Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

With this improvement in arm/hand function from 11 years ago, DID YOUR HOSPITAL DO ONE FUCKING THING WITH THIS? NO? Then you don't have a functioning stroke hospital.

Effects of a robot-assisted training of grasp and pronation/supination in chronic stroke: a pilot study

 

• Olivier Lambercy,
• Ludovic Dovat,
• Hong Yun,
• Seng Kwee Wee,
• Christopher WK Kuah,
• Karen SG Chua,
• Roger Gassert,
• Theodore E Milner,
• Chee Leong Teo &
• Etienne Burdet 

Journal of NeuroEngineering and Rehabilitation volume 8, Article number: 63 (2011) Cite this article

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Abstract

Background

Rehabilitation of hand function is challenging, and only few studies have investigated robot-assisted rehabilitation focusing on distal joints of the upper limb. This paper investigates the feasibility of using the HapticKnob, a table-top end-effector device, for robot-assisted rehabilitation of grasping and forearm pronation/supination, two important functions for activities of daily living involving the hand, and which are often impaired in chronic stroke patients. It evaluates the effectiveness of this device for improving hand function and the transfer of improvement to arm function.

Methods

A single group of fifteen chronic stroke patients with impaired arm and hand functions (Fugl-Meyer motor assessment scale (FM) 10-45/66) participated in a 6-week 3-hours/week rehabilitation program with the HapticKnob. Outcome measures consisted primarily of the FM and Motricity Index (MI) and their respective subsections related to distal and proximal arm function, and were assessed at the beginning, end of treatment and in a 6-weeks follow-up.

Results

Thirteen subjects successfully completed robot-assisted therapy, with significantly improved hand and arm motor functions, demonstrated by an average 3.00 points increase on the FM and 4.55 on the MI at the completion of the therapy (4.85 FM and 6.84 MI six weeks post-therapy). Improvements were observed both in distal and proximal components of the clinical scales at the completion of the study (2.00 FM wrist/hand, 2.55 FM shoulder/elbow, 2.23 MI hand and 4.23 MI shoulder/elbow). In addition, improvements in hand function were observed, as measured by the Motor Assessment Scale, grip force, and a decrease in arm muscle spasticity. These results were confirmed by motion data collected by the robot.

Conclusions

The results of this study show the feasibility of this robot-assisted therapy with patients presenting a large range of impairment levels. A significant homogeneous improvement in both hand and arm function was observed, which was maintained 6 weeks after end of the therapy.

Background

Stroke is one of the leading causes of adult disability. While there is strong evidence that physiotherapy promotes recovery, conventional therapy remains suboptimal due to limited financial and human resources, and there are many open questions, e.g. when therapy should be started, how to optimally engage the patient, what is the best dosage, etc. [1–3]. Furthermore, exercise therapy of the upper limb has been shown to be only of limited impact on arm function in stroke patients [4].

Robot-assisted rehabilitation can address these shortcomings and complement traditional rehabilitation strategies. Robots designed to accurately control interaction forces and progressively adapt assistance/resistance to the patients' abilities can record the patient's motion and interaction forces to objectively and precisely quantify motor performance, monitor progress, and automatically adapt therapy to the patient's state.

Studies with robots such as the MIT-Manus, the ARM Guide or the MIME have demonstrated improved proximal arm function after stroke [5–8], although these improvements did not transfer to the distal arm function which is necessary for most Activities of Daily Living (ADL) [9–11]. Robot-assisted training which specifically targets the hand might be required to achieve significant improvements in hand function. Furthermore, several studies indicate a generalization effect of distal arm training, e.g. hand and wrist, on proximal arm function, i.e. elbow and shoulder, which may lead to improved control of the entire arm [10, 12, 13].

We therefore focused on robot-assisted rehabilitation of the hand, adopting a functional approach based on the combined training of grasping and forearm pronation/supination, two critical functions for manipulation. This paper presents the results of a pilot study using the HapticKnob, a portable end-effector based robotic device to train hand opening/closing and forearm rotation. In contrast to robotic devices based on exoskeletons attached to the arm [14], the HapticKnob applies minimal constraints to the different joints of the upper arm, thus corresponding to situations encountered during ADL. The forearm rests on an adjustable padded support, while the shoulder and upper arm are not restrained.

The objectives of this pilot study were to determine the feasibility of training chronic stroke patients with the HapticKnob, and to reduce motor impairment of the upper limb in a safe and acceptable manner. Although a few studies have investigated post-stroke rehabilitation of the hand [12, 13], ours is the first to use robot-assisted training that combines grasp and forearm pronation/supination to perform functional tasks. With this pilot study, we tested the hypothesis that training the hand using this functional approach improves function of the entire arm.

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