A new study in Disability and Rehabilitationexplores clinician perspectives about an experimental robotic arm orthosis developed by NewYork-Presbyterian physicians for stroke patients with upper limb weakness. Occupational and physical therapists in the study recognized both a rehabilitative and assistive role for the novel device, called MyHand, and provided input into its on-going development.
Below, Joel Stein, MD, chair of the Department of Rehabilitation and Regenerative Medicine at NewYork-Presbyterian and Columbia and senior author of the study, shares his insights from the study and on the role of robotics in rehabilitation and home settings.
Designing a Device to Address Upper Limb Weakness
Most stroke survivors with upper limb weakness have more difficulty opening their hand than closing it. We envisioned a robotic device that would allow them to use their preserved ability to bend the fingers but assists them with opening them. This could help people to pick up objects and manipulate them better. For example, they might be able to prepare a meal or pick up a bite of food and bring it to their mouth.
Our device uses sensors to pick up electrical signals from the muscles in the forearm to elicit movement. Recently, we have been using machine learning and artificial intelligence to anticipate what the user intends to do in real time and equip the device to assist them with that action.
The Role of Clinicians in Device Design
As a clinician involved in research and technology, I have been approached in the past by engineering teams saying, “We built this impressive new device Do you think you could find a good use for it? Would this help your patients?” That is disappointing on the clinician side because the engineers missed the opportunity to hear from us earlier on in the design phase. As a result, a lot of these devices are technologically impressive but not that appealing clinically.
With this device, clinicians were involved from the beginning of the design process. We then expanded our understanding of clinician perspective by surveying a large national group of occupational and physical therapists to gather their perceptions of the MyHand prototype to guide future development. We wanted to understand their perceptions about the prototype, how they would use it with patients during treatment, and their opinions about the cost and other factors.
Study Results
The majority of the survey participants (64.9%) reported that they would have patients use the device for both rehabilitation and daily assistance performing household tasks, compared to those who would use it only for rehabilitation (28.6%) or assistance (6.6%). The respondents thought that the device could be used in outpatient (85.1%), acute rehabilitation (61.7%), and subacute rehabilitation (57.8% ) settings, and most perceived it useful in all stages of stroke. More than one-third of participants (37.5%) thought the device could be used in home settings.
One of our key findings was that less than 20% of the participating therapists have used robotic devices with patients. That's startling given that robotics started entering into the commercial realm for rehabilitation medicine in the late 1990s. Some of the challenges to adoption include device design and financial barriers.
MyHand device and EMG armband
Next Steps
In addition to clinicians’ views on the device, we have collected data on patients’ perspective about the prototype, which we are still analyzing. We’re also working on a number of technological improvements to enhance the function of the device.
One of the issues that has been a huge barrier in this field is that patients develop spasticity and that can worsen when they try and move the arm. We are partnering with colleagues at other institutions to try and find ways to address this so that people are not fighting the device.
When we do testing, our graduate students and engineering graduate students are present. The interaction between engineers and clinicians with patients in the room—the ability to troubleshoot in real time and get feedback from the patient—is priceless.
— Dr. Joel Stein
What sets us apart are our academic partnerships between NewYork-Presbyterian and Columbia, NewYork-Presbyterian and Weill Cornell Medicine, and Cornell University. When we perform testing, our medicine graduate students and engineering graduate students are present. The interaction between engineers and clinicians with patients in the room—the ability to troubleshoot in real time and get feedback from the patient—is priceless.
