Reducing Abnormal Synergies of Forearm, Elbow, and Shoulder Joints in Stroke Patients with Neuro-rehabilitation Robot Treatment and Assessment

Quantifying something does nothing to help survivors recover.  Where is the protocol to fix these problems? No protocol, you just wasted time and money on this; you're fired!

Reducing Abnormal Synergies of Forearm, Elbow, and Shoulder Joints in Stroke Patients with Neuro-rehabilitation Robot Treatment and Assessment

 Pin-Cheng Kung 1
 Chou-Ching K. Lin 1,3
 Ming-Shaung Ju 1,2,*
 Shu-Min Chen 1,4
 
1  Medical Device Innovation Center, National Cheng Kung University, Tainan 701, Taiwan, ROC
2  Department of Mechanical Engineering, National Cheng Kung University, Tainan 701, Taiwan, ROC
3  Department of Neurology, National Cheng Kung University Hospital, Tainan 701, Taiwan, ROC
4  Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan 701, Taiwan, ROC
Received 10 Jul 2009; Accepted 8 Sep 2009;
 
doi: 10.5405/jmbe.894

Abstract

Chronic stroke patients are often unable to control their joint movements independently due to abnormal synergies. In our previous work, three robot-assisted therapy indices (two biomechanical indices and one electromyography assessment) were applied to quantify the abnormal synergies of upper limbs with the aid of a neurorehabilitation robot. In this study, these quantitative indices are employed to investigate the time course of abnormal synergies in the affected upper limbs of chronic stroke patients treated with the robot. Eight chronic stroke patients are recruited to perform rectilinear tracking movements in four directions (back-forth, two oblique movements at 45 degrees, and right-left) during robot-assisted treatments for 4 months and 4 months of follow-up. The robot-assisted therapy indices (variation of forearm pronation/supination torque, and co-activation of elbow and shoulder muscles) reveal a significant decrease of abnormal synergies after 4 months of robot-assisted treatment and a slight regression in the following 4 months. Significant recovery is found in motor outcomes evaluated using Brunnstrom stage and Fugl-Meyer assessments. Both the robot-assisted therapy indices and clinical scales indicate modifications in abnormal synergies. The rectilinear tracking movements along the contra-proximal to ipsidistal directions and the right-left directions are suitable for robot-assisted movement treatment for reducing abnormal synergies.