Developing a Wearable Ankle Rehabilitation Robotic Device for in-Bed Acute Stroke Rehabilitation

Ankle movement training is important in motor recovery post stroke and early intervention is critical to stroke rehabilitation. However, acute stroke survivors receive motor rehabilitation in only a small fraction of time, partly due to the lack of effective devices and protocols suitable for early in-bed rehabilitation. Considering the first few months post stroke is critical in stroke recovery, there is a strong need to start motor rehabilitation early, mobilize the ankle, and conduct movement therapy. This study seeks to address the need and deliver intensive passive and active movement training in acute stroke using a wearable ankle robotic device. Isometric torque generation mode under real-time feedback is used to guide patients in motor relearning. In the passive stretching mode, the wearable robotic device stretches the ankle throughout its range of motion to the extreme dorsiflexion forcefully and safely. In the active movement training mode, a patient is guided and motivated to actively participate in movement training through game playing. Clinical testing of the wearable robotic device on 10 acute stroke survivors over 12 sessions of feedback-facilitated isometric torque generation, and passive and active movement training indicated that the early in-bed rehabilitation could have facilitated neuroplasticity and helped improve motor control ability.

[1]  Julie Bernhardt,et al.  Little therapy, little physical activity: rehabilitation within the first 14 days of organized stroke unit care. , 2007, Journal of rehabilitation medicine.

[2]  Susan D Horn,et al.  Timing of initiation of rehabilitation after stroke. , 2005, Archives of physical medicine and rehabilitation.

[3]  Jörgen Borg,et al.  Time-course and determinants of spasticity during the first six months following first-ever stroke. , 2010, Journal of rehabilitation medicine.

[4]  Ruud W Selles,et al.  Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. , 2005, Archives of physical medicine and rehabilitation.

[5]  P. Tang,et al.  Analysis of impairments influencing gait velocity and asymmetry of hemiplegic patients after mild to moderate stroke. , 2003, Archives of Physical Medicine and Rehabilitation.

[6]  P. Langhorne,et al.  Stroke rehabilitation , 2011, The Lancet.

[7]  Tao Xu,et al.  Develop a wearable ankle robot for in-bed acute stroke rehabilitation , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[8]  Bruce H Dobkin,et al.  Training and exercise to drive poststroke recovery , 2008, Nature Clinical Practice Neurology.

[9]  Li-Qun Zhang,et al.  Intelligent stretching of ankle joints with contracture/spasticity , 2002, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[10]  Yupeng Ren,et al.  Combined Passive Stretching and Active Movement Rehabilitation of Lower-Limb Impairments in Children With Cerebral Palsy Using a Portable Robot , 2011, Neurorehabilitation and neural repair.

[11]  TIME-COURSE AND DETERMINANTS OF SPASTICITY DURING THE FIRST , 2010 .

[12]  R. Wertz,et al.  Communication Deficits in Stroke Survivors: An Overview of Classification and Treatment , 1990, Stroke.

[13]  S. H. Hayes,et al.  Early intervention care in the acute stroke patient. , 1986, Archives of physical medicine and rehabilitation.

[14]  R. Teasell,et al.  Inpatient rehabilitation following stroke: amount of therapy received and associations with functional recovery , 2012, Disability and rehabilitation.

[15]  Hermano Igo Krebs,et al.  Ankle Training With a Robotic Device Improves Hemiparetic Gait After a Stroke , 2011, Neurorehabilitation and neural repair.

[16]  Geoffrey Donnan,et al.  Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care , 2004, Stroke.

[17]  D. Jette,et al.  The relation between therapy intensity and outcomes of rehabilitation in skilled nursing facilities. , 2005, Archives of physical medicine and rehabilitation.

[18]  Ray-Yau Wang,et al.  The relation between ankle impairments and gait velocity and symmetry in people with stroke. , 2006, Archives of physical medicine and rehabilitation.

[19]  M. V. von Arbin,et al.  Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations , 2003, Stroke.

[20]  J. Kesselring,et al.  Neurorehabilitation of stroke , 2012, Journal of Neurology.

[21]  Robert Teasell,et al.  Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. , 2006, Journal of rehabilitation medicine.

[22]  D. Bourbonnais,et al.  Weakness in patients with hemiparesis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[23]  E. Roth,et al.  Changes in Passive Properties of Hemiplegic nkles With Spastic , 2004 .

[24]  Hermano I Krebs,et al.  Changes in passive ankle stiffness and its effects on gait function in people with chronic stroke. , 2013, Journal of rehabilitation research and development.

[25]  Hermano Igo Krebs,et al.  Robot-Aided Neurorehabilitation: A Novel Robot for Ankle Rehabilitation , 2009, IEEE Transactions on Robotics.

[26]  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.

[27]  Donald Hedeker,et al.  Error Augmentation Enhancing Arm Recovery in Individuals With Chronic Stroke , 2014, Neurorehabilitation and neural repair.

[28]  C. Richards,et al.  Contribution of passive stiffness to ankle plantarflexor moment during gait after stroke. , 2000, Archives of physical medicine and rehabilitation.

[29]  Pamela W Duncan,et al.  Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. , 2005, Stroke.

[30]  E. Roth,et al.  Effects of repeated ankle stretching on calf muscle-tendon and ankle biomechanical properties in stroke survivors. , 2011, Clinical biomechanics.

[31]  Talicia Tarver,et al.  HEART DISEASE AND STROKE STATISTICS–2014 UPDATE: A REPORT FROM THE AMERICAN HEART ASSOCIATION , 2014 .

[32]  B Cooper,et al.  Efficiency, effectiveness, and duration of stroke rehabilitation. , 1990, Stroke.

[33]  T. Murphy,et al.  Plasticity during stroke recovery: from synapse to behaviour , 2009, Nature Reviews Neuroscience.

[34]  L. Harvey,et al.  Effectiveness of Stretch for the Treatment and Prevention of Contractures in People With Neurological Conditions: A Systematic Review , 2011, Physical Therapy.

[35]  Michael Brainin,et al.  Toward an epidemiology of poststroke spasticity , 2013, Neurology.

[36]  A. Tennant,et al.  A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. , 2002, Journal of rehabilitation medicine.

[37]  Neville Hogan,et al.  Feasibility of dynamic entrainment with ankle mechanical perturbation to treat locomotor deficit , 2010, 2010 Annual International Conference of the IEEE Engineering in Medicine and Biology.

[38]  J. Feigenson,et al.  Factors Influencing Outcome and Length of Stay in a Stroke Rehabilitation Unit: Part 2. Comparison of 318 Screened and 248 Unscreened Patients , 1977, Stroke.

[39]  Yupeng Ren,et al.  Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke. , 2013, NeuroRehabilitation.