SPECIAL INTEREST REPORT PLATFORM PRESENTATION

UNI-MANUAL AND BI-MANUAL TRAINING UTILIZING ROBOTICS IN A VIRTUAL ENVIRONMENT POST-STROKE. Fluet G¹, Qiu Q², Talati B², Merians A¹, Adamovich S²; ¹University of Medicine and Dentistry of New Jersey, Doctoral Programs in Physical Therapy, Newark, NJ, USA. ²New Jersey Institute of Technology, Department of Bio-Medical Engineering, Newark, NJ, USA

PURPOSE: New therapeutic interventions such as sensory enriched virtual environments (VE), intensive periods of goal-oriented practice, use of bimanual tasks and robotically assisted rehabilitation are being developed to improve functional outcomes post-stroke. The purpose of this presentation is to describe a unique, therapeutic approach that combines two novel interventions; intensive movement re-education in VE with bilateral robotically assisted upper extremity training. RELEVANCE: Previously we have successfully utilized unilateral intensive practice of the hemiplegic hand in VE to renormalize hand function post-stroke. However, activity in the ipsilateral hemisphere has been purported to play an important role in recovery of function of the hemiplegic arm. It is believed that during bilateral movements both hemispheres are activated and cortical inhibition is reduced, allowing for recruitment of undamaged neurons into new task-related neural networks. DESCRIPTION: A sixty-nine year old female (7 years post CVA) was trained using her hemiparetic extremity in isolation and in combination with the less affected extremity. Chedoke Impairment Inventory Stage was 7 (arm) and 4 (hand). She trained 4 consecutive days, 2½ hours/day. Shoulder/ elbow VE simulations were interfaced with a 3-dimensional (3D) haptic robot. Wrist/finger VE simulations were interfaced with a 22 sensor data glove. Unilateral and bilateral game-like virtual environments were developed. Unlike other robot-assisted interventions, this innovative system enables multiplanar movements against gravity in a full 3D workspace. Arm activities included touching and manipulating virtual moving and stationary objects. The haptic robot was programmed to use the movement of the less affected arm to passively assist the movement of the hemiparetic arm when necessary during symmetrical bilateral activities. During hand activities the subjects were trained to use individual finger movements in appropriate patterns to catch falling objects and play a virtual piano. The piano plays the appropriate melodic notes when keys were pressed by the virtual fingers. Position and orientation of hands and flexion/abduction of each finger were recorded in real time and translated into 3D movement. EVALUATION: Kinematic data from haptic robot indicated mean time to complete the ten target reaching sequence decreased from mean (SD) 2.6 (3.5) minutes to 2.1 (1.7) minutes. Reaching distance decreased from mean 2.6 (2.8) to 2.1 (1.5) m. Velocity, measured during bimanual arm activity emphasizing speed, improved in two planes. These improvements suggest more skilled, consistent and efficient movement. Smoothness of movement (dimensionless measure calculated as the normalized integrated third derivative of path length) improved by 38%. Literature suggests this measure may be related to the integration of sub-movements into a more coordinated pattern, an indicator of neurological recovery. Clinically, total time on the Wolf Motor Function Test decreased from 59.3sec to 51.1sec with the Functional Ability Score increasing from 62 to 67. CONCLUSIONS: This combination of novel interventions appears to improve the consistency and efficiency of skilled upper extremity and hand movement. IMPLICATIONS: Robotics combined with VE may allow for intensive goal directed activity and bimanual practice providing a training paradigm congruent with current neuroscience research. KEYWORDS: cerebrovascular accident,robotics,bilateral arm practice,virtual environment. FUNDING ACKNOWLEDGEMENTS: NIDRR-supported Rehabilitation Engineering Research Center (RERC) for Children with Orthopedic Disabilities. CONTACT: fluet179@comcast.net

ETHICS COMMITTEE: University of Medicine and Dentistry of New Jersey, Office of the Institutional Review Board