Robotic Therapy Provides a Stimulus for Upper Limb Motor Recovery After Stroke That Is Complementary to and Distinct From Conventional Therapy

Brokaw, Elizabeth B.; Nichols, Diane; Holley, Rahsaan J.; Lum, Peter S.

doi:10.1177/1545968313510974

Cited by 69 publications

(38 citation statements)

References 41 publications

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“…Reduced compliance and engagement with the home-based intervention could have been a factor for these individuals. Additionally, the potential for gains may have already been exhausted in these 2 subjects; they were the only subjects in the group who participated in a prior treatment study that involved 24 hours of upper extremity therapy, 12 of which involved using the HandSOME in conjunction with an arm robot [38]. A larger sample size could provide additional information about the characteristics of the individuals most likely to benefit from the treatment.…”

Section: Discussionmentioning

confidence: 99%

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)

Nichols

Brokaw

et al. 2017

IEEE Trans. Neural Syst. Rehabil. Eng.

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In previous work, we developed a lightweight wearable hand exoskeleton (HandSOME) that improves range of motion and function in laboratory testing. In this pilot study, we added the ability to log movement data for extended periods and recruited 10 chronic stroke subjects to use the device during reach and grasp task practice at home for 1.5 hours/day, 5 days per week, for 4 weeks. Seven subjects completed the study, performing 448±651 hand movements per training day. After training, impairment was reduced (Fugl-Meyer Test; gain=4.9±4.1; p=.039) and function was improved (Action Research Arm Test; gain=3.3±2.6; p=.032). There was a significant correlation between gains in the Action Research Arm Test and the number of movements during training (r=0.90; p=.005). Proximal arm control also improved, as evidenced by a significant reduction in the reach path ratio (p=0.038). Five subjects responded well to the treatment, having gains of 6 points or more on the Fugl-Meyer or Action Research Arm Test, and achieving significant gains in digit extension (gain=19.8±10.2 degrees; p=0.024). However, all of the gains that were significant immediately after training were no longer significant at the 3 month follow-up. This treatment approach appears promising, but longer periods of home training may be needed to achieve sustainable gains.

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Section: Discussionmentioning

confidence: 99%

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)

Nichols

Brokaw

et al. 2017

IEEE Trans. Neural Syst. Rehabil. Eng.

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“…This strategy provided assistance as correction to bad motion coordination of the main joints active during the task, in particular on shoulder and elbow joints. This controller was tested on 12 impaired subjects in a 3-month pilot study [96]. Data suggested that this robotic therapy could elicit improvements in arm function that were distinct from conventional therapy (improved inter-joint coordination), and thus it could integrate to conventional methods to improve outcomes.…”

Section: B Corrective Modesmentioning

confidence: 99%

Upper-Limb Robotic Exoskeletons for Neurorehabilitation: A Review on Control Strategies

Proietti

Crocher

Roby-Brami

et al. 2016

IEEE Rev. Biomed. Eng.

305

225

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Since the late 1990s, there has been a burst of research on robotic devices for poststroke rehabilitation. Robot-mediated therapy produced improvements on recovery of motor capacity; however, so far, the use of robots has not shown qualitative benefit over classical therapist-led training sessions, performed on the same quantity of movements. Multidegree-of-freedom robots, like the modern upper-limb exoskeletons, enable a distributed interaction on the whole assisted limb and can exploit a large amount of sensory feedback data, potentially providing new capabilities within standard rehabilitation sessions. Surprisingly, most publications in the field of exoskeletons focused only on mechatronic design of the devices, while little details were given to the control aspects. On the contrary, we believe a paramount aspect for robots potentiality lies on the control side. Therefore, the aim of this review is to provide a taxonomy of currently available control strategies for exoskeletons for neurorehabilitation, in order to formulate appropriate questions toward the development of innovative and improved control strategies.

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“…Pilot studies establishing the feasibility of these systems describe clinical outcomes comparable or superior to those reported in studies of traditionally presented rehabilitation. 11–14 A newer study by Klamroth-Marganska et al compared an integrated upper extremity robotic intervention to a dose-matched program of RTP. 15 They identified a small impairment level advantage for the virtually simulated/robotic training condition, but activity level changes were identical for the two groups.…”

Section: Introductionmentioning

confidence: 99%

Does training with traditionally presented and virtually simulated tasks elicit differing changes in object interaction kinematics in persons with upper extremity hemiparesis?

Fluet

Merians

Qiu

et al. 2015

Topics in Stroke Rehabilitation

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Objective To contrast changes in clinical and kinematic measures of upper extremity movement in response to virtually simulated and traditionally presented rehabilitation interventions in persons with upper extremity hemiparesis due to chronic stroke. Methods This was a non-randomized controlled trial set in an ambulatory research facility. The participants were a volunteer sample of twenty one community-dwelling adults (mean age: 51±12 years) with residual hemiparesis due to stroke more than 6 months before enrollment (mean:74±48 months), recruited at support groups. Partial range, against gravity shoulder movement and at least 10° of active finger extension were required for inclusion. All subjects completed the study without adverse events. Interventions - A 2 weeks, 24-hour program of robotic/virtually simulated, arm and finger rehabilitation activities was compared to the same dose of traditionally presented arm and finger activities. Results Subjects in both groups demonstrated statistically significant improvements in the ability to interact with real-world objects as measured by the Wolf Motor Function Test (P=0.01). The robotic/virtually simulated activity (VR) group but not the traditional, repetitive task practice (RTP) group demonstrated significant improvements in peak reaching velocity (P=0.03) and finger extension excursion (P=0.03). Both groups also demonstrated similar improvements in kinematic measures of reaching and grasping performance such as increased shoulder and elbow excursion along with decreased trunk excursion. Conclusions Kinematic measurements identified differing adaptations to training that clinical measurements did not. These adaptations were targeted in the design of four of the six simulations performed by the simulated activity group. Finer grained measures may be necessary to accurately depict the relative benefits of dose matched motor interventions.

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Robotic Therapy Provides a Stimulus for Upper Limb Motor Recovery After Stroke That Is Complementary to and Distinct From Conventional Therapy

Abstract: Data suggest that robotic therapy can elicit improvements in arm function that are distinct from conventional therapy and supplements conventional methods to improve outcomes. Results from this pilot study should be confirmed in a larger study.

Cited by 69 publications

References 41 publications

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)

Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME)

Upper-Limb Robotic Exoskeletons for Neurorehabilitation: A Review on Control Strategies

Does training with traditionally presented and virtually simulated tasks elicit differing changes in object interaction kinematics in persons with upper extremity hemiparesis?

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