Abstract
Background.
High-intensity repetitive training is challenging to provide
post stroke. Robotic approaches can facilitate such training by
unweighting the limb and/or by improving trajectory control, but the
extent to which these types of assistance are necessary is not known.
Objective.
The purpose of this study was to examine the extent to which robotic
path assistance and/or weight support facilitate repetitive 3D movements
in high functioning and low functioning subjects with poststroke arm
motor impairment relative to healthy controls.
Methods.
Seven
healthy controls and 18 subjects with chronic poststroke right-sided
hemiparesis performed 300 repetitions of a 3D circle-drawing task using a
3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100
repetitions each with path assistance alone, weight support alone, and
path assistance plus weight support in a random order over a single
session. Kinematic data from the task were used to compute the
normalized error and speed as well as the speed-error relationship.
Results.
Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5)
showed the lowest error with path assistance plus weight support,
whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ±
6.8) moved faster with path assistance alone. When both speed and error
were considered together, low functioning subjects significantly
reduced their error and increased their speed but showed no difference
across the robotic conditions.
Conclusions.
Robotic assistance
can facilitate repetitive task performance in individuals with severe
arm motor impairment, but path assistance provides little advantage over
weight support alone. Future studies focusing on antigravity arm
movement control are warranted poststroke.
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