Motivation. There is a widely recognized need for new approaches to neurorehabilitation. This has motivated considerable novel research and development (R&D) approaches in areas such as rehabilitation robotics as well as the use of virtual reality and telerehabilitation tools. Most of the focus has been on technologies that are intended for use within the clinic. There is a need for complementary alternatives that are of more moderate cost that are designed for use in either the home or clinic, and that also accommodate the abilities and preferences of users as well as their clinical needs.
UniTherapy software. In response to this need, the UniTherapy software has aimed to develop and evaluate a personalized computer-assisted rehabilitation framework that integrates Computer-Assisted Motivating Rehabilitation (CAMR) therapy with remote support and assessment. It supports lower-cost commercial force-reflecting joysticks and wheels, and emerging consumer electronics standards. This framework is currently being used study the viability of developing personalized protocols that include assessment tasks that yield sensitive metrics to functional changes/levels of human subjects.
Organizational Structure of UniTherapy. There are three modes:
This help document targets the Therapy Designer (TD) mode. The user in TD mode has access to a suite of toolboxes that are intended to enable a rich variety of protocols to be developed. Across the top of this Windows program are menus, each with dropdown capabilities (as is common for Windows packages). The toolbar sequence that is just below the menu bar provide a collection of commonly used operational controls, while the toolbar sequence along the bottom opens up several common UniTherapy toolboxes and capabilities. See Getting Started and Menu for help on using the package.
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There are several ways to get started using the package. To get a quick overview of the features, it is useful to start by spending a few minutes going through the drop-down menu.
The first item is typically to establish your hardware devices for the "Practitioner" and "Patient" interfaces by going to the Device drop-down menu (second from the far right) and selecting from the list of available devices - UniTherapy should list all the "plug-and-play" devices that Windows is aware of as being connected, such as joysticks, mouse pointers, wheels and keyboards. If you don't see a device that you wanted to use, make sure it is plugged in to a USB port, or try re-plugging it. Note that certain capabilities of UniTherapy are only functional if you choose a Patient device that supports force-reflection.
The next likely step is to try it out. There are two common ways to start. If you'd like to try out some tasks, click on any of the task buttons that show on the front "home" screen. This loads settings for the task that was selected, and the screen should change to a new set of options. Click the "Start" toolbar button to try it out (or use the menu with Command>Start). After finishing, consider trying to change one or more of the options for the task, and try it again with the new settings. Exploration like this is a great way to better understand the cause-effect between task settings and task implementation.
The other way to start is to load an existing protocol. This can be initiated by either clicking on the "Load" toolbar or from the menu pulldown (File>Load Protocol). Assuming that your default Windows folder is populated by existing protocols, this is a great way to develop a better understanding of the various capabilities of the UniTherapy package. Some protocol templates are specially designed to be instructional, giving examples of possible home-based and research protocols. An advantage of trying a few of the protocols is that it helps you experience many different capabilities. Of note is that these protocols can be viewed as templates. You can adjust settings for tasks within the protocols, or you can insert or delete tasks from a protocol. You can then save this new protocol with a new name.
A third approach is to use the Wizard, which can be accessed by a toolbar on the lower right of the opening window or from the menu drop-down (Assessment>Design Wizard). This Wizard asks a series of questions, some based on answers to previous questions, that help set up a task. At the moment it does not appear operational.
A fourth approach is to go straight to use of menu drop-downs. In particular, the Assessment pulldown can be used to develop tasks [range-of-motion, tracking, systems identification (force-input response tasks)].
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The first (far left) of the pull-down menus, File, is common for Window programs. This includes supports loading for three types of stored files (Load ROM, Load Protocol, Load Profile). The ROM (range-of-motion, also called range-of-capability) is tied to a given user. This file provides the mapping settings, and once loaded, all tasks can use the mapping to the user's ability space. Thus protocols often needn't start with a ROM task, but rather can load previous ROM data for the patient user. Note that if a user's abilities are changing over time, it is worthwhile to periodically collect new ROM data. See also ROM help. Loading a protocol, as the name suggests, will load a sequence of tasks. This can be viewed as analogous to a CD with songs that by default are played in a certain order, with the user having options to, for instance, repeat or skip a certain task. By using File>Protocol Manager, a screen opens that helps the designer to easily modify the "play" list of tasks. See the Protocol help for more on these capabilities. One can also use File>Save ROM and File>Save Protocol to save information.
Also under the File drop-down is the Settings capability. This opens a window that enables the default settings for varies features and capabilities of UniTherapy to be modified. Setting tabs include basic (e.g., saving defaults, visual and audio cue defaults), hardware (e.g., button mappings), network (e.g., naming for any remote connection), tracking (e.g., timing features, target size and shape), system ID (e.g., default time for most forces), therapy (e.g., path to a game, background data collection options), preferences (e.g., font sizes, colors), and UPnP (Universal Plug and Play) option, Changes in these setting will also apply to subsequent openings of the UniTherapy package in this folder.
The View drop-down includes options for viewing three types of windows and other viewing features. By default the two Toolbar's are checked: View>ToolBar>Command is the toolbar along the top (Load, Save, Start, Reset, Delete, Help) while the View>ToolBar>Navigation is the toolbar at the bottom (ROM, Track, SID, Form, Wizard).
The Command drop-down top collection of commands (Start, Stop, Remove, Reset) are self-explanatory. The Allow Connection and Remote Connection refer to telerehab connectivity, which should always be under the control of each user. The Calibrate command relates to force-reflection, and is rarely needed.
The Assessment drop-down houses some of the key capabilities of UniTherapy: the ROM, Tracking and Systems Identification (Force Input Response) Toolboxes, the collection of Conventional Forms that is supported for data entry, and the option for device and screen mapping.that is based on ROM data.
The Therapy drop-down supports background collection of device use (Therapy>Collect Reduction Data) while other Windows programs (e.g., Solitaire) are being used. A rich collection of graphical metrics are available for time-, space- and frequency-based analysis of summary use history data. Note that this is use history data rather than performance data since there is no way for UniTherapy to know the goals for any third-party product. However, this ability to capture and present such use history data is valuable, and complements the assessment capabilities. Also under this pulldown is the Joymouse capability, which when selected enables a joystick to function as the mouse pointing device. This opens the door to use, with a joystick, of the many third-party programs that only support operation of a mouse pointing device (e.g., even internet browsers and Microsoft Office products).
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A Protocol is defined as a task sequence. Normally, protocols are designed for a specific user or a specific research protocol involving human subjects. The way a Protocol works is analogous to a CD with songs, only here with the named CD being the named Protocol, and the sequence of songs being the sequence of tasks. As with a song list, by default the tasks are run in a sequence. However, as with a CD player, the user has been option of repeating a task, skipping a task, jumping to a different task within a protocol, and so on. Tasks can be named, have a text caption, have patient instructions, and include a user (or practitioner) text memo.
A Protocol Manager is available to accommodate design of a Protocol, for instance to add, delete or re-order tasks.
Additionally, the designer has "write permission" in that the settings for a given task can be edited, and re-saved. This is useful if, for instance, a remote therapist wants to change setting because of changes in performance in a client.
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One of the great challenges in neurorehabilitation is to increase the intensity, duration and frequency of therapeutic intervention. It is recognized that tracking tasks are not necessarily "fun" therapy. Rather, they can be viewed as important assessment tools that should occupy a subset of the time of a therapy session. There are many programs that run within the Windows environment, and it is likely that some of these provide the user with enjoyable therapeutic activities that include goal-directed tasks, from playing card games to racing cars. UniTherapy supports the collection of use history data during such tasks. The Therapy>Collect Reduction Data enables the collection of operation data from the joystick or mouse device. There are also settings that can be adjusted under File>Settings and then the Therapy tab of the System Settings window. The data can be subsequently viewed as summary use history data in a number of forms, including spatial, temporal and frequency representations.
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UniTherapy includes support for several remote communication, or telerehabilitation, capabilities. There are three main modes for interaction across a distance:
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