Functional Assisted Gaming for Upper-Extremity Therapy After Stroke: Background, Evaluation, and Future Directions of the Spring Orthosis Approach

We describe the use of a passive, spring-based orthosis approach (as exemplified by T-WREX and Armeo®Spring) to enhance upper-extremity movement therapy after neurologic injury. This approach incorporates an arm exoskeleton that assists a patient in moving his or her weakened arm by using springs to support the weight of the arm: a grip sensor that can sense minimal grasp forces, and thus allows even very weak patients to practice integrating hand movement with arm movement; and a suite of computer games that simulate functional, whole-arm activities and provide objective feedback on performance. This chapter first traces the development of the spring orthosis approach to upper-extremity arm therapy within the context of the development of robot-assisted therapy. Then, this chapter evaluates the spring orthosis approach in light of recent evidence concerning the role of functional exercise, external assistance, and gaming in promoting movement recovery of the arm and hand after stroke. The chapter concludes by analyzing possible future directions for technology for upper-extremity movement therapy relative to the spring orthosis approach.