Biomedical Engineering Reference
In-Depth Information
Tab l e 9 . 1
Quantitative and clinical indices in the initial and fourth month evalu-
ations
Initial
$1
4
th
month
$1
P
$2
Index
r
-0.25
-0.02
<
0.05
I
82.9
56.9
<
0.05
C
-7.0
-36.9
0.09
BrS
3
4
0.13
MAS
2
1
0.25
FM
20
32
<
0.05
$1
Values are medians
$2
Wilcoxon signed-rank test
benefits for the motor recovery, especially in the proximal joints, but no influence
on functional ability.
We performed, in addition to the conventional rehabilitation for 0.5 hours,
rehabilitation with the robot for another 0.5 hours, 3 times per week for 4 months.
Seven stroke patients in the chronic stage were recruited. Rectilinear movements
in 4 directions (right-left, forward-backward and two 45
◦
oblique directions) were
chosen as the rehabilitation movements. In addition to the traditional scales
(BrS, MAS and FM), we developed three indicators to quantify the abnormal
synergy.
r
was the correlation coefficient between the elbow joint angle and the
supination/pronation angle of the forearm,
I
(Integration of Absolute Deviation of
Torque) was used to quantify the total variation of forearm pronation-supination
torque and
C
was a parameter derived from principle component analyses of 8 sur-
face EMG of upper limbs during movements. The whole results are summarized
Two of three quantitative indicators (
r
and
I
showed significant improvement
after 4 months of rehabilitation with the robot, while one of three semi-quantitative
scales, FM showed significant improvement. The reason that there was no differ-
ence in BrS, and MAS scores might be that BrS was invented for the global status
and MAS was specific for hypertonia, i.e., they were not indicators for abnormal
synergies. In addition, these scales are rather coarse and might not be able to
differentiate subtle difference. In summary, our preliminary results indicated that
rehabilitation with robots may help to break the abnormal synergies.
)
9.4 FUTURE DEVELOPMENT
One logical extension of the planar robots is to 3D robots. However, as mentioned
in the Introduction, many problems and challenges need to be solved before the
3D robots can be practically useful. There are other modifications and augmenta-
tions, including rehabilitation of the hand and wrist, self-control by EEG, custom-
tailored treatment protocol, developing evidence-based evaluation parameters
and designing more efficient movements, that can make the robot systems more
powerful.
