title: Robots integrated with virtual reality simulations for customized motor training in a person with upper extremity hemiparesis:  a case study.
abstract: OBJECTIVE
  A majority of studies examining repetitive task practice facilitated by robots for the treatment of upper extremity paresis utilize standardized protocols applied to large groups. Others utilize interventions tailored to patients but do not describe the clinical decision-making process utilized to develop and modify interventions. This case study describes a robot-based intervention customized to match the goals and clinical presentation of person with upper extremity hemiparesis secondary to stroke.
  
  
  METHODS
  The patient, P.M., was an 85-year-old man with left hemiparesis secondary to an intracerebral hemorrhage 5 years prior to examination. Outcomes were measured before and after a 1-month period of home therapy and after a 1-month robotic intervention. The intervention was designed to address specific impairments identified during his physical therapy examination. When necessary, activities were modified on the basis of response to the first week of treatment.
  
  
  RESULTS
  P.M. trained in 12 sessions, using six virtually simulated activities. Modifications to original configurations of these activities resulted in performance improvements in five of these activities. P.M. demonstrated a 35-second improvement in Jebsen Test of Hand Function time and a 44-second improvement in Wolf Motor Function Test time subsequent to the robotic training intervention. Reaching kinematics, 24-hour activity measurement, and scores on the Hand and Activities of Daily Living scales of the Stroke Impact Scale all improved as well.
  
  
  CONCLUSIONS
  A customized program of robotically facilitated rehabilitation was associated with short-term improvements in several measurements of upper extremity function in a patient with chronic hemiparesis.
authors.affiliation: Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA. fluetge@umdnj.edu
authors.forename: Gerard G
authors.initials: GG
authors.lastname: Fluet
authors.forename: Alma S
authors.initials: AS
authors.lastname: Merians
authors.forename: Qinyin
authors.initials: Q
authors.lastname: Qiu
authors.forename: Ian
authors.initials: I
authors.lastname: Lafond
authors.forename: Soha
authors.initials: S
authors.lastname: Saleh
authors.forename: Viviana
authors.initials: V
authors.lastname: Ruano
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Delmonico
authors.forename: Sergei V
authors.initials: SV
authors.lastname: Adamovich
mesh_terms: D000203:Activities of Daily Living; D001696:Biomechanical Phenomena / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000150:complications; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D014584:User-Computer Interface