Haptic virtual rehabilitation in stroke: transferring research into clinical practice

Objective: The paper will give an overview of our work with a haptic immersive workbench which can be used in different setting for rehabilitation. Method: Forty-eight subjects participated in three different experiments. Twenty-nine users had a stroke and 19 were healthy individuals. The intervention in the first two experiments consisted of playing three-dimensional computer games. A computerised task was developed to assess motor movement of the affected upper extremity. In the third experiment, a computerised visuospatial neglect test was developed and compared with traditional neglect tests. The subject hand position data (haptic stylus end-point, i.e. x-, y-and z-coordinates) was measured during each trial in the different experiments. Results: All experiments demonstrated that this haptic immersive workbench can provide a quantitative analysis of hand movements. The first experiment showed improvements in the computerised task. One subject improved in occupational performance, i.e. improvement reflected in activities of daily living. The second experiment was consistent with the first, but the results have extended these findings, showing that virtual rehabilitation can be beneficial not only to younger users but also to elderly people in terms of enhancing their motor performance. In the third experiment, we showed that the computerised visuospatial neglect test gave additional information compared to traditional tests. Both the subjects with neglect and the subjects clinically recovered from neglect showed aberrant search performance in the cancellation task in the virtual environment. Conclusion: The haptic immersive workbench features assessment methods and three-dimensional computer games, which are adjustable with respect to degree of difficulty and users' abilities. For the future, we propose a system for Internet based connection and communication between users and between users and rehabilitation centres. The benefits of a system for rehabilitation after stroke, employing telemedicine, haptics, 3D-visualisation and serious-games should be more frequent exercising, better compliance with training in the home setting and improved quality of life.