Feasibility, usability and effectiveness of a robot-assisted finger proprioception therapy

Feasibility, usability and effectiveness of a robot-assisted finger proprioception therapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility, usability and effectiveness of a robot-assisted finger proprioception therapy Monika Zbytniewska-Mégret, Christian Salzmann, Aida Sehle, Raffaele Ranzani, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3916719/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Neurological injuries, such as stroke, often lead to motor and somatosensory impairments of the hand. Deficits in somatosensation, especially proprioception, result in difficulties performing activities of daily living involving fine motor tasks. As those impairments are challenging to accurately evaluate and monitor, therapies rarely focus on proprioception specifically, even though it has been shown that such training could promote functional benefits. In this work we propose and preliminarily evaluate the feasibility, usability and effectiveness of a robot-assisted therapy focused on finger proprioception. Methods: We designed and implemented on an existing robotic platform (ETHMIKE) five therapeutic exercises, focusing on finger somatosensation, two targeting passive and three active position sense. The difficulty level of the therapy exercises was automatically adapted to each patient’s proprioceptive impairment, assessed using the same platform (i.e., assessment-driven therapy). Nine subacute stroke participants completed the robotic therapy for at least two weeks, 30 minutes per day, five times a week. Data was compared to a control group based on a previously collected dataset where subacute stroke participants received usual care and the same assessments. Results: We found that the proposed exercises were feasible for stroke participants, as everyone managed to progress in difficulty levels. Moreover, the exercise performance averaged between 59% and 70% of maximum possible performance for the different exercises, indicating adequacy of the difficulty adaptation algorithm and a balance between motivation and challenge. Further, usability was rated as acceptable, as NASA Task Load Index (raw TLX), which provides an overall workload score, was mostly below 50%, except for mentaldemand. There was a significant improvement in proprioceptive error and in the Box and Block Test score from study inclusion to discharge for the intervention group, which was not the case for the control group. Conclusions: This work demonstrated the first insights into feasibility, usability and effectiveness of a novel robot-assisted therapeutic approach. These encouraging results pave the way for further development and validation of therapy approaches focusing on somatosensory function. robot-assisted therapy neurorehabilitation stroke recovery proprioception hand function Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3916719","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":271282750,"identity":"8c724a62-624d-466e-b610-68464f5b63b8","order_by":0,"name":"Monika Zbytniewska-Mégret","email":"data:image/png;base64,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","orcid":"","institution":"ETH Zurich","correspondingAuthor":true,"prefix":"","firstName":"Monika","middleName":"","lastName":"Zbytniewska-Mégret","suffix":""},{"id":271282751,"identity":"e390ef98-1281-4edd-8c63-c192607af60c","order_by":1,"name":"Christian Salzmann","email":"","orcid":"","institution":"Kliniken Schmieder","correspondingAuthor":false,"prefix":"","firstName":"Christian","middleName":"","lastName":"Salzmann","suffix":""},{"id":271282752,"identity":"7a24b319-f188-405d-9edf-c3b849f07562","order_by":2,"name":"Aida Sehle","email":"","orcid":"","institution":"Kliniken Schmieder","correspondingAuthor":false,"prefix":"","firstName":"Aida","middleName":"","lastName":"Sehle","suffix":""},{"id":271282753,"identity":"4c90d1cd-792d-4ec6-90d4-b8ab3f2dfe5b","order_by":3,"name":"Raffaele Ranzani","email":"","orcid":"","institution":"ETH Zurich","correspondingAuthor":false,"prefix":"","firstName":"Raffaele","middleName":"","lastName":"Ranzani","suffix":""},{"id":271282754,"identity":"25039bf7-fc9a-4e39-a14e-edfc8943c741","order_by":4,"name":"Christoph M. Kanzler","email":"","orcid":"","institution":"ETH Zurich","correspondingAuthor":false,"prefix":"","firstName":"Christoph","middleName":"M.","lastName":"Kanzler","suffix":""},{"id":271282755,"identity":"4961c866-205a-4ea2-b250-8763a9845d91","order_by":5,"name":"Roger Gassert","email":"","orcid":"","institution":"ETH Zurich","correspondingAuthor":false,"prefix":"","firstName":"Roger","middleName":"","lastName":"Gassert","suffix":""},{"id":271282756,"identity":"c02487c1-95a2-4a89-a578-352f76d638af","order_by":6,"name":"Joachim Liepert","email":"","orcid":"","institution":"Kliniken Schmieder","correspondingAuthor":false,"prefix":"","firstName":"Joachim","middleName":"","lastName":"Liepert","suffix":""},{"id":271282757,"identity":"6adbcd12-62b7-4710-a138-f487e582d419","order_by":7,"name":"Olivier Lambercy","email":"","orcid":"","institution":"ETH Zurich","correspondingAuthor":false,"prefix":"","firstName":"Olivier","middleName":"","lastName":"Lambercy","suffix":""}],"badges":[],"createdAt":"2024-02-01 08:49:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3916719/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3916719/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50820394,"identity":"b0dcaa6d-dc0e-4418-bffd-0c0ea7f939c0","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3184036,"visible":true,"origin":"","legend":"\u003cp\u003eETH MIKE robot for the assessment and therapy of hand proprioception.\u003c/p\u003e\n\u003cp\u003eThe platform focuses on the index finger metacarpophalangeal (MCP)\u003c/p\u003e\n\u003cp\u003ejoint. It consists of an end-effector of the robot where the finger is inserted and\u003c/p\u003e\n\u003cp\u003esecured using Velcro straps (right image), as well as a tablet computer placed\u003c/p\u003e\n\u003cp\u003edirectly above the hand (left image), which displays the graphical user interface\u003c/p\u003e\n\u003cp\u003eof assessments and therapy exercises. The robot can either move the user’s finger\u003c/p\u003e\n\u003cp\u003e(passive tasks) or be actively moved by the user (active tasks). Interaction force,\u003c/p\u003e\n\u003cp\u003evelocity and position signals are recorded via integrated sensors.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/e5bf998ab2cb2a61d5e845e1.png"},{"id":50820393,"identity":"c78e4206-da70-4cb0-bb6f-c6d6e05150ec","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1215552,"visible":true,"origin":"","legend":"\u003cp\u003eVisualization of the graphical user interface of the two example therapy\u003c/p\u003e\n\u003cp\u003eexercises, one passive (Passive Matching) and one active (Active Matching). (a)\u003c/p\u003e\n\u003cp\u003eThe goal of the Passive Matching exercise is to choose, on the tablet screen\u003c/p\u003e\n\u003cp\u003elocated directly above the hand, among presented options, the location of one’s\u003c/p\u003e\n\u003cp\u003efinger after it has been passively displaced by the robot. The choice is made by\u003c/p\u003e\n\u003cp\u003epressing a button on the touch screen corresponding to the color of the perceived\u003c/p\u003e\n\u003cp\u003eposition. (b) In the Active Matching exercise participants need to move their\u003c/p\u003e\n\u003cp\u003efinger as accurately as possible from the starting position (grey needle) to the\u003c/p\u003e\n\u003cp\u003etarget position (green needle). (c-d) Visual feedback is provided after every trial\u003c/p\u003e\n\u003cp\u003eto facilitate learning. In (c) the pink needle indicates an incorrect answer that\u003c/p\u003e\n\u003cp\u003ewas selected by the participant (e.g., orange instead of yellow). A correct answer\u003c/p\u003e\n\u003cp\u003ewould be indicated by a needle highlighted in green. In (d) the blue needle\u003c/p\u003e\n\u003cp\u003eindicates the actual finger position, while the green shaded area shows the margin\u003c/p\u003e\n\u003cp\u003eof allowable error.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/d2fd0d3ac9e6741bf170bfbc.png"},{"id":50820392,"identity":"c7a7d514-9635-49f2-b33e-c49f1a546f5c","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":105081,"visible":true,"origin":"","legend":"\u003cp\u003eSummary of the study protocol. It consisted of clinical and robotic assessments\u003c/p\u003e\n\u003cp\u003eat baseline (study inclusion) and post-intervention (study discharge),\u003c/p\u003e\n\u003cp\u003e13 days of robotic therapy (30 min per day, 5 days a week) and usability evaluation\u003c/p\u003e\n\u003cp\u003econducted every 4 days. Each robotic therapy session consisted of 3 exercises,\u003c/p\u003e\n\u003cp\u003e2 runs of each, with 15 trials per run. For patients that could actively move their\u003c/p\u003e\n\u003cp\u003eindex finger by more than 10◦ the protocol consisted of a predefined combination\u003c/p\u003e\n\u003cp\u003eof the battery of 5 exercises. For patients who could not actively move the hand\u003c/p\u003e\n\u003cp\u003edue to severe paresis the robotic therapy protocol consisted of a combination of\u003c/p\u003e\n\u003cp\u003e2 passive exercises (case 2, second row in the table).\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/3d01bb4951ccf0651e7b7a8c.png"},{"id":50820396,"identity":"525b0e66-1197-4324-8a75-ea7a0db491a2","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":112654,"visible":true,"origin":"","legend":"\u003cp\u003e(a-e) Performance in each exercise (% of trials with a correct answer)\u003c/p\u003e\n\u003cp\u003eand difficulty levels at which the exercise runs were conducted (1-12). Performance\u003c/p\u003e\n\u003cp\u003eis shown as mean and standard deviation across all stroke participants\u003c/p\u003e\n\u003cp\u003eper exercise run (each run consisting of 15 exercise trials), only considering runs\u003c/p\u003e\n\u003cp\u003ethat were performed by all participants (because two participants performed\u003c/p\u003e\n\u003cp\u003emore runs in Passive Matching and Trajectory Perception, but these runs were\u003c/p\u003e\n\u003cp\u003enot considered in plots a-e). The difficulty levels are shown as the average across\u003c/p\u003e\n\u003cp\u003eall stroke participants (N=7 for exercises involving active hand movement, N=9\u003c/p\u003e\n\u003cp\u003efor passive exercises). A dashed blue line represents the target performance of\u003c/p\u003e\n\u003cp\u003e70%. (f) Each dot corresponds to the difficulty level per exercise run, one participant\u003c/p\u003e\n\u003cp\u003eper colour. Participants #8 and #13 were highlighted as they performed\u003c/p\u003e\n\u003cp\u003eonly passive exercises, hence more exercise runs were completed by these individuals\u003c/p\u003e\n\u003cp\u003efor the Passive Matching task.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/1a283407f0c47b037b595f71.png"},{"id":50820395,"identity":"a77b03d2-05b4-4a13-b64b-f6fee65bca64","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":21065,"visible":true,"origin":"","legend":"\u003cp\u003eDifficulty level increase (b) and exercise performance (a) correlate with\u003c/p\u003e\n\u003cp\u003eimprovement in proprioception. A similar trend was observed between performance\u003c/p\u003e\n\u003cp\u003eand change in BBT, when excluding participants with severe hand paresis\u003c/p\u003e\n\u003cp\u003e(c). The exercise performance per subject is taken as the average across all runs\u003c/p\u003e\n\u003cp\u003eand all exercises. The difficulty level is the maximum level reached throughout\u003c/p\u003e\n\u003cp\u003etherapy averaged across all exercises. Abbreviations - AE: Absolute Error, BBT:\u003c/p\u003e\n\u003cp\u003eBox and Block Test, Δ: difference between discharge and baseline assessment\u003c/p\u003e\n\u003cp\u003escore. Numbers next to the data points correspond to participant number. The\u003c/p\u003e\n\u003cp\u003edashed line represents a linear fit. The rho reported next to the line is the Spearman\u003c/p\u003e\n\u003cp\u003ecorrelation coefficient.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/aec5bbe0ef33205bda49cdd5.png"},{"id":50820397,"identity":"d013de22-a712-4f10-b6ec-605bcd2bf125","added_by":"auto","created_at":"2024-02-07 20:39:48","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":30913,"visible":true,"origin":"","legend":"\u003cp\u003eResults of the raw NASA TLX indicating the perceived task load as\u003c/p\u003e\n\u003cp\u003eindicated by participants (N=9). The smaller the score, the lower the perceived\u003c/p\u003e\n\u003cp\u003eworkload. The evaluation was performed every 4 days over the 3 weeks intervention\u003c/p\u003e\n\u003cp\u003eand considering all exercises together as a whole robotic therapy experience.\u003c/p\u003e\n\u003cp\u003eIt is desired for the raw TLX values to be below 50% (red line).\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1/f9d51d501fbee93b03f0f299.png"},{"id":50929977,"identity":"5e135f76-5657-47aa-ba4e-91b9067ac42d","added_by":"auto","created_at":"2024-02-09 17:54:14","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":783772,"visible":true,"origin":"","legend":"","description":"","filename":"ZbytniewskaMegret2024JNERManuscriptSubmission01022024.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3916719/v1_covered_ba3b9833-bec9-4785-b1fb-8474f0935623.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility, usability and effectiveness of a robot-assisted finger proprioception therapy","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"robot-assisted therapy, neurorehabilitation, stroke, recovery, proprioception, hand function","lastPublishedDoi":"10.21203/rs.3.rs-3916719/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3916719/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Neurological injuries, such as stroke, often lead to motor and somatosensory impairments of the hand. Deficits in somatosensation, especially proprioception, result in difficulties performing activities of daily living involving fine motor tasks. As those impairments are challenging to accurately evaluate and monitor, therapies rarely focus on proprioception specifically, even though it has been shown that such training could promote functional benefits. In this work we propose and preliminarily evaluate the feasibility, usability and effectiveness of a robot-assisted therapy focused on finger proprioception.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We designed and implemented on an existing robotic platform (ETHMIKE) five therapeutic exercises, focusing on finger somatosensation, two targeting passive and three active position sense. The difficulty level of the therapy exercises was automatically adapted to each patient’s proprioceptive impairment, assessed using the same platform (i.e., assessment-driven therapy). Nine subacute stroke participants completed the robotic therapy for at least two weeks, 30 minutes per day, five times a week. Data was compared to a control group based on a previously collected dataset where subacute stroke participants received usual care and the same assessments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e We found that the proposed exercises were feasible for stroke participants, as everyone managed to progress in difficulty levels. Moreover, the exercise performance averaged between 59% and 70% of maximum possible performance for the different exercises, indicating adequacy of the difficulty adaptation algorithm and a balance between motivation and challenge. Further, usability was rated as acceptable, as NASA Task Load Index (raw TLX), which provides an overall workload score, was mostly below 50%, except for mentaldemand. There was a significant improvement in proprioceptive error and in the Box and Block Test score from study inclusion to discharge for the intervention group, which was not the case for the control group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e This work demonstrated the first insights into feasibility, usability and effectiveness of a novel robot-assisted therapeutic approach. These encouraging results pave the way for further development and validation of therapy approaches focusing on somatosensory function.\u003c/p\u003e","manuscriptTitle":"Feasibility, usability and effectiveness of a robot-assisted finger proprioception therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-07 20:39:43","doi":"10.21203/rs.3.rs-3916719/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce21b831-b63b-494e-8614-4bb48e31dd43","owner":[],"postedDate":"February 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-01T12:20:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-07 20:39:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3916719","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3916719","identity":"rs-3916719","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}