This chapter focuses on a patient self-controlled rehabilitation system using our developed exoskeleton-type hand-motion-assist robot and tele-rehabilitation. The virtual reality-enhanced new hand rehabilitation support system, which we have developed for stroke patients in the acute stage, is aiming to allow such patients to conduct every day exercises by themselves without supervisors. This system features a multi-DOF motion assistance device, a virtual reality interface for patients, and a symmetrical master-slave motion assistance training strategy called ”self-motion control”, in which the stroke patients' healthy hand on the master side creates the assistance motion for the impaired hand on the slave side. Moreover, a tele-rehabilitation system consisting of a hand rehabilitation support system for the patients, an anthropomorphic robot hand for the therapist, and a remote monitoring system for diagnosing the degree of recovery is explained.
Top1. Introduction
A stroke occurs when the blood supply to the brain is blocked or a blood vessel in the brain bursts. The loss of blood to the brain means a loss of oxygen, which then injures or kills brain cells. Fifteen million people worldwide suffer a stroke every year. Nearly 6 million die, and another 5 million are left permanently disabled (www.e-stat.go.jp, 2013).
Stroke patients require timely and persistent rehabilitation to recover lost abilities and regain their normal daily lives. Successful rehabilitation depends on the amount of damage to the brain, the skill of the rehabilitation team, cooperation of family and friends, and timing of rehabilitation. Rehabilitation training can be categorized into the following stages: acute, convalescence, and maintenance. It is understood that the earlier phases of rehabilitation contribute to the recovery of lost abilities and skills. In particular, the acute and convalescence stages can have a significant effect on preventing muscle atrophy. However, it is not always possible for patients to receive long rehabilitation sessions with therapists, who are in relatively short supply. A solution to this problem would be a rehabilitation support system that allowed patients to carry out rehabilitation exercises by themselves. We call this patient self-controlled rehabilitation therapy, and estimate that such systems will find a large market in an aging world.
Many systems for rehabilitation have been studied. Functional electrical stimulation (FES) (Heasmam et al., 2000; Thorsen, Spadone, & Ferrarin, 2001) has proven to be a valuable tool in the restoration of arm function, but is not suitable for patient self-controlled rehabilitation therapy. Many aspects of robotic arm rehabilitation therapy (Krebs, Hogan, Aisen, & Volpe, 1998; Carignan, Liszka, & Roderick 2005; Gupta & O'Malley, 2006; Reinkensmeyer, Pang, Nessler, & Painter, 2002), including clinical tests (Volosyak, Ivlev, & Graser, 2005; Kahn, Zygman, Rymer, & Reinkensmeyer, 2001; Mahoney, Machiel Van der Loos, Lum, & Burgar, 2003), have been reported. Similarly, lower limb rehabilitation therapy (Saint-Bauzel, Pasqui, & Monteil, 2009) has been reported with clinical results. Most disabilities caused by CVAs are hemiplegic; that is, only one side is affected. Arm rehabilitation therapy with the aid of a robot (Burger, Lum, Shor, & Machiel Van der Loos, 2000), which involves bimanual, mirror-image, patient-controlled therapeutic exercises, is one type of self-controlled rehabilitation.