A joint research team from the University of Medicine and Dentistry of New Jersey (UMDNJ) and the New Jersey Institute of Technology (NJIT) is combining an immersive virtual reality (VR) environment with robots to shatter the limits of post-stroke rehabilitation. The study is funded by grants from the U.S. National Institutes of Health to Dr. Sergei Adamovich (NJIT) and Dr. Alma Merians (UMDNJ). “We’re helping patients make significant improvement even several years after a stroke,” explains Dr. Gerard Fluet, assistant professor at UMDNJ.
Previous research indicated that patients need to work at high-intensity levels to benefit most from therapy; the combination of a VR environment and robots is designed to help patients work longer and harder than they could on their own — three hours a day, four days a week for two intense weeks. The VR environment combats boredom by offering variety, while the robot combats fatigue by helping patients complete motions they otherwise could not. Together, they create a stronger sense of accomplishment, giving patients the will to persevere.
MORE MOVEMENT, MORE HEALING
In the VR world, patients might be asked to move a cup from a shelf and place it on a table, catch a ball or use a hammer. The therapist sets the difficulty of the task to optimize the challenge. If the patient completes a task successfully, the object they are working with shrinks or gets further away for the next try, increasing the difficulty; if the patient fails, the object grows or moves closer, making the activity a bit easier.
ADDING ROBOTS SPEEDS PROGRESS
“It helps patients work at the top of their abilities,” explains Dr. Qinyin Qiu, a research engineer who helped program the VR environment. “As a computer scientist, I find it amazing to see virtual reality games play such a positive role in people’s lives.”
Robots measure what part of the task a patient has completed, how much force the patient has exerted, and provide the additional force needed to complete the movement, if necessary. That helps patients translate even small movements—simply wiggling a finger, for example—into meaningful movements.
“Meaningful movement has a long-term impact on the way the brain heals,” Fluet says. “We’re not only working toward improving rehabilitation, but gaining insight into how the brain controls movement.”
Before-and-after brain imaging of the patients actually shows new neural connections being made in response to training. “It’s exciting to see those connections occur, especially over such a short period of time,” Fluet says.
“When therapists tell patients, ‘we don’t think you’re going to improve anymore,’ we feel we’ve failed them,” he continues. But the new research proves improvement is possible years after a stroke. “Now we can tell patients, ‘Keep trying. There’s still hope.’”