What qualities should a rehab robot have?

Pilot study

Robots in Rehab: Towards socially assistive robots for paediatric rehabilitation

McMarthy C, Butchart J, George M, Kerr D, Kingsley H, Scheinberg A M & Sterling L

OzCHI '15 Proceedings of the Annual Meeting of the Australian Special Interest Group for Computer Human Interaction, pp. 39-43

Link to abstract: dx.doi.org/10.1145/2838739.2838791

Objective: What are the possible clinical benefits of social robots in rehabilitation for children? This preliminary study explores the characteristics required of robots which interact with children in a post-surgery inpatient setting.

Process: In this setting, NAO robot was used to mimic exercises and motivate children when the therapist was not present. Children had two sessions weekly with a therapist, followed by a third session with NAO, over a period of five months. NAO speaks and demonstrates each exercise, provides a focus during the exercises to minimize boredom, provides encouraging and rewarding vocalizations and records the child’s activity for later review.

Findings: Outcomes of interest are specific to the characteristics of the device. Issues that detracted from NAO’s functionality were movement and speech slowness, physical stability and limited balance, voice clarity and battery life.

Therapy Robots: What Therapists Think

Survey

Views of Physiatrists and Physical Therapists on the use of Gait-training Robots for Stroke Patients

Journal of Physical Therapy Science 28: pp. 202 – 206, 2016

Kang, CG, Chun, MH, Jang, MC, Kim, W & Do, KH

Link to full text: www.jstage.jst.go.jp/article/jpts/28/1/28_jpra-2015-652/_article

Objective: to survey therapists on the desired characteristics of gait-training robots.

Process: 100 physiatrists and 100 physical therapists from 38 hospitals were given questionnaires. One-third of the respondents had worked with a gait-training robot before, and a third had more than 5 years experience with stroke rehabilitation.

Results: therapists thought that treadmill type gait-training robots should be used with non-independent ambulators to "improve treatment effects" one to three months after stroke. Sensors should detect electromyography, foot pressure, joint torque, tilt sensor. Qualities of design and production should include: stability, comfort, easiness on-and-off, "fitting sense" and light weight.

Therapists Report on Virtual Reality Adoption Barriers

Single group

Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation

Glegg, SMN, Holsti, L, Stanton, S, Hanna, S, Velikonja, D, Ansley, B, Sartor, D & Brum, C

Disability and Rehabilitation: Assistive Technology, 2016

Link to abstract: dx.doi.org/10.3109/17483107.2015.1111944

Objective: to explore the barriers to adoption of VR technology by clinicians before and after training and support.

Method: 42 therapists at 2 rehabilitation centres were surveyed using the “Assessing Determinants of Prospective Uptake of Virtual Reality (ADOPT-VR) Instrument”. They completed the assessment before and following training, including receiving a manual and support.

Findings: The most often reported pre-test barrier of limited knowledge in how to use the system is absent in post-test reporting. The most significant barriers at post-test included “lack of time, appropriate clients, poor client motivation, technical issues, difficulty explaining the system to clients, and compatibility issues with wheelchair users”.

Article contact: Stephanie Glegg sglegg@cw.bc.ca

Studying Themes in Therapeutic Gameplay

Qualitative Study

Understanding Engagement in Home-Based Interactive Computer Play: Perspectives of Children with Unilateral Cerebral Palsy and Their Caregivers

James, S., Ziviani, J., King, G. & &. Boyd, R. N.

Physical & Occupational Therapy In Pediatrics (2015), DOI: 10.3109/01942638.2015.1076560

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26606419

Purpose: using qualitative methodology, therapy researchers studied themes arising from children with CP and their caregivers on therapeutic computer game play. The software " (Mitii™) is intended to improve physical and mental skills and to be used in the home setting.

Method: Ten 8 - 18 year old children with one-sided cerebral palsy and their caregivers participated in semi-structured interviews following use of the Mitii game in a 20 week trial reported elsewhere (Boyd et al., 2013) Inclusion for the study required children to be of GMFCS level 1 or 2, and MACS study level 1 to 3. The theoretical positioning of the authors and their perspective as therapists is made explicit.

Findings: The inductive methodology identified three key themes: child and caregiver, themes relating to the intervention and themes that related to therapists’ involvement.
"Child/family characteristics: children's interest captured through novelty and technology, motivation declines as novelty wears off, children require "finely tuned" programs, strong family support facilitates engagement, and children develop confidence and ownership."
"Intervention characteristics: increased therapy frequency with reduced caregiver involvement, Mitii™ "becomes therapy" and competes with other interests; convenience within family routine, lack of real-time feedback and technical issues, and therapist guidance is essential."
"Service provider characteristics: initial and ongoing therapist input, family-friendly therapy approach, and tailored strategies to sustain engagement."

Reference
Boyd, R.N., Mitchell, L.Ee, James, S.T., Ziviani, J., Sakzewski, L., Smith, A. et al. (2013). Move it to improve it (Mitii): Study protocol of a randomised controlled trial of a novel web-based multimodal training program for children and adolescents with cerebral palsy.
Link to full text: bmjopen.bmj.com/content/3/4/e002853.full

Effectiveness of robot play for kids with CP

Case Series

Playfulness in Children with Limited Motor Abilities when using a Robot

Rios-Rincon, A. M., Adams, K., Magill-Evans, J. & Cook, A.

Physical & Occupational Therapy in Pediatrics, 00(00):1 – 15, 2015

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/26566226

Objective: For children with cerebral palsy, will robot play increase playfulness? Children with cerebral palsy may have fewer opportunities to play. “Promoting playfulness in children with CP… might have a positive effect on self-determination, adaptive behaviors, and problem solving in creative ways. "Will Test of Playfulness (ToP) scores increase during the intervention?"

Process: Four 4 – 9 year old children with Gross Motor Function Classification System (GMFCS) levels 4 or 5 and Manual Ability Classification Scale (MACS) level 4 or 5 and they needed to be able to respond to yes/no questions and to operate the robot using two switches. During the intervention phase, the children were encouraged by their mothers to play with the robot for 15 minutes twice a week for 5 weeks.

Findings: The baseline ToP scores for three of the four children were stable. During the intervention, all four children showed significantly increased scores. "This study adds to the limited evidence for the effectiveness of interventions for play… (and) that adapted Lego robots promote playfulness in children with cerebral palsy who have limitations in mobility and manual ability through free play in family routines."

Futures for Virtual Reality in Cerebral Palsy Management

Review

Role of Virtual Reality for Cerebral Palsy Management

Weiss, P. T., Tirosh, E. & Fehlings, D.
Journal of Child Neurology, 2014, 29(8): 1119 – 1124

Link to abstract: www.ncbi.nlm.nih.gov/pubmed/24799367

Virtual reality can occupy a unique space in rehabilitation when designed by therapists as it can provide a motivating yet challenging place to learn transferrable skills and to capture performance feedback.

Objective: This article overviews several topics: virtual reality and clinical gaming for the population of children with cerebral palsy, key studies that identify different components of virtual reality systems as children with cerebral palsy interact with them, and aspects of virtual reality interaction beyond the enjoyable and motivating aspects of gameplay to measuring deeper emotional and psychological characteristics like autonomic responses to gaming.

"Virtual reality for rehabilitation has become more accessible and less expensive and more popular for clinicians… who want to take advantage of virtual reality’s assets for rehabilitation while ensuring that it is best suited to the client’s cognitive, motor and emotional abilities in the context of specific therapeutic goals". "Available data suggest exciting prospects for the use of virtual reality in the rehabilitation of children with physical disabilities."

VR Rehab Reviewed

Virtual Reality in Rehabilitation of Children with Cerebral Palsy

Review article

Gunel, M. K., Kara, K. O., Ozal, C. & Turker, D. (2014) In E. Svraka (Ed) Cerebral Palsy - Challenges for the Future (pp. 273-301). InTech: DOI: 10.5772/56981 Creative Commons BY 3.0 license

Link to full text: dx.doi.org/10.5772/57486

Chapter 9, Virtual Reality in Rehabilitation of Children with Cerebral Palsy, is found within the book Cerebral Palsy - Challenges for the Future, published as an open source volume by InTech. The book develops the following ideas… "lifelong re/habilitation (habilitation and rehabilitation) in persons with cerebral palsy is the first part of this book which has four chapters about management in children and adults with cerebral palsy through the life span, providing evidence-based and family-centered support and services. Three chapters of the second part are exploring the new therapy options which could improve the family quality of life. Third part has two chapters about complementary therapies with new possibilities for the future."

The chapter on virtual reality therapy begins with an ICF perspective. In CP treatment, VR (re)habilitation modalities are identified separately as ‘evidence-based and clinical’ applications. The authors provide an extensive review of CP rehabilitation from the ICF perspective, and connect to a history of VR. They consider the theoretical base of VR therapy and include a neurology lesson and a review of virtual reality systems used in pediatric rehabilitation (immersive or desktop). A classification of VR systems for rehabilitation from (Galvin and Levac) is provided. The chapter finishes with a review of VR studies relating to upper extremity, lower extremity, postural control, fitness and other topics.

Reference
Galvin, J. and Levac, D. (2011). Faciliating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: describing and classifying virtual reality systems. Developmental neurorehabilitation, 2011:14 (2):112-22