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. 2025 Mar 25;10(4):200.
doi: 10.3390/biomimetics10040200.

Development and Evaluation of a Novel Upper-Limb Rehabilitation Device Integrating Piano Playing for Enhanced Motor Recovery

Xin Zhao  1 , Ying Zhang  2 , Yi Zhang  3 , Peng Zhang  4 , Jinxu Yu  5 , Shuai Yuan  1
Affiliations

Development and Evaluation of a Novel Upper-Limb Rehabilitation Device Integrating Piano Playing for Enhanced Motor Recovery

Xin Zhao et al. Biomimetics (Basel). .

Abstract

This study developed and evaluated a novel upper-limb rehabilitation device that integrates piano playing into task-oriented occupational therapy, addressing the limitations of traditional continuous passive motion (CPM) training in patient engagement and functional recovery. The system features a bi-axial sliding platform for precise 61-key positioning and a ten-link, four-loop robotic hand for key striking. A hierarchical control framework incorporates MIDI-based task mapping, finger optimization using an improved Hungarian algorithm, and impedance-admittance hybrid control for adaptive force-position modulation. An 8-week randomized controlled trial demonstrated that the experimental group significantly outperformed the control group, with a 74.7% increase in Fugl-Meyer scores (50.5 ± 2.5), a 14.6-point improvement in the box and block test (BBT), a 20.2-s reduction in nine-hole peg test (NHPT) time, and a 72.6% increase in rehabilitation motivation scale (RMS) scores (55.4 ± 3.8). The results indicate that combining piano playing with robotic rehabilitation enhances neuroplasticity and engagement, significantly improving motor function, daily activity performance, and rehabilitation adherence. This mechanical-control synergy introduces a new paradigm for music-interactive rehabilitation, with potential applications in home-based remote therapy and multimodal treatment integration.

Keywords: music-interactive rehabilitation; task-oriented occupational therapy; upper-limb rehabilitation device.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The specific structure of the novel upper-limb rehabilitation device.
Figure 2
Figure 2
Structure of the translation mechanism: (a) horizontal translation; (b) vertical translation.
Figure 3
Figure 3
Transmission mechanism and kinematic analysis model of the hand rehabilitation robot: (a) transmission mechanism of the hand rehabilitation robot; (b) Lagrangian coordinate system of the transmission mechanism.
Figure 4
Figure 4
Four loops of the transmission mechanism for the hand rehabilitation robot: (a) Five-bar loop L1, (b) Five-bar loop L2, (c) Four-bar loop L3, and (d) Four-bar loop L4.
Figure 5
Figure 5
Analysis and solutions for the lifting problem of the push rod motor: (a) Analysis of the motor lifting problem; (b) Three-dimensional design drawing of the slider structure.
Figure 6
Figure 6
The specific structure of the newly designed upper-limb rehabilitation occupational therapy device integrated with piano playing.
Figure 7
Figure 7
Hierarchical control flow chart.
Figure 8
Figure 8
The specific settings for the hand rehabilitation training of the patients in the experimental group: (a) The hand state when striking the piano keys; (b) The hand state when switching between striking the white and black keys.
Figure 9
Figure 9
The rehabilitation evaluation data of the experimental group and the control group: (a) Comparison of upper-limb motor function; (b) Comparison of finger flexibility; (c) Comparison of fine finger movement control ability; (d) Comparison of patients’ subjective experience.
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