User Perspectives on Robotics for Post-stroke Hand Rehabilitation
Chloe Ng · 2019 · Proceedings of the 21st International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS 2019) · doi:10.1145/3308561.3356108
Summary
This student research abstract presents a preliminary qualitative study investigating user perceptions of an exoskeleton robotic device designed for post-stroke hand rehabilitation. Impaired hand motor function is one of the most significant disabilities following stroke, affecting activities of daily living. While robotic rehabilitation devices have shown clinical effectiveness in improving hand function through intensive, repetitive exercises, very few studies have examined the subjective experience of patients using these devices. The study recruited six participants across three stakeholder groups: two stroke survivors (S1, who used the device in person; S2, who participated remotely via video demonstration), two caregivers (C1, C2), and two biomedical/rehabilitative engineering researchers (R1, R2). Participants experienced the exoskeleton device through four passive movements (open and close, cylindrical grip and close, three-finger grip and close, two-finger grip and close) and one active movement mode where the device responded to surface electromyography (sEMG) signals detected through an armband, opening or closing based on the user’s muscle activity patterns. Semi-structured interviews lasting approximately one hour were conducted alongside validated questionnaires: the Credibility and Expectancy Questionnaire (CEQ) and the Intrinsic Motivation Inventory (IMI).
Key findings
The study revealed a striking split in attitudes across stakeholder groups. Stroke patients and caregivers rated the device highly on both credibility and expectancy (patients: 8.0 and 7.5; caregivers: 8.9 and 8.5 out of 10), considering it credible and valuable for rehabilitation. In contrast, biomedical researchers gave markedly low scores (credibility: 4.6; expectancy: 1.5), perceiving the device as not adding significant value. The in-person stroke patient (S1) showed high intrinsic motivation scores across enjoyment (7/7), perceived competence (6.33/7), perceived choice (7/7), effort (6.33/7), and usefulness (6.67/7), with minimal pressure (1/7). S1 was "fascinated by" the device and described his hand feeling "normal again" when using it — he could extend his hand and move his thumb for the first time. Notably, participants with less experience with robot-assisted rehabilitation showed more positive attitudes, while those with more domain expertise expressed reservation. All participants envisioned the device being used beyond clinical settings — in gyms, at home, or in countries with limited healthcare access — and wanted it to assist with functional everyday tasks like dressing, eating, and brushing teeth, rather than being limited to pre-defined rehabilitation movements. Key criticisms included slow and restrained movement, the "fiddly" donning process, large device size and weight, the stereotypic hand positions that do not accommodate individual patient capacities, and concerns about requiring sufficient upper arm strength.
Relevance
Although preliminary with only six participants, this study highlights an important gap in rehabilitation robotics research: the disconnect between clinical/engineering evaluation and patient experience. The finding that domain expert researchers rated the device poorly while patients and caregivers rated it highly underscores that clinical effectiveness metrics and user satisfaction can diverge significantly. For accessibility practitioners and rehabilitation technology designers, this suggests that involving patients and caregivers in evaluation — not just clinicians and engineers — is essential, particularly for home-based and portable devices where user motivation and perceived effectiveness directly influence adherence. The patients’ desire to use the device for functional daily tasks rather than abstract rehabilitation exercises points toward a broader design opportunity: rehabilitation devices that integrate into daily living rather than requiring dedicated exercise sessions. As a student research abstract, this is a proof-of-concept for larger studies examining subjective experience in robot-assisted rehabilitation across the full range of stakeholders.
Tags: stroke rehabilitation · exoskeleton · robotics · motor disability · assistive technology · user experience · hand function · rehabilitation · caregiver perspectives