Biomedical Engineering Reference
In-Depth Information
ventional therapy. These improvements correspond to a noticeable increase of
hand and arm function of stroke survivors, and are in accordance with results
obtained in other robot- assisted studies on upper limb rehabilitation of chronic
stroke patients. Further, the observed improvements in arm and hand function
were found to be maintained after the completion of the therapy, suggesting long
term improvement in motor abilities.
4.5 CONCLUSIONS
This chapter offered an overview of the field of robot-assisted rehabilitation of
hand function after stroke, by presenting the challenges of restoring fine hand
movement and sensation, as well as describing two novel robotic devices devel-
oped to train hand and fingers, the HapticKnob and the HandCARE. These robots
are based on an end-effector approach, i.e. interacting with the user only at the
level of the hand or finger, which we believe provides more freedom and comfort
for subjects to perform the required tasks, corresponds better to real interaction
with objects during ADL, and also significantly decreases complexity and cost of
robotic systems. Two clinical studies have been performed with chronic stroke
survivors to determine the potential of our approach and these devices to restore
hand sensorimotor function.
First, results of both studies show that robot-assisted rehabilitation with our
robots was safe and well accepted by stroke survivors. All patients actively
participated in the therapy and completed the study. They found the proposed
exercises motivating and useful, eventually asking for more therapy time with the
robots. This suggests that the stroke population is ready to accept robot-assisted
rehabilitation as a new therapy standard in rehabilitation centers or at home.
Improvements in sensorimotor function of arm and hand were observed in all
participants, which illustrates that an intensive and repetitive training program
leads to improvement in motor function in chronic stroke subjects even long
after completion of conventional therapy, suggesting long term improvement in
the motor condition. Although most subjects reached a plateau, several subjects
continued to significantly improve their arm and hand motor function after com-
pletion of the robot-assisted therapy. This may be due to an increased use of the
impaired limb in daily activities at home, mediated by the motor improvements
obtained during the therapy, and increased confidence in their motor abilities.
In most robot-assisted studies where only shoulder and elbow were trained,
improvement in clinical assessments were mainly observed at the level of the
upper arm, and only minimal change was observed in the components relative
to the hand (Krebs
et al.
(2007); Volpe
et al.
(2008)). While upper arm training may
lead to an increase in arm function, the benefits in subjects' ability to performADL
may be limited without a similar increase in wrist and hand function. On the other
hand, studies on robot- assisted training of hand and wrist function showed an
increase in all arm segments (Krebs
et al.
(2007); Takahashi
et al
. (2008)).
