Picking Cubes: A Rehabilitation Tool for Improving the Rehabilitation of Gross Manual Dexterity

  • Miguel A. TeruelEmail author
  • Ana de los Reyes-Guzmán
  • Juan Villanueva
  • Vicente Lozano-Berrio
  • María Alvarez-Rodríguez
  • Silvia Ceruelo-Abajo
  • Elena Navarro
  • Pascual Gonzalez
Conference paper
Part of the Advances in Intelligent Systems and Computing book series (AISC, volume 806)


After Spinal Cord Injury the loss of motor function, and mainly of the upper limb, is a sharp limitation that difficult people in performing many Activities of Daily Living essential for their autonomy. The Box and Block Test is one the most relevant clinical scale for the rehabilitation of the gross manual dexterity. However, the human-supervision of rehabilitation can introduce errors. For this aim, in this paper we present a tool that simulates this test by using a virtual environment, where patients can grasp a cube with their dominant hand, transport the block and release it into the opposite compartment. For controlling the hand and fingers we use leap motion, a low-cost 3D tracking device that tracks users’ palm and fingers. Moreover, in order to increase patients´ motivation, we have included additional feedback so that they become aware of their competence while carrying out their rehabilitation exercises.


Upper limb rehabilitation Box and Block Test Virtual reality Leap motion Motivation 



This work was partially supported by Spanish Ministerio de Economía, Industria y Competitividad, Agencia Estatal de Investigación (AEI)/European Regional Development Fund (FEDER, UE) under Vi-SMARt (TIN2016-79100-R) and RehabHand (DPI2016-77167-R) grants.


  1. 1.
    Van den Berg, M., Castellote, J.M., Mahillo-Fernandez, I., de Pedro-Cuesta, J.: Incidence of spinal cord injury worldwide: a systematic review. NeuroEpidemiology 34(3), 184–192 (2010)CrossRefGoogle Scholar
  2. 2.
    Wyndaele, M., Wyndaele, J.J.: Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey? Spinal Cord 44(9), 523–529 (2006)CrossRefGoogle Scholar
  3. 3.
    Broeks, J.G., Lankhorst, G.J., Rumping, K., Prevo, A.J.H.: The long-term outcome of arm function after stroke: results of a follow-up study. Disabil. Rehabil. 21(8), 357–364 (1999)CrossRefGoogle Scholar
  4. 4.
    Yang, N., Zhang, M., Huang, C., Jin, D.: Motion quality evaluation of upper limb target-reaching movements. Med. Eng. Phys. 24(2), 115–120 (2002)CrossRefGoogle Scholar
  5. 5.
    Van Tuijl, J.H., Janssen-Potten, Y.J., Seelen, H.A.: Evaluation of upper extremity motor function tests in tetraplegics. Spinal Cord 40(2), 51–64 (2002)CrossRefGoogle Scholar
  6. 6.
    Zhou, H., Hu, H.: Human motion tracking for rehabilitation—a survey. Biomed. Signal Process 3(1), 1–18 (2008)CrossRefGoogle Scholar
  7. 7.
    de los Reyes-Guzmán, A., Gil-Agudo, A., Peñasco-Martín, B., Solís-Mozos, M., del Ama-Espinosa, A.J., Pérez-Rizo, E.: Kinematic analysis of the daily activity of drinking from a glass in a population with cervical spinal cord injury. J. Neuroeng. Rehabil. 7(1), 41 (2010)CrossRefGoogle Scholar
  8. 8.
    Holden, M.K.: Virtual environments for motor rehabilitation: review. Cyberpsychology Behav. 8(3), 187–211 (2005)CrossRefGoogle Scholar
  9. 9.
    Rose, F.D., Brooks, B.M., Rizzo, A.A.: Virtual reality in brain damage rehabilitation: review. Cyberpsychology Behav. 8(3), 241–262 (2005)CrossRefGoogle Scholar
  10. 10.
    Burdea, G.C., Coiffet, P.: Virtual Reality Technology, 2nd edn. Wiley, Hoboken (2003)Google Scholar
  11. 11.
    Leap Motion Controller. Accessed 01 Feb 2018
  12. 12.
    Khademi, M., Mousavi Hondori, H., McKenzie, A., Dodakian, L., Lopes, C.V., Cramer, S.C.: Free-hand interaction with leap motion controller for stroke rehabilitation. In: CHI 2014 Extended Abstracts, pp. 1663–1668. ACM (2014)Google Scholar
  13. 13.
    Iosa, M., Morone, G., Fusco, A., Castagnoli, M., Fusco, F.R., Pratesi, L., Paolucci, S.: Leap motion controlled videogame-based therapy for rehabilitation of elderly patients with subacute stroke: a feasibility pilot study. Top. Stroke Rehabil. 22(4), 306 (2015)CrossRefGoogle Scholar
  14. 14.
    Mathiowetz, V., Volland, G., Kashman, N., Weber, K.: Adult norms for the Box and Block Test of manual dexterity. Am. J. Occup. Ther. 39(6), 386–391 (1985)CrossRefGoogle Scholar
  15. 15.
    López-Jaquero, V., Montero, F., Teruel, M.A.: Influence awareness: considering motivation in computer-assisted rehabilitation. J. Ambient. Intell. Hum. Comput. 1–13 (2017)Google Scholar
  16. 16.
    Cialdini, R.B.: Influence: the Psychology of Persuasion. Morrow, New York (1993)Google Scholar
  17. 17.
    Ryan, R.M., Deci, E.L.: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 55(1), 68 (2000)CrossRefGoogle Scholar
  18. 18.
    Ryan, R.M., Deci, E.L.: Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp. Educ. Psychol. 25(1), 54–67 (2000)CrossRefGoogle Scholar
  19. 19.
    Flores, E., Tobon, G., Cavallaro, E., Cavallaro, F.I., Perry, J.C., Keller, T.: Improving patient motivation in game development for motor deficit rehabilitation. In: Proceedings of the 2008 International Conference on Advances in Computer Entertainment Technology, Yokohama, Japan, pp. 381–384 (2008)Google Scholar
  20. 20.
    Goršič, M., Cikajlo, I., Novak, D.: Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity. J. Neuroeng. Rehabil. 14(1), 23 (2017)CrossRefGoogle Scholar
  21. 21.
    Menard, M., Wagstaff, B.: Game Development with Unity. Cengage Learning, Boston (2014)Google Scholar
  22. 22.
    Leap Motion Inc.: Orion Beta (2017).

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.LoUISE Research Group, Computing SystemsUniv. of Castilla-La ManchaAlbaceteSpain
  2. 2.Biomechanics and Technical Aids UnitNational Hospital for ParaplegicsToledoSpain
  3. 3.Rehabilitation DepartmentNational Hospital for ParaplegicsToledoSpain

Personalised recommendations