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

This paper presents a novel ankle rehabilitation device currently under development. The haptic interface component has a Stewart platform structure with pneumatic actuators controlled by an electronic interface. It allows movement of the ankle though its full range of motion. The system communicates with a PC through an RS232 port. The PC will run game-like virtual reality exercises that control the movement and output forces of the device. These simulations will make exercising more enjoyable, transparently recording patient progress for evaluation by therapists. The “Rutgers Ankle” Orthopedic Rehabilitation Interface will facilitate the healing of one of the most often injured joints of the body. Inherently safe and easy-to-operate, it will combine the capabilities of many current rehabilitation devices. This system will enhance rehabilitation routines by providing three types of exercises: strengthening, stretching, and balancing. Eventually, this system will allow patients to exercise in their homes while being monitored remotely by therapists or physicians.

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'Rutgers ankle' orthopedic rehabilitation interface

Magnetorheological fluid (MRF) is a smart material that has the property of changing its viscosity when exposed to a magnetic field. By placing this fluid into a sealed cylinder with an electromagnet piston as a core, a controllable resistance motion dampener can be created. A novel exoskeleton mechanical power transmission system was designed, utilizing rapid prototype parts, to transmit these resistive forces to the user's fingertips. A first iteration force feedback glove was developed and tested on human subjects for overall usability. The eventual goal of the system is to provide an alternative force producing system for exercises and rehabilitation. The entire system is lightweight, low power, and easily portable

Use of Magnetorheological Fluid in a Force Feedback Glove

There is increasing realization that some tasks can be performed significantly better by humans than robots but, due to associated hazards, distance, etc., only a robot can be employed. Telemedicine is one area where remotely controlled robots can have a major impact by providing urgent care at remote sites. In recent years, remotely controlled robotics has been greatly advanced and the NASA Johnson Space Center’s robotic astronaut, “Robonaut,” is one such exa mple. Unfortunately, due to the unavailability of force and tactile feedback the operator must determine the required action by visually examining the remote site and therefore limiting the tasks that Robonaut can perform. There is a great need for dexterous, fast, accurate teleoperated robots with the operator's ability to "feel" the environment at the robot's field. The authors conceived a haptic mechanism called MEMICA (Remote MEchanical MIrroring using Controlled stiffness and Actuators) that can enable the design of high dexterity, rapid response, and large workspace haptic system. The development of a novel MEMICA gloves and virtual reality models are being explored to allow simulation of telesurgery and other applications. The MEMICA gloves are being designed to provide intuitive mirroring of the conditions at a virtual site where a robot simulates the presence of a human operator. The key components of MEMICA are miniature electrically controlled stiffness (ECS) elements and Electrically Controlled Force and Stiffness (ECFS) actuators that are based on the use of Electro-Rheological Fluids (ERF). In this paper the design of the MEMICA system and initial experimental results are presented.

Virtual reality robotic telesurgery simulations using MEMICA haptic system

Stroke is one of the leading causes of death and disability worldwide Its prevalence calls for innovative rehabilitation methods The Rutgers Arm is a novel upper extremity rehabilitation system consisting of a low-friction table, three-dimensional (3D) tracker, custom forearm support, PC workstation, library of Java 3D virtual reality (VR) exercises, clinical database module, and a tele-rehabilitation extension The system was tested on a chronic stroke subject, under local and tele-rehabilitation conditions, over 5 weeks of training Results show improvements in arm motor control and shoulder range of motion, corresponding to improved Fugl-Meyer test scores Exercise duration, level of difficulty, and patient motivation were maintained under tele-rehabilitaion A 1-week retention trial showed that gains were maintained

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The Rutgers Arm, a rehabilitation system in virtual reality: a pilot study.

The present invention relates to a force feedback and sensing system for a hand in which an actuator system and sensing system is coupled to a palm base attached to the hand or a glove. The actuator system includes double acting actuators which provide force feedback against digits of the hand to simulate a real experience a user would have if directly manipulating a real object. The actuators are rotatably mounted to the palm base through a two degrees of freedom rotation joint.

Mourad Bouzit

Papers

'Rutgers ankle' orthopedic rehabilitation interface

Use of Magnetorheological Fluid in a Force Feedback Glove

Virtual reality robotic telesurgery simulations using MEMICA haptic system

The Rutgers Arm, a rehabilitation system in virtual reality: a pilot study.

Hand force feedback and sensing system