title: The development of an adaptive upper-limb stroke rehabilitation robotic system.
abstract: BACKGROUND
  Stroke is the primary cause of adult disability. To support this large population in recovery, robotic technologies are being developed to assist in the delivery of rehabilitation. This paper presents an automated system for a rehabilitation robotic device that guides stroke patients through an upper-limb reaching task. The system uses a decision theoretic model (a partially observable Markov decision process, or POMDP) as its primary engine for decision making. The POMDP allows the system to automatically modify exercise parameters to account for the specific needs and abilities of different individuals, and to use these parameters to take appropriate decisions about stroke rehabilitation exercises.
  
  
  METHODS
  The performance of the system was evaluated by comparing the decisions made by the system with those of a human therapist. A single patient participant was paired up with a therapist participant for the duration of the study, for a total of six sessions. Each session was an hour long and occurred three times a week for two weeks. During each session, three steps were followed: (A) after the system made a decision, the therapist either agreed or disagreed with the decision made; (B) the researcher had the device execute the decision made by the therapist; (C) the patient then performed the reaching exercise. These parts were repeated in the order of A-B-C until the end of the session. Qualitative and quantitative question were asked at the end of each session and at the completion of the study for both participants.
  
  
  RESULTS
  Overall, the therapist agreed with the system decisions approximately 65% of the time. In general, the therapist thought the system decisions were believable and could envision this system being used in both a clinical and home setting. The patient was satisfied with the system and would use this system as his/her primary method of rehabilitation.
  
  
  CONCLUSIONS
  The data collected in this study can only be used to provide insight into the performance of the system since the sample size was limited. The next stage for this project is to test the system with a larger sample size to obtain significant results.
authors.affiliation: Institute of Biomaterials and Biomedical Engineering, Rosebrugh Building, 164 College Street, Room 407, University of Toronto, Toronto M5T 1P7, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kan
authors.forename: Rajibul
authors.initials: R
authors.lastname: Huq
authors.forename: Jesse
authors.initials: J
authors.lastname: Hoey
authors.forename: Robby
authors.initials: R
authors.lastname: Goetschalckx
authors.forename: Alex
authors.initials: A
authors.lastname: Mihailidis
mesh_terms: D000328:Adult; D006801:Humans; D008390:Markov Chains; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D010865:Pilot Projects; D012371:Robotics / Q000295:instrumentation* / Q000379:methods*; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000502:physiology*; D014584:User-Computer Interface