# Making Best Use of Home-Based Rehabilitation Robots
## 2 Materials and Methods  
This study was a single centre prospective design involving 16 people recovering from stroke. Participants were recruited from the local stroke services who were over 18 years old, had a diagnosis of ischaemic, or hemorrhagic, stroke at least one month prior, had residual strength of the upper limb, and had enough voluntary movement to initiate movement of the joystick. However, participants were not taken on to the study if they had pain in the arm affecting use of the system, had cognitive impairments affecting understanding and capacity to consent, or were medically unstable (e.g., uncontrolled epilepsy). The clinical exploratory study evaluates the system in people's homes across an eight-week period with functional clinical assessments at the start, the end, and after a four-week washout period from the end. The washout period allows assessment of any improvement after the robotic study has finished. Clinical assessment measures include the Fugl Meyer (FM) measure, which evaluates recovery after stoke and is a commonly used measure, the Action Research Arm Test (ARAT) which assesses upper limb function using observational methods, the Chedoke Arm and Hand Activity Inventory (CAHAI) which uses a number of functional tasks to assess recovery, the ABILHAND which is another measure of manual ability for upper limb impairment based on interview questions, and the Motor Assessment Scale (MAS) which is an activity observation scale and the Medical Research Council (MRC) scale for muscle strength. The clinical results for this study are fully presented by [PERSON] et al. [32]. Robotic measures were calculated between start and end of the eight weeks, as the device was used by each participant. MyPAM (University of Leeds, Leeds, UK) is a bespoke rehabilitation device consisting of a 2D planar robot powered by two DC motors, controlled by National Instruments CompactRIO (National Instruments, Austin, TX, USA) linked to a PC which displays menus and games to the participant. Figure 1 shows the original MyPAM device in a home setting. MyPAM was built using principles of user centred design and design philosophies such as [PERSON] and [PERSON]'s six-phase product-development process [33] where usability, safety, and functionality are essential. The key features of the MyPAM device are:  
* 2D planar movement over a comfortable workspace, allowing the patient to be assisted in a safe area--the device was designed to be 2D to reduce complexity and reduce cost, but still provide appropriate movement therapy;
* Doctor-/therapist-led initial assistance profiles based on clinical assessment to get the user started with the system;
* An adaptive algorithm (based on user performance to alter the force profile through the user's rehabilitation);
* Interactive games to engage the user in the rehabilitation; and
* All data is stored locally for later analysis, as presented in this paper. Studies have relied on clinical measures to identify changes in participant improvement, but there are several suggestions that clinical measures are not sensitive enough to capture small changes over a short amount of time [34]. However, as rehabilitation robotic devices are used movement analysis can be collected and analysed continuously. This raises several questions around capturing the impact of robotic therapy. Can robots be used to deliver therapy that is effective and useful for the user? Can robotic data be used for more or better measurement to inform the efficacy of the therapy being delivered? The intervention involved 19 participants recruited who were recovering from stroke, however, two participants dropped out due to personal factors and one user didn't use the system leaving 16 sets of data. Thirteen were male and three female, with an age range of 34 to 81 years old (mean = 56.8, median = 60.7, IQR = 12.04, and SD = 11.2). Seven of the participants have left-sided paralysis and the remaining nine right-sided.