Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot
Identifieur interne : 001433 ( Main/Merge ); précédent : 001432; suivant : 001434Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot
Auteurs : Jean-Claude Metzger [Suisse] ; Olivier Lambercy [Suisse] ; Antonella Califfi ; Daria Dinacci ; Claudio Petrillo ; Paolo Rossi ; Fabio M. Conti ; Roger Gassert [Suisse]Source :
- Journal of NeuroEngineering and Rehabilitation [ 1743-0003 ] ; 2014.
Abstract
Selecting and maintaining an engaging and challenging training difficulty level in robot-assisted stroke rehabilitation remains an open challenge. Despite the ability of robotic systems to provide objective and accurate measures of function and performance, the selection and adaptation of exercise difficulty levels is typically left to the experience of the supervising therapist.
We introduce a patient-tailored and adaptive robot-assisted therapy concept to optimally challenge patients from the very first session and throughout therapy progress. The concept is evaluated within a four-week pilot study in six subacute stroke patients performing robot-assisted rehabilitation of hand function. Robotic assessments of both motor and sensory impairments of hand function conducted prior to the therapy are used to adjust exercise parameters and customize difficulty levels. During therapy progression, an automated routine adapts difficulty levels from session to session to maintain patients’ performance around a target level of 70%, to optimally balance motivation and challenge.
Robotic assessments suggested large differences in patients’ sensorimotor abilities that are not captured by clinical assessments. Exercise customization based on these assessments resulted in an average initial exercise performance around 70% (62% ± 20%, mean ± std), which was maintained throughout the course of the therapy (64% ± 21%). Patients showed reduction in both motor and sensory impairments compared to baseline as measured by clinical and robotic assessments. The progress in difficulty levels correlated with improvements in a clinical impairment scale (Fugl-Meyer Assessment) (r
Initial robotic assessments combined with progressive difficulty adaptation have the potential to automatically tailor robot-assisted rehabilitation to the individual patient. This results in optimal challenge and engagement of the patient, may facilitate sensorimotor recovery after neurological injury, and has implications for unsupervised robot-assisted therapy in the clinic and home environment.
The online version of this article (doi:10.1186/1743-0003-11-154) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/1743-0003-11-154
PubMed: 25399249
PubMed Central: 4273449
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Conti</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Gassert, Roger" sort="Gassert, Roger" uniqKey="Gassert R" first="Roger" last="Gassert">Roger Gassert</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich</wicri:regionArea><wicri:noRegion>8092 Zurich</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25399249</idno><idno type="pmc">4273449</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273449</idno><idno type="RBID">PMC:4273449</idno><idno type="doi">10.1186/1743-0003-11-154</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000832</idno><idno type="wicri:Area/Pmc/Curation">000832</idno><idno type="wicri:Area/Pmc/Checkpoint">000E12</idno><idno type="wicri:Area/Ncbi/Merge">003452</idno><idno type="wicri:Area/Ncbi/Curation">003452</idno><idno type="wicri:Area/Ncbi/Checkpoint">003452</idno><idno type="wicri:Area/Main/Merge">001433</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot</title><author><name sortKey="Metzger, Jean Claude" sort="Metzger, Jean Claude" uniqKey="Metzger J" first="Jean-Claude" last="Metzger">Jean-Claude Metzger</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich</wicri:regionArea><wicri:noRegion>8092 Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Lambercy, Olivier" sort="Lambercy, Olivier" uniqKey="Lambercy O" first="Olivier" last="Lambercy">Olivier Lambercy</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich</wicri:regionArea><wicri:noRegion>8092 Zurich</wicri:noRegion></affiliation></author><author><name sortKey="Califfi, Antonella" sort="Califfi, Antonella" uniqKey="Califfi A" first="Antonella" last="Califfi">Antonella Califfi</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Dinacci, Daria" sort="Dinacci, Daria" uniqKey="Dinacci D" first="Daria" last="Dinacci">Daria Dinacci</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Petrillo, Claudio" sort="Petrillo, Claudio" uniqKey="Petrillo C" first="Claudio" last="Petrillo">Claudio Petrillo</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Rossi, Paolo" sort="Rossi, Paolo" uniqKey="Rossi P" first="Paolo" last="Rossi">Paolo Rossi</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Conti, Fabio M" sort="Conti, Fabio M" uniqKey="Conti F" first="Fabio M" last="Conti">Fabio M. Conti</name><affiliation><nlm:aff id="Aff2">Clinica Hildebrand Centro di Riabilitazione Brissago, Via Crodolo, 6614 Brissago Switzerland</nlm:aff><wicri:noCountry code="subfield">6614 Brissago Switzerland</wicri:noCountry></affiliation></author><author><name sortKey="Gassert, Roger" sort="Gassert, Roger" uniqKey="Gassert R" first="Roger" last="Gassert">Roger Gassert</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Rehabilitation Engineering Laboratory, ETH Zurich, Leonhardstrasse 27, 8092 Zurich</wicri:regionArea><wicri:noRegion>8092 Zurich</wicri:noRegion></affiliation></author></analytic><series><title level="j">Journal of NeuroEngineering and Rehabilitation</title><idno type="eISSN">1743-0003</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Selecting and maintaining an engaging and challenging training difficulty level in robot-assisted stroke rehabilitation remains an open challenge. Despite the ability of robotic systems to provide objective and accurate measures of function and performance, the selection and adaptation of exercise difficulty levels is typically left to the experience of the supervising therapist.</p></sec><sec><title>Methods</title><p>We introduce a patient-tailored and adaptive robot-assisted therapy concept to optimally challenge patients from the very first session and throughout therapy progress. The concept is evaluated within a four-week pilot study in six subacute stroke patients performing robot-assisted rehabilitation of hand function. Robotic assessments of both motor and sensory impairments of hand function conducted prior to the therapy are used to adjust exercise parameters and customize difficulty levels. During therapy progression, an automated routine adapts difficulty levels from session to session to maintain patients’ performance around a target level of 70%, to optimally balance motivation and challenge.</p></sec><sec><title>Results</title><p>Robotic assessments suggested large differences in patients’ sensorimotor abilities that are not captured by clinical assessments. Exercise customization based on these assessments resulted in an average initial exercise performance around 70% (62% ± 20%, mean ± std), which was maintained throughout the course of the therapy (64% ± 21%). Patients showed reduction in both motor and sensory impairments compared to baseline as measured by clinical and robotic assessments. The progress in difficulty levels correlated with improvements in a clinical impairment scale (Fugl-Meyer Assessment) (r <sub><italic>s</italic></sub> = 0.70), suggesting that the proposed therapy was effective at reducing sensorimotor impairment.</p></sec><sec><title>Conclusions</title><p>Initial robotic assessments combined with progressive difficulty adaptation have the potential to automatically tailor robot-assisted rehabilitation to the individual patient. This results in optimal challenge and engagement of the patient, may facilitate sensorimotor recovery after neurological injury, and has implications for unsupervised robot-assisted therapy in the clinic and home environment.</p><p><bold>Trial registration:</bold> ClinicalTrials.gov, <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/ct2/show/NCT02096445?term=NCT02096445&rank=1">NCT02096445</ext-link></p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/1743-0003-11-154) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Woldag, H" uniqKey="Woldag H">H Woldag</name></author><author><name sortKey="Hummelsheim, H" uniqKey="Hummelsheim H">H Hummelsheim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lotze, M" uniqKey="Lotze M">M 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Teo</name></author><author><name sortKey="Burdet, E" uniqKey="Burdet E">E Burdet</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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