Robot-assisted stroke rehabilitation has become popular as one approach to helping patients recover function post-stroke. Robotic rehabilitation requires four important elements to match the robot to the patient: realistic biomechanical robotic elements, an assistive control scheme enabled through the human-robot interface, a task oriented rehabilitation program based on the principles of plasticity, and objective assessment tools to monitor change. This paper reports on a randomized clinical trial utilizing a complete robot-assisted rehabilitation system for the recovery of upper limb function in patients post-stroke. In this study, a seven degree-of-freedom (DOF) upper limb exoskeleton robot (UL-EXO7) is applied in a rehabilitation clinical trial for patients stable post-stroke (greater than six months). Patients had a Fugl-Meyer Score between 16-39, were mentally alert (> 19 on the VA Mini Mental Status Exam) and were between 27 and 70 years of age. Patients were randomly assigned to three groups: bilateral robotic training, unilateral robotic training, and usual care. This study is concerned with the changes in kinematics in the two robotic groups. Both patient groups played eight therapeutic video games over 12 sessions (90 min, two times a week). In each session, patients intensively played the different combination of video games that directly interacted with UL-EXO7 under the supervision of research assistant. At each session, all of the joint angle data was recorded for the evaluation of therapeutic effects. A new assessment metric is reported along with conventional metrics. The experimental result shows that both groups of patients showed consistent improvement with respect to the proposed and conventional metrics.
Stroke is the leading cause of long-term neurological disability and the principle reason for seeking rehabilitative services in the US. Learning based rehabilitation training enables independent mobility in the majority of patients post stroke, however, restoration of fine manipulation, motor function and task specific functions of the hemiplegic arm and hand is noted in fewer than 15% of the stroke patients. Brain plasticity is the innate mechanism enabling the recovery of motor skills through neurological reorganization of the brain as a response to limbs' manipulation. The objective of this research was to evaluate the therapeutic efficacy for the upper limbs with a dual arm exoskeleton system (EXO-UL7) using three different modalities: bilateral mirror image with symmetric movements of both arms, unilateral movement of the affected arm and standard care. Five hemiparetic subjects were randomly assigned to each therapy modality. An upper limb exoskeleton was used to provide bilateral and unilateral treatments. Standard care was provided by a licensed physical therapist. Subjects were evaluated before and after the interventions using 13 different clinical measures. Following these treatments all of the subjects demonstrated significant improved of their fine motor control and gross control across all the treatment modalities. Subjects exhibited significant improvements in range of motion of the shoulder, and improved muscle strength for bilateral training and standard care, but not for unilateral training. In conclusion, a synergetic approach in which robotic treatments (unilateral and bilateral depending on the level of the motor control) are supplemented by the standard of care may maximize the outcome of the motor control recover following stroke.
Intermediate goals in addition to ultimate goals should be set with both static and dynamic games such that even with the patient's limited range of motion, speed, or coordination, the game should be playable and provide a sense of accomplishment to the patient. Marking the games' ultimate goals that can be accomplished only by healthy subjects, such as range of motion and workspace, provide references and encouragement to the patient for improving motor control and performance through the process of playing the game.
Purpose-The purpose of this paper is to evaluate the physiotherapeutic benefits of bilateral symmetric training (BST) for stroke survivors affected by hemiparesis. Design/methodology/approach-Other studies have investigated symmetric physiotherapy. A key difficulty in previous work is in maintaining mirror-imaged trajectories between the affected and less-affected limbs. This obstacle was overcome in this work by using a two-armed robotic exoskeleton to enforce symmetry. In total, 15 subjects, W 6 months post stroke were, randomly assigned to bilateral symmetric robotic training, unilateral robotic training, and standard physical therapy. Findings-After 12 training sessions (90 minutes/session), the bilateral training group had the greatest intensity of movement training. They also had the greatest improvement in range of motion at the shoulder. The unilateral training group showed the greatest reduction in spasticity. Research limitations/implications-The rationale for symmetric physiotherapy is that it might promote connections from the undamaged brain hemisphere. The robot generated copious amounts of detailed kinematic data. Even though these data provided insights into the human to machine interface using different training modalities, it proved difficult to draw neurological conclusions. It is recommended that future research along these lines should include measures of neurophysiological change and/or changes in neurological activity. Practical implications-This research suggests that the advantage of bilateral symmetric movement over other modalities is slight, and that robotic training has comparable results with standard care. If BST is used, care is potentially needed to avoid exacerbation of spasticity. Finally, this research includes a novel quantitative approach for evaluating robotic training.
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