In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

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Virtual environments for motor rehabilitation: review.

The invention provides an articulating mechanism useful, for example, for remote manipulation of various surgical instruments and diagnostic tools within, or to, regions of the body. Movement of segments at the proximal end of the mechanism results in a corresponding, relative movement of segments at the distal end of the mechanism. The proximal and distal segments are connected by a set of cables in such a fashion that each proximal segment forms a discrete pair with a distal segment. This configuration allows each segment pair to move independently of one another and also permits the articulating mechanism to undergo complex movements and adopt complex configurations.

Articulating mechanism for remote manipulation of a surgical or diagnostic tool

The existing shortage of therapists and caregivers assisting physically disabled individuals at home is expected to increase and become serious problem in the near future The patient population needing physical rehabilitation of the upper extremity is also constantly increasing Robotic devices have the potential to address this problem as noted by the results of recent research studies However, the availability of these devices in clinical settings is limited, leaving plenty of room for improvement The purpose of this paper is to document a review of robotic devices for upper limb rehabilitation including those in developing phase in order to provide a comprehensive reference about existing solutions and facilitate the development of new and improved devices In particular the following issues are discussed: application field, target group, type of assistance, mechanical design, control strategy and clinical evaluation This paper also includes a comprehensive, tabulated comparison of technical solutions implemented in various systems

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A survey on robotic devices for upper limb rehabilitation

Articulating mechanisms, link systems, and components thereof, useful for a variety of purposes including, but not limited to, the remote manipulation of instruments such as surgical or diagnostic instruments or tools are provided. The link systems include links wherein at least two adjacent links are pivotable relative to one another around two distinct pivot points. Mechanisms for locking the links are also provided.

Link systems and articulation mechanisms for remote manipulation of surgical or diagnostic tools

A personal computer (PC)-based desktop virtual reality (VR) system was developed for rehabilitating hand function in stroke patients. The system uses two input devices, a CyberGlove and a Rutgers Master II-ND (RMII) force feedback glove, allowing user interaction with a virtual environment. This consists of four rehabilitation routines, each designed to exercise one specific parameter of hand movement: range, speed, fractionation or strength. The use of performance-based target levels is designed to increase patient motivation and individualize exercise difficulty to a patient's current state. Pilot clinical trials have been performed using the above system combined with noncomputer tasks, such as pegboard insertion or tracing of 2D patterns. Three chronic stroke patients used this rehabilitation protocol daily for two weeks. Objective measurements showed that each patient showed improvement on most of the hand parameters over the course of the training. Subjective evaluation by the patients was also positive. This technical report focuses on this newly developed technology for VR rehabilitation.

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Virtual reality-enhanced stroke rehabilitation

The Rutgers Master II-ND glove is a haptic interface designed for dextrous interactions with virtual environments. The glove provides force feedback up to 16 N each to the thumb, index, middle, and ring fingertips. It uses custom pneumatic actuators arranged in a direct-drive configuration in the palm. Unlike commercial haptic gloves, the direct-drive actuators make unnecessary cables and pulleys, resulting in a more compact and lighter structure. The force-feedback structure also serves as position measuring exoskeleton, by integrating noncontact Hall-effect and infrared sensors. The glove is connected to a haptic-control interface that reads its sensors and servos its actuators. The interface has pneumatic servovalves, signal conditioning electronics, A/D/A boards, power supply and an imbedded Pentium PC. This distributed computing assures much faster control bandwidth than would otherwise be possible. Communication with the host PC is done over an RS232 line. Comparative data with the CyberGrasp commercial haptic glove is presented.

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The Rutgers Master II-new design force-feedback glove

The “Rutgers Ankle” is a Stewart platform-type haptic interface designed for use in rehabilitation The system supplies six-DOF resistive forces in response to virtual reality-based exercises running on a host PC The Stewart platform uses double-acting pneumatic cylinders, linear potentiometers as position sensors, and a six-DOF force sensor The Rutgers Ankle controller contains an embedded Pentium board, pneumatic solenoid valves, valve controllers, and associated signal conditioning electronics Communication with the host PC is over a standard RS232 line The platform movement and output forces are transparently recorded by the host PC in a database This database can be accessed remotely over the Internet Thus, the Rutgers Ankle Orthopedic Rehabilitation Interface will allow patients to exercise at home while being monitored remotely by therapists A prototype was constructed, and proof-of-concept trials were conducted at the University of Medicine and Dentistry of New Jersey The results indicate that the system works well as a diagnostic tool The subjective evaluation by patients was very positive Further medical trials are needed before the system clinical efficacy in rehabilitation can be established

A Stewart Platform-Based System for Ankle Telerehabilitation

The Rutgers Master II-ND glove is a follow up on the earlier Rutgers Master II haptic interface. The redesigned glove has all the sensing placed on palm support, avoiding routing wires to the fingertips. It uses custom pneumatic actuators arranged in a direct-drive configuration between the palm and the thumb, index middle and ring fingers. The supporting glove used in the RMII design is eliminated, thus the RMII-ND can better accommodate varying hand sizes. The glove is connected to a haptic control interface that reads its sensors and servos its actuators. The interface pneumatic pulse-width modulated servo-valves have higher bandwidth than those used in the earlier RMII, resulting in better force control. A comparison with the CyberGrasp commercial haptic glove is provided.

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The Rutgers Master II-ND force feedback glove

The present invention relates to a system for rehabilitating an ankle in which a mobile platform receives a patient's foot. The mobile platform can be moved in six degrees of freedom. The position and orientation of the mobile platform is measured in relation to the fixed platform in six degrees of freedom. The force exerted by the foot against the mobile platform is measured in six degrees of freedom. The measured position and measured force are forwarded to an electronic interface and fed to a programmable computer. The programmable computer determines desired force feedback to be applied by the controller interface to the mobile platform. The desired feedback signal moves the mobile platform to a desired position or applies a desired force or torque to the mobile platform. The rehabilitation system can include simulation of virtual objects which can be moved by the user to simulate an exercise. For example, the virtual reality simulation can include exercises for balance, flexibility and strength. The system can be remotely controlled in a telerehabilitation environment.

Ankle rehabilitation system

A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

Mourad Bouzit

Papers

The Rutgers Master II-new design force-feedback glove

A Stewart Platform-Based System for Ankle Telerehabilitation

The Rutgers Master II-ND force feedback glove

Ankle rehabilitation system

Orthopedic rehabilitation using the "Rutgers ankle" interface.