Developing an Intelligent Assessment and Rehabilitation System for Bilateral Upper Limb Coordination Control of Upper Extremity in Hemiparetic Subjects

Background: Stroke leads to motor impairment of paretic upper limbs and affects many daily activities that require the use of both hands and thus increases the dependence in activities of daily living and decreases the quality of life. Research has demonstrated that bilateral movement training is helpful in facilitating neural plasticity in the bilateral hemispheres and improving the motor recovery of paretic upper extremities. However, there have been few studies that have used bilateral movement concepts to promote the recovery of the functional performance of paretic hands. There have also been few investigations of the relationship between the functional recovery of the paretic hand and inter-limb coordination control, which can provide important evidence-based information for clinical therapists to develop appropriate rehabilitation training. Furthermore, there is no tool or system to provide real-time feedback to understand the movements of the paretic limb and the training effects of rehabilitation for stroke patients, and such a system could be used to design individual rehabilitation training programs to aid in the promotion of rehabilitation effects and motivation by clinical therapists. Objectives: The objectives of this study are the following: 1) to develop a computer-aided rehabilitation system based on bilateral movement and investigate the effects of an intervention with the computer-aided rehabilitation system on the functional recovery of paretic hands and upper extremities in chronic stroke patients; 2) to develop a computer-aided assessment system for bilateral limb coordination control, analyze the differences in coordination control between the healthy young people, elderly adults and stroke subjects, and investigate the relationships between bilateral upper extremity coordination control deficits, daily activities and clinical assessments in people with stroke; and 3) to establish the intelligent bilateral upper extremity coordination control rehabilitation system (IBUECCRS) with real-time feedback, individualize rehabilitation programs, and investigate the effects of IBUECCRS interventions on the functional recovery of paretic hands and upper extremities in chronic stroke patients. Methods: The first year of this study will be used to establish the system by combining a rehabilitation interface written in LabVIEW with two three-axes connecting rods with rotary potentiometers and load cells to measure the joint motions of the shoulder, elbow and wrist and grip force. The first year of the study will also involve the recruitment of 48 chronic stroke subjects and randomly assign them to control and experimental groups to investigate the training effects of using the computer-aided rehabilitation system for 4 weeks on the functional recovery of paretic hands and upper extremities in chronic stroke patients. The second year this study will be used to combine the equipment developed in the first year with the interface of a computer-aided bilateral coordination control assessment system written in LabVIEW. Next, this study will recruit 20 healthy young people, 20 healthy elderly people and 20 chronic stroke adults to analyze the differences in the coordination control of the bilateral upper extremities between the different groups and investigate the relationships between bilateral upper extremity coordination control deficits, daily activities 1 表C011 共 2 頁第 頁 and clinical assessment scales among the people with stroke. The third year of this study will be used to establish the IBUECCRS, which will combine smart phones, wearable devices and a mobile application. The wearable devices will include wearable grip force sensors and joint motion sensors for the shoulder, elbow and wrist to provide real-time feedback. The kinematic data will be transferred to the smart phone and will be displayed in the mobile application and be uploaded to the cloud for storage and statistical analyses via Bluetooth communication during the rehabilitation process. Furthermore, this year will also be used to recruit 60 chronic stroke adults and investigate the effects of the IBUECCRS intervention on the functional recovery of the paretic hands and upper extremities of these chronic stroke patients. Expected contributions: The first year of this study will involve the development of a computer-aided rehabilitation system based on bilateral movement that can be used not only to provide real-time feedback to stroke patients during rehabilitation training tasks but also to alter the rehabilitation program and intensity parameters of the training based on individual capabilities during the off-line functioning of the system. This process will improve the rehabilitation effects and aid academic research and clinical applications in the future. The second year of this study will involve the development of a computer-aided assessment system for bilateral limb coordination control that can be used not only to quantitative evaluations and parameters to clinical therapists but also for analysis of bilateral hand coordination control and investigation of the relationships between bilateral upper extremity coordination control deficits, daily activities and clinical assessments in stroke patients. These findings will be very important and helpful for developing appropriate rehabilitation strategies to improve inter-limb coordination control in stroke patients in the future. The third year of this study will involve the development of an intelligent bilateral upper extremity coordination control rehabilitation system (IBUECCRS) that can not only be used in real-time to appropriately adjust the training program and provide information based on individual stroke capabilities to clinical therapists but can also maintain the stroke patients’’ understanding of the functional recovery of their paretic limbs and promote their participation as well as the benefits of rehabilitation via the rehabilitation record in the mobile application.