Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin

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Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin

 Stefan Hesse, MD;
1
*
 Henning Schmidt, Dipl-Ing;
2
 Cordula Werner, MA
1
1
Klinik Berlin/Charité University Hospital, Department of Neurological Rehabilitation, Berlin, Germany;
2
Fraunhofer  Institut–Institut für Produktionsanlagen und Konstruktionstechnik

(IPK) Berlin, Germany

Abstract—

The group at Klinik Berlin/Charite University Hospital in Berlin, Germany, began studies to promote motor recovery after stroke in the early 1990s. Following the intro-duction of treadmill training with partial body-weight support, the group designed an electromechanical gait trainer, GT I, based on movable foot plates that relieve therapist effort (e.g., when assisting the movement of the paretic limbs) and intensify patient gait training (GT). Preliminary results of a recent multicenter trial of 155 acute stroke patients showed that the GT I effectively promotes gait ability and competence in activities of daily living. The experimental group received 20 min of GT and 25 min of physiotherapy (PT) and the control group received 45 min of PT every day for 4 weeks. The laboratory’s next step was the Haptic Walker, a robotic walking simulator with freely programmable foot plates so that patients can, for example, additionally train for stair climbing and perturbations. The foot plates can be operated in full guidance or compliance control modes, thus reducing foot support according to the patient’s learning success. For the severely affected upper limb, the laboratory’s computerized arm trainer, called the Bi-Manu-Track, enables bilateral practice of forearm prona-tion/supination and wrist flexion/extension. Compared with electrical stimulation of the paretic wrist extensors, acute stroke patients with severe arm paresis (n = 44) had significantly more upper-limb muscle strength and control at the end of the 6-week intervention period and at follow-up. The laboratory’s most recent and cost-effective development, the Nudel-holz, is a purely mechanical device that bilaterally trains the shoulder, elbow, and wrist joints. It is intended for home therapy.

Key words:
arm rehabilitation, controlled trials, gait, hemi-paresis, locomotion, motor rehabilitation, physiotherapy, robot-assisted therapy, robotics, stroke.
INTRODUCTION
We at the neurorehabilitation research laboratory at Klinik Berlin/Charité University Hospital began work in motor rehabilitation of stroke patients in the early 1990s. Guided by the task-specific treatment concept, we successfully introduced treadmill training with partial body-weight support in the gait rehabilitation of chronic hemi-paretic subjects [1]. In daily practice, the therapist effort required to assist patients’ walking, e.g., when placing the paretic limbs, limits the intensity of therapy. Our next step was to develop the electromechanical gait trainer, GT I. On this machine, patients are secured with a harness and their feet placed on two driven foot plates whose movement simulates stance and swing. The robotic walking simulator, Haptic Walker, continues this concept. It is based on the principle of programmable foot plates that allows the training of arbitrary foot motions, such as walking on level ground and climbing up and down stairs, based on real foot motion data. The control modes range from position-controlled to force- and compliance-controlled motions during swing phase, and include simulation of perturbations. For the upper limb, we developed the Bi-Manu-Track to treat severely affected stroke subjects who have no volitional distal wrist and finger activity. The Bi-Manu-Track enables the bilateral practice of two distal movement cycles. It is a robotic device offering different position and compliance control modes for therapy. Our latest, most cost-effective development, the purely mechanical Nudelholz (“rolling pin”), is intended for home therapy. This article presents the devices and related clinical studies for the motor rehabilitation of these upper and lower limbs.