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      Design strategies to improve patient motivation during robot-aided rehabilitation

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          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.

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          Most cited references35

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          Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke

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            Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke.

            A limited number of clinical studies have examined the effect of poststroke rehabilitation with robotic devices on hemiparetic arm function. We systematically reviewed the literature to assess the effect of robot-aided therapy on stroke patients' upper-limb motor control and functional abilities. Eight clinical trials were identified and reviewed. For four of these studies, we also pooled short-term mean changes in Fugl-Meyer scores before and after robot-aided therapy. We found that robot-aided therapy of the proximal upper limb improves short- and long-term motor control of the paretic shoulder and elbow in subacute and chronic patients; however, we found no consistent influence on functional abilities. In addition, robot-aided therapy appears to improve motor control more than conventional therapy.
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              Qualitative analysis of stroke patients' motivation for rehabilitation.

              To explore the attitudes and beliefs of stroke patients identified by professionals as having either "high" or "low" motivation for rehabilitation. Qualitative study with semistructured interviews. The stroke unit of an inner city teaching hospital. 22 patients with stroke who were undergoing rehabilitation; 14 with high motivation for rehabilitation and eight with low motivation. All patients thought rehabilitation was important for recovery. High motivation patients were more likely to view rehabilitation as the most important means of recovery and to accord themselves an active role in rehabilitation. These patients were also more likely to understand rehabilitation and in particular to understand the specialist role of the nursing staff. Many patients reported independence at home as a personal goal, though few low motivation patients related this goal to success in rehabilitation. Information from professionals about rehabilitation, favourable comparisons with other stroke patients, and the desire to leave hospital had a positive effect on motivation. Conversely, overprotection from family members and professionals, lack of information or the receipt of "mixed messages" from professionals, and unfavourable comparisons with other patients had a negative effect. There are some differences in beliefs between stroke patients identified as having low or high motivation for rehabilitation. These beliefs seem to be influenced by the environment in which the patient is rehabilitated. Professionals and carers should be made aware of the ways in which their behaviour can positively and negatively affect motivation.
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                Author and article information

                Journal
                J Neuroengineering Rehabil
                Journal of NeuroEngineering and Rehabilitation
                BioMed Central (London )
                1743-0003
                2007
                19 February 2007
                : 4
                : 3
                Affiliations
                [1 ]Service of Bioengineering, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy
                [2 ]Division of Neurology, Salvatore Maugeri Foundation, IRCCS Via Revislate 13, 28010 Veruno (NO), Italy
                [3 ]ARTS Lab Scuola Superiore Sant'Anna V.le Piaggio 34, 56025 Pontedera (PI), Italy
                Article
                1743-0003-4-3
                10.1186/1743-0003-4-3
                1805445
                17309790
                0b3d79e2-5b1a-4bb2-a1b2-695156a89109
                Copyright © 2007 Colombo et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2006
                : 19 February 2007
                Categories
                Research

                Neurosciences
                Neurosciences

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