Patient performance assessment methods for upper extremity rehabilitation in assist-as-needed therapy strategies: a comprehensive review

Abstract

This paper aims to comprehensively review patient performance assessment (PPA) methods used in assist-as-needed (AAN) robotic therapy for upper extremity rehabilitation. AAN strategies adjust robotic assistance according to the patient's performance, aiming to enhance engagement and recovery in individuals with motor impairments. This review categorizes the implemented PPA methods in the literature for the first time in such a wide scope and suggests future research directions to improve adaptive and personalized therapy. At first, the studies are examined to evaluate PPA methods, which are subsequently categorized according to their underlying implementation strategies: position error-based methods, force-based methods, electromyography (EMG), electroencephalography (EEG)-based methods, performance indicator-based methods, and physiological signal-based methods. The advantages and limitations of each method are discussed. In addition to the classification of PPA methods, the current study also examines clinically tested AAN strategies applied in upper extremity rehabilitation and their clinical outcomes. Clinical findings from these trials demonstrate the potential of AAN strategies in improving motor function and patient engagement. Nevertheless, more extensive clinical testing is necessary to establish the long-term benefits of these strategies over conventional therapies. Ultimately, this review aims to guide future developments in the field of robotic rehabilitation, providing researchers with insights into optimizing AAN strategies for enhanced patient outcomes.