Upper and lower extremity robotic devices for rehabilitation and for studying motor control

Hesse, Stefan; Schmidt, Henning; Werner, Carsten; Bardeleben, Anita

doi:10.1097/00019052-200312000-00010

Cited by 313 publications

(173 citation statements)

References 14 publications

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“…Small trials have shown modest clinical improvement in disabilities after stroke with the use of the following techniques: electrical stimulation over the surface of muscles to contract them for simple movements, such as grasping, or to assist ankle dorsiflexion while walking 49 ; intense practice with electromechanical devices that assist in reaching or stepping 50 ; noninvasive stimulation of the peripheral nerve of the arm 51 or direct stimulation of the motor cortex over the hand representation 52 to augment cortical plasticity and learning during arm therapies; pharmacotherapy with agonists of dopamine, acetylcholine, and serotonin, which may modulate neurotransmission and learning 53 ; and the use of mental imagery of an action, 54 which may enhance training because it activates many of the same cortical neurons that are involved in performing the action. Phase 1 trials are beginning in order to assess the safety of the injection of drugs into the cerebrospinal fluid or of cells into brain tissue to replace neurons and promote dendrite sprouting and axon regeneration, 55 with the goal of possible neural repair.…”

Section: Areas Of Uncertaintymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities? THE CLINICAL PROBLEMApproximately 400 persons per 100,000 population over the age of 45 years have a first stroke each year in the United States, Europe, and Australia. Stroke is the most frequent cause of adult-onset disability among people in the United States, and the cost of related care is among the fastest-growing expenses for Medicare. 1 The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without full physical assistance. 2 Six months after stroke, about 65 percent of patients cannot incorporate the affected hand into their usual activities. Poor upper-extremity outcomes are probable after a hemispheric infarction when the leg cannot move by two weeks and the hand has no movement or only slight finger flexion with no opening by four weeks, consistent with considerable damage to the corticospinal tract. 3 Patients who survive a stroke almost always have less physical disability by the end of the first three months. Functional scales, such as the Barthel Index and the Functional Independence Measure (which measure the physical assistance or supervision needed for self-care, including using the toilet, dressing, bathing, eating, and mobility), tend to show a plateau of gains by three to four months after stroke, partly owing to insensitivity of the scale to further improvements. Patients who no longer require assistance at that point may still be unable to use the affected hand, walk at speeds and distances that permit activities outside the home, or live alone. Only 25 percent of patients return to the level of everyday participation and physical functioning of community-matched persons who have not had a

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Section: Areas Of Uncertaintymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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“…Two current examples include robotic treadmill ambulation devices and robotic upper limb-retraining devices. 15 Research has found that repetitive movement can enhance the return of motor function. These exoskeletally applied rehabilitative robotics are ideally suited to this role and have the added benefit of measurable outcomes, a critical issue in healthcare.…”

Section: Impact On Specific Devices Roboticsmentioning

confidence: 99%

Technology for mobility in SCI 10 years from now

et al. 2012

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Objectives: To identify technological advances and that are likely to have a great impact on the quality of life and participation in individuals with spinal cord injury (SCI). Methods: In this paper we use the International Classification of Function to frame a discussion on how technology is likely to impact SCI in 10 years. In addition, we discuss the implication of technological advances on future research. Results/Conclusion: Although technology advances are exciting, a large challenge for the research community will be how to effectively apply and deploy this technology. Advances occurring in the next 10 years that reduce cost of technology may be more important to the population with SCI than brand new technologies. Social context is everything. As a research community we must advocate for better systems of care. Advocating now for better care will lead to a world in 2020 that is ready to adopt new technologies that are truly transformative.

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“…The feedback can be provided either after a task in the form of scores, or during the task using dynamic biofeedback visual and auditory cues [16]. Some systems also provide physical assistance with movement and/or simulate haptic feedback [7,13,17,18,20,21,26,34].…”

Section: Introductionmentioning

confidence: 99%

Interactive visuo-motor therapy system for stroke rehabilitation

et al. 2007

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We present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas (mirror neurons); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of nonparetic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results. Abstract We present a virtual reality (VR)-based motor neurorehabilitation system for stroke patients with upper limb paresis. It is based on two hypotheses: (1) observed actions correlated with self-generated or intended actions engage cortical motor observation, planning and execution areas (''mirror neurons''); (2) activation in damaged parts of motor cortex can be enhanced by viewing mirrored movements of non-paretic limbs. We postulate that our approach, applied during the acute post-stroke phase, facilitates motor re-learning and improves functional recovery. The patient controls a first-person view of virtual arms in tasks varying from simple (hitting objects) to complex (grasping and moving objects). The therapist adjusts weighting factors in the non-paretic limb to move the paretic virtual limb, thereby stimulating the mirror neuron system and optimizing patient motivation through graded task success. We present the system's neuroscientific background, technical details and preliminary results.

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Upper and lower extremity robotic devices for rehabilitation and for studying motor control

Abstract: Technical possibilities are one aspect, but multi-centre trials and a consideration of the unsubstantiated fears among therapists of being replaced by machines will decide on the successful implementation of this most promising field to the benefit of patients.

Cited by 313 publications

References 14 publications

Rehabilitation after Stroke

Rehabilitation after Stroke

Technology for mobility in SCI 10 years from now

Interactive visuo-motor therapy system for stroke rehabilitation

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