High-force Haptic Rehabilitation Robot and Motor Outcomes in Chronic Stroke

Abstract

Background: Haptic TheraDrive is a low-cost robotic system that uses off-the-shelf computer gaming wheels with force feedback for post-stroke upper extremity rehabilitation. Preliminary results have shown that the Haptic TheraDrive system is not capable of delivering effective therapy to low-functioning patients. A new low-cost, high-force haptic robot with a single degree of freedom has been developed to address this concern. The purpose of this case is to determine the impact on motor performance and function with use of a custom force-feedback device, Haptic TheraDrive, to complete games for rehabilitation in a low-to-moderate functioning stroke survivor with hemiplegia. Methods: A case study design was used with a 52-year old male 22 months post stroke. His Fugl-Meyer Assessment of the Upper Extremity of 37/66 indicated a low-to-moderate functioning upper extremity. The subject participated in Haptic TheraDrive robot use for computer gaming of movement timing, velocity and accuracy for 3 x/a week for one month (10 sessions) - approximately 60 minutes per session. An adaptive controller monitored the subject's performance to ensure that the exercises were difficult but doable. Results: After session 10 the subject demonstrated improvements in: Fugl-Meyer Arm Motor Scale (8 points), coordination speed (59%), grip strength (18%) and Box and Block Test (122%). Gains at one month follow up included: Fugl-Meyer Arm Motor Scale (11 points, a minimally clinically important difference), coordination speed (63%), and grip strength (39%). Since completion of the training long terms gains included: Fugl-Meyer Arm Motor Scale (3 points), coordination speed (9%) and grip strength (18%). Conclusion: TheraDrive provides an adaptive controller using force-feedback to deliver individualized and effective therapy for a single low-to-moderate functioning stroke survivor with hemiplegia. The long-term goal of this project is to develop an inexpensive high-force haptic rehabilitation robot that can safely be used by patients at home.