Effects of robot viscous forces on arm movements in chronic stroke survivors: a randomized crossover study

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Effects of robot viscous forces on arm movements in chronic stroke survivors: a randomized crossover study

• Yazan Abdel Majeed,
• Saria Awadalla &
• James L. Patton 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 156 (2020) Cite this article

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Abstract

Background

Our previous work showed that speed is linked to the ability to recover in chronic stroke survivors. Participants moving faster on the first day of a 3-week study had greater improvements on the Wolf Motor Function Test.

Methods

We examined the effects of three candidate speed-modifying fields in a crossover design: negative viscosity, positive viscosity, and a “breakthrough” force that vanishes after speed exceeds an individualized threshold.

Results

Negative viscosity resulted in a significant speed increase when it was on. No lasting after effects on movement speed were observed from any of these treatments, however, training with negative viscosity led to significant improvements in movement accuracy and smoothness.

Conclusions

Our results suggest that negative viscosity could be used as a treatment to augment the training process while still allowing participants to make their own volitional motions in practice.

Trial registration

This study was approved by the Institutional Review Boards at Northwestern University (STU00206579) and the University of Illinois at Chicago (2018-1251).

Background

Stroke neurorehabilitation often uses the unique aspects of technology to improve motor recovery. While some researchers endeavored to simply assist movement to more closely resemble healthy patterns [1,2,3], others have attempted to exploit unique capabilities of robotics or graphic feedback to encourage neuroplasticity by augmenting error [4,5,6,7,8]. Even some traditional physical therapy exercises use mirrors to get the paretic side of the body to imitate the non-paretic side [9]. These are beneficial but far from a complete cure, and it remains to be seen what strategies emerge as optimal and what might still be left undiscovered.

An alternative strategy is to first uncover the attributes associated with better clinical movement outcomes, and then target training around these [10, 11]. Our previous work [12] employed a data-driven approach to model participant improvement using metrics derived from the movements themselves. We found that participant movement speed during the initial evaluation was most predictive of clinical changes. This speed was also the most strongly correlated with changes in the Wolf Motor Function Test (WMFT), making heightened speed a possible intervention for stroke. However, before such an intervention might be tested in clinical trials, we need to establish effective methods for speeding up participants.

There are multiple possible training conditions that may achieve this increase, and here we compare three candidate classes of conditions. One approach to affect movement speed is to directly increase it with a negative viscous field; previous work [13,14,15,16] showed that training with negative viscosity can improve participant movement and movement generalization abilities. Another possibility is to leverage the motor control mechanisms of error augmentation and after effects. Under this paradigm, participants would train with positive viscosity, under the expectation that their speed would increase as an aftereffect of that training when these resistive forces are removed [6, 17]. Finally, some research has shown that combining a resistive paradigm with a reward mechanism [18] may help participants learn better. In this case, participants will move in a positive viscosity field that attempts to slow them down, but moving above a certain speed is rewarded by a “breakthrough” where resistance vanishes. Participants may bias movements towards higher speeds to avoid the resistance.

Though it is somewhat understandable why these training conditions would change participant movement speed, the change being an increase is less obvious, especially when it comes to positive viscosity and breakthrough. Many research studies have demonstrated that training under certain conditions that alter normal movement - or perception of it - will induce an aftereffect in the opposite direction. This was shown to be true for primates [19] and humans [20]. Our reasoning for including positive viscosity is that the aftereffect of slowing movement speed would be an increase in speed when the slowing forces are removed. The breakthrough condition leverages the idea of limit-push. There is some evidence that introducing a “penalty” for participant movements that are undesired, and removing that penalty when participants conform to desired movements will bias subsequent motion towards these desired patterns, this was demonstrated using robotic forces [21] and purely visual distortions [22]. By penalizing slower movements in our breakthrough condition, and rewarding faster movements with removal of that penalty, we hope to bias participant motion towards these higher speeds.

In this preliminary clinical study, we simply compared the effects of these three paradigms on participant speed. Our modest goal was to determine if it was possible to influence participants’ speed. If speed is something that can be changed, we will explore the more difficult question of its influence on functional recovery for a later trial. Chronic stroke survivors participated in a single-visit crossover trial, where they trained for a short time under these three conditions. While we were mainly interested in the direct- and after-effects of these force paradigms on participant movement speed, we examined their effects on other movement metrics as well, such as error, efficiency, and smoothness.