Utilising technology for rehabilitation of the upper limb following stroke: the Ulster experience

Objectives: The aim of this research team has been to develop and test a range of virtual technologies for their feasibility and effectiveness in upper limb stroke rehabilitation. The principles of neural plasticity, motor control and skill training have informed the design and development of our systems and practice tasks. The purpose of this paper is to present a summary of our work to date and discuss what we have learned throughout the development, testing and implementation of this type of intervention in people with stroke. Methods: Virtual technologies are being used to provide people who have stroke with opportunities to practice in a more focused way, and to offer support to continue having access to therapy for more extended periods of time. The systems reported on in this paper are at various stages of development and user testing. Methods employed during the course of our investigations have been both qualitative and quantitative, including questionnaires, participant interviews, single case series and a randomized controlled trial design. Results: Our work has focused mainly on incorporating the principles of motor learning which seem to be most effective in promoting motor recovery following stroke, i.e. repetitive, functional and task related practice of active movement of the limbs. A number of other research groups have prioritised game style activities which concentrate on the motivation to practice. Results from a series of studies, with both non disabled and stroke users, indicate that the use of virtual technologies to augment and support rehabilitation after stroke is feasible and has positive effects on motor impairment and activity levels. Discussion/conclusion: This paper has presented an overview of the work our research team has been engaged in since 2003. There have been developments in two key areas, moving from unilateral practice to bilateral practice and incorporating these movements into game based systems. We plan to continue to test our systems against current standard care with a long-term aim to empower stroke users in their own rehabilitation.