[ARTICLE] Brain-machine Interface in Robot-assisted Neurorehabilitation for Patients with Stroke and Upper Extremity Weakness – the Therapeutic Turning Point – Full Text HTML


Activity and participation after stroke can be increased by neurorehabilitation of upper extremity. As the technology advances, a robot-assisted restorative therapy with/without a brain-machine interface (BMI) is suggested as a promising therapeutic option. Understanding the therapeutic point of view about robots and BMIs can be linked to the patient-oriented usability of the devices. The therapeutic turning point concept of robot-assisted rehabilitation with BMIs, basics of robotics for stroke and upper extremity weakness and consequent neuroplasticity/motor recovery are reviewed.


  • Robot with BMI therapy for arm after stroke has closed feedback and more chance of neural plasticity.
  • Understanding of the new rehabilitation technologies such as robot with BMI therapy for arm after stroke shall give the therapeutic turning point.


Stroke is a sudden neurologic deficit caused by disturbance of vascular supply to the brain by ending up ischemic/hemorrhagic lesions on it. A large proportion of disease burden of stroke can be explained by the loss of motor function causing decreased activity of daily living and participation restriction for the patient. Affected brain regions in stroke, especially in sensorimotor areas, could show various kinds of motor deficits such as weakness, incoordination and changes of muscle tone. For the execution of activity of daily living, those motor deficits need to be properly intervened, which would be the reason why we claim an intensive neurorehabilitation for the recovery of functions during long survival period after stroke [1, 2, 3].

In Merriam-Webster (http://merriam-webster.com; accessed on 26 August 2016), one simple definition of robot is a machine that do the work of a person and that works automatically or is controlled by a computer. Some kinds of a robot can move human body parts, and the purpose of the robot can be the neurorehabilitation and the improvement of the function of that body parts.

Robot-assisted arm rehabilitation can give the patient repetitive, controlled motion of upper extremity without exhaustion of therapist. Level of difficulty for the training task can be adjusted according to the status of the patient [4]. Through robot-assisted upper extremity training of movement, neural plasticity and motor recovery can be facilitated [5].

The motivation for the use of devices and the study of psychological stability would be important in terms of efficacy in all kinds of therapies, including robot therapy. Closed feedback during the robot therapy can elevate the patient’s emersion to the task and increase the motivation. Among many methods of closed feedback, brain-machine interface (BMI) system can give the direct and immediate feedback to the patient [5]. The BMI is a system that picks up the brain signal, by extracting a useful characteristic, and develop some logics to control other devices using that characteristic, which ideally congruent with the patient’s intention [6]. Many logics of current BMI are used for controlling robots. Through such robot-assisted rehabilitation with BMI system, closed feedback from patient’s immediate, not preprogrammed, intention can be completed. Even though robotic devices or BMIs do not give any haptic sensory feedback, visual or proprioceptive observation of the robotic arm to perform the intended movement will give the BMI-controlling patients more appropriate feedback. In this review, non-invasive electroencephalogram based BMI combined with robot-assisted rehabilitation technique is considered.

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