High-force Haptic Rehabilitation Robot and Motor Outcomes in Chronic Stroke: A Case Study.

Case Study Report
Population: Adult

Carol Ann Wamsley, PT, DPT, BS, NCS, CBIS, Advanced Clinician I/Coordinator CARF Stroke Specialty Program, Therapy Division, Good Shepherd Penn Partners, Penn Rehab, University of Pennsylvania Health System, Philadelphia, PA. carol.wamsley@uphs.upenn.edu

Roshan Rai, MS, Engineer, Rehabilitation Robotics R&D Lab (PMR,3RD Lab), University of Pennsylvania, Philadelphia, PA. roshan.rai@uphs.upenn.edu

Nicholas Vivio, MS, Clinical Research Coordinator, Rehabilitation Robotics R&D Lab (PMR,3RD Lab), University of Pennsylvania, Philadelphia, PA. nvivio@mail.med.upenn.edu

Michelle Johnson, PhD, Assistant Professor, Department of Physical Medicine and Rehabilitation (PM&R), University of Pennsylvania; Director, Rehabilitation Robotics R&D Lab (PMR,3RD Lab), University of Pennsylvania., Department of Bioengineering, Department of Mechanical Engineering and Applied Science, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA. johnsmi@uphs.upenn.edu

Keywords: Plasticity, Stroke, Robotics, Hemiplegia

Background/Purpose: TheraDrive is a low-cost robotic system for post-stroke upper extremity rehabilitation. The system uses off-the-shelf computer gaming wheels with force feedback to help reduce motor impairment and improve function in the arms of stroke survivors. Preliminary results from  studies have shown that the 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 to complete games for rehabilitation in a low-to-moderate functioning stroke survivor with hemiplegia.

Case Description: A 52-year old male 22 months post stroke. He was not receiving therapy, worked in a sedentary position, and reported difficulty with activities of daily living (ADLs) of showering and getting his wallet out of his left rear pant pocket. The subject was not cognitively impaired as demonstrated by a Montreal Cognitive Assessment Scale of 30/30. He had a low-to-moderate functioning left upper extremity (UE) with a Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) of 37/66. His left grip strength on the average of 3 trials with a dynamometer was 16.76 pounds as compared to 72.46 on his right. Modified Ashworth Scale (MAS) indicated increased tone of 1-1+/4 in his left shoulder adductor, elbow flexor, forearm pronator and wrist flexors. Initial performance of the Box and Block Test (BBT) resulted in a score of 9 on the left compared with 49 on the right. The subject participated in TheraDrive robot use (static and adaptive force modes) 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.

Outcomes: Outcome measures were assessed at baseline, after 10 sessions and at one month follow up. All primary outcomes (FMA-UE, ADLs and dynamometry) and BBT demonstrated improvement and were sustained and/or gained at one month follow up. After session 10 the subject demonstrated improvements in: FMA-UE (8 points), coordination speed (59%), grip strength (18%) and BBT (122%). Functionally he was able to pick up 11 more blocks, use his left UE to shower his right shoulder and reach his left rear pant pocket. Gains at follow up included: FMA-UE (11 points, a minimally clinically important difference), coordination speed (63%), and grip strength (39%).  Since completion of the training long terms gains included: FMA-UE (3 points), coordination speed (9%) and grip strength (18%).

Discussion/Conclusion: TheraDrive provides an adaptive controller using force-feedback to deliver individualized and effective therapy for low-to-moderate functioning stroke survivors with hemiplegia. This intervention impacts motor performance, function, grip strength, coordination, finger dexterity and to a lesser extent spasticity. Recognize that robots have a role in rehabilitation. 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.

Wamsley, Carol Ann, PT, DPT, BS, NCS, CBIS; Rai, Roshan , MS; Vivio, Nicholas , MS; Johnson, Michelle J., PhD. High-force Haptic Rehabilitation Robot and Motor Outcomes in Chronic Stroke: A Case Study.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online. https://u.osu.edu/ivstep/poster/abstracts/056_wamsley-et-al/