Advances in upper limb stroke rehabilitation: a technology push

Abstract

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, robot-aided 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 robot-mediated 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.

Bridging the gap between robotic technology and health care

“…Over the past decade several studies have emerged looking at the use of highly sophisticated technologies, such as robotics and virtual reality to tap into the needs of clinicians and patients [27]. Although traditional physiotherapy coupled with machine mediated therapy can be beneficial in the recovery process, once patients are discharged from hospital it is difficult to exercise correctly the affected limb without the support from clinicians.…”

“…In general these systems can be grouped according to the rehabilitation principle they follow [28]: (i) treadmill gait trainers, (ii) foot-plate-based gait trainers, (iii) overground gait trainers, (iv) stationary gait trainers, (v) ankle rehabilitation systems (stationary systems and active foot orthoses). The description of a number of upper limb rehabilitation devices can be found in [27,29,30].…”

“…A recent review [27,35] has concluded that despite mounting evidence suggesting robotic therapies are not more likely to improve patients' activities of the daily living than any other therapy, it has shown great capacity to improve patients' motor function and core strength [27,[35][36][37]. The consensus exists that equal importance should be placed by clinicians and researchers working in the field in establishing guidelines on the study design and assessment and on pushing for more efficient, safer and inexpensive technologies.…”

“…Clinical outcomes reported in the literature vary [27] and might be ascribed to variations on patient characteristics, exposure to therapies and intensity. This in turn has implications to the study design and prompts for careful interpretation of the data.…”

Trends in rehabilitation robotics

“…Several studies have shown a positive effect of gameplaying on therapy outcome by increasing motivation. Latest works, like Guidali [7], with those devices involve the application of virtual reality to train activities of daily living.…”