Using Assistive Robotic Technology in Motor Neurorehabilitation After Childhood Stroke

Abstract

An intracranial haemorrhage resulted in severe motor impairment in the right upper limb in a previously physically-active young adolescent. Robot-assisted therapy was implemented over the course of 9 months to reduce motor impairment in the affected right upper limb. Robot-assisted therapy consisted of twice weekly sessions containing repetitive and progressively intense practice of hand grasping and arm reaching. The amount of assistance offered by the robot during grasping and reaching was adaptive such that as impairment reduced, the robot offered less assistance. Motor impairment was evaluated with the Fugl-Meyer assessment score for the upper limb. The robot-assisted therapy was associated with an increase in a clinical outcome measure of motor impairment following childhood stroke. The increase was distributed across both upper and lower arm segments. The final, stable reduction in motor impairment in the patient matched that demonstrated in a group of adult unilateral stroke survivors receiving similar treatment with robotics early in their recovery process. We conclude that robotassisted therapy offers a promising treatment option in childhood stroke involving severe upper limb motor impairment. Robot-assisted therapy could be implemented safely in an acute in-patient hospital unit and be continued after discharge to the community setting.

Devices and Protocols for Upper Limb Robot-Assisted Rehabilitation of Children with Neuromotor Disorders

“…They showed that, at the end of the training, the child decreased muscle tone, improved upper limb coordination and quality of movement while the strength remained the same, concluding that these outcomes were similar to those obtained after conventional occupation therapy combined with injections of BTX-A. Moreover, Turner et al [79] confirmed also the benefits of using robotic therapy in children affected by stroke. More specifically, they compared the reactions to InMotion2 robotic training of pediatric stroke patients with those of adult stroke population undergoing early robotic-assisted therapy.…”

“…Such three parameters are not only used to trigger robotic assistance, but also constantly measured to continuously modulate the robotic assistance according to child's performance and to make the rehabilitation adaptive and progressive. In particular, we quote 7 clinical studies involving this device [14,21,26,[76][77][78][79][80]. In one study [76], the robot was used to show the different responses of healthy children and pediatric patients to perturbing force fields: specifically, healthy subjects tend to learn to compensate for perturbed forces and consequently predict the force field; in contrast, children affected by weakness and spasticity due to CP, show a limitation of brain capacity to calibrate the sensorimotor system.…”

Neurophysiology of Robot-Mediated Training and Therapy: A Perspective for Future Use in Clinical Populations

“…Rather combinations will provide a highly individualized training that is delivered in a repetitive and standardized fashion, for example tDCS and robot-mediated therapy ( 63 ). This will produce robot-based assessment measures that are comparable across patients with different motor disorders or at different time points of their lifespan (e.g., childhood vs. adult; ( 118 )) in the clinic and at home ( 119 ).…”