Effects of the Alternate Combination of "Error-Enhancing" and "Active Assistive" Robot-Mediated Treatments on Stroke Patients

Abstract

This paper aimed at investigating the effects of a novel robotic-aided rehabilitation treatment for the recovery of the upper limb related capabilities in chronic post stroke patients. Eighteen post-stroke patients were enrolled in a six-week therapy program and divided into two groups. They were all required to perform horizontal pointing movements both in the presence of a robot-generated divergent force field (DF) that pushed their hands proportional to the trajectory error and perpendicular to the direction of motion, and according to the typical active assistive (AA) approach used in robotic therapy. We used a crossover experimental paradigm where the two groups switched from one therapy treatment to the other. The hypothesis underlying this paper was that the use of the destabilizing scenario forced the patient to keep the end-point position as close as possible to the ideal path, hence requiring a more active control of the arm with respect to the AA approach. Our findings confirmed this hypothesis. In addition, when the DF treatment was provided in the first therapy cycle, patients also showed straighter and smoother paths during the subsequent AA therapy cycle, while this was not true in the opposite case. In conclusion, the results herein reported provide evidence that the use of an unstable DF field can lead to better recovery outcomes, and therefore it potentially more effective than solely active assistance therapy alone.

Keywords: Rehabilitation robotics; assisted-as-needed; error-enhancing; stroke; upper arm.

Fig. 1.

Rehabilitative scenario. The figure shows the fan paradigm adopted in this study and the assessment of the deviation (error) between the ideal (thin line) and the real (tick line) paths.

Fig. 2.

Trajectory of the end-effector. The figure shows the trajectory of the end-effector (one turn) for two representative subjects (P6 and P17) belonging respectively to Group I (on the left) and to Group II (on the right) during the 4 observations (i.e., s1, e1, s2 and e2). Curves in blue and red respectively refer to the DF and AA scenarios.

Fig. 3.

Changes in and MD metrics parameters over the course of the therapy. Top panel: Box plot of parameter (mean across subjects) of the beginning of the treatment type therapy (s) and at the end of the treatment type (e) for both Group I and Group II. Red boxes are relative to the active assistive therapy, and blue boxes represent results from the divergent field therapy. Bottom panel: Box plot of MD parameter.

Fig. 4.

Changes in N and PL metrics parameters over the course of the therapy. Top panel: Box plot of N parameter (mean across subjects) of the beginning of the treatment type therapy (s) and at the end of the treatment type (e) for both Group I and Group II. Red boxes are relative to the active assistive therapy, and blue boxes represent results from the divergent field therapy. Bottom panel: Box plot of PL parameter.

Fig. 5.

Changes in , , and J metrics parameters over the course of the therapy. Top panel: Box plot of parameter (mean across subjects) of the beginning of the treatment type therapy (s) and at the end of the treatment type (e) for both Group I and Group II. Red boxes are relative to the active assistive therapy, and blue boxes represent results from the divergent field therapy. Middle panel: Box plot of parameter. Bottom panel: Box plot of J parameter.