Intel Serv Robotics (2008) 1:109–121 DOI 10.1007/s11370-007-0010-3 SPECIAL ISSUE Collaborative tele-rehabilitation and robot-mediated therapy for stroke rehabilitation at home or clinic Michelle J. Johnson · Rui C. V. Loureiro · William S. Harwin Received: 25 July 2007 / Accepted: 6 December 2007 / Published online: 23 January 2008 © Springer-Verlag 2008 Abstract Successful home-rehabilitation should reduce cost, facilitate virtual therapeutic visits, and motivate stroke survivors to engage in under-supervised therapeutic activity at levels necessary for motor learning and generalization to occur. We explored long-distance collaborative “play” using two 6DOF robot-mediated environments and examined the influence on the motivation of able-bodied persons to engage in therapy, sustain play, and relate during a shared task, tic- tac-toe. A clear positive trend existed in favor of the collab- orative robot-mediated environment, which subjects found more valuable, interesting, and enjoyable, and was therefore willing to spend more time at the task. Kinematic metrics such as mean velocity of movement and movement smooth- ness were sensitive to the changes in the level of collaboration Financial support from the FCT (Fundação para a Ciência e a Tecnologia) and the ESF (European Social Fund) in the scope of the III communitarian framework of support for the Gentle/S Project. In addition, NIH R24 Grant #2203792 through the Rehabilitation Institute of Chicago, the Medical College of Wisconsin Research Affairs Committee Grant # 3303017, and the Advancing a Healthier Wisconsin Grant # 5520015 for the ADLER project. M. J. Johnson (B ) Medical College of Wisconsin - Physical, Medicine & Rehabilitation, Milwaukee, WI, USA e-mail: mjjohnso@mcw.edu M. J. Johnson Biomedical Engineering, Olin Engineering Center, Marquette University, Milwaukee, WI, USA R. C. V. Loureiro · W. S. Harwin School of Systems Engineering, Cybernetics, The University of Reading, Whiteknights, Reading RG66AY, UK e-mail: r.c.v.loureiro@reading.ac.uk W. S. Harwin e-mail: w.s.harwin@reading.ac.uk in the environment in that sub-movements from rest to the piece were slower and less directed than movements to place the piece at the target tic-tac-toe location. We discuss our experiment, results and its application to stroke rehabilitation and to the development of collaborative tele-rehabilitation at home. Keywords Collaborative tele-rehabilitation · Home and clinical neurorehabilitation · Motivation · Robot-mediated therapy 1 Introduction There is a need for affordable yet effective rehabilitation approaches to maximize the functionality independence of persons experiencing disability after stroke. Stroke is the leading cause of serious and long-term disability in adults in the USA with about 30% of persons after stroke expe- riencing permanent disability like hemiparesis, immobility, institutionalized, and highly dependent in daily living activ- ities [1, 16, 39]. At 6 months post-stroke 50% of survivors at least 65 years old had some hemiparesis, 30% were unable to walk, and 26% were dependent in activities of daily living (ADLs) [1]. An estimated cost is $62.7 billion with lifetime cost of $140,048. This cost will increase in the future since the at-risk population for stroke will increase significantly to about 20% of the population by 2010. In examining reviews of rehabilitation outcomes, we can state that the rate of recovery and the amount of functional gain of an impaired arm after stroke often depends on focused, intense, and continual therapy [2, 11, 23, 39]. Recent findings also suggest that maintaining attention and engage- ment during the learning of new motor skills or the re-learning of forgotten skills are important for inducing cerebral plasticity after neurological impairments [2, 11, 32]. 123