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Posts Tagged Robotic
[Abstract] Lessons learned from robotic gait training during rehabilitation: Therapeutic and medical severity considerations over 3 years
BACKGROUND: Robotic exoskeletons are increasingly available to inpatient rehabilitation facilities though programmatic implementation evidence is limited.
OBJECTIVE: To describe therapists’ clinical practice experiences with robotic gait training (RGT) over 3 years during inpatient rehabilitation.
METHODS: Therapists participated in a survey and semi-structured focus group to discuss their RGT experiences. Interviews were recorded, transcribed, and analyzed using a theoretical analysis-driven thematic approach.
RESULTS: Therapists averaged 7.6 years of neurologic rehabilitation experience and 1.85 years with RGT. Eight of 10 therapists had completed ⩾ 50 RGT sessions, with frequency of 1–5 sessions/week, including on-label (spinal cord injury, stroke) and off-label (e.g., traumatic brain injury) experiences. Three adverse events occurred over 716 RGT sessions with 186 patients. Qualitative analysis identified three major themes and corresponding subthemes: 1-Comparison with traditional gait training approaches (6 sub-themes), 2-Clinical decision-making considerations (3), and 3-On-label and off-label utilization (4). Stated RGT benefits included decreased therapists’ physical burden and increased patient motivation. Clinical concerns with RGT included tonicity, continence, and patient communication (e.g., aphasia). Off-label RGT was used to overcome barriers in traditional gait therapy and achieve early mobility.
CONCLUSIONS: Therapists’ level of training and clinical knowledge furthered RGT implementation and allowed for safe utilization with on-label and off-label patients.
Background: Stroke is the leading cause of serious long-term disability in the United States. Barriers to rehabilitation include cost, transportation, lack of trained personnel, and equipment. Telerehabilitation (TR) has emerged as a promising modality to reduce costs, improve accessibility, and retain patient independence. TR allows providers to remotely administer therapy, potentially increasing access to underserved regions.
Objectives: To describe types of stroke rehabilitation therapy delivered through TR and to evaluate whether TR is as effective as traditional in-person outpatient therapy in improving satisfaction and poststroke residual deficits such as motor function, speech, and disability.
Methods: A literature search of the term “telerehabilitation and stroke” was conducted across three databases. Full-text articles with results pertaining to TR interventions were reviewed. Articles were scored for methodological quality using the PEDro scale.
Results: Thirty-four articles with 1,025 patients were included. Types of TR included speech therapy, virtual reality (VR), robotic, community-based, goal setting, and motor training exercises. Frequently measured outcomes included motor function, speech, disability, and satisfaction. All 34 studies reported improvement from baseline after TR therapy. PEDro scores ranged from 2 to 8 with a mean of 4.59 ± 1.94 (on a scale of 0-10). Studies with control interventions, randomized allocation, and blinded assessment had significantly higher PEDro scores. All 15 studies that compared TR with traditional therapy showed equivalent or better functional outcomes. Home-based robotic therapy and VR were less costly than in-person therapy. Patient satisfaction with TR and in-person clinical therapy was similar.
Conclusions: TR is less costly and equally as effective as clinic-based rehabilitation at improving functional outcomes in stroke patients. TR produces similar patient satisfaction. TR can be combined with other therapies, including VR, speech, and robotic assistance, or used as an adjuvant to direct in-person care.
- Efficacy of Home-Based Telerehabilitation vs In-Clinic Therapy for Adults After Stroke: A Randomized Clinical Trial.Cramer SC, Dodakian L, Le V, See J, Augsburger R, McKenzie A, Zhou RJ, Chiu NL, Heckhausen J, Cassidy JM, Scacchi W, Smith MT, Barrett AM, Knutson J, Edwards D, Putrino D, Agrawal K, Ngo K, Roth EJ, Tirschwell DL, Woodbury ML, Zafonte R, Zhao W, Spilker J, Wolf SL, Broderick JP, Janis S; National Institutes of Health StrokeNet Telerehab Investigators.JAMA Neurol. 2019 Jun 24;76(9):1079-87. doi: 10.1001/jamaneurol.2019.1604. Online ahead of print.PMID: 31233135 Free PMC article.
- Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient’s home: study protocol of a randomized clinical trial.Kairy D, Veras M, Archambault P, Hernandez A, Higgins J, Levin MF, Poissant L, Raz A, Kaizer F.Contemp Clin Trials. 2016 Mar;47:49-53. doi: 10.1016/j.cct.2015.12.006. Epub 2015 Dec 4.PMID: 26655433 Clinical Trial.
- Telerehabilitation services for stroke.Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C.Cochrane Database Syst Rev. 2013 Dec 16;2013(12):CD010255. doi: 10.1002/14651858.CD010255.pub2.PMID: 24338496 Free PMC article. Updated. Review.
- Study protocol: home-based telehealth stroke care: a randomized trial for veterans.Chumbler NR, Rose DK, Griffiths P, Quigley P, McGee-Hernandez N, Carlson KA, Vandenberg P, Morey MC, Sanford J, Hoenig H.Trials. 2010 Jun 30;11:74. doi: 10.1186/1745-6215-11-74.PMID: 20591171 Free PMC article. Clinical Trial.
- Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation.Veras M, Kairy D, Rogante M, Giacomozzi C, Saraiva S.J Telemed Telecare. 2017 Jul;23(6):567-587. doi: 10.1177/1357633X16656235. Epub 2016 Jun 24.PMID: 27342850 Review.
[ARTICLE] The ReWalk ReStore™ soft robotic exosuit: a multi-site clinical trial of the safety, reliability, and feasibility of exosuit-augmented post-stroke gait rehabilitation – Full Text
Atypical walking in the months and years after stroke constrain community reintegration and reduce mobility, health, and quality of life. The ReWalk ReStore™ is a soft robotic exosuit designed to assist the propulsion and ground clearance subtasks of post-stroke walking by actively assisting paretic ankle plantarflexion and dorsiflexion. Previous proof-of-concept evaluations of the technology demonstrated improved gait mechanics and energetics and faster and farther walking in users with post-stroke hemiparesis. We sought to determine the safety, reliability, and feasibility of using the ReStore™ during post-stroke rehabilitation.
A multi-site clinical trial (NCT03499210) was conducted in preparation for an application to the United States Food and Drug Administration (FDA). The study included 44 users with post-stroke hemiparesis who completed up to 5 days of training with the ReStore™ on the treadmill and over ground. In addition to primary and secondary endpoints of safety and device reliability across all training activities, an exploratory evaluation of the effect of multiple exposures to using the device on users’ maximum walking speeds with and without the device was conducted prior to and following the five training visits.
All 44 study participants completed safety and reliability evaluations. Thirty-six study participants completed all five training days. No device-related falls or serious adverse events were reported. A low rate of device malfunctions was reported by clinician-operators. Regardless of their reliance on ancillary assistive devices, after only 5 days of walking practice with the device, study participants increased both their device-assisted (Δ: 0.10 ± 0.03 m/s) and unassisted (Δ: 0.07 ± 0.03 m/s) maximum walking speeds (P’s < 0.05).
When used under the direction of a licensed physical therapist, the ReStore™ soft exosuit is safe and reliable for use during post-stroke gait rehabilitation to provide targeted assistance of both paretic ankle plantarflexion and dorsiflexion during treadmill and overground walking.
Bipedal locomotion is characterized by alternating periods of single and double limb support, with ground clearance by the swing limb and propulsion by the trailing stance limb serving as crucial walking subtasks [1, 2]. Healthy individuals are able to generate an ankle dorsiflexion moment during each limb’s swing phase to lift the foot and facilitate ground clearance. They are also able to generate an ankle plantarflexion moment during each limb’s late stance phase to produce the propulsive force required to advance the limb and body . In contrast, post-stroke hemiparesis results in impaired paretic dorsiflexion and plantarflexion that, in turn, hinders ground clearance and propulsion [4,5,6,7,8] and, ultimately, necessitates compensatory walking strategies [9, 10] that make walking more effortful and unstable [11,12,13,14].
The ReWalk ReStore™ is a soft robotic exosuit designed to augment the paretic ankle’s ability to produce both dorsiflexor and plantarflexor moments during walking. In early proof-of-concept studies conducted with a research version of the device [15, 16], exosuits were shown to facilitate immediate increases in swing phase paretic ankle dorsiflexion by an average 5 degrees , the propulsion force generated by the paretic limb by an average 10% , and the positive center of mass (COM) power generated by the paretic limb during late stance phase by an average 22% . Together, these improvements in paretic limb function resulted in reduced propulsion asymmetry by 20%  and the asymmetry in positive COM power generated during late stance phase by 39% . Also observed were immediate reductions in hip hiking and circumduction compensations of over 20% , reductions in the energy cost of walking by an average 10% [17, 18], faster overground walking speeds by a median 0.14 m/s, and farther walking distances during the 6-min walk test by a median 32m .
Building on this foundational biomechanical, physiological, and clinical research, the objective of this multi-site clinical trial was to evaluate safety, feasibility, and reliability of using exosuits during post-stroke rehabilitation in preparation for a commercial clinical application to the United States Food and Drug Administration (FDA). In contrast to previous laboratory-based research that studied the immediate effects of exosuit prototypes on clinical, biomechanical, and physiological outcomes, this translational research sought to determine the safety of clinicians and patients with post-stroke hemiparesis using the commercially-adapted ReStore™ in clinical settings, the feasibility of clinician operators applying the ReStore™ during both treadmill and over ground gait training activities, and the reliability of the technology across multiple training visits. In addition to outcomes of safety, feasibility, and device reliability, an exploratory evaluation of the impact that multiple training visits with the device have on users’ maximum walking speeds, both with and without the device, was also included.
The ReStore™ is indicated for use by individuals with post-stroke hemiparesis undergoing stroke rehabilitation under the supervision of a licensed physical therapist. To assess the safety, device reliability, and clinical feasibility of using the ReStore™ during post-stroke gait rehabilitation, a multi-site trial was conducted. The trial included five clinical sites and 44 users with post-stroke hemiparesis. The study was approved by the Institutional Review Boards of Boston University, Spaulding Rehabilitation Hospital, The Shirley Ryan AbilityLab, TIRR Memorial Hermann Hospital, Kessler Rehabilitation Hospital, and Moss Rehabilitation Hospital. Written informed consent was secured for all participants.
Study inclusion and exclusion criteria
Study participant eligibility requirements consisted of: (i) one-sided ischemic or hemorrhagic stroke, (ii) > 2 weeks post-stroke, (iii) age > 18 years, (iv) height between 4′8″ and 6′7″, (v) weight < 264lbs, (vi) medical clearance, (vii) ability to ambulate at least 5 ft without an AFO and with no more than minimal contact assistance, (viii) ability to follow a 3-step command, (ix) ability to fit suit components, (x) no greater than 5 degrees of ankle plantar flexion contracture, and (xi) Modified Ashworth Scale for tone at 3 or less for ankle dorsiflexor and plantarflexor muscles. Exclusion criteria included: (i) severe aphasia limiting ability to express needs or discomfort verbally or non-verbally, (ii) serious co-morbidities that interfere with ability to participate, (iii) significant Peripheral Artery Disease, (iv) colostomy bag, (v) current pregnancy, (vi) uncontrolled hypertension, (vii) participation in any other clinical trial, (viii) open wounds or broken skin at device locations requiring medical management, (ix) urethane allergies, (x) and current DVT.
After screening and enrollment, study participants completed up to two walking evaluations and five device exposure visits. Each exposure visit consisted of up to 20 min of overground walking practice and 20 min of treadmill walking practice while receiving assistance from the device. The visit schedule consisted of a minimum of two visits per week, with the expectation of no more than 4 weeks between the pretraining and posttraining evaluations. Actual activities and durations were dependent on each study participant’s abilities as determined by the treating physical therapist as per their usual practices. The target level for plantarflexion assistance during all active walking with the ReStore™ was 25% of the user’s bodyweight [17, 19]. The target level for dorsiflexion assistance was the minimum needed for adequate ground clearance and heel strike, as determined visually by the physical therapist.
The exosuit consists of motors worn at the waist that generate mechanical forces that are transmitted by cables to attachment points located proximally on a functional textile worn around the calf and distally on a shoe insole (Fig. 1). The overall weight of the exosuit is approximately 5kgs, with the vast majority of the weight located proximally in the actuation pack worn at the waist. Each functional textile contains a detachable liner that can be washed. For users who require medio-lateral ankle support in addition to ankle plantarflexion and dorsiflexion assistance, an optional textile component that prevents ankle inversion without restricting dorsiflexion and plantarflexion can also be used. Inertial sensors that attach to a patient’s shoes measure gait events and automate the independent timing of the active ankle plantarflexion and dorsiflexion assistance provided by the ReStore™ as previously described . Load cell sensors located at the end of each cable are used to monitor the interaction between user and exosuit and ensure that the target level of assistance is achieved [16, 17]. A hand-held device with a graphical interface allows clinicians to monitor patients’ performance and select and progress, in real-time, the assistance parameters (Fig. 2).
[Abstract] Can robotic gait rehabilitation plus Virtual Reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols
The rehabilitation of cognitive and behavioral abnormalities in individuals with stroke is essential for promoting patient’s recovery and autonomy. The aim of our study is to evaluate the effects of robotic neurorehabilitation using Lokomat with and without VR on cognitive functioning and psychological well-being in stroke patients, as compared to traditional therapy.
Ninety stroke patients were included in this randomized controlled clinical trial. The patients were assigned to one of the three treatment groups, i.e. the Robotic Rehabilitation group undergoing robotic rehab with VR (RRG+VR), the Robotic Rehabilitation Group (RRG-VR) using robotics without VR, and the Conventional Rehabilitation group (CRG) submitted to conventional physiotherapy and cognitive treatment.
The analysis showed that either the robotic training (with and without VR) or the conventional rehabilitation led to significant improvements in the global cognitive functioning, mood, and executive functions, as well as in activities of daily living. However, only in the RRG+VR we observed a significant improvement in cognitive flexibility and shifting skills, selective attention/visual research, and quality of life, with regard to the perception of the mental and physical state.
Our study shows that robotic treatment, especially if associated with VR, may positively affect cognitive recovery and psychological well-being in patients with chronic stroke, thanks to the complex interation between movement and cognition.
[NEWS] Researchers at the UI create robotic rehabilitation device to help increase range of motion in the wrist
Assistant professors in the University of Iowa College of Engineering have developed a robotic device to help people increase their range of motion in the wrist using artificial muscles to increase flexibility.
Two mechanical-engineering assistant professors at the University of Iowa have created a robotic device to give people with limb impairment a wider range of motion. Right now, the pair is focused on the upper limbs and their first prototype increases mobility in the wrist.
The researchers, Venanzio Cichella and Caterina Lamuta, worked together to develop a flexible, lightweight device that can be powered with a small battery. Lamuta and her students are designing and developing the device itself and Cichella and his student are developing the controls of the device.
The device fits over the hand and wrist like a glove, and uses artificial muscles made from carbon fibers which are strong and flexible, Lamuta said. The muscles can lift 12,600 times their weight, and a lot of these artificial muscles can be used to reproduce the arrangement of human muscle. A small battery can be used to power the device, she said.
“So, the idea is to use this more flexible artificial muscle as an alternative for noisy and heavy traditional actuators like electrical motors or hydraulic or pneumatic actuators,” Lamuta said.
The current prototype can perform a few degrees of wrist extension and flexion, she said, but the researchers are working to increase the motion capabilities of the device.
The actuators the researchers are using are very inexpensive, Cichella said. This allows them to not only create a device that is portable and cheap, he said, but allows them to put more of the actuators in the device.
With so many actuators, the question eventually became how to move each of them in order to get the desired action or movement, he said.
Cichella is developing robust control algorithms that can be implemented in the device. He and his student are developing theoretical tools that will help find the optimal controls for the device, Cichella said, and the goal is to implement the algorithms on the side of the device.
Amid spread of the novel coronavirus, some orders for supplies to build sensors have been delayed and working from home makes it so they can’t use larger machinery in the labs, Lamuta said, so they’re going to have delays in their work.
“Part of our research takes place in the lab, which now is the living room of our house and our students’ houses, and also on paper and pen, so it (the challenge) spans both for theoretical and experimental,” Cichella said.
Two UI Ph.D. students and a visiting scholar from Italy are helping with the development of the algorithms and prototypes of the device.
Thilina Weerakkody, a Ph.D. student, and Carlo Greco, the visiting scholar, are working with Lamuta to develop the device itself.
Weerakkody, who has a background in biomedical-device development, has worked on the device, which is similar to an exoskeleton hand, to control it with external feedback. Now, he’s in the process of developing external sensors for the device, he said.
The first prototype only had a single degree of freedom for the wrist, he added.
“Now in the second prototype, we’ve developed a 3D-printed prototype, so in this phase we are trying to elicit two freedom instances,” Weerakkody said.
Greco helped design the muscle used in the glove, choosing the dimension and length of the muscles and studying the schematics of the wrist, he said. The glove was initially able to move up and down in one motion, Greco said, but now they are working to improve movement in the other direction.
“Our testing now is done on a 3D-printed hand with a forearm and we can measure the displacement of the angle of rotation,” Greco said. “…[If] a person does a motion on his own hand and our hand [should] do the same motion in the same [amount of] time.”
Calvin Kielas-Jensen, a Ph.D. student, has worked with Cichella to develop the control algorithms for the device. They’re working with a motion-capture system to give them submillimeter accuracy for the positions of the wrist.
With a background in electrical engineering, Kielas-Jensen has helped with the electronics in the device. He is providing feedback for what kind of sensors should be used and what kind of algorithms should be used to read the data, Kielas-Jensen added.
“It’s a rehabilitation device, so there are plenty of rehabilitation doctors that say that it’s really good to have people do something with their hands,” he said. “It’s one thing to give a patient a stress ball to squeeze, but it gets tired — it gets boring.”
[ARTICLE] Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System – Full Text
Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.
Insufficient motor control compromises the ability of Stroke Patients (SP) to perform activities of daily living and will likely have a negative impact on the quality of life. Improving Upper Limb (UL) function is an important part of post-stroke rehabilitation in order to reduce disability . Recovery in the context of motor ability may refer to the return of pre-stroke muscle activation patterns or to compensation involving the appearance of alternative muscle activation patterns that attempt to compensate for the motor function deficit . The past decades have seen rapid development of a wide variety of assistive technologies that can be used in UL rehabilitation. These include electromyographic biofeedback, virtual reality, electromechanical and robotic devices, electrical stimulation, transcranial magnetic stimulation, direct current stimulation, and orthoses . Currently, two effective technologies that provide external feedback to SP during training, improve the retention of learned skills, and may be able to enhance the motor recovery are discussed .
Virtual Reality (VR): The Microsoft TM Kinect-based system provides feedback on movement execution and/or goal attainment . Incorporating therapy exercises into virtual games can make therapy more enjoyable and more realistic, such that task-based exercises have increased applicability in the clinical environment [6,7], increasing motivation and therefore adherence, which are useful for navigating this virtual environment; this has been identified as the most feasible for future implementation .
Electromechanical and robotic devices can move passive UL along more secure movement trajectories and provide either assistance or resistance to movement of a single joint or control of inter-segmental coordination. Recent technological advances have the ability to control multiple joints accurately at the same time, enabling them to produce more realistic task-based exercises for SP . Compared to manual therapy, robots have the potential to provide intensive rehabilitation consistently for a longer duration . Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires physiological limb muscle activation, which can be achieved through functional UL movement exercises and activation of the appropriate peripheral receptors . The Armeo Spring robot-assisted trainer device may improve UL motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability . Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy [12,13]. There is evidence that robot training for the hand is superior; during post-stroke rehabilitation, hand training is likely to be the most useful [8,13].
Previous studies have shown that the use of systems based on VR environments, motion sensors, and robotics can improve motor function. Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions [14,15,16].
The objectives of the study are to clarify in which area of functional UL recovery these new technologies are more suitable and effective and how much these interventions affect functional state and cognitive functions.
We raise the hypothesis that a robot-assisted device and virtual reality both have a positive effect on functional independence recovery in stroke-affected patients; however, having a different influence on UL motor function and cognitive changes. We assume that the robot-assisted device is more efficient and more accurately allows selecting tasks for developing specific motor function (range of motion, strength or dexterity of the affected arm), while Kinect-based games provide more free movements that are less suitable for specific motor function development and may be more targeted for cognitive functions.
An adaptive robotic system has been developed to be used for hand rehabilitation. Previously developed exoskeletons are either very complex in terms of mechanism, hardware and software, or simple but have limited functionality only for a specific rehabilitation task. Some of these studies use simple position controllers considering only to improve the trajectory tracking performance of the exoskeleton which is inadequate in terms of safety and health of the patient. Some of them focus only on either passive or active rehabilitation, but not both together. Some others use EMG signals to assist the patient, but this time active rehabilitation is impossible unless different designs and control strategies are not developed. The proposed mechanical structure is extremely simple. The middle and the proximal phalanxes are used as a link of consecutively connected two 4-bar mechanisms, respectively. The PIP and MCP joints are actuated by a single electro mechanical cylinder to produce complex flexion and extension movements. It is simpler than similar ones from aspect with the mechanical structure and the biodynamic fit of the hand, making it practicable in terms of production and personal usage. Simple design lets to implement adaptive compliance controller for all active and passive rehabilitation tasks, instead of developing complex and different strategies for different rehabilitation tasks. Furthermore, using the Luenberger observer for unmeasured velocity state variable, an on-line estimation method is used to estimate the dynamic parameters of the system. This makes possible to estimate the force exerted by the patient as well, without a force sensor.
[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.
The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.
50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.
The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).
These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.
These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.
This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.
Motus Nova is expanding its list of partner hospitals and clinics using its FDA-approved robotic stroke therapy system. It also plans to introduce its system to the consumer market for home use in Q3 2019.
Twenty-five hospitals in the Atlanta area within Emory Healthcare, the Grady Health System, and the Wellstar Health System are now using the Motus Nova rehabilitation therapy system, which is designed to use Artificial Intelligence (AI) to accelerate recovery from neurological injuries such as strokes.
The system features a Hand Mentor and Foot Mentor, which are sleeve-like robots that fit over a stroke survivor’s impaired hand or foot. Equipped with an active-assist air muscle and a suite of sensors and accelerometers, they provide clinically appropriate assistance and resistance while individual’s perform the needed therapeutic exercises.
A touchscreen console provides goal-directed biofeedback through interactive games—which Motus Nova calls “theratainment”—that make the tedious process of neuro rehab engaging and fun.
“It’s a system that has proven to be a valuable partner to stroke therapy professionals, where it complements skilled clinical care by augmenting the repetitive rehabilitation requirements of stroke recovery and freeing the clinician to do more nuanced care and assessment,” says Nick Housley, director of clinical research for Atlanta-based Motus Nova, in a media release.
“And while we continue to fill orders for the system to support therapy in the clinic and hospital, we also are looking to use our system to fill the gap patients often experience in receiving the needed therapy once they go home.”
Clinical studies show that neuroplasticity begins after approximately many 10’s to 100’s of hours of active guided rehab. The healing process can take months or years, and sometimes the individuals might never fully recover. Yet the typical regimen for stroke survivors is only two to three hours of outpatient therapy per week for a period of three to four months.
“These constraints were instituted by the Centers for Medicare & Medicaid Services (CMS) in determining Medicare reimbursement without a full understanding of the appropriate dosing required for stroke recovery, and many private insurers have adopted the policy, as well,” states David Wu, Motus Nova’s CEO.
Motus Nova plans to offer a more practical model, the release continues.
“By making the system available for home use at a reasonable weekly rate as long as the patient needs it, the individual can perform therapy anytime,” Wu adds. “A higher dosage of therapy can be achieved without the inconvenience of scheduling appointments with therapists or traveling to and from a clinic, and without the high cost of going to an outpatient center every time the individual wants to do therapy.”
While the system gathers data about individual performance, AI tailors the regimen to maximize user gains, discover new approaches, minimize side effects and help the stroke survivor realize his or her full potential more quickly.
“By optimizing factors such as frequency, intensity, difficulty, encouragement, and motivation, the AI system builds a personalized medicine plan uniquely tailored to each individual user of the system,” Housley comments.
“Our system is durable, too, proven in clinical trials to deliver an engaging physical therapy experience over thousands of repetitions. We look forward to making it available on a much wider scale in the coming months.”
[Source(s): Motus Nova, PR Newswire]