Post-stroke rehabilitation with the Rutgers Ankle system: A case study

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.