabilitation Robotics, Machines Assisting Rehabilitation Robotics, Machines Assisting Rehabilitation after Strokeafter Stroke

ProgressProgress

• Developed complete CAD model of orthosis Developed 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 Shapetape has poor repeatability for this

applicationapplication

Next Steps: Instrument Arm MovementNext 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 MovementNext 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 Next Steps: Develop Software for Functional ExercisesFunctional Exercises

Approach: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: TestingNext Steps: Testing

THERAPY EVALUATIONS

GROUP

Inpatient Java

Therapy

Home-Based Java

Therapy Inpatient Week 1

Inpatient Week 3

Home Month 2

Home Month 6

Inpatient + Home Use (n = 30) 5 hrs/week 3 weeks

10 hrs/week 2 mos

X X X X

Inpatient Only (n = 30) 5 hrs/week 3 weeks

- X X X X

Reduced Inpatient (n =30) ½ hr/week 3 weeks

- X X X X

Table 2: Protocol Summary

• Years 1 and 2: Evaluate Years 1 and 2: Evaluate software/hardware interfaces and measure software/hardware interfaces and measure short-term motor learning with current short-term motor learning with current PHANToM/Anti-gravity orthosis set-upPHANToM/Anti-gravity orthosis set-up

• Years 3-5: Larger, controlled study: Years 3-5: Larger, controlled study: