Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

The word protocol is used twice in here but not in reference to something they created or was found out there, just that protocols should be created. So all in all this is useless because doctors and therapists don't have the time or ability to create effective protocols. And since we have fucking failures of stroke associations they aren't creating protocols either. And with no protocols your chances of fully recovering are almost nil. You'll get better and your doctors will declare that a success but it is a complete failure because their tyranny of low expectations is so low that they can declare ANY RECOVERY A SUCCESS.

All because of spontaneous recovery, nothing that your doctors did.

This is where you need to get into screaming bloody murder with your stroke medical team.

Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics

Giovanni Morone1,2 Stefano Paolucci1,2 Andrea Cherubini3 Domenico De Angelis1 vincenzo venturiero1 Paola Coiro1 Marco iosa1,2 1Private inpatient Unit, 2Clinical Laboratory of experimental Neurorehabilitation, iRCCS Santa Lucia Foundation, Rome, italy; 3Department of Robotics, LiRMM UM-CNRS, Montpellier, France

Correspondence: Stefano Paolucci Private inpatient Unit, iRCCS Santa Lucia Foundation, via Ardeatina 306-354, 00179 Rome, italy Tel +39 06 5150 1001 Fax +39 06 5150 1004 email s.paolucci@hsantalucia.it

Abstract: 

In this review, we give a brief outline of robot-mediated gait training for stroke patients, as an important emerging field in rehabilitation. Technological innovations are allowing rehabilitation to move toward more integrated processes, with improved efficiency and less long term impairments. In particular, robot-mediated neurorehabilitation is a rapidly advancing field, which uses robotic systems to define new methods for treating neurological injuries, especially stroke. The use of robots in gait training can enhance rehabilitation, but it needs to be used according to well-defined neuroscientific principles. The field of robot-mediated neurorehabilitation brings challenges to both bioengineering and clinical practice. This article reviews the state of the art (including commercially available systems) and perspectives of robotics in post stroke rehabilitation for walking recovery. A critical revision, including the problems at stake regarding robotic clinical use, is also presented. 

Introduction 

Stroke is a leading cause of movement disability in the US and Europe.1 By 2030, it has been estimated that there could be as many as 70 million stroke survivors around the world.2 The proportion of patients achieving independence by 1 year after a stroke ranges from ~60% to 83% in self-care and between 10% and 15% in a residential clinical institution.3 Concerning mobility recovery, a 2008 study showed that ~50% of patients with stroke leave the rehabilitation hospital on a wheelchair, ,<15% are able to walk indoor without aids, ,<10% are able to walk outdoor, and ,<5% are able to climb stairs.4 Post stroke rehabilitation demand will increase in the near future, leading to stronger pressure on health care budgets. For example, in the US, the estimated direct and indirect cost of stroke in 2010 was $73.7 billion, and the mean lifetime cost of ischemic stroke was estimated at $140.048.5 For ethical reasons, in adjunction to these economical reasons, an increase of rehabilitation efficacy is mandatory. New technologies, early discharge after intensive training, and home rehabilitation are among the innovations proposed for achieving this. Current literature suggests that rehabilitative interventions are more effective if they ensure early, intensive, task-specific, and multisensory stimulation, with both bottom-up and top-down integration, favoring brain plasticity.6,7 In fact, there is growing evidence that the motor system is plastic following stroke and that motor training can be of aid, particularly in the first 3 months.8 Neuroplasticity can lead to recovery mechanisms and functional adaptation resulting from global changes
in neuronal organization. It is associated with changes in excitatory/inhibitory balance as well as the spatial extent and activation of cortical maps and structural remodeling.9,10 In this scenario, the emerging field of robotic rehabilitation needs to be integrated with the neurological principles supporting the scientific evidences that a robot may improve specific abilities of neurological patients. Figure 1 shows the determinants of gait rehabilitation of patients with stroke that may benefit from robotic training, including those related to other technologies such as serious video games and augmented biofeedback. This review aims to exploit, by following user-centered principles, the clinical efficacy of robotic devices and enhance their role in the next generation of rehabilitation protocols.