Poststroke Upper Extremity Rehabilitation: A Review of Robotic Systems and Clinical Results

Abstract Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of clinical study of the devices make it difficult to follow and interpret the results in this new field. This article is a review of the current state-of-the-art in robotic applications in poststroke therapy for the upper extremity, written specifically to help clinicians determine the differences between various systems. We concentrate primarily on systems that have been tested clinically. Robotic systems are grouped by rehabilitation application (e.g., gross motor movement, bilateral training, etc.), and, where possible, the neurorehabilitation strategies employed by each system are described. We close with a discussion of the benefits and concerns of using robotics in rehabilitation and an indication of challenges that must be addressed for therapeutic robots to be applied practically in the clinic.

[1]  K. Glass,et al.  Occupational therapists' views about the use of robotic aids for people with disabilities. , 1987, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[2]  Patricia McKenney Moulton A Motor Relearning Programme for Stroke (2nd ed.) , 1989 .

[3]  F Chollet,et al.  The functional anatomy of recovery from brain injury. , 1991, Ciba Foundation symposium.

[4]  David Geer,et al.  Patient and staff acceptance of robotic technology in occupational therapy: a pilot study. , 1991, Journal of rehabilitation research and development.

[5]  Richard S. J. Frackowiak,et al.  The functional anatomy of motor recovery after stroke in humans: A study with positron emission tomography , 1991, Annals of neurology.

[6]  C H Shea,et al.  Composition of practice: influence on the retention of motor skills. , 1991, Research quarterly for exercise and sport.

[7]  Carol A. Seger,et al.  Implicit learning. , 1994, Psychological bulletin.

[8]  G. Lenzi,et al.  Prolonged muscular flaccidity after stroke. Morphological and functional brain alterations. , 1995, Brain : a journal of neurology.

[9]  R. Hanlon Motor learning following unilateral stroke. , 1996, Archives of physical medicine and rehabilitation.

[10]  E Bizzi,et al.  Augmented Feedback Presented in a Virtual Environment Accelerates Learning of a Difficult Motor Task. , 1997, Journal of motor behavior.

[11]  W D Memberg,et al.  Instrumented objects for quantitative evaluation of hand grasp. , 1997, Journal of rehabilitation research and development.

[12]  N. Hogan,et al.  The effect of robot-assisted therapy and rehabilitative training on motor recovery following stroke. , 1997, Archives of neurology.

[13]  N. Hogan,et al.  Robot-aided neurorehabilitation. , 1998, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[14]  G. Stelmach,et al.  The co-ordination and phasing of a bilateral prehension task. The influence of Parkinson's disease. , 1998, Brain : a journal of neurology.

[15]  J. Liepert,et al.  Motor cortex plasticity during constraint-induced movement therapy in stroke patients , 1998, Neuroscience Letters.

[16]  W. Rymer,et al.  Guidance-based quantification of arm impairment following brain injury: a pilot study. , 1999, IEEE transactions on rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society.

[17]  E. Todorov,et al.  Virtual Environment Training Improves Motor Performance in Two Patients with Stroke: Case Report , 1999 .

[18]  E. Taub,et al.  Constraint-Induced Movement Therapy: a new family of techniques with broad application to physical rehabilitation--a clinical review. , 1999, Journal of rehabilitation research and development.

[19]  N. Hogan,et al.  Quantization of continuous arm movements in humans with brain injury. , 1999, Proceedings of the National Academy of Sciences of the United States of America.

[20]  C. Trombly,et al.  Effect of rehabilitation tasks on organization of movement after stroke. , 1999, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[21]  N. Hogan,et al.  Robot training enhanced motor outcome in patients with stroke maintained over 3 years , 1999, Neurology.

[22]  N. Hogan,et al.  A novel approach to stroke rehabilitation , 2000, Neurology.

[23]  W. Rymer,et al.  End points of planar reaching movements are disrupted by small force pulses: an evaluation of the hypothesis of equifinality. , 2000, Journal of neurophysiology.

[24]  N. Hogan,et al.  Increasing productivity and quality of care: robot-aided neuro-rehabilitation. , 2000, Journal of rehabilitation research and development.

[25]  H. F. Machiel van der Loos,et al.  Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience. , 2000, Journal of rehabilitation research and development.

[26]  E. A. Attree,et al.  Training in virtual environments: transfer to real world tasks and equivalence to real task training , 2000, Ergonomics.

[27]  Marko Munih,et al.  Upper limb motion analysis using haptic interface , 2001 .

[28]  N. Hogan,et al.  Is robot-aided sensorimotor training in stroke rehabilitation a realistic option? , 2001, Current opinion in neurology.

[29]  A. Inmann, M. Haugland An instrumented object for evaluation of lateral hand grasp during functional tasks , 2001, Journal of medical engineering & technology.

[30]  J. Dewald,et al.  Abnormal joint torque patterns in the paretic upper limb of subjects with hemiparesis , 2001, Muscle & nerve.

[31]  C. Burgar,et al.  Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. , 2002, Archives of physical medicine and rehabilitation.

[32]  D.J. Reinkensmeyer,et al.  Web-based telerehabilitation for the upper extremity after stroke , 2002, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[33]  H Poizner,et al.  Virtual reality-based post-stroke hand rehabilitation. , 2002, Studies in health technology and informatics.

[34]  N. Hogan,et al.  Movement Smoothness Changes during Stroke Recovery , 2002, The Journal of Neuroscience.

[35]  William S. Harwin,et al.  Minimum Jerk Trajectory Control for Rehabilitation and Haptic Applications , 2002, ICRA.

[36]  N. Hogan,et al.  Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke , 2003, Neurology.

[37]  S. Hesse,et al.  Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. , 2003, Archives of physical medicine and rehabilitation.

[38]  H. F. Machiel Van der Loos,et al.  Design and evaluation of Driver's SEAT: A car steering simulation environment for upper limb stroke therapy , 2003, Robotica.

[39]  Richard S. J. Frackowiak,et al.  Neural correlates of motor recovery after stroke: a longitudinal fMRI study. , 2003, Brain : a journal of neurology.

[40]  Hermano Igo Krebs,et al.  Rehabilitation Robotics: Performance-Based Progressive Robot-Assisted Therapy , 2003, Auton. Robots.

[41]  N. Hogan,et al.  Robot-aided sensorimotor training in stroke rehabilitation. , 2003, Advances in neurology.

[42]  W. Harwin,et al.  The effect of GENTLE/s robot mediated therapy on upper extremity function post stroke , 2003 .

[43]  N. Hogan,et al.  Robotic Technology and Stroke Rehabilitation: Translating Research into Practice , 2004, Topics in stroke rehabilitation.

[44]  Hermano I Krebs,et al.  Rehabilitation robotics: pilot trial of a spatial extension for MIT-Manus , 2004, Journal of NeuroEngineering and Rehabilitation.

[45]  W. Rymer,et al.  Assessment of Active and Passive Restraint During Guided Reaching After Chronic Brain Injury , 1999, Annals of Biomedical Engineering.

[46]  N. Hogan,et al.  Robotic therapy for chronic motor impairments after stroke: Follow-up results. , 2004, Archives of physical medicine and rehabilitation.

[47]  N. Hogan,et al.  Comparison of Two Techniques of Robot-Aided Upper Limb Exercise Training After Stroke , 2004, American journal of physical medicine & rehabilitation.

[48]  A. Luft,et al.  Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. , 2004, JAMA.

[49]  P. Bach-y-Rita,et al.  Reconsidering the motor recovery plateau in stroke rehabilitation. , 2004, Archives of physical medicine and rehabilitation.

[50]  C.G. Burgar,et al.  Evidence for improved muscle activation patterns after retraining of reaching movements with the MIME robotic system in subjects with post-stroke hemiparesis , 2004, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[51]  Ferdinando A. Mussa-Ivaldi,et al.  Robot-assisted adaptive training: custom force fields for teaching movement patterns , 2004, IEEE Transactions on Biomedical Engineering.

[52]  John W Krakauer,et al.  Arm function after stroke: from physiology to recovery. , 2005, Seminars in neurology.

[53]  M. Munih,et al.  Linear and circular tracking exercises in haptic virtual environments for hand control assessment , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[54]  R.V. Dubey,et al.  Eye-hand coordination assessment/therapy using a robotic haptic device , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[55]  Victor W. Mark,et al.  AutoCITE: Automated Delivery of CI Therapy With Reduced Effort by Therapists , 2005, Stroke.

[56]  T.M. Sukal,et al.  Use of a Novel Robotic System for Quantification of Upper Limb Work Area Following Stroke , 2005, 2005 IEEE Engineering in Medicine and Biology 27th Annual Conference.

[57]  Xun Luo,et al.  An augmented reality training environment for post-stroke finger extension rehabilitation , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[58]  J. Hidler,et al.  Advances in the Understanding and Treatment of Stroke Impairment Using Robotic Devices , 2005, Topics in stroke rehabilitation.

[59]  R. Riener,et al.  ARMin - design of a novel arm rehabilitation robot , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[60]  J.M. Winters,et al.  Evaluation of tracking performance using joystick manipulators that engage different arm workspaces , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[61]  Y. Matsuoka,et al.  Perceptual limits for a robotic rehabilitation environment using visual feedback distortion , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[62]  S.C. Cramer,et al.  A robotic device for hand motor therapy after stroke , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[63]  S. Micera,et al.  Robotic techniques for upper limb evaluation and rehabilitation of stroke patients , 2005, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[64]  H.I. Krebs,et al.  Wrist rehabilitation following stroke: initial clinical results , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[65]  F. Amirabdollahian,et al.  The peg-in-hole: a VR-based haptic assessment for quantifying upper limb performance and skills , 2005, 9th International Conference on Rehabilitation Robotics, 2005. ICORR 2005..

[66]  James L. Patton,et al.  A Real-Time Haptic/Graphic Demonstration of how Error Augmentation can Enhance Learning , 2005, Proceedings of the 2005 IEEE International Conference on Robotics and Automation.

[67]  J. Patton,et al.  Evaluation of robotic training forces that either enhance or reduce error in chronic hemiparetic stroke survivors , 2005, Experimental Brain Research.

[68]  J. Mehrholz,et al.  Computerized Arm Training Improves the Motor Control of the Severely Affected Arm After Stroke: A Single-Blinded Randomized Trial in Two Centers , 2005, Stroke.

[69]  T.M. Sukal,et al.  Source of Work Area Reduction Following Hemiparetic Stroke and Preliminary Intervention Using the ACT 3D System , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[70]  J. Krakauer Motor learning: its relevance to stroke recovery and neurorehabilitation. , 2006, Current opinion in neurology.

[71]  M. Munih,et al.  Application of Haptic Interface for Finger Exercise , 2006, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[72]  M. Mon-Williams,et al.  Motor Control and Learning , 2006 .

[73]  W. Harwin,et al.  Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy , 2007, Journal of NeuroEngineering and Rehabilitation.

[74]  C. Burgar,et al.  MIME robotic device for upper-limb neurorehabilitation in subacute stroke subjects: A follow-up study. , 2006, Journal of rehabilitation research and development.

[75]  R. Abresch,et al.  Effectiveness of an Upper Extremity Exercise Device Integrated With Computer Gaming for Aerobic Training in Adolescents With Spinal Cord Dysfunction , 2006, The journal of spinal cord medicine.

[76]  J. Patton,et al.  Custom-designed haptic training for restoring reaching ability to individuals with poststroke hemiparesis. , 2006, Journal of rehabilitation research and development.

[77]  W. Rymer,et al.  Robot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does? , 2006, Journal of rehabilitation research and development.

[78]  N. Hogan,et al.  Motions or muscles? Some behavioral factors underlying robotic assistance of motor recovery. , 2006, Journal of rehabilitation research and development.

[79]  D.J. Reinkensmeyer,et al.  Automating Arm Movement Training Following Severe Stroke: Functional Exercises With Quantitative Feedback in a Gravity-Reduced Environment , 2006, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[80]  Henning Schmidt,et al.  Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin. , 2006, Journal of rehabilitation research and development.

[81]  D. Filion,et al.  Implicit learning of a motor skill after mild and moderate stroke , 2006, Clinical rehabilitation.

[82]  Roberta L. Klatzky,et al.  Visual-Feedback Distortion in a Robotic Rehabilitation Environment , 2006, Proceedings of the IEEE.

[83]  Chris Scharver,et al.  Robotics and Virtual Reality: A Perfect Marriage for Motor Control Research and Rehabilitation , 2006, Assistive technology : the official journal of RESNA.

[84]  G. Burdea,et al.  Low-cost Virtual Rehabilitation of the Hand for Patients Post-Stroke , 2006, 2006 International Workshop on Virtual Rehabilitation.

[85]  Katharina S Sunnerhagen,et al.  Three-dimensional kinematic motion analysis of a daily activity drinking from a glass: a pilot study , 2006, Journal of NeuroEngineering and Rehabilitation.

[86]  D.J. Reinkensmeyer,et al.  Control of a Pneumatic Orthosis for Upper Extremity Stroke Rehabilitation , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[87]  M. Johnson,et al.  Quantifying kinematics of purposeful movements to real, imagined, or absent functional objects: Implications for modelling trajectories for robot-assisted ADL tasks** , 2007, Journal of NeuroEngineering and Rehabilitation.

[88]  S. Adamovich,et al.  Sensorimotor Training in a Virtual Reality Environment: Does It Improve Functional Recovery Poststroke? , 2006, Neurorehabilitation and neural repair.

[89]  Hermano I Krebs,et al.  Telerehabilitation robotics: bright lights, big future? , 2006, Journal of rehabilitation research and development.

[90]  Gabor Fazekas,et al.  A novel robot training system designed to supplement upper limb physiotherapy of patients with spastic hemiparesis , 2006, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[91]  Younbo Jung,et al.  Pilot Trial Results from a Virtual Reality System Designed to Enhance Recovery of Skilled Arm and Hand Movements after Stroke , 2006, 2006 International Workshop on Virtual Rehabilitation.

[92]  S. Small,et al.  Functions of the Mirror Neuron System: Implications for Neurorehabilitation , 2006, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[93]  Y. Matsuoka,et al.  Initial Therapeutic Results of Visual Feedback Manipulation in Robotic Rehabilitation , 2006, 2006 International Workshop on Virtual Rehabilitation.

[94]  R. Gassert,et al.  Development of a Robot-Assisted Rehabilitation Therapy to train Hand Function for Activities of Daily Living , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[95]  R. Gassert,et al.  A Cable Driven Robotic System to Train Finger Function After Stroke , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[96]  R. Hughes,et al.  Electromyography-Controlled Exoskeletal Upper-Limb–Powered Orthosis for Exercise Training After Stroke , 2007, American journal of physical medicine & rehabilitation.

[97]  Derek G. Kamper,et al.  An Actuated Finger Exoskeleton for Hand Rehabilitation Following Stroke , 2007 .

[98]  R.C.V. Loureiro,et al.  Reach & Grasp Therapy: Design and Control of a 9-DOF Robotic Neuro-rehabilitation System , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[99]  H. Kawasaki,et al.  Development of a Hand Motion Assist Robot for Rehabilitation Therapy by Patient Self-Motion Control , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[100]  Qinyin Qiu,et al.  Design of a Virtual Reality-Based System For Hand and Arm Rehabilitation , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[101]  H.I. Krebs,et al.  Design, Characterization, and Impedance Limits of a Hand Robot , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.