This paper presents preliminary results from a virtual reality (VR)-based system for hand rehabilitation that uses a CyberGlove and a Rutgers Master II-ND haptic glove. This computerized system trains finger range of motion, finger flexion speed, independence of finger motion, and finger strength using specific VR simulation exercises. A remote Web-based monitoring station was developed to allow telerehabilitation interventions. The remote therapist observes simplified versions of the patient exercises that are updated in real time. Patient data is stored transparently in an Oracle database, which is also Web accessible through a portal GUI. Thus the remote therapist or attending physician can graph exercise outcomes and thus evaluate patient outcomes at a distance. Data from the VR simulations is complemented by clinical measurements of hand function and strength. Eight chronic post-stroke subjects participated in a pilot study of the above system. In keeping with variability in both their lesion size and site and in their initial upper extremity function, each subject showed improvement on a unique combination of movement parameters in VR training. Importantly, these improvements transferred to gains on clinical tests, as well as to significant reductions in task-completion times for the prehension of real objects. These results are indicative of the potential feasibility of this exercise system for rehabilitation in patients with hand dysfunction resulting from neurological impairment.

Usability studies are an essential and iterative component of technology development and ease its transfer from the laboratory to the clinic. Although such studies are standard methodology in today's graphical user-interface applications, it is not clear that current methods apply to new technologies such as virtual reality. Thus experimentation is needed to examine what existing methods can be viably transferred to the new user-interaction situations. In this paper, 5 integrated interfaces with 3 simultaneous users are evaluated via a set of usability studies, which adapt traditional methods for assessing the ease of use of the interface design. A single expert domain user was run in an intensive study that examined the therapist manual and interfaces of the Rutgers Ankle Rehabilitation System (RARS). The interface and manual were extensively modified based on this evaluation. A second study involving 5 therapists was then conducted to evaluate the telerehabilitation component of the RARS system. In both studies, the tester and developer's observations, along with the session videotapes and therapist-user questionnaires, were triangulated to identify user problems and suggest design changes expected to increase the usability of the system. Changes that resulted from the analysis with the domain expert are described and recommendations for how to conduct usability studies in such multiuser remote virtual reality situations are proposed. Results from the pilot usability telemonitoring studies are also presented. The validity of usability studies in the development and refinement of rehabilitation technology is highlighted.

The “Rutgers Ankle” is a Stewart platform-type haptic interface designed for use in rehabilitation. The system supplies six-degree-of-freedom (DOF) resistive forces on the patient's foot, in response to virtual reality-based exercises. The Rutgers Ankle controller contains an embedded Pentium board, pneumatic solenoid valves, valve controllers, and associated signal conditioning electronics. The rehabilitation exercise used in our case study consists of piloting a virtual airplane through loops. The exercise difficulty can be selected based on the number and placement of loops, the airplane speed in the virtual environment, and the degree of resistance provided by the haptic interface. Exercise data is stored transparently, in real time, in an Oracle database. These data consist of ankle position, forces, and mechanical work during an exercise, and over subsequent rehabilitation sessions. The number of loops completed and the time it took to do that are also stored online. A case study is presented of a patient nine months post-stroke using this system. Results showed that, over six rehabilitation sessions, the patient improved on clinical measures of strength and endurance, which corresponded well with torque and power output increases measured by the Rutgers Ankle. There were also substantial improvements in task accuracy and coordination during the simulation and the patient's walking and stair-climbing ability.