Robot-Assisted Motivating Rehabilitation

Typically, after brain damage due to a stroke, the affected arm is weak and suffering from
some of paralysis. As a result, adults with this condition are unable to move their impaired
arm well during their activities of daily living. Our research is focused on understanding
how best to improve the ability of the arm to move after brain damage due to a stroke. We
have implemented novel robot technology designed for eventual use as a home therapy device
and have used software and hardware technologies to design activities that can assess the
arm ability and engage the person during therapy. We will study how the prolong use of this
device with simple, functional, and engaging activities improve the arm's movement ability
and sustain motivation to use the arm over repeated therapy sessions and away from
supervision.

Overall, we will establish whether using our technology to perform tasks that are more or
less game-like and functionally relevant to driving will make a difference in the impaired
arm after stroke. Two groups of stroke survivors will be followed while they complete
therapy. We have three main aims. In aim #1, we will determine whether therapy using
functional tasks compared to simple rote tasks lead to significant increases in the use of
the arm during therapy and the arm improvements experienced by the subjects after the
therapy. In aim #2, we will measure how each group engage in the more and less functional
therapy and monitor their effort and enjoyment during training. This aim will help us to
determine the value of more fun training. In aim #3, we will upgrade our technology for use
in the home therapy environment and follow some subjects to determine if the results change
in under supervised condition (at home)

Inclusion Criteria:

Subjects will be included in the study on the basis of the following criteria:

- They must be at least six months post-stroke.

- 18 years of age or older with a clinical diagnosis of hemiparesis (as verified by
medical record and a medical expert).

- They have voluntary control with a low to medium range of motion function (UE-FT<5)
and a muscle tone.

- They are functionally stable (no significant changes in motor function over a week)
and are able to tolerate being seated upright for 90 minutes.

- They report no excessive pain the impaired arm.

- If left neglect or spasticity is detected in the impaired arm, these levels must not
interfere with the ability to cognitively complete the tasks or turn a wheel.

- They must not be participating in any experimental rehabilitation or drug therapies.

- If subjects are receiving chemical injections for spasticity, they must be at least
3-months away from their last treatment.

- They must have driven prior to stroke.

- They are not clinically depressed (as measured by the Geriatric Depression Scale
(GDS) short form (Sheikh and Yesavage, 1986).

Exclusion Criteria:

- Subjects will be excluded from the study if they voluntarily decide to withdraw from
the study or if they do not meet the above inclusion criteria.

Once informed consent is given twenty-four of these subjects will be randomized into two
training groups (fun driving: fun and functional driving activities and rote tracking (12
subjects): rote and functional tracking activities). Two subjects will be randomized the
case study group. The groups will be matched in initial motor function.

Subjects will be excluded if they voluntarily decide to withdraw from the study or if they
do not meet the above inclusion criteria.