Socially Assistive Robot for Stroke Rehabilitation: A Long-Term in-the-Wild Pilot Randomized Controlled Trial.

Socially assistive robots (SARs) have been suggested as a platform for post-stroke training. It is not yet known whether long-term interaction with a SAR can lead to an improvement in the functional ability of individuals post-stroke. The aim of this pilot study was to compare the changes in motor ability and quality of life following a long-term intervention for upper-limb rehabilitation of post-stroke individuals using three approaches: 1) training with a SAR in addition to usual care; 2) training with a computer in addition to usual care; and 3) usual care with no additional intervention. Thirty-three post-stroke patients with moderate-severe to mild impairment were randomly allocated into three groups: two intervention groups - one with a SAR (ROBOT group) and one with a computer (COMPUTER group) - and one control group with no intervention (CONTROL group). The intervention sessions took place three times/week, for a total of 15 sessions/participant; The study was conducted over a period of two years, during which 306 sessions were held. Twenty-six participants completed the study. Participants in the ROBOT group significantly improved in their kinematic and clinical measures which included smoothness of movement, action research arm test (ARAT), and Fugl-Meyer upper-extremity assessment (FMA-UE). No significant improvement in these measures was found in the COMPUTER or the control groups. 100% of the participants in the SAR group gained improvement which reached - or exceeded - the minimal clinically important difference in the ARAT, the gold standard for upper-extremity activity performance post-stroke. This study demonstrates both the feasibility and the clinical benefit of using a SAR for long-term interaction with post-stroke individuals as part of their rehabilitation program. Trial Registration: ClinicalTrials.gov NCT03651063.

Barriers and Facilitators of Vestibular Rehabilitation: Patients and Physiotherapists' Perspectives.

BACKGROUND AND PURPOSE: Poor adherence to vestibular rehabilitation protocols is a known barrier to optimal care. Vestibular clinicians' comprehensive understanding of the barriers and facilitators to vestibular home exercise programs (VHEP) is a key element to achieving optimal care in the context of vestibular rehabilitation. The aims of this study are as follows: (1) to identify primary barriers and facilitators to VHEP from the perspective of patients with vestibular dysfunction and vestibular physical therapists (PTs); and (2) to provide strategies for clinicians to improve adherence and outcomes of VHEP. METHODS: A qualitative research with single-session focus groups conducted separately for: (1) patients with vestibular disorders and (2) vestibular PTs. Six focus groups were conducted, 3 for each population, with a total of 39 participants. An online survey was conducted to evaluate the estimates of adherence rates, followed by a structured discussion over barriers and facilitators to VHEP as perceived by patients and PTs. Thematic data analyses were performed using a mixed deductive-inductive approach. RESULTS: Eighteen patients with vestibular disorders and 21 experienced vestibular PTs participated in this study. Six barrier categories and 5 facilitator categories were identified. Barriers included motivation aspects, provocation of symptoms, time management, associated impairments, missing guidance and feedback, and psychosocial factors. Facilitators included motivation aspects, time management, patient education and exercise instructions, exercise setting, and associated symptom management. DISCUSSION AND CONCLUSIONS: Clinicians who prescribe home exercise to patients with vestibular disorders can use this information about common barriers and facilitators for patient education and to provide optimal care and improve rehabilitation outcomes. VIDEO ABSTRACT AVAILABLE: for more insights from the authors (see the video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A467).

"Robots for good": Ten defining questions.

Ten questions to guide reflection and assessment of the "good" in robotics projects are suggested.

A novel socially assistive robotic platform for cognitive-motor exercises for individuals with Parkinson's Disease: a participatory-design study from conception to feasibility testing with end users.

The potential of socially assistive robots (SAR) to assist in rehabilitation has been demonstrated in contexts such as stroke and cardiac rehabilitation. Our objective was to design and test a platform that addresses specific cognitive-motor training needs of individuals with Parkinson's disease (IwPD). We used the participatory design approach, and collected input from a total of 62 stakeholders (IwPD, their family members and clinicians) in interviews, brainstorming sessions and in-lab feasibility testing of the resulting prototypes. The platform we developed includes two custom-made mobile desktop robots, which engage users in concurrent cognitive and motor tasks. IwPD (n = 16) reported high levels of enjoyment when using the platform (median = 5/5) and willingness to use the platform in the long term (median = 4.5/5). We report the specifics of the hardware and software design as well as the detailed input from the stakeholders.

Ethical considerations in child-robot interactions.

Social robots hold promise in augmenting education, rehabilitative care, and leisure activities for children. Despite findings suggesting various benefits of social robot use in schools, clinics, and homes, stakeholders have voiced concerns about the potential social and emotional effects of children engaging in long-term interactions with robots. Given the challenges of conducting large long-term studies of child-robot interaction (CRI), little is known about the impact of CRI on children's socio-emotional development. Here we summarize the literature on predictions and expectations of teachers, parents, therapists, and children regarding the effects of CRI on children's socio-emotional functioning and skill building. We then highlight the limited body of empirical research examining how CRI affects children's social behavior and emotional expression, and we provide a summary of available questionnaires for measuring socio-emotional constructs relevant to CRI. We conclude with design recommendations for research studies aimed at better understanding the effects of CRI, before social robots become ubiquitous. This review is relevant to researchers, educators, roboticists, and clinicians interested in designing and using social robots with developmental populations.

Corrigendum: Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke.

[This corrects the article DOI: 10.3389/fnins.2023.1264513.].

Correlation between kinetic and kinematic measures, clinical tests and subjective self-evaluation questionnaires of the affected upper limb in people after stroke.

Introduction: Assessment of stroke recovery should include multiple sources of information in order to obtain a complete understanding of the individual's rehabilitation progress. Self-evaluation questionnaires' scores do not always correspond to the scores of commonly used clinical evaluation tools. The purpose of this study was to assess the relationship between self-evaluation questionnaires, clinical tests, and kinematic and kinetic analyses of the affected upper limb after stroke, and to determine the correlation between these measures and self-reported general function 2-4 years after the stroke. Methods: Twenty-six subjects recovering from stroke were included in the study. Spearman's correlation coefficient was used to measure the correlation between Stroke Impact Scale (SIS), Motor activity Log (MAL), Fugl-Meyer Assessment (FMA) and Action Reach Arm Test (ARAT) scores, and kinematic and kinetic analyses. A logistic regression was used to assess the extent to which these measures may predict the participants' functional self-reported status 2-4 years post stroke. Results: Sections regarding hand function, hand force and general ADL of the self-evaluation questionnaires correlated with kinematic variables. However, only questionnaires that focus on hand function correlated with clinical tests. Mean and maximal hand velocity had the strongest correlations with self-evaluation questionnaires and with the clinical tests, more than other kinematic variables. Self-evaluation questionnaires and clinical tests were found to be correlated with hand kinetic metrics force-to-time ratio and number of force peaks. SIS hand force domain, mean velocity and maximal velocity predicted self-reported general function 2-4 years after the stroke. Conclusion: Self-evaluation questionnaires should be considered for wider use in the clinical evaluation of a patient's stroke recovery, since they add important information on the individual's functional status, which is not reflected in the clinical tests.

Extended Interviews with Stroke Patients Over a Long-Term Rehabilitation Using Human-Robot or Human-Computer Interactions.

Socially assistive robots (SARs) have been proposed to assist post-stroke patients in performing their exercise during their rehabilitation process, with the trust in the robot identified as an important factor in human-robot interaction. In the current study, we aimed to identify and characterize factors that influence post-stroke patients' trust in a robot-operated and a computer-operated rehabilitation platform during and after a long-term experience with the platform. We conducted 29 interviews with 16 stroke patients who underwent a long-term rehabilitation process, assisted by either a SAR or a computer interface. The intervention lasted 5-7 weeks per patient, for a total of 229 sessions over 18 months. By using a qualitative research method-extended interviews "in the wild" with stroke patients, over a long-term rehabilitation process-our study reveals users' perspectives regarding factors affecting trust in the SAR or in the computer interface during their rehabilitation process. The results support the assertion that SARs have an added value in the rehabilitative care of stroke patients; It appears that personal characteristics, such as age and gender, have an effect on the users' acceptance of a non-human operator as a practice assistant. Our findings support the notion that SARs augment rehabilitative therapies beyond a standard computer; Importantly, patients appreciated different aspects of the non-human operator in the two groups: In the SAR group, users preferred its functional performance over its anthropomorphized social skills; In the Computer group, users highlighted its contribution to the training of their memory skills. Supplementary Information: The online version contains supplementary material available at 10.1007/s12369-022-00909-7.

Automating provision of feedback to stroke patients with and without information on compensatory movements: A pilot study.

Providing effective feedback to patients in a rehabilitation training program is essential. As technologies are being developed to support patient training, they need to be able to provide the users with feedback on their performance. As there are various aspects on which feedback can be given (e.g., task success and presence of compensatory movements), it is important to ensure that users are not overwhelmed by too much information given too frequently by the assistive technology. We created a rule-based set of guidelines for the desired hierarchy, timing, and content of feedback to be used when stroke patients train with an upper-limb exercise platform which we developed. The feedback applies to both success on task completion and to the execution of compensatory movements, and is based on input collected from clinicians in a previous study. We recruited 11 stroke patients 1-72 months from injury onset. Ten participants completed the training; each trained with the rehabilitation platform in two configurations: with motor feedback (MF) and with no motor feedback (control condition) (CT). The two conditions were identical, except for the feedback content provided: in both conditions they received feedback on task success; in the MF condition they also received feedback on making undesired compensatory movements during the task. Participants preferred the configuration that provided feedback on both task success and quality of movement (MF). This pilot experiment demonstrates the feasibility of a system providing both task-success and movement-quality feedback to patients based on a decision tree which we developed.

Interaction Matters: The Effect of Touching the Social Robot PARO on Pain and Stress is Stronger When Turned ON vs. OFF.

Social touch between humans, as well as between humans and animals, was previously found to reduce pain and stress. We previously reported that touching a social robot can also induce a reduction in pain ratings. However, it is unclear if the effect that touching a robot has on pain perception is due to its appearance and its pleasant touch, or due to its ability to socially interact with humans. In the current experiment, we aimed to assess the contribution of the interactive quality to pain perception. We assessed the effect of touching the social robot PARO on mild and strong pain ratings and on stress perception, on a total of 60 healthy young participants. The robot either interacted with participants (ON group, n = 30) or was turned off (OFF group, n = 30). Touching the robot induced a decrease in mild pain ratings (compared to baseline) only in the ON group while strong pain ratings decreased similarly in both the ON and the OFF groups. The decrease in mild pain ratings in the ON group was significantly greater in participants with a higher positive perception of the interaction with PARO. We conclude that part of the effect that touching the robot has on pain stems from its interactive features.

The effects of an object's height and weight on force calibration and kinematics when post-stroke and healthy individuals reach and grasp.

Impairment in force regulation and motor control impedes the independence of individuals with stroke by limiting their ability to perform daily activities. There is, at present, incomplete information about how individuals with stroke regulate the application of force and control their movement when reaching, grasping, and lifting objects of different weights, located at different heights. In this study, we assess force regulation and kinematics when reaching, grasping, and lifting a cup of two different weights (empty and full), located at three different heights, in a total of 46 participants: 30 sub-acute stroke participants, and 16 healthy individuals. We found that the height of the reached target affects both force calibration and kinematics, while its weight affects only the force calibration when post-stroke and healthy individuals perform a reach-to-grasp task. There was no difference between the two groups in the mean and peak force values. The individuals with stroke had slower, jerkier, less efficient, and more variable movements compared to the control group. This difference was more pronounced with increasing stroke severity. With increasing stroke severity, post-stroke individuals demonstrated altered anticipation and preparation for lifting, which was evident for either cortical lesion side.

A robot goes to rehab: a novel gamified system for long-term stroke rehabilitation using a socially assistive robot-methodology and usability testing.

BACKGROUND: Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Yet, to date, there are no data on the motivating benefit of SARs in a long-term interaction with post-stroke patients. METHODS: Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 24 post-stroke patients were randomly allocated to exercise with this platform-either with the robot or the computer configuration-over a 5-7 week period, 3 times per week, for a total of 306 sessions. RESULTS: The participants in both groups reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with it even after the study ended. We found a trend for higher acceptance of the system by the participants in the robot group on all parameters; however, this difference was not significant. We found that system failures did not affect the long-term trust that users felt towards the system. CONCLUSIONS: We demonstrated the usability of using this platform for a long-term rehabilitation with post-stroke patients in a clinical setting. We found high levels of acceptance of both platform configurations by patients following this interaction, with higher ratings given to the SAR configuration. We show that it is not the mere use of technology that increases the motivation of the person to practice, but rather it is the appreciation of the technology's effectiveness and its perceived contribution to the rehabilitation process. In addition, we provide a list of guidelines that can be used when designing and implementing other technological tools for rehabilitation. TRIAL REGISTRATION: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://clinicaltrials.gov/ct2/show/NCT03651063 .

A Socially Assistive Robot for Stroke Patients: Acceptance, Needs, and Concerns of Patients and Informal Caregivers.

Stroke patients often contend with long-term physical challenges that require treatment and support from both formal and informal caregivers. Socially Assistive Robots (SARs) can assist patients in their physical rehabilitation process and relieve some of the burden on the informal caregivers, such as spouses and family members. We collected and analyzed information from 23 participants (11 stroke patients and 12 informal caregivers) who participated in a total of six focus-group discussions. The participants responded to questions regarding using a SAR to promote physical exercises during the rehabilitation process: (a) the advantages and disadvantages of doing so; (b) specific needs that they wish a SAR would address; (c) patient-specific adaptations they would propose to include; and (d) concerns they had regarding the use of such technology in stroke rehabilitation. We found that the majority of the participants in both groups were interested in experiencing the use of a SAR for rehabilitation, in the clinic and at home. Both groups noted the advantage of having the constant presence of a motivating entity with whom they can practice their rehabilitative exercises. The patients noted how such a device can assist formal caregivers in managing their workload, while the informal caregivers indicated that such a system could ease their own workload and sense of burden. The main disadvantages that participants noted related to the robot not possessing human abilities, such as the ability to hold a conversation, to physically guide the patient's movements, and to express or understand emotions. We anticipate that the data collected in this study-input from the patients and their family members, including the similarities and differences between their points of view-will aid in improving the development of SARs for rehabilitation, so that they can better suit people who have had a stroke, and meet their individual needs.

Touching the social robot PARO reduces pain perception and salivary oxytocin levels.

Human-human social touch improves mood and alleviates pain. No studies have so far tested the effect of human-robot emotional touch on experimentally induced pain ratings, on mood and on oxytocin levels in healthy young adults. Here, we assessed the effect of touching the robot PARO on pain perception, on mood and on salivary oxytocin levels, in 83 young adults. We measured their perceived pain, happiness state, and salivary oxytocin. For the 63 participants in the PARO group, pain was assessed in three conditions: Baseline, Touch (touching PARO) and No-Touch (PARO present). The control group (20 participants) underwent the same measurements without ever encountering PARO. There was a decrease in pain ratings and in oxytocin levels and an increase in happiness ratings compared to baseline only in the PARO group. The Touch condition yielded a larger decrease in pain ratings compared to No-Touch. These effects correlated with the participants' positive perceptions of the interaction with PARO. Participants with higher perceived ability to communicate with PARO experienced a greater hypoalgesic effect when touching PARO. We show that human-robot social touch is effective in reducing pain ratings, improving mood and - surprisingly - reducing salivary oxytocin levels in adults.

Implicit task switching in Parkinson's disease is preserved when on medication.

People with Parkinson's disease have been shown to have difficulty switching between movement plans. In the great majority of studies, the need to switch between tasks was made explicitly. Here, we tested whether people with Parkinson's disease, taking their normal medication, have difficulty switching between implicitly specified tasks. We further examined whether this switch is performed predictively or reactively. Twenty five people with Parkinson's disease continuously increased or decreased the frequency of their arm movements, inducing an abrupt-but unaware-switch between rhythmic movements (at high frequencies) and discrete movements (at low frequencies). We tested whether that precipitous change was performed reactively or predictively. We found that 56% of participants predictively switched between the two movement types. The ability of people with Parkinson's disease, taking their regular medication, to predictively control their movements on implicit tasks is thus preserved.

Trust in socially assistive robots: Considerations for use in rehabilitation.

Incorporation of social robots into rehabilitation calls for understanding what factors affect user motivation and success of the interaction. Trust between the user and the robot has been identified as important in human-robot interaction and in human-human interactions in therapy. Trust has been studied in the context of automation technology, (e.g., autonomous cars), but not in the context of social robots for rehabilitation. In this narrative review, we address the unique patient-clinician-robot triad, and argue that this context calls for specific design features in order to foster trust with the users. We review pertinent methods for measuring trust, and studies demonstrating that culture, prior experience and propensity-to-trust affect to what extent users trust robots. We suggest design guidelines for fostering trust and methods for measuring trust in human-robot interactions in rehabilitation. We stress the need to create measures of trust that are accessible to people who suffer from speech or cognitive impairments. This review is pertinent to researchers, roboticists, and clinicians interested in designing and using social robots for rehabilitation.

Improvement in upper-limb UPDRS motor scores following fast-paced arm exercise: A pilot study.

BACKGROUND: The symptoms of patients with Parkinson's disease (PD) have been shown to improve when they perform fast-paced rhythmic cycling movements with their lower limbs. OBJECTIVE: Our goal in this pilot experiment was to test the feasibility and the benefits of a short exercise program involving fast-paced rhythmic movements of the upper limb for patients with PD. METHODS: We used an experimental procedure that elicits large, fast-paced movements by the participants without the direct instructions to do so by the experimenter. Ten participants with PD (71.0±6.5 years old) performed a 50-min fast-paced rhythmic exercise of the upper limb after withdrawal from PD medication for at least 12 hours. RESULTS: Participants improved their kinematic performance, in terms of accuracy and combined speed and amplitude (p < 0.02), as well as their upper-limb MDS-UPDRS motor scores (p = 0.023). CONCLUSIONS: The results demonstrate the feasibility of using the described apparatus to perform an exercise session of approximately 50 min with both arms, and give a preliminary indication of the potential benefit of such an exercise program.

Robotic gaming prototype for upper limb exercise: Effects of age and embodiment on user preferences and movement.

BACKGROUND: Effective human-robot interactions in rehabilitation necessitates an understanding of how these should be tailored to the needs of the human. We report on a robotic system developed as a partner on a 3-D everyday task, using a gamified approach. OBJECTIVES: To: (1) design and test a prototype system, to be ultimately used for upper-limb rehabilitation; (2) evaluate how age affects the response to such a robotic system; and (3) identify whether the robot's physical embodiment is an important aspect in motivating users to complete a set of repetitive tasks. METHODS: 62 healthy participants, young (<30 yo) and old (>60 yo), played a 3D tic-tac-toe game against an embodied (a robotic arm) and a non-embodied (a computer-controlled lighting system) partner. To win, participants had to place three cups in sequence on a physical 3D grid. Cup picking-and-placing was chosen as a functional task that is often practiced in post-stroke rehabilitation. Movement of the participants was recorded using a Kinect camera. RESULTS: The timing of the participants' movement was primed by the response time of the system: participants moved slower when playing with the slower embodied system (p = 0.006). The majority of participants preferred the robot over the computer-controlled system. Slower response time of the robot compared to the computer-controlled one only affected the young group's motivation to continue playing. CONCLUSION: We demonstrated the feasibility of the system to encourage the performance of repetitive 3D functional movements, and track these movements. Young and old participants preferred to interact with the robot, compared with the non-embodied system. We contribute to the growing knowledge concerning personalized human-robot interactions by (1) demonstrating the priming of the human movement by the robotic movement - an important design feature, and (2) identifying response-speed as a design variable, the importance of which depends on the age of the user.

Smooth leader or sharp follower? Playing the mirror game with a robot.

BACKGROUND: The increasing number of opportunities for human-robot interactions in various settings, from industry through home use to rehabilitation, creates a need to understand how to best personalize human-robot interactions to fit both the user and the task at hand. In the current experiment, we explored a human-robot collaborative task of joint movement, in the context of an interactive game. OBJECTIVE: We set out to test people's preferences when interacting with a robotic arm, playing a leader-follower imitation game (the mirror game). METHODS: Twenty two young participants played the mirror game with the robotic arm, where one player (person or robot) followed the movements of the other. Each partner (person and robot) was leading part of the time, and following part of the time. When the robotic arm was leading the joint movement, it performed movements that were either sharp or smooth, which participants were later asked to rate. RESULTS: The greatest preference was given to smooth movements. Half of the participants preferred to lead, and half preferred to follow. Importantly, we found that the movements of the robotic arm primed the subsequent movements performed by the participants. CONCLUSION: The priming effect by the robot on the movements of the human should be considered when designing interactions with robots. Our results demonstrate individual differences in preferences regarding the role of the human and the joint motion path of the robot and the human when performing the mirror game collaborative task, and highlight the importance of personalized human-robot interactions.