Posts Tagged Robot-assisted therapy

[ARTICLE] Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients – Full Text


Objective: To determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients.


Methods: Subjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment.


Results: The RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups.


Conclusion: RT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity.


Spasticity is defined as a velocity-dependent increase in tonic stretch reflex, resulting from over-excitation of the stretch reflex due to upper motor neuron lesions [1]. It occurs frequently in patients with post-stroke hemiplegia. Excessive spasticity reduces patients’ range of motion (ROM) to the extent that it obstructs daily living activities and functional improvement, thereby adversely affecting successful rehabilitation.

Various treatment methods are used to control spasticity, such as exercise, drug therapy, electrostimulation, surgery, and local nerve block using botulinum toxin [2, 3, 4, 5]. Conventional rehabilitation therapy for spasticity administered by therapists includes passive stretching and ROM exercise treatment. The amount and effects of repetitive exercise manually induced by therapists may differ according to the therapists’ levels of experience [6].

In recent decades, rehabilitation treatment using a robot has been developed to reproduce accurate motions repeatedly with less input of physical effort and time by therapists. Upper extremity rehabilitation treatment using robots has been available since the 1990s and the clinical effects on upper extremity function recovery are reported.

Studies on robotic assisted rehabilitation therapy in stroke patients have shown significant improvement in motor abilities of the exercised limb and enhanced functional outcomes [7, 8, 9, 10, 11]. However, some studies indicated that when the duration and intensity of conventional treatment is matched with robotic treatment, motor recovery, activities of daily living, strength, and motor control show no group-wise differences [7]. Nevertheless, additional sessions of robotic treatment promote better motor recovery in patients with stroke, as compared with additional conventional treatment [12].

Previously, studies indicated variable treatment effects of robot-assisted rehabilitation treatment on upper extremity spasticity. Fazekas et al. [13] reported significant change in Modified Ashworth Score (MAS) of shoulder adductors and elbow flexor only in the robotic treatment group. However, it reportedly has a small, non-significant effect on muscle tone based on MAS in other studies [10, 11, 14].

The aim of the present study was to evaluate the effect of upper extremity rehabilitation robots on spasticity in stroke patients. We conducted a randomized controlled trial to evaluate upper extremity spasticity, motor power and functions in response to therapy.


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[Abstract] Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey


Recent neurological research indicates that the impaired motor skills of post-stroke patients can be enhanced and possibly restored through task-oriented repetitive training.

This is due to neuroplasticity – the ability of the brain to change through adulthood. Various rehabilitation processes have been developed to take advantage of neuroplasticity to retrain neural pathways and restore or improve motor skills lost as a result of stroke or spinal cord injuries (SCI).

Research in this area over the last few decades has resulted in a better understanding of the dynamics of rehabilitation in post-stroke patients and development of auxiliary devices and tools to induce repeated targeted body movements. With the growing number of stroke rehabilitation therapies, the application of robotics within the rehabilitation process has received much attention. As such, numerous mechanical and robot-assisted upper limb and hand function training devices have been proposed.

A systematic review of robotic-assisted upper extremity (UE) motion rehabilitation therapies was carried out in this study. The strengths and limitations of each method and its effectiveness in arm and hand function recovery were evaluated. The study provides a comparative analysis of the latest developments and trends in this field, and assists in identifying research gaps and potential future work.

Source: Robot-assisted post-stroke motion rehabilitation in upper extremities: a survey : International Journal on Disability and Human Development

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[Abstract] The Effects of Combination of Robot-Assisted Therapy With Task-Specific or Impairment-Oriented Training on Motor Function and Quality of Life in Chronic Stroke – PM&R



Robot-assisted therapy (RT) is a promising intervention for stroke rehabilitation. RT hybridized with therapist-mediated therapy (eg, RT plus task-specific or impairment-oriented training) may possibly yield functionally relevant improvements. A comparative study of the different combination regimens is needed.


To investigate the efficacy of RT combined with task-specific training or impairment-oriented training on motor function and quality of life in patients with chronic stroke.


A single-blind, randomized comparative efficacy study.


Two medical centers in Taiwan.


Twenty-one subjects with chronic stroke.


Participants were recruited and randomized into 1 of 2 groups: (1) RT combined with task-specific (RTT) training (enrolled, n = 11; completed, n = 11) or (2) RT combined with impairment-oriented (RTI) training (enrolled, n = 10; completed, n = 9). Participants received 20 intervention sessions (90-100 min/d, 5 d/wk for 4 weeks).


The Fugl-Meyer Motor Assessment Upper Extremity subscale, Stroke Impact Scale, Action Research Arm Test, and Medical Research Council Scale were administered at baseline, posttreatment, and at 3-month follow-up. Two-way repeated-measures analysis of variance was used to investigate the treatment effects.


The improvements of the RTT group in motor function measured by the Fugl-Meyer Motor Assessment Upper Extremity subscale and quality of life assessed by the Stroke Impact Scale were significantly superior to the RTI group after the interventions. The improvements of the RTT group were maintained for 3 months. Both groups demonstrated significant within-group improvements in motor function, muscle power, and quality of life.


RTT may be a more compelling approach to enhance motor function and quality of life for a long-term period than RTI. The combination of RT with task-specific training and with impairment-oriented training had similar benefits on upper limb motor function and muscle strength immediately after the interventions.

Source: The Effects of Combination of Robot-Assisted Therapy With Task-Specific or Impairment-Oriented Training on Motor Function and Quality of Life in Chronic Stroke – PM&R

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[ARTICLE] Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study – Neurocase


The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits.

After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up.

These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.

Source: Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study – Neurocase –

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[ARTICLE] Effects of combining robot-assisted therapy with neuromuscular electrical stimulation on motor impairment, motor and daily function, and quality of life in patients with chronic stroke: a double-blinded randomized controlled trial – Full Text HTML

The electronic version of this article is the complete one and can be found online at:



Robot-assisted therapy (RT) is a widely used intervention approach to enhance motor recovery in patients after stroke, but its effects on functional improvement remained uncertain. Neuromuscular electrical stimulation (NMES) is one potential adjuvant intervention approach to RT that could directly activate the stimulated muscles and improve functional use of the paretic hand.


This was a randomized, double-blind, sham-controlled study. Thirty-nine individuals with chronic stroke were randomly assigned to the RT combined with NMES (RT + ES) or to RT with sham stimulation (RT + Sham) groups. The participants completed the intervention 90 to 100 minutes/day, 5 days/week for 4 weeks. The outcome measures included the upper extremity Fugl-Meyer Assessment (UE-FMA), modified Ashworth scale (MAS), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale 3.0 (SIS). All outcome measures were assessed before and after intervention, and the UE-FMA, MAL, and SIS were reassessed at 3 months of follow-up.


Compared with the RT + Sham group, the RT + ES group demonstrated greater improvements in wrist flexor MAS score, WMFT quality of movement, and the hand function domain of the SIS. For other outcome measures, both groups improved significantly after the interventions, but no group differences were found.


RT + ES induced significant benefits in reducing wrist flexor spasticity and in hand movement quality in patients with chronic stroke.

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Flow diagram of participants who enrolled and completed the study. Abbreviations: RT, robot-assistive therapy; ES, electrical stimulation Lee et al. Journal of NeuroEngineering and Rehabilitation 2015 12:96 doi:10.1186/s12984-015-0088-3 Download authors’ original image

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[ARTICLE] Effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients – Full Text PDF


[Purpose] The aim of this study was to examine the effects of upper limb robot-assisted therapy in the rehabilitation of stroke patients.

[Subjects and Methods] Fifteen stroke patients with no visual or cognitive problems were enrolled. All subjects received robot-assisted therapy and comprehensive rehabilitation therapy for 30 minutes each. The experimental group received a conventional therapy and an additional half hour per weekday of robot therapy. The patients participated in a total of 20 sessions, each lasting 60 minutes (conventional therapy 30 min, robot-assisted therapy 30 min), which were held 5 days a week for 4 weeks.

[Result] The patients showed a significant difference in smoothness and reach error of the point to point test, circle size and independence of the circle in the circle test, and hold deviation of the playback static test between before and after the intervention. On the other hand, no significant difference was observed in the displacement of the round dynamic test. The patients also showed significant improvement in the Fugl-Meyer Assessment and Modified Barthel Index after the intervention.

[Conclusion] These kinematic factors can provide good information when analyzing the upper limb function of stroke patients in robot-assisted therapy. Nevertheless, further research on technology-based kinematic information will be necessary.

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[ARTICLE] Use of robots in rehabilitative treatment


Recently, rehabilitation robotics technology has advanced, and several therapeutic robots have been developed. Robot-assisted rehabilitation therapy has a number of advantages over manual physical therapy. It can relieve the physical therapist from the strenuous task of manual assistance and provide high-dosage and high-intensity training. Therapeutic rehabilitation robots include end-effector and exoskeleton types, which are mainly applied for rehabilitation of upper extremity motor dysfunction or gait disturbance. In addition, they are used for patients with stroke, traumatic brain injury, spinal cord injury, parkinsonism, and cerebral palsy. Several studies have reported that robot-assisted therapy has a beneficial effect on motor function in patients with impaired motor function, either alone or as an additional therapeutic tool in combination with conventional rehabilitation therapy. We believe that ongoing improvement in robotic technology will help to overcome the disadvantages of conventional rehabilitation therapy and to optimize rehabilitation therapies for disabled patients.

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[ARTICLE] Robotic upper-limb neurorehabilitation in chronic stroke patients – Full Text


This pilot study tested the effectiveness of an intense, short-term upper-limb robotic therapy for improvement in motor outcomes among chronic stroke patients. We enrolled 30 subjects with upper-limb deficits due to stroke of at least 6 mo duration and with a Motor Power Assessment grade of 3 or less. Over 3 wk, 18 sessions of robot-assisted task-specific therapy were delivered with the use of a robotic exercise device that simulates a conventional therapy known as skateboard therapy.

Primary outcome measures included reliable, validated impairment and disability measures of upper-limb motor function. Statistically significant improvements were observed for severely impaired participants when we compared baseline and posttreatment outcomes (p < 0.05).

These results are important because they indicate that improvement is not limited to those with moderate impairments but is possible among severely impaired chronic stroke patients as well. Moderately and severely impaired patients in our study were able to tolerate a massed-practice therapy paradigm with intensive, frequent, and repetitive treatment. This information is useful in determining the optimal target population, intensity, and duration of robotic therapy and sample size for a planned larger trial.

Full Text–> Robotic upper-limb neurorehabilitation in chronic stroke patients.

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[ARTICLE] Robotic Training System for Upper Limb Rehabilitation – Full Text PDF


Background: Robot-assisted therapy or exoskeleton is an active mechanical device that can be easily adjusted to fit a different patient limb length, and is able to coordinate and amplify movements. The aim of this study focuses on developing a robotic training system and quantification methods for upper limbs rehabilitation in clinic environments to be used in survivor stroke patients with motor disorders or loss of physical strength on one side of the body.

Methods: From an integrated approach, a design of one exoskeleton is presented which allows patients perform complex movements in four degrees of freedom (DOF) rehabilitation system. The system is controlled by means of user interface developed with Lab view v8.6 software that supports control and user interaction with the exoskeleton; so it’s possible for therapist to modify the patient routine including new movements and a number of repetitions in articulating joints of shoulder, elbow and wrist. On other hand system permits bio-feedback of electromyogram patient activity during rehabilitation sessions.

Results: Biomechanical analyses and structure design, implementation of power systems, the development of the control system and user interface as well as its integration with the mechanical system is presented.

Conclusions: A robot arm exoskeleton device with four DOF; able to develop complex, accurate and repetitive therapeutic routines for articulating joints of shoulder, elbow and wrist trough an interface is shown. The device permits to follow chronologically patient outcomes recording the electromyogram activity during rehabilitation progress.

Full Text [PDF] Plataforma Robótica para la rehabilitación de miembros superiores, Robotic Training System for Upper Limb Rehabilitation

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[REVIEW] Robot-assisted Therapy in Stroke Rehabilitation – Full Text

…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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