Low-Cost Telerehabilitation Using Force Feedback Joysticks

Research Status: Pilot study. Background/Problem: Telerehabilitation and rehabilitation robotics are two new technologies being applied in the field of physical rehabilitation. In recent years, many researchers have investigated the use of these technologies to improve movement therapy for neurological conditions. However, most of these systems are expensive and not suitable for standard clinic or home use. We are developing a low cost robotic system - The Jerusalem Telerehabilitation System - using a commercially available force feedback joystick, an ordinary home PC, and a standard high-speed internet connection. Methods/Tools: Using the joystick, the patient performs exercises designed to aid in recovering motor function of the upper limb. Patients who are unable to grasp the joystick use a specially designed armrest that allows them to control the joystick with movements of the shoulder and elbow joints. The system monitors the status and progress of the patient, records the kinematic parameters of his movements, and summarizes the results. There are two modes of operation - the cooperative mode in which therapist and patient are online together and the therapist can guide the patient's movements, and the stand-alone mode in which the patient works by himself, not necessarily online. As a preliminary test of our system, we conducted a pilot usability trial of the stand-alone mode with two subjects who had suffered a stroke. Two physical therapists also tested the system. The goal was to see if the subjects and the physical therapists felt comfortable using the system. In addition, we have also carried out some preliminary tests of the cooperative mode of the system over the Internet. Results: After a short training session, the therapists were able to use the system independently. Also, patient subjects had no problem understanding how to do the exercises; they reported that they enjoyed using the system as an alternative to their regular exercises, and felt safe using it. Tests of the cooperative mode over the Internet demonstrated that the controlling joystick was able to steer the guided joystick with a delay of 30-150 msec. Novelty/Discussion: In our system, client programs and data on exercise sessions are stored locally on the client's computer and uploaded to a central server at a later date. A specially designed arm support allows even subjects with little or no control of wrist and fingers to control the joystick without the inconvenience of attaching a splint. The Internet cooperative mode is another novel aspect of our system. Conclusion: We have shown that this low-cost system works as designed and that there is potential for the use of this type of system. Both therapists and patients are able to use the system, and we are ready to begin a full-scale trial.