ROBOTIC THERAPY FOR FORCE TRAINING OF THE UPPER EXTREMITY IN CHRONIC HEMIPARETIC STROKE

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ROBOTIC THERAPY FOR FORCE TRAINING OF THE UPPER
EXTREMITY IN CHRONIC HEMIPARETIC STROKE

• Leonard Kahn, M.S.
• W. Zev Rymer, M.D., Ph.D.
• David Reinkensmeyer, Ph.D.

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Visual distortion
Proprioceptive neuromuscular facilitation
Bobath technique
Task-specific reeducation
Bilateral imitation
Resistive
WHICH ONE(S)??
Destabilizing
Active assist
Peg-in-groove
Passive constrained
Isometric
Stabilizing
Passive
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Background - Rehabilitators for UE

• MIT MANUS planar assistance in acute stroke
• MIME bimanual and 3-D assistance in chronic
  stroke
• ARM Guide linear assistance throughout workspace
  in chronic stroke

MIT - MANUS
MIME
ARM Guide
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Rationale
ARM Guide results
Reaching along Guide
Performance of ADLs
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Free Reaching Results
Data adapted from Lum et al., Arch. PMR, 2002
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Aims Hypotheses

• Aims
• to implement force guided training using the ARM
  Guide
• to compare force guided training with traditional
  therapy and free reaching therapy for restoring
  UE function
• Hypotheses Guided force training
• accounts for the difference between the MIME and
  ARM Guide free reaching outcomes
• will be more effective than free reaching
  exercises and conventional therapy in promoting
  arm movement recovery

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Subject Population
Chedoke-McMaster Scale
Normal unimpaired movement
7 6 5 4 3 2 1

• Chronic hemiparesis (gt 6 months post injury)
• Absence of impairment or injury to ipsilesional
  arm
• Absence of visual neglect or visuo-perceptual
  disturbance

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Complete hemi-paralysis
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Therapy group 1 conventional therapy

• scapular/shoulder alignment
• passive active assisted ROM
• task-oriented re-education
• 1 hr/day, 3 days/wk, 8wks

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Therapy group 2 free reaching therapy
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Therapy group 3 Guided Force Training
S
F
A
M
adaptive assistance
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Expected Results

• Improved free reach extent from first ARM Guide
  study
• Better results for robot therapy group than free
  reaching and NDT group
• Ultimately, greater functional gains in guided
  force training group

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Early results adaptive assistance
early trial
late trial
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Early results supported reaching
Reach distance cm
Free reaching
Guided force