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[BOOK Chapter] Application of a Robotic Rehabilitation Training System for Recovery of Severe Plegie Hand Motor Function after a Stroke – Full Text PDF

Abstract

We have developed a rehabilitation training system (UR-System-PARKO: Useful
and Ultimate Rehabilitation System-PARKO) for patients after a stroke to promote
recovery of motor function of the severe plegic hand with hemiplegia. A clinical
test with six patients for the therapeutic effect of the UR-System-PARKO for severe
plegic hand was performed. For all patients, the active ranges of motion (total
active motion) of finger extension improved after training with the UR-SystemPARKO. Moreover, the modified Ashworth scale (MAS) scores of finger extension
increased. Thus, the training reduced the spastic paralysis. These results suggest the
effectiveness of training with the UR-System-PARKO for recovery of motor function as defined by finger extension in the severe plegic hand.

1. Introduction

Stroke is the leading cause of disability in Japan, with more than 1 million people
in Japan living with a disability as a result of stroke. Therefore, interventions that
address the sensorimotor impairments resulting from stroke are important. Motor
function may be restored more than 6 months after a stroke [1, 2], but these studies
included patients with only moderate poststroke hemiplegia, whereas most stroke
survivors have a severely plegic hand with difficulty extending the fingers [3]. This
suggests that a method is needed for treatment of these severely affected cases.
However, although a few studies on rehabilitation therapy for severe plegic hands
have been reported, no marked recovery of ability in extension of the fingers of
the plegic hands was achieved in any study [4, 5]. Proprioceptive neuromuscular
facilitation (PNF) is a therapeutic method that was reported to increase the muscle
strength of the plegic extremities in patients with stroke-induced hemiplegia [6].
However, since PNF is indicated for patients with a certain level of joint motion,
this method has not been used for severe plegic hands where the fingers cannot
extend. Thus, the first author developed a method to build up the extensor digitorum muscle strength using PNF [7, 8] for stroke patients with severe hemiplegia.

With this therapy, he has performed repeated facilitation training using his hands
on stroke patients with a severe plegic hand to help them recover their motor function, and a good treatment outcome was achieved [9, 10] (Figure 1).
Facilitation training uses extension of the elbow joint with resistance applied to
the tips of the fully extended hemiplegic fingers to increase the force of the extensor digitorum muscle. However, this approach is time-consuming for the therapist.
Therefore, development of a training system is required instead of repeated
facilitation training by a therapist. The objectives of this study were to develop
a training system to increase the output of the extensor digitorum muscle force
and to verify the effect of training with the developed system on a severe plegic
hand. The training system is called the UR-System-PARKO (a useful and ultimate
rehabilitation support system for PARKO). The UR-System-PARKO was developed
by remodeling the simplified training system, which developed previously for
resistance training of hemiplegic upper limbs [11]. A brace for securing the plegic
hand to the UR-System-PARKO was developed on the basis of repeated facilitation
training by a therapist.[…]

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