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Journal ArticleDOI

Robot-aided neurorehabilitation

TL;DR: Evidence is presented that robot-aided therapy does not have adverse effects, that patients tolerate the procedure, and that peripheral manipulation of the impaired limb may influence brain recovery, and one approach using kinematic data in a robot- aided assessment procedure.
Abstract: The authors' goal is to apply robotics and automation technology to assist, enhance, quantify, and document neurorehabilitation. This paper reviews a clinical trial involving 20 stroke patients with a prototype robot-aided rehabilitation facility developed at the Massachusetts Institute of Technology, Cambridge, (MIT) and tested at Burke Rehabilitation Hospital, White Plains, NY. It also presents the authors' approach to analyze kinematic data collected in the robot-aided assessment procedure. In particular, they present evidence (1) that robot-aided therapy does not have adverse effects, (2) that patients tolerate the procedure, and (3) that peripheral manipulation of the impaired limb may influence brain recovery. These results are based on standard clinical assessment procedures. The authors also present one approach using kinematic data in a robot-aided assessment procedure.

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Citations
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Journal ArticleDOI
TL;DR: Future research into the effects of robot-assisted therapy should distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.
Abstract: Objective. The aim of the study was to present a systematic review of studies that investigate the effects of robot-assisted therapy on motor and functional recovery in patients with stroke. Method...

1,360 citations


Cites background from "Robot-aided neurorehabilitation"

  • ...This 2 degrees of freedom (DoF) robot enables unrestricted movements of the shoulder and elbow joints.(5) The ARM Guide is a trombone-like device and has 4 controlled DoF....

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Journal ArticleDOI
TL;DR: In patients with long-term upper-limb deficits after stroke, robot-assisted therapy did not significantly improve motor function at 12 weeks, as compared with usual care or intensive therapy.
Abstract: Background Effective rehabilitative therapies are needed for patients with long-term deficits after stroke. Methods In this multicenter, randomized, controlled trial involving 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke, we randomly assigned 49 patients to receive intensive robot-assisted therapy, 50 to receive intensive comparison therapy, and 28 to receive usual care. Therapy consisted of 36 1-hour sessions over a period of 12 weeks. The primary outcome was a change in motor function, as measured on the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes were scores on the Wolf Motor Function Test and the Stroke Impact Scale. Secondary analyses assessed the treatment effect at 36 weeks. Results At 12 weeks, the mean Fugl-Meyer score for patients receiving robot-assisted therapy was better than that for patients receiving usual care (difference, 2.17 points; 95% confidence interval [CI], −0.23 to 4.58) and worse than ...

1,227 citations

Journal ArticleDOI
TL;DR: This review will focus on arm movements and address the following questions: What is motor learning, do patients with hemiparesis have a learning deficit, and are approaches based on motor learning principles useful for rehabilitation?
Abstract: Purpose of reviewMuch of neurorehabilitation rests on the assumption that patients can improve with practice. This review will focus on arm movements and address the following questions: (i) What is motor learning? (ii) Do patients with hemiparesis have a learning deficit? (iii) Is recovery after in

1,113 citations

Journal ArticleDOI
TL;DR: There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury, and this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance.
Abstract: There is increasing interest in using robotic devices to assist in movement training following neurologic injuries such as stroke and spinal cord injury. This paper reviews control strategies for robotic therapy devices. Several categories of strategies have been proposed, including, assistive, challenge-based, haptic simulation, and coaching. The greatest amount of work has been done on developing assistive strategies, and thus the majority of this review summarizes techniques for implementing assistive strategies, including impedance-, counterbalance-, and EMG- based controllers, as well as adaptive controllers that modify control parameters based on ongoing participant performance. Clinical evidence regarding the relative effectiveness of different types of robotic therapy controllers is limited, but there is initial evidence that some control strategies are more effective than others. It is also now apparent there may be mechanisms by which some robotic control approaches might actually decrease the recovery possible with comparable, non-robotic forms of training. In future research, there is a need for head-to-head comparison of control algorithms in randomized, controlled clinical trials, and for improved models of human motor recovery to provide a more rational framework for designing robotic therapy control strategies.

992 citations

Journal ArticleDOI
TL;DR: It is found that robot-aided therapy of the proximal upper limb improves short- and long-term motor control of the paretic shoulder and elbow in subacute and chronic patients; however, it is found no consistent influence on functional abilities.
Abstract: Spinal orthoses are common in the treatment of various conditions that affect the spine. They encompass both the spine and pelvis and thus have implications for pelvic and lower-limb motion during walking in addition to a direct effect on spinal motion. The role of the spine in walking is largely ill-defined, and the consequences of restricted spinal motion on walking have yet to be explored. This study investigated the effect of spinal restriction on gait in able-bodied persons. Gait analyses were performed on 10 able-bodied subjects as they walked at five different speeds that were distributed across their comfortable range of speeds. Data were collected during walking with and without spinal restriction by a fiberglass body jacket, which is similar to a thoracolumbosacral orthosis (TLSO). With spinal restriction, peak-to-peak (PP) pelvic obliquity and rotation were significantly reduced across all walking speeds (p < 0.001), while PP pelvic tilt was significantly reduced at only the fastest walking speeds (p = 0.017). PP hip abduction-adduction motion was significantly reduced with spinal restriction across all speeds (p < 0.001), while PP hip flexion-extension significantly increased at only the slow and very slow speeds (p < 0.001 and p = 0.023, respectively). A better understanding of the effects of restricted spinal motion on gait may help clinicians predict and avoid development of additional problems from TLSO use or surgical restriction of spinal motion. An awareness of these issues will enable clinicians to monitor patients for problems that may result from decreased spine and pelvic motion.

895 citations

References
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Journal Article
TL;DR: The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.
Abstract: A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.

4,540 citations


"Robot-aided neurorehabilitation" refers methods in this paper

  • ...The standard assessment procedure used widely accepted procedures including: functional independence measure (FIM) and the upper limb subsection of the Fugl–Meyer (F–M) scales [23], [24]....

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Journal ArticleDOI
TL;DR: It is shown that components of the manipulator impedance may be combined by superposition even when they are nonlinear, and a generalization of a Norton equivalent network is defined for a broad class of nonlinear manipulators which separates the control of motion from theControl of impedance while preserving the superposition properties of the Norton network.
Abstract: Manipulation fundamentally requires the manipulator to be mechanically coupled to the object being manipulated; the manipulator may not be treated as an isolated system. This three-part paper presents an approach to the control of dynamic interaction between a manipulator and its environment. In Part I this approach is developed by considering the mechanics of interaction between physical systems. Control of position or force alone is inadequate; control of dynamic behavior is also required. It is shown that as manipulation is a fundamentally nonlinear problem, the distinction between impedance and admittance is essential, and given the environment contains inertial objects, the manipulator must be an impedance. A generalization of a Norton equivalent network is defined for a broad class of nonlinear manipulators which separates the control of motion from the control of impedance while preserving the superposition properties of the Norton network. It is shown that components of the manipulator impedance may be combined by superposition even when they are nonlinear.

3,356 citations

Proceedings ArticleDOI
06 Jun 1984
TL;DR: In this paper, a unified approach to kinematically constrained motion, dynamic interaction, target acquisition and obstacle avoidance is presented, which results in a unified control of manipulator behaviour.
Abstract: Manipulation fundamentally requires a manipulator to be mechanically coupled to the object being manipulated. A consideration of the physical constraints imposed by dynamic interaction shows that control of a vector quantity such as position or force is inadequate and that control of the manipulator impedance is also necessary. Techniques for control of manipulator behaviour are presented which result in a unified approach to kinematically constrained motion, dynamic interaction, target acquisition and obstacle avoidance.

3,292 citations


"Robot-aided neurorehabilitation" refers methods in this paper

  • ...This is achieved using impedance control, a key feature of the robot control system [20]....

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Journal ArticleDOI
21 Jun 1996-Science
TL;DR: The results suggest that, after local damage to the motor cortex, rehabilitative training can shape subsequent reorganization in the adjacent intact cortex, and that the undamaged motor cortex may play an important role in motor recovery.
Abstract: Substantial functional reorganization takes place in the motor cortex of adult primates after a focal ischemic infarct, as might occur in stroke. A subtotal lesion confined to a small portion of the representation of one hand was previously shown to result in a further loss of hand territory in the adjacent, undamaged cortex of adult squirrel monkeys. In the present study, retraining of skilled hand use after similar infarcts resulted in prevention of the loss of hand territory adjacent to the infarct. In some instances, the hand representations expanded into regions formerly occupied by representations of the elbow and shoulder. Functional reorganization in the undamaged motor cortex was accompanied by behavioral recovery of skilled hand function. These results suggest that, after local damage to the motor cortex, rehabilitative training can shape subsequent reorganization in the adjacent intact cortex, and that the undamaged motor cortex may play an important role in motor recovery.

1,821 citations

Journal Article
TL;DR: Extensive restraint of an unaffected upper extremity and practice of functional movements with the impaired limb proved to be an effective means of restoring substantial motor function in stroke patients with chronic motor impairment identified by the inclusion criteria of this project.

1,566 citations


"Robot-aided neurorehabilitation" refers background in this paper

  • ...Several studies have reported positive outcomes with different approaches, including repetitive passive exercises [1], forced use of the paretic limb by restraining the contralateral limb [2], [3] increased amounts of therapy and external manipulation [4], [5] biofeedback [6], and functional electrical stimulation [7]....

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