Training modalities in robot-mediated upper limb rehabilitation in stroke: a framework for classification based on a systematic review (original) (raw)
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Functionally-Based Rehabilitation: Benefit or Buzzword?
9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005.
In 1991, a novel robot named MIT-MANUS was introduced as a test bed to study the potential of using robots to assist in and quantify the neuro-rehabilitation of motor function. It introduced a new type of therapy, offering a highly back-drivable mechanism with a soft and stable feel for the user. MIT-MANUS proved an excellent fit for rehabilitation of the paretic shoulder and elbow in patients with stroke, with clinical trials showing a reduction of impairment at these joints. However, the desired outcome of rehabilitation services is reduced impairment in movement capacities, as well as improved functional abilities and participation in daily life tasks. While we have seen reductions in motor impairment, no specific attempts were made during these studies to help the person link the movements practiced during robotic therapy to motor actions during daily tasks. In this paper we are presenting our first attempt to link movements practiced in robotic therapy with distal training during functional tasks.
Innovative technologies for rehabilitation and health promotion: what is the evidence?
Physical therapy, 2015
Health Promotion: What Is the Evidence? Innovative Technologies for Rehabilitation and http://ptjournal.apta.org/content/95/3/294 found online at: The online version of this article, along with updated information and services, can be Online-Only Material 4.DC1.html References 1 Kahn LE, Lum PS, Rymer WZ, Reinkensmeyer DJ. Robot-assisted movement training for the stroke-impaired arm: does it matter what the robot does? J Rehabil Res Dev. 2006;43:619 -630. 2 Tefertiller C, Pharo B, Evans N, Winchester P. Efficacy of rehabilitation robotics for walking training in neurological disorders: a review. J Rehabil Res Dev. 2011;48:387-416. 3 Krishnan C, Ranganathan R, Dhaher YY, Rymer WZ. A pilot study on the feasibility of robot-aided leg motor training to facilitate active participation. PloS One. 2013;8:e77370. doi: 10.1371/journal.pone.0077370. 4 Collinger JL, Kryger MA, Barbara R, et al. Collaborative approach in the development of high-performance brain-computer interfaces for a neuroprosthetic arm: translation from animal models to human control. Clin Transl Sci.
Neurorehabilitation and neural repair, 2015
Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke. To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved. In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, o...
SPECIAL ISSUE -REVIEW Advances in upper limb stroke rehabilitation: a technology push
Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robotaided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robotmediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.
Health Technology Assessment
Background Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. Objective The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. Design This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. Setting The trial was set in four NHS trial centres. Participants Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. Interventions Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. Main outcome measures The primary outcome was up...
The Journal of Rehabilitation Research and Development, 2011
This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains.
Current physical medicine and rehabilitation reports, 2014
Stroke is one of the leading causes of long-term disability today; therefore, many research efforts are focused on designing maximally effective and efficient treatment methods. In particular, robotic stroke rehabilitation has received significant attention for upper-limb therapy due to its ability to provide high-intensity repetitive movement therapy with less effort than would be required for traditional methods. Recent research has focused on increasing patient engagement in therapy, which has been shown to be important for inducing neural plasticity to facilitate recovery. Robotic therapy devices enable unique methods for promoting patient engagement by providing assistance only as needed and by detecting patient movement intent to drive to the device. Use of these methods has demonstrated improvements in functional outcomes, but careful comparisons between methods remain to be done. Future work should include controlled clinical trials and comparisons of effectiveness of differ...
Applied Sciences, 2019
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for incr...
Effect of robot-mediated therapy on upper extremity dysfunction post-stroke—a single case study
Physiotherapy, 2005
Objectives Studies of neuroplasticity suggest that repetitious movements optimise changes at brain level, and that this response is optimised if the task is challenging and engaging. The evidence to date on physiotherapy interventions suggests that an increased intensity of therapy provides better outcomes and that exercise-based interventions demonstrate positive treatment effects. Robot-mediated therapy (RMT) is an innovative way of providing these components. This study investigated the effect of RMT on upper extremity function post-stroke. Design Single case study using an ABC design. Setting Physiotherapy outpatient department. Participant A 79-year-old female, 22 months following right cerebrovascular accident. Interventions Phase A consisted of a series of nine baseline measurements, phase B consisted of nine 30-minute sessions of RMT, and phase C consisted of nine 30-minute sessions of sling suspension. Main outcome measures Fugl-Meyer Assessment, the Motor Assessment Scale and the Short-Form-36 (SF-36) questionnaire. Results The rate of recovery during the RMT phase B was greater than that with no treatment (A) and that with sling suspension (C) for the Fugl-Meyer Assessment and the Motor Assessment Scale. Improvement was seen only in those domains addressed by the RMT system. No change in quality of life as measured by the SF-36 was noted. Conclusions Treatment delivered by this RMT system had a positive effect on the rate of recovery at the level of impairment of body function and at the level of activities. The superiority of RMT over sling suspension is consistent with the theories of neuroplasticity which suggest that repetitious movements must be challenging and meaningful. While these initial results concur with those of previous studies of RMT, further evidence is required before this form of intervention should be incorporated routinely into clinical practice.
The Effect of Robot Mediated Therapy on Upper Extremity Dysfunction Post Stroke
Objectives Studies of neuroplasticity suggest that repetitious movements optimise changes at brain level, and that this response is optimised if the task is challenging and engaging. The evidence to date on physiotherapy interventions suggests that an increased intensity of therapy provides better outcomes and that exercise-based interventions demonstrate positive treatment effects. Robot-mediated therapy (RMT) is an innovative way of providing these components. This study investigated the effect of RMT on upper extremity function post-stroke. Design Single case study using an ABC design. Setting Physiotherapy outpatient department. Participant A 79-year-old female, 22 months following right cerebrovascular accident. Interventions Phase A consisted of a series of nine baseline measurements, phase B consisted of nine 30-minute sessions of RMT, and phase C consisted of nine 30-minute sessions of sling suspension. Main outcome measures Fugl-Meyer Assessment, the Motor Assessment Scale and the Short-Form-36 (SF-36) questionnaire. Results The rate of recovery during the RMT phase B was greater than that with no treatment (A) and that with sling suspension (C) for the Fugl-Meyer Assessment and the Motor Assessment Scale. Improvement was seen only in those domains addressed by the RMT system. No change in quality of life as measured by the SF-36 was noted. Conclusions Treatment delivered by this RMT system had a positive effect on the rate of recovery at the level of impairment of body function and at the level of activities. The superiority of RMT over sling suspension is consistent with the theories of neuroplasticity which suggest that repetitious movements must be challenging and meaningful. While these initial results concur with those of previous studies of RMT, further evidence is required before this form of intervention should be incorporated routinely into clinical practice.