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Journal Article•DOI•

Robot-assisted Therapy in Stroke Rehabilitation.

Won Hyuk Chang1, Yun-Hee Kim1•
Samsung Medical Center1
27 Sep 2013-Journal of stroke (Korean Stroke Society)-Vol. 15, Iss: 3, pp 174-181
TL;DR: The present evidence supports the use of robot-assisted therapy for improving motor function in stroke patients as an additional therapeutic intervention in combination with the conventional rehabilitation therapies.
Abstract: Research into rehabilitation robotics has grown rapidly and the number of therapeutic rehabilitation robots has expanded dramatically during the last two decades. Robotic rehabilitation therapy can deliver high-dosage and high-intensity training, making it useful for patients with motor disorders caused by stroke or spinal cord disease. Robotic devices used for motor rehabilitation include end-effector and exoskeleton types; herein, we review the clinical use of both types. One application of robot-assisted therapy is improvement of gait function in patients with stroke. Both end-effector and the exoskeleton devices have proven to be effective complements to conventional physiotherapy in patients with subacute stroke, but there is no clear evidence that robotic gait training is superior to conventional physiotherapy in patients with chronic stroke or when delivered alone. In another application, upper limb motor function training in patients recovering from stroke, robot-assisted therapy was comparable or superior to conventional therapy in patients with subacute stroke. With end-effector devices, the intensity of therapy was the most important determinant of upper limb motor recovery. However, there is insufficient evidence for the use of exoskeleton devices for upper limb motor function in patients with stroke. For rehabilitation of hand motor function, either end-effector and exoskeleton devices showed similar or additive effects relative to conventional therapy in patients with chronic stroke. The present evidence supports the use of robot-assisted therapy for improving motor function in stroke patients as an additional therapeutic intervention in combination with the conventional rehabilitation therapies. Nevertheless, there will be substantial opportunities for technical development in near future.

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Citations
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Journal Article•DOI•
Rehabilitation of Motor Function after Stroke: A Multiple Systematic Review Focused on Techniques to Stimulate Upper Extremity Recovery.

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Samar Hatem1, Samar Hatem2, Geoffroy Saussez1, Margaux M. della Faille1, Vincent Prist, Xue X. Zhang3, Delphine Dispa1, Delphine Dispa4, Yannick Bleyenheuft1 •
Université catholique de Louvain1, Vrije Universiteit Brussel2, Katholieke Universiteit Leuven3, Cliniques Universitaires Saint-Luc4
13 Sep 2016-Frontiers in Human Neuroscience
TL;DR: This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients to achieve the maximal motor function recovery for each patient.
Abstract: Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.

552 citations

Journal Article•DOI•
Effects of Robot-Assisted Therapy for the Upper Limb After Stroke

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Janne M. Veerbeek1, Anneli C. Langbroek-Amersfoort, Erwin E. H. van Wegen2, Erwin E. H. van Wegen1, Carel G. M. Meskers, Gert Kwakkel •
VU University Medical Center1, VU University Amsterdam2
01 Feb 2017-Neurorehabilitation and Neural Repair
TL;DR: Limited findings could be related to poor understanding of robot-induced motor learning as well as inadequate designing of RT-UL trials, by not applying an appropriate selection of stroke patients with a potential to recovery at baseline aswell as the lack of fixed timing of baseline assessments and using an insufficient treatment contrast early poststroke.
Abstract: Background. Robot technology for poststroke rehabilitation is developing rapidly. A number of new randomized controlled trials (RCTs) have investigated the effects of robot-assisted therapy for the...

383 citations

Cites background or result from "Robot-assisted Therapy in Stroke Re..."

  • ...RT-UL can offer patients feedback about position and force and is typically supported by games that facilitate functional use of the upper paretic limb.(14,15) An alternative classification of upper limb robotics can be based on the number of joints (ie, arm segments), and hence the degrees of freedom that they control in upper limb performance out of basic motor synergies (ie, synergy-independent movements)....

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  • ...However, our review also confirms that the effects of the technologically more complex and expensive exoskeleton devices have been insufficiently investigated.(15) Therefore, our conclusions with respect to robot type should be interpreted with caution, since the statistical power of all trials was low, * References 31, 34, 36, 37, 39, 42, 45, 47-49, 52, 56, 58, 67-69, 74, 75....

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Journal Article•DOI•
Upper-Limb Robotic Exoskeletons for Neurorehabilitation: A Review on Control Strategies

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Tommaso Proietti1, Vincent Crocher2, Agnès Roby-Brami1, Nathanaël Jarrassé1•
Pierre-and-Marie-Curie University1, University of Melbourne2
08 Apr 2016-IEEE Reviews in Biomedical Engineering
TL;DR: The aim of this review is to provide a taxonomy of currently available control strategies for exoskeletons for neurorehabilitation in order to formulate appropriate questions toward the development of innovative and improved control strategies.
Abstract: Since the late 1990s, there has been a burst of research on robotic devices for poststroke rehabilitation. Robot-mediated therapy produced improvements on recovery of motor capacity; however, so far, the use of robots has not shown qualitative benefit over classical therapist-led training sessions, performed on the same quantity of movements. Multidegree-of-freedom robots, like the modern upper-limb exoskeletons, enable a distributed interaction on the whole assisted limb and can exploit a large amount of sensory feedback data, potentially providing new capabilities within standard rehabilitation sessions. Surprisingly, most publications in the field of exoskeletons focused only on mechatronic design of the devices, while little details were given to the control aspects. On the contrary, we believe a paramount aspect for robots potentiality lies on the control side. Therefore, the aim of this review is to provide a taxonomy of currently available control strategies for exoskeletons for neurorehabilitation, in order to formulate appropriate questions toward the development of innovative and improved control strategies.

259 citations

Cites background from "Robot-assisted Therapy in Stroke Re..."

  • ...Indeed, the first and only commercially available upper-limb exoskeleton for rehabilitation (the ArmeoPower© by Hocoma, based on ARMinIII robot) was only released at the end of 2011 [11]....

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Journal Article•DOI•
Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial.

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Carolyn Buesing1, Gabriela Fisch1, Megan O’Donnell1, Ida Shahidi1, Lauren Thomas1, Chaithanya K. Mummidisetty2, Kenton J. Williams3, Hideaki Takahashi3, William Z. Rymer2, Arun Jayaraman2 •
Northwestern University1, Rehabilitation Institute of Chicago2, Honda R&D Americas3
20 Aug 2015-Journal of Neuroengineering and Rehabilitation
TL;DR: SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points.
Abstract: Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage, and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda RD except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials. SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits. This study is registered under the title “Development of walk assist device to improve community ambulation” and can be located in clinicaltrials.gov with the study identifier: NCT01994395 .

149 citations

Cites background from "Robot-assisted Therapy in Stroke Re..."

  • ...Specifically, in individuals with stroke, two different types of robotic devices, end-effector and exoskeleton robots, can effectively complement conventional physical therapy to improve gait function [36]....

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Journal Article•DOI•
Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation

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Claudia Alia1, Cristina Spalletti1, Stefano Lai2, Alessandro Panarese2, Giuseppe Lamola, Federica Bertolucci, Fabio Vallone3, Fabio Vallone2, Fabio Vallone1, Angelo Di Garbo1, Carmelo Chisari, Silvestro Micera2, Silvestro Micera4, Matteo Caleo1 •
National Research Council1, Sant'Anna School of Advanced Studies2, Istituto Italiano di Tecnologia3, École Polytechnique Fédérale de Lausanne4
16 Mar 2017-Frontiers in Cellular Neuroscience
TL;DR: Advances in the comprehension of post-stroke network reorganization in patients and animal models are discussed, and the potential use of non-invasive brain stimulation techniques to boost recovery is illustrated.
Abstract: Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration.

147 citations

Cites background from "Robot-assisted Therapy in Stroke Re..."

  • ...This datum stands for a positive impact of end-effector devices on upper-limb recovery in patients in the subacute phase of stroke, thus recommending their use (Chang and Kim, 2013)....

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  • ...Nevertheless, it is believed that LFP recordings are the most informative signals of the underlying neural activity generated by an ensemble of coupled neurons (Buzsáki et al., 2012)....

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  • ...…the direct relationship between neuronal activity and EEG recordings it is not well defined because the electrical activity, generated by thousands of neurons, must diffuse through various media (cerebrospinal fluid, dura mater, cranium, muscle and skin) that distort and attenuate the signals....

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  • ...An effect of robot-assisted therapy on ADL function is observed only in patients with subacute stroke (Chang and Kim, 2013)....

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  • ...Most of the robotic devices applied in clinical practice offer the possibility of choosing among four modalities for training: active, active-assisted, passive and resistive (Chang and Kim, 2013)....

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References
More filters
Journal Article•DOI•
Guidelines for management of ischaemic stroke and transient ischaemic attack 2008

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Peter A. Ringleb, Marie-Germaine Bousser, Gary A. Ford, Philip M.W. Bath, Michael Brainin, Valeria Caso, Álvaro Cervera, Ángel Chamorro, Charlotte Cordonnier, László Csiba1, Antoni Dávalos, Hans-Christoph Diener, José M. Ferro, Werner Hacke2, Michael G. Hennerici, Markku Kaste, Peter Langhorne, Kennedy R. Lees, Didier Leys, J. Lodder, Hugh S. Markus, Jean-Louis Mas, Heinrich Mattle, Keith W. Muir, Bo Norrving, Victor Obach, Stefano Paolucci, E. Bernd Ringelstein, Peter D. Schellinger, Juhani Sivenius, Skvortsova Vi, Katharina S. Sunnerhagen, Lars Thomassen, Danilo Toni, Rüdiger von Kummer, Nils Wahlgren, Marion F Walker, Joanna M. Wardlaw •
University of Debrecen1, Heidelberg University2
06 May 2008-Cerebrovascular Diseases
TL;DR: The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.
Abstract: This article represents the update of the European Stroke Initiative Recommendations for Stroke Management. These guidelines cover both ischaemic stroke and transient ischaemic attacks, which are now considered to be a single entity. The article covers referral and emergency management, Stroke Unit service, diagnostics, primary and secondary prevention, general stroke treatment, specific treatment including acute management, management of complications, and rehabilitation.

2,125 citations

Journal Article•DOI•
Stroke Care 2: Stroke rehabilitation

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Peter Langhorne, Julie Bernhardt, Gert Kwakkel
01 Jan 2011-The Lancet
TL;DR: There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams and promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training.

1,691 citations

Journal Article•DOI•
Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke

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Albert C. Lo1, Peter Guarino, Lorie Richards2, Jodie K. Haselkorn3, George F. Wittenberg4, Daniel G. Federman5, Daniel G. Federman6, Robert J. Ringer7, Todd H. Wagner5, Hermano Igo Krebs8, Bruce T. Volpe9, Christopher T. Bever4, Dawn M. Bravata, Pamela W. Duncan10, Barbara H. Corn, Alysia D. Maffucci, Stephen E. Nadeau2, Susan S. Conroy5, Janet M. Powell3, Grant D. Huang11, Peter Peduzzi •
Brown University1, University of Florida2, University of Washington3, University of Maryland, Baltimore4, Veterans Health Administration5, Yale University6, University of New Mexico7, Massachusetts Institute of Technology8, Cornell University9, Duke University10, United States Environmental Protection Agency11
12 May 2010-The New England Journal of Medicine
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

"Robot-assisted Therapy in Stroke Re..." refers background or methods in this paper

  • ...End-effector-type robotic devices Fourteen randomized controlled trials comparing robot-assisted therapy that use end-effector-type devices with conventional therapies for improvement of upper limb motor function after stroke were selected for review (Table 2).(29-41) The metaanalysis in a 2012 Cochrane review demonstrated that robotassisted arm training improved upper limb function (standardized mean difference 0....

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  • ...A study by Lo et al.(36) that recruited 127 chronic stroke patients reported that robot-assisted therapy and conventional therapy produced similar amounts of improvement after 12 weeks of treatment....

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  • ...…5 weeks Yes No difference More effective Volpe et al., 2008 InMotion2 21 Chronic 1 hour, 3 times per week for 6 weeks No No difference No difference Lo et al., 2010 MIT-MANUS 127 Chronic a maximum of 36 sessions over 12 weeks No More effective Not assessed Burgar et al., 2011 MIME 54 Subacute 1…...

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Journal Article•DOI•
Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.

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Peter S. Lum1, Charles G. Burgar, Peggy C. Shor, Matra Majmundar, Machiel Van der Loos •
VA Palo Alto Healthcare System1
01 Jul 2002-Archives of Physical Medicine and Rehabilitation
TL;DR: Compared with conventional treatment, robot-assisted movements had advantages in terms of clinical and biomechanical measures and was justified into the use of robotic manipulation for motor rehabilitation.

1,111 citations

"Robot-assisted Therapy in Stroke Re..." refers methods or result in this paper

  • ...End-effector-type robotic devices Fourteen randomized controlled trials comparing robot-assisted therapy that use end-effector-type devices with conventional therapies for improvement of upper limb motor function after stroke were selected for review (Table 2).(29-41) The metaanalysis in a 2012 Cochrane review demonstrated that robotassisted arm training improved upper limb function (standardized mean difference 0....

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  • ...…therapy Summary of results in comparison with conventional therapies Upper limb function Activities of daily living End-effector-type devices Lum et al., 2002 MIME 27 Chronic 55 minutes, 24 sessions total over 8 weeks No No difference Not assessed Fasoli et al., 2004 MIT-MANUS 56 Subacute 1…...

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Journal Article•DOI•
Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial

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Gert Kwakkel1, Robert C. Wagenaar2, Jos W. R. Twisk1, Gustaaf J. Lankhorst1, Johan C. Koetsier1 •
VU University Amsterdam1, Boston University2
17 Jul 1999-The Lancet
TL;DR: Greater intensity of leg rehabilitation improves functional recovery and health-related functional status, whereas greater intensity of arm rehabilitation results in small improvements in dexterity, providing further evidence that exercise therapy primarily induces treatment effects on the abilities at which training is specifically aimed.

889 citations

Related Papers (5)
Effects of Robot-Assisted Therapy on Upper Limb Recovery After Stroke: A Systematic Review

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Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke

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12 May 2010-The New England Journal of Medicine
Albert C. Lo, Peter Guarino, Lorie Richards, Jodie K. Haselkorn, George F. Wittenberg, Daniel G. Federman, Daniel G. Federman, Robert J. Ringer, Todd H. Wagner, Hermano Igo Krebs, Bruce T. Volpe, Christopher T. Bever, Dawn M. Bravata, Pamela W. Duncan, Barbara H. Corn, Alysia D. Maffucci, Stephen E. Nadeau, Susan S. Conroy, Janet M. Powell, Grant D. Huang, Peter Peduzzi 
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01 Jan 2011-The Lancet
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Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke.

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01 Jul 2002-Archives of Physical Medicine and Rehabilitation
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The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance.

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