Effect of visual distraction and auditory feedback on patient effort during robot-assisted movement training after stroke.
Effect of visual distraction and auditory feedback on patient effort during robot-assisted movement training after stroke.
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DOI：
10.1186/1743-0003-8-21
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发表时间：
2011-04-23
影响因子：
5.1
通讯作者：
Reinkensmeyer DJ
中科院分区：
文献类型：
--
作者：
Secoli R;Milot MH;Rosati G;Reinkensmeyer DJ
神经损伤后，在机器人辅助下练习手臂和步态运动可以帮助患者提高运动能力，但患者有时会在训练过程中减少对辅助的反应。减少的努力已经被假设为减少机器人训练的临床结果。为了更好地理解患者的懈怠，我们研究了视觉分心和听觉反馈在一个常见的机器人辅助跟踪任务中调节患者努力的作用。14名中风导致的慢性左半瘫患者、5名慢性右半瘫患者和14名未受损的健康对照者，在接受机械臂外骨骼的适应性辅助的同时，用手臂追踪一个视觉目标。我们比较了四种练习条件：单独的基线跟踪任务；跟踪的同时也在执行视觉干扰任务；利用视觉干扰和声音反馈进行跟踪；用声音反馈跟踪。在干扰任务中，计算机屏幕的各个角落随机显示一些符号，参与者被要求在目标符号出现时点击鼠标按钮。声音反馈由重复的蜂鸣声组成，重复的频率随着跟踪误差的增加而增加。中风患者用左半瘫痪的手臂执行视觉干扰任务时，他们的努力减少了一半，跟踪误差增加了一倍。然而，有了声音反馈，这些参与者增加了他们的努力，减少了他们的跟踪误差，接近他们的基线水平，同时也成功地完成了分散注意力的任务。对于使用非麻痹性手臂的参与者和没有中风的参与者，这些影响明显较小。在一个标准的机器人辅助运动训练任务中，视觉分心降低了参与者的努力。对于偏瘫的手臂，这种影响更大，这表明与控制受影响的手臂相关的需求增加使得运动系统在分心时更容易松弛。提供一种替代的感官反馈通道，即跟踪误差的听觉反馈，使参与者能够有效地同时执行跟踪任务和分心任务。因此，结合实时听觉反馈的表现错误可能会改善机器人治疗系统的临床结果。
Practicing arm and gait movements with robotic assistance after neurologic injury can help patients improve their movement ability, but patients sometimes reduce their effort during training in response to the assistance. Reduced effort has been hypothesized to diminish clinical outcomes of robotic training. To better understand patient slacking, we studied the role of visual distraction and auditory feedback in modulating patient effort during a common robot-assisted tracking task. Fourteen participants with chronic left hemiparesis from stroke, five control participants with chronic right hemiparesis and fourteen non-impaired healthy control participants, tracked a visual target with their arms while receiving adaptive assistance from a robotic arm exoskeleton. We compared four practice conditions: the baseline tracking task alone; tracking while also performing a visual distracter task; tracking with the visual distracter and sound feedback; and tracking with sound feedback. For the distracter task, symbols were randomly displayed in the corners of the computer screen, and the participants were instructed to click a mouse button when a target symbol appeared. The sound feedback consisted of a repeating beep, with the frequency of repetition made to increase with increasing tracking error. Participants with stroke halved their effort and doubled their tracking error when performing the visual distracter task with their left hemiparetic arm. With sound feedback, however, these participants increased their effort and decreased their tracking error close to their baseline levels, while also performing the distracter task successfully. These effects were significantly smaller for the participants who used their non-paretic arm and for the participants without stroke. Visual distraction decreased participants effort during a standard robot-assisted movement training task. This effect was greater for the hemiparetic arm, suggesting that the increased demands associated with controlling an affected arm make the motor system more prone to slack when distracted. Providing an alternate sensory channel for feedback, i.e., auditory feedback of tracking error, enabled the participants to simultaneously perform the tracking task and distracter task effectively. Thus, incorporating real-time auditory feedback of performance errors might improve clinical outcomes of robotic therapy systems.
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通讯作者：
Miall, RC
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