HomeBased Telerehabilitation following Stroke

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Home-Based Telerehabilitation following Stroke

• David Reinkensmeyer, Ph.D., Robert Sanchez, M.S.
• Dept. of Mechanical and Aerospace Engineering
• University of California Irvine

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The Stroke Rehabilitation Paradox

• There is increasing evidence that intensive
  sensory motor training can improve functional
  recovery.
• However, stroke patients are getting less therapy
  and going home sooner due to economic pressures.
• There is little technology available to continue
  therapy at home in order to maintain, improve, or
  monitor recovery.

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Web-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
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Java Therapy Results
Improvement in Movement Trajectory with Practice

• Improvement in Movement Time with Practice

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Java Therapy Results

• Demonstrates feasibility of using a web-based
  system to
• direct a therapy program
• mechanically assist in movement
• track improvements
• However, no functional improvements, using
  standard clinical scales
• Subjects likely get better at the movements they
  practice
• Improved input devices are needed to measure and
  assist in more functional movements

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Current Work

• Develop large-workspace, instrumented orthosis
  for arm movement
• based on anti-gravity orthosis for children
• WREX, Tariq Rahman, A.I. duPont Institute
• Develop integrated hand function measure
• based on ShapeTape
• Test efficacy of the device in improving/maintaing
  recovery after termination of conventional
  therapy
• Project V NIDRR RERC on Rehabilitation Robotics,
  Machines Assisting Rehabilitation after Stroke

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Progress

• Developed complete CAD model of orthosis
• Fabricated adult-sized version of orthosis
• Designed adjustable mount to generic chair
• Instrumented with Shapetape
• Orthosis has excellent range of motion
• Anti-gravity function appears adequate
• Shapetape has poor repeatability for this
  application

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Next Steps Instrument Arm Movement

• Option 1 Develop external digitizing linkage
• Requires 3 sensors
• Sensors can be in a protected box
• Separate piece of equipment
• Use off the shelf equipment? (3500)
• Option 2 Instrument joints themselves
• Requires 5 sensors
• Sensors are exposed
• Single piece of equipment
• Rotary sensor options
• Relative encoders, resolvers require
  zeroing, impractical for home use?
• Absolute
• Optical encoders (350)
• Potentiometers (60) (resolution questionable 1
  linearity 360 counts)

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Next Steps Instrument Hand Movement

• Option 1 Work with Shapetape
• Shorter lengths have better resolution
• Option 2 Dataglove (5DT) (500)
• Difficult to don problematic for home use
• Must be zeroed
• Option 3 External goniometers (600)
• Option 4 External Workstation
• measure hand function rather than joint range of
  motion
• Example Box and balls task motor weighs balls
  and resets task

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Next Steps Develop Software for Functional
Exercises

• Approach
• Base exercises on standard clinical tests (e.g.
  Fugl-Meyer scale)
• Use external, physical landmarks as 3D targets
• Example Touch your nose
• Example Activities of Daily Living Workstation
• Make Java Therapy software run off-line
• Provide video demonstration and video feedback to
  subjects?

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Next Steps Testing

• Years 1 and 2 Evaluate software/hardware
  interfaces and measure short-term motor learning
  with current PHANToM/Anti-gravity orthosis set-up
• Years 3-5 Larger, controlled study