Skip to main content
Top
Published in: Journal of NeuroEngineering and Rehabilitation 1/2007

Open Access 01-12-2007 | Research

Design strategies to improve patient motivation during robot-aided rehabilitation

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

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2007

Login to get access

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.
Appendix
Available only for authorised users
Literature
2.
go back to reference Volpe B, Krebs HI, Hogan N, Edelstein OTRL, Diels C, Aisen M: A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation. Neurology 2000, 54: 1938-1944.CrossRefPubMed Volpe B, Krebs HI, Hogan N, Edelstein OTRL, Diels C, Aisen M: A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation. Neurology 2000, 54: 1938-1944.CrossRefPubMed
3.
go back to reference Fasoli SE, Krebs HI, Stein J, Frontera WR, Hughes R, Hogan N: Robotic therapy for chronic motor impairments after stroke: Follow-up results. Arch Phys Med Rehabi 2004, 85: 1106-1111. 10.1016/j.apmr.2003.11.028CrossRef Fasoli SE, Krebs HI, Stein J, Frontera WR, Hughes R, Hogan N: Robotic therapy for chronic motor impairments after stroke: Follow-up results. Arch Phys Med Rehabi 2004, 85: 1106-1111. 10.1016/j.apmr.2003.11.028CrossRef
4.
go back to reference Burgar CG, Lum PS, Shor PC, Machiel Van der Loos HF: Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience. J Rehabil Res Dev 2000, 37: 663-673.PubMed Burgar CG, Lum PS, Shor PC, Machiel Van der Loos HF: Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience. J Rehabil Res Dev 2000, 37: 663-673.PubMed
5.
go back to reference Lum PS, Burgar CG, Shor PC, Majmundar M, Van der Loos M: Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil 2002, 83: 952-959. 10.1053/apmr.2001.33101CrossRefPubMed Lum PS, Burgar CG, Shor PC, Majmundar M, Van der Loos M: Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil 2002, 83: 952-959. 10.1053/apmr.2001.33101CrossRefPubMed
6.
go back to reference Reinkensmeyer DJ, Schmit BD, Rymer WZ: Assessment of active and passive restraint during guided reaching after chronic brain injury. Ann Biomed Eng 1999, 27: 805-814. 10.1114/1.233CrossRefPubMed Reinkensmeyer DJ, Schmit BD, Rymer WZ: Assessment of active and passive restraint during guided reaching after chronic brain injury. Ann Biomed Eng 1999, 27: 805-814. 10.1114/1.233CrossRefPubMed
7.
go back to reference Hesse S, Schulte-Tigges G, Konrad M, Bardeleben A, Werner C: Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. Arch Phys Med Rehabil 2003, 84: 915-20. 10.1016/S0003-9993(02)04954-7CrossRefPubMed Hesse S, Schulte-Tigges G, Konrad M, Bardeleben A, Werner C: Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. Arch Phys Med Rehabil 2003, 84: 915-20. 10.1016/S0003-9993(02)04954-7CrossRefPubMed
8.
go back to reference Loureiro R, Amirabdollahian F, Topping M, Driessen B, Harwin W: Upper Limb Robot Mediated Stroke Therapy Gentle/s Approach. Autonomous Robots 2003, 15: 35-51. 10.1023/A:1024436732030CrossRef Loureiro R, Amirabdollahian F, Topping M, Driessen B, Harwin W: Upper Limb Robot Mediated Stroke Therapy Gentle/s Approach. Autonomous Robots 2003, 15: 35-51. 10.1023/A:1024436732030CrossRef
9.
go back to reference Patton JL, Mussa-Ivaldi FA: Robot-assisted adaptive training: custom force fields for teaching movement patterns. IEEE Trans Biomed Eng 2004, 51: 636-646. 10.1109/TBME.2003.821035CrossRefPubMed Patton JL, Mussa-Ivaldi FA: Robot-assisted adaptive training: custom force fields for teaching movement patterns. IEEE Trans Biomed Eng 2004, 51: 636-646. 10.1109/TBME.2003.821035CrossRefPubMed
10.
11.
go back to reference Maclean N, Pound P, Wolfe C, Rudd A: The concept of patient motivation. A quantitative analysis of stroke professionals' attitudes. Stroke 2002, 33: 444-448. 10.1161/hs0202.102367CrossRefPubMed Maclean N, Pound P, Wolfe C, Rudd A: The concept of patient motivation. A quantitative analysis of stroke professionals' attitudes. Stroke 2002, 33: 444-448. 10.1161/hs0202.102367CrossRefPubMed
12.
go back to reference Sabari JS: Motor learning concepts applied to activity-based intervention with adults with hemiplegia. Am J Occup Therapy 1991, 45: 523-530.CrossRef Sabari JS: Motor learning concepts applied to activity-based intervention with adults with hemiplegia. Am J Occup Therapy 1991, 45: 523-530.CrossRef
13.
go back to reference Colombo R, Pisano F, Micera S, Mazzone A, Delconte C, Carrozza MC, Dario P, Minuco G: Robotic Techniques for Upper Limb Evaluation and Rehabilitation of Stroke Patients. IEEE Trans on Neural Sys Rehab Eng 2005, 13: 311-324. 10.1109/TNSRE.2005.848352CrossRef Colombo R, Pisano F, Micera S, Mazzone A, Delconte C, Carrozza MC, Dario P, Minuco G: Robotic Techniques for Upper Limb Evaluation and Rehabilitation of Stroke Patients. IEEE Trans on Neural Sys Rehab Eng 2005, 13: 311-324. 10.1109/TNSRE.2005.848352CrossRef
14.
go back to reference Micera S, Carrozza MC, Guglielmelli E, Cappiello G, Zaccone F, Freschi C, Colombo R, Mazzone A, Delconte C, Pisano F, Minuco G, Dario P: A Simple Robotic System for Neurorehabilitation. Autonomous Robots 2005, 19: 271-284. 10.1007/s10514-005-4749-0CrossRef Micera S, Carrozza MC, Guglielmelli E, Cappiello G, Zaccone F, Freschi C, Colombo R, Mazzone A, Delconte C, Pisano F, Minuco G, Dario P: A Simple Robotic System for Neurorehabilitation. Autonomous Robots 2005, 19: 271-284. 10.1007/s10514-005-4749-0CrossRef
15.
go back to reference Chen CY, Neufeld PS, Feely CA, Skinner CS: Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. Am J Occup Ther 1999, 53: 171-80.CrossRefPubMed Chen CY, Neufeld PS, Feely CA, Skinner CS: Factors influencing compliance with home exercise programs among patients with upper-extremity impairment. Am J Occup Ther 1999, 53: 171-80.CrossRefPubMed
16.
go back to reference Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I: Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998, 79: 475-87. 10.1016/S0003-9993(98)90059-4CrossRefPubMed Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I: Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 1998, 79: 475-87. 10.1016/S0003-9993(98)90059-4CrossRefPubMed
17.
go back to reference Meichenbaum D, Turk DC: Facilitating treatment adherence: a practitioner's guidebook. New York: Plenum; 1987.CrossRef Meichenbaum D, Turk DC: Facilitating treatment adherence: a practitioner's guidebook. New York: Plenum; 1987.CrossRef
18.
go back to reference Becker MH: Patient adherence to prescribed therapies. Med Care 1985, 23: 539-555. 10.1097/00005650-198505000-00014CrossRefPubMed Becker MH: Patient adherence to prescribed therapies. Med Care 1985, 23: 539-555. 10.1097/00005650-198505000-00014CrossRefPubMed
19.
go back to reference Oldridge NB: Compliance and exercise in primary and secondary prevention of coronary heart disease: a review. Prev Med 1982, 11: 56-70. 10.1016/0091-7435(82)90005-6CrossRefPubMed Oldridge NB: Compliance and exercise in primary and secondary prevention of coronary heart disease: a review. Prev Med 1982, 11: 56-70. 10.1016/0091-7435(82)90005-6CrossRefPubMed
20.
go back to reference Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL: Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health 2001, 55: 132-138. 10.1136/jech.55.2.132PubMedCentralCrossRefPubMed Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL: Why don't patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health 2001, 55: 132-138. 10.1136/jech.55.2.132PubMedCentralCrossRefPubMed
21.
go back to reference Mayo NE: Patient compliance: practical implications for physical therapists. A review of the literature. Phys The 1978, 58: 1083-90. Review Mayo NE: Patient compliance: practical implications for physical therapists. A review of the literature. Phys The 1978, 58: 1083-90. Review
22.
go back to reference Ryan RM: Control and information in the intrapersonal sphere: An extension of cognitive evaluation theory. J Personality and Social Psychology 1982, 43: 450-461. 10.1037/0022-3514.43.3.450CrossRef Ryan RM: Control and information in the intrapersonal sphere: An extension of cognitive evaluation theory. J Personality and Social Psychology 1982, 43: 450-461. 10.1037/0022-3514.43.3.450CrossRef
23.
go back to reference Deci EL, Eghrari H, Patrick BC, Leone DR: Facilitating internalization: the self-determination theory perspective. J Pers 1994, 62: 119-142. 10.1111/j.1467-6494.1994.tb00797.xCrossRefPubMed Deci EL, Eghrari H, Patrick BC, Leone DR: Facilitating internalization: the self-determination theory perspective. J Pers 1994, 62: 119-142. 10.1111/j.1467-6494.1994.tb00797.xCrossRefPubMed
24.
go back to reference Plant RW, Ryan RM: Intrinsic motivation and the effects of self-consciousness, self-awareness, and ego-involvement: An investigation of internally controlling styles. Journal of Personality 1985, 53: 435-449. 10.1111/j.1467-6494.1985.tb00375.xCrossRef Plant RW, Ryan RM: Intrinsic motivation and the effects of self-consciousness, self-awareness, and ego-involvement: An investigation of internally controlling styles. Journal of Personality 1985, 53: 435-449. 10.1111/j.1467-6494.1985.tb00375.xCrossRef
26.
go back to reference McAuley E, Duncan T, Tammen VV: Psychometric properties of the intrinsic motivation inventory in a competitive sport setting: a confirmatory factor analysis. Research Quartely for Exercise and Sport 1987, 60: 48-58.CrossRef McAuley E, Duncan T, Tammen VV: Psychometric properties of the intrinsic motivation inventory in a competitive sport setting: a confirmatory factor analysis. Research Quartely for Exercise and Sport 1987, 60: 48-58.CrossRef
27.
go back to reference Loureiro RCV, Johnson MJ, Harwin WS: Collaborative Tele-rehabilitation: A Strategy for Increasing Engagement. In Proceedings of first IEEE/RAS-EMBS Int. Conf. on Biomedical Robotics and Biomechatronics (BIOROB 2006). Pisa, Italy; Loureiro RCV, Johnson MJ, Harwin WS: Collaborative Tele-rehabilitation: A Strategy for Increasing Engagement. In Proceedings of first IEEE/RAS-EMBS Int. Conf. on Biomedical Robotics and Biomechatronics (BIOROB 2006). Pisa, Italy;
28.
go back to reference Fugl-Meyer AR, Jaasko L, Leyman L, Olsson S, Steglind S: The post-stroke hemiplegic patient. Scand. J Rehabil Med 1975,7(1):13-31. Fugl-Meyer AR, Jaasko L, Leyman L, Olsson S, Steglind S: The post-stroke hemiplegic patient. Scand. J Rehabil Med 1975,7(1):13-31.
29.
go back to reference Lindmark B, Hamrin E: Evaluation of functional capacity after stroke as a basis for active intervention. Validation of a modified chart for motor capacity assessment. Scand J Rehabil Med 1988,20(3):111-115.PubMed Lindmark B, Hamrin E: Evaluation of functional capacity after stroke as a basis for active intervention. Validation of a modified chart for motor capacity assessment. Scand J Rehabil Med 1988,20(3):111-115.PubMed
30.
go back to reference Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL: Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing 2000,29(3):223-8. 10.1093/ageing/29.3.223CrossRefPubMed Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL: Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing 2000,29(3):223-8. 10.1093/ageing/29.3.223CrossRefPubMed
31.
go back to reference Morasso P, Mussa-Ivaldi FA: Trajectory formation in handwriting: a computational model. Biol Cybern 1982, 45: 131-142. 10.1007/BF00335240CrossRefPubMed Morasso P, Mussa-Ivaldi FA: Trajectory formation in handwriting: a computational model. Biol Cybern 1982, 45: 131-142. 10.1007/BF00335240CrossRefPubMed
32.
go back to reference Roher B, Fasoli S, Krebs HI, Hughes R, Volpe B, Frontera WR, Stein J, Hogan N: Movement smoothness changes during stroke recovery. J Neuroscience 2002, 22: 8297-8304. Roher B, Fasoli S, Krebs HI, Hughes R, Volpe B, Frontera WR, Stein J, Hogan N: Movement smoothness changes during stroke recovery. J Neuroscience 2002, 22: 8297-8304.
33.
go back to reference Ryan RM, Koestner R, Deci EL: Varied Forms of persistence: When free-choice behavior is not intrinsically motivated. Motivation & Emotion 1991, 15: 185-205. 10.1007/BF00995170CrossRef Ryan RM, Koestner R, Deci EL: Varied Forms of persistence: When free-choice behavior is not intrinsically motivated. Motivation & Emotion 1991, 15: 185-205. 10.1007/BF00995170CrossRef
34.
go back to reference Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977,33(1):159-74. 10.2307/2529310CrossRefPubMed Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977,33(1):159-74. 10.2307/2529310CrossRefPubMed
35.
go back to reference Cook AM, Meng MQ, Gu JJ, Howery K: Development of a robotic device for facilitating learning by children who have severe disabilities. IEEE Trans Neural Syst Rehabil Eng 2002,10(3):178-87. 10.1109/TNSRE.2002.802877CrossRefPubMed Cook AM, Meng MQ, Gu JJ, Howery K: Development of a robotic device for facilitating learning by children who have severe disabilities. IEEE Trans Neural Syst Rehabil Eng 2002,10(3):178-87. 10.1109/TNSRE.2002.802877CrossRefPubMed
36.
go back to reference Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, Ijzerman MJ: Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev 2006,43(2):171-84. 10.1682/JRRD.2005.04.0076CrossRefPubMed Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, Ijzerman MJ: Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev 2006,43(2):171-84. 10.1682/JRRD.2005.04.0076CrossRefPubMed
Metadata
Title
Design strategies to improve patient motivation during robot-aided rehabilitation
Authors
Roberto Colombo
Fabrizio Pisano
Alessandra Mazzone
Carmen Delconte
Silvestro Micera
M Chiara Carrozza
Paolo Dario
Giuseppe Minuco
Publication date
01-12-2007
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2007
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-4-3

Other articles of this Issue 1/2007

Journal of NeuroEngineering and Rehabilitation 1/2007 Go to the issue