Motions or muscles? Some behavioral factors underlying robotic assistance of motor recovery

Abstract

Abstract-Robotics and related technologies have begun to realize their promise to improve the delivery of rehabilitation therapy. However, the mechanism by which they enhance recovery remains unclear. Ultimately, recovery depends on biology, yet the details of the recovery process remain largely unknown; a deeper understanding is important to accelerate refinements of robotic therapy or suggest new approaches. Fortunately, robots provide an excellent instrument platform from which to study recovery at the behavioral level. This article reviews some initial insights about the process of upper-limb behavioral recovery that have emerged from our work. Evidence to date suggests that the form of therapy may be more important than its intensity: muscle strengthening offers no advantage over movement training. Passive movement is insufficient; active participation is required. Progressive training based on measures of movement coordination yields substantially improved outcomes. Together these results indicate that movement coordination rather than muscle activation may be the most appropriate focus for robotic therapy.

Short-term ankle motor performance with ankle robotics training in chronic hemiparetic stroke

“…Evidence from upper limb (UL) studies suggests that physical interaction or interactive training produces the greatest gains in recovery of motor function compared with purely passive or resistive modes [20]; we chose to use a robot for training in part because robots lend themselves to application of ML principles that are now widely accepted as a modern basis for effective rehabilitation. Compared with a human therapist, robots allow for massed repetitive practice of affected limbs and can provide therapists with a variety of practice conditions that can be tailored to the needs of individual patients.…”

Potential of robots as next-generation technology for clinical assessment of neurological disorders and upper-limb therapy

“…This plateau is determined by the same problematic clinical tools already discussed. Some authors have suggested that this plateau may actually be the patients consolidating their poststroke practice experience rather than optimal biological recovery [85][86][87] and this, in itself, has important implications in the timing of how we deliver treatment after a stroke.…”

Identificación de Tareas Isométricas y Dinámicas del Miembro Superior Basada en EMG de Alta Densidad

“…En estos casos, se suelen seguir terapias de rehabilitación asistida por robots para estimular la neuroplasticidad (Van Peppen et al 2004). Si la intención de movimiento de los pacientes pudiera extraerse en tiempo real, sería posible controlar los dispositivos de asistencia de una manera más natural de forma que se prestase solo la asistencia requerida, incentivando la participación activa del paciente y, por tanto, maximizando los beneficios de dicha terapia (Hogan et al, 2006). La utilización de la información espacial de mapas de activación mioeléctrica constituye un método novedoso que ya ha demostrado buenos resultados en la identificación de tareas en trabajos previos (Stango et al, 2015), tanto en sujetos sanos comoen pacientes con lesión medular incompleta durante contracciones isométricas (Jordanic, et al, 2016a, b;Rojas-Martínez et al, 2013).…”