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Question: Despite intensive rehabilitation, stroke patients keep neurological impairments limiting their activities of daily living. To improve upper limb (UL) rehabilitation, current guidelines recommend robotic assisted therapy (RAT). To date, RAT relies on assisted-as-needed (AAN) principles. New treatment modalities, combining simultaneous motor and cognitive rehabilitation, aim for better recovery outcomes. Our team developed ROBiGAME, a serious game that simultaneously rehabilitates motor and cognitive functions and continuously regulates game difficulty. Exercise characteristics are continuously adapted according to the patients’ performances during the game. This study investigated whether this dynamic difficulty adjustment is optimal according to neurorehabilitation principles of variable practice and increasing difficulty (using as optimal success rate of 75%). Method: 9 stroke patients were enrolled in a 5-day protocol. Clinical and robot-based assessment (including Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT)) was done during the first two sessions. Then, every participant completed three 30 minutes sessions of RAT playing with ROBiGAME. Initial low level of game difficulty was set to be the same for every participant at the beginning of the first session. Patients’ performance and the serious game’s exercise characteristics were recorded throughout the sessions. Results: Motor difficulty parameters oscillate towards a steady state half-way through the first session (after 10 to 15 exercises) underlying a rapid adaptation of the system to every individual. In addition, mean success rates average 74,55% ±3% indicating an optimal success rate to maintain patients’ motivation. Finally, FMA and ARAT scores strongly correlated to haptic assistance indices (FMA:r=0,95 p<0,001; ARAT: r=0,87 p=0,005) showing that motor difficulty adapts well to the severity of patients’ motor impairment. Conclusions: This study demonstrates that continuous motor difficulty adjustment when using ROBiGAME is adapted to the patients’ degree of impairment and remains optimal throughout treatment. Further investigations on how cognitive parameters influence game difficulty adjustment and arm kinematics indices should be done.
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Doumas, I., Lejeune, T., Edwards, M., Stoquart, G., Montedoro, V., Heins, S., & Dehem, S. (2020). Motor and cognitive combined control system for upper limb robot assisted rehabilitation after stroke. 11th World Congress of NeuroRehabilitation jointly with 35th Congress of the French Society of Physical and Rehabilitation Medi, Virtuel. https://hdl.handle.net/2078.5/215654