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 different methods for patients with different abilities and needs in order to inform future development of patient-specific therapeutic protocols.
SUMMARYRobotic devices are well-suited to provide high intensity upper limb therapy in order to induce plasticity and facilitate recovery from brain and spinal cord injury. In order to realise gains in functional independence, devices that target the distal joints of the arm are necessary. Further, the robotic device must exhibit key dynamic properties that enable both high dynamic transparency for assessment, and implementation of novel interaction control modes that significantly engage the participant. In this paper, we present the kinematic design, dynamical characterization, and clinical validation of the RiceWrist-S, a serial robotic mechanism that facilitates rehabilitation of the forearm in pronation-supination, and of the wrist in flexion-extension and radial-ulnar deviation. The RiceWrist-Grip, a grip force sensing handle, is shown to provide grip force measurements that correlate well with those acquired from a hand dynamometer. Clinical validation via a single case study of incomplete spinal cord injury rehabilitation for an individual with injury at the C3-5 level showed moderate gains in clinical outcome measures. Robotic measures of movement smoothness also captured gains, supporting our hypothesis that intensive upper limb rehabilitation with the RiceWrist-S would show beneficial outcomes.
Objective: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. Design: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. T etraplegia caused by injury to spinal cord has a significant disabling effect on independence in daily life. Approximately half of people with tetraplegia reported regaining arm and hand functions as the most important factor to improve their quality of life.1,2 Treatment options aiming to improve upper limb motor functions are sparse; functional electrical stimulation 3 and exercise 4 are aimed at sensory-motor recovery, whereas other treatments offer functional gains with minimal or no effects on neurorecovery. For example, neuroprostheses 5 and brain computer interface systems 6 increase motor control through alternative communication and control systems, whereas reconstructive surgery of the upper limb offers permanent changes to muscle structure. 7 There is evidence that repetitive and intensive practice can induce practice-dependent brain and spinal plasticity and that exercise intensity has a profound effect on sensory-motor recovery of patients with spinal cord injury (SCI). 8,9 In this regard, rehabilitation robots hold promise for enhancing traditional physical and/or occupational therapy. They can deliver repetitive exercises at high intensities, for extended time periods, in a consistent and precise manner. In addition, real-time measurement of performance may provide advantage to therapists to modify the therapy protocol based on improvement in performance. In this context, previous studies have reported that robotic-assisted rehabilitation can improve motor recovery after stroke and that robotic devices are safe and feasible in rehabilitation.10 Despite considerable interest in robotic gait training after SCI, 11,12 very few reports have evaluated the effect of robotic training of arm and hand function in patients with tetraplegia. [13][14][15] The current study aimed to demonstrate the feasibility and tolerability and to assess effectiveness of robotic-assisted training in improving arm and hand functions in chronic, incomplete cervical SCI. We hypothesized that intense active repetitive movement training, with a robotic device, would
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