Abstract
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization. Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34 +/- 20 to 38 +/- 19, P< 0.0005) and arm motor Fugl-Meyer score (45 +/- 10 to 52 +/- 10, P < 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions. The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.
Highlights
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand
The current study aimed to develop, assess clinical effects of, a robotic therapy targeting the distal arm
Goals of the current study were to develop a robotic system and therapy program to retrain hand grasping/releasing after stroke based on motor learning theories, to assess safety and effectiveness of this intervention, to examine how dose of robotic assistance influences behavioural gains, and to evaluate the degree to which therapy effects on motor cortex organization are task-specific
Summary
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. Robots can provide therapy for long time periods, in a consistent and precise manner, without fatigue; can be programmed to perform in different functional modes with a single click; can be automated for many functions; can measure and record a range of behaviours in parallel with therapeutic applications; and can be enabled to do the above with only remote human control (Burgar et al, 2000; Dobkin, 2004; Fasoli et al, 2004; Reinkensmeyer et al, 2004; Volpe et al, 2005) The latter extends the promise of telerehabilitation, which might improve access by underserved populations (Reinkensmeyer et al, 2002; Lai et al, 2004; Winters, 2004). Though robot-assisted therapy has been shown to significantly improve arm motor function after stroke (Aisen et al, 1997; Volpe et al, 1999; Krebs et al, 2002; Lum et al, 2002; Fasoli et al, 2003; Ferraro et al, 2003; Kahn et al, 2006b), with few exceptions (Jack et al, 2001; Hesse et al, 2003b), these efforts have been primarily focused on the proximal arm (Krebs et al, 1999; Reinkensmeyer et al, 2000; Lum et al, 2002)
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