Design strategies to improve patient motivation during robot-aided rehabilitation

So patient motivation has always been wrong, in this case since 2007. 

Motivation is extremely easy to understand and implement. 

Write up 100% recovery protocols on this and survivors will do the millions of reps needed, no external motivation required. You don't understand one goddamn thing about stroke survivors, DO YOU? The problem is stroke researchers are not motivated to solve stroke. What the fuck is your solution to that failure? We still don't know how to motivate stroke medical 'professionals' to solve stroke to 100% recovery!

Design strategies to improve patient motivation during robot-aided rehabilitation

• Roberto Colombo,
• Fabrizio Pisano,
• Alessandra Mazzone,
• Carmen Delconte,
• Silvestro Micera,
• M Chiara Carrozza,
• Paolo Dario &
• Giuseppe Minuco 

Journal of NeuroEngineering and Rehabilitation volume 4, Article number: 3 (2007) Cite this article

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Abstract

Background

Motivation is an important factor in rehabilitation and frequently used as a determinant of rehabilitation outcome. Several factors can influence patient motivation and so improve exercise adherence. This paper presents the design of two robot devices for use in the rehabilitation of upper limb movements, that can motivate patients during the execution of the assigned motor tasks by enhancing the gaming aspects of rehabilitation. In addition, a regular review of the obtained performance can reinforce in patients' minds the importance of exercising and encourage them to continue, so improving their motivation and consequently adherence to the program. In view of this, we also developed an evaluation metric that could characterize the rate of improvement and quantify the changes in the obtained performance.

Methods

Two groups (G1, n = 8 and G2, n = 12) of patients with chronic stroke were enrolled in a 3-week rehabilitation program including standard physical therapy (45 min. daily) plus treatment by means of robot devices (40 min., twice daily) respectively for wrist (G1) and elbow-shoulder movements (G2). Both groups were evaluated by means of standard clinical assessment scales and the new robot measured evaluation metric. Patients' motivation was assessed in 9/12 G2 patients by means of the Intrinsic Motivation Inventory (IMI) questionnaire.

Results

Both groups reduced their motor deficit and showed a significant improvement in clinical scales and the robot measured parameters. The IMI assessed in G2 patients showed high scores for interest, usefulness and importance subscales and low values for tension and pain subscales.

Conclusion

Thanks to the design features of the two robot devices the therapist could easily adapt training to the individual by selecting different difficulty levels of the motor task tailored to each patient's disability. The gaming aspects incorporated in the two rehabilitation robots helped maintain patients' interest high during execution of the assigned tasks by providing feedback on performance. The evaluation metric gave a precise measure of patients' performance and thus provides a tool to help therapists promote patient motivation and hence adherence to the training program.

Background

Recent epidemiological data point to an increasing trend in prevalence of stroke and this fact has prompted novel treatment approaches based on robot-aided neurorehabilitation. Many researchers using these new rehabilitation tools have investigated upper limb rehabilitation effects by means of detailed kinematic analyses before and after treatment. In particular the MIT-Manus [1–3] and Mirror-Image Motion Enabler (MIME) robots [4, 5], which were developed for unrestricted unilateral or bilateral shoulder and elbow movement, show that recovery can be improved through additional therapy aided by robot technology. The ARM guide [6], which assists reaching in a straight-line trajectory, and the Bi-Manu-Track [7], which enables active and passive bilateral forearm and wrist movement, show also that use of simple devices makes possible intensive training of chronic post stroke subjects with positive results in terms of reduction in spasticity, easier hand hygiene, and pain relief. The Gentle/s system [8] is an appealing device that, by coupling models for human arm movement with haptic interfaces and virtual reality technology, can provide robot mediated motor tasks in a three dimensional space. Finally, a robot device based on recent studies of neuro-adaptive control, has been used to generate custom training forces to "trick" subjects into altering their target-directed reaching movements to a prechosen movement as an after-effect of adaptation [9]. This system applies a form of "implicit learning" for teaching motor skills, so demonstrating that it is possible to learn at a quasi-subconscious level with minimal attention and less motivation than more explicit types of practice like pattern tracing.

Motivation is an important factor in rehabilitation and is frequently used as a determinant of rehabilitation outcome [10]. In particular, active engagement towards a treatment/training intervention is usually equated with motivation, and passivity with lack of motivation. Consequently, high adherence to a rehabilitation program is seen as indicative of motivation [11]. In addition to personality and social factors the motivation and adherence of patients to robot-aided treatments can be greatly influenced by the design features of the biomedical robot. In particular the difficulty level of the motor task, the awareness of the performance obtained, and the quantity and quality of feedbacks presented to the patient can influence patient motivation and produce different ways of acting and different performances. Environmental demands play a critical role in the determination of how people execute purposeful actions. Environmental features usually influence the choice of motor strategies. These environmental features are referred to as "regulatory conditions". Often in rehabilitation therapy, patients are asked to perform one or two movement patterns repetitively, the goal being to improve motor performance. Persons with hemiplegia need opportunities to practise skills in situations with varying regulatory conditions so that they can develop motor schemata that are versatile enough to meet the situations they encounter in daily life [12]. Therefore, robot-aided rehabilitation, even if it involves practising only a few articular movements with simple motor tasks, may be considered a tool to help the therapist motivate patients to do voluntary activity with the affected limb when the practice of daily living activities (ADL) is hindered by disability. Robot devices used in neurorehabilitation can offer the patient various different types of feedback and modes of interaction, so influencing the learning process at different levels. It is worth noting that the possibility of assessing patients' performance in a repeatable, objective manner is of great advantage in stroke rehabilitation, and in evaluating treatment effects.

The aim of this paper is to present two rehabilitation robots and the design strategies we implemented in order to boost patient motivation and improve adherence. In addition, we outline a new evaluation metric for quantifying the patient's rate of improvement and allowing a regular review of the performance.

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