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Robotic Upper Extremity Training in Rehabilitation

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Lucas Enman

on 8 November 2013

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Transcript of Robotic Upper Extremity Training in Rehabilitation

Robotic Upper Extremity Training in Rehabilitation
What is Robotic Therapy?
Therapy aid for assisting sensoriomotor functions.
Allows the patient to receive consistent, repetitive movement
Easily graded, cognitively challenging, and goal directed
Assists patients in moving their limb through a predetermined trajectory during a given motor task
Takes advantage of growth promoting factors in the brain in early recovery
For therapists it provides objective and reliable means of monitoring patient progress through treatment
Synaptic Plasticity
Plasticity & Long Term Potentiation
AMPA receptors and depolarization
NMDA receptors and calcium
Protein phosphorylation
Outcome of LTP:
Increase in AMPA receptors at synapse
Increased proficiency of current AMPA receptors
Positive presynaptic effects
OT/PT Implications
Emphasis on active, specific, repetitive exercise
Facilitate improved U/E motor function
Increase joint ROM
Enhance U/E coordination
Outline for today:
What is Robotic Therapy?
Sensorimotor pathway
Mechanisms behind Robotic Therapy
Evidence of synaptogenesis
Synaptic plasticity
The Armeo®Spring and supporting research
OT/PT implications and clinical benefits
Mechanisms Behind Robotic U/E Therapy
Acute stage growth promoting factors
Diffuse connectivity and secondary pathways
Plasticity of brain organization
Stroke in the somatosensory cortex
Neurons in the penumbra survived but lost dendric spines
New synapses from unaffected regions formed in the penumbra
Neurons in the penumbra rewired to process information that was previously done by the infarct-affected region (Murphy & Corbett, 2009)
Murphy & Corbett, 2009
Proprioceptive information from U/E travels via this pathway
VPL of Thalamus → Somatosensory Cortex → Motor Cortex → UMN → LMN → Target Muscle(s)
By repeating this loop the “healthy” remaining synapses are strengthened through neuroplasticity
Dorsal Column Medial Leminiscus Pathway
The Armeo®Spring
An adjustable suspension system for the upper limb
Connects to virtual reality settings with varying degrees of complexity
The suspension system is an exoskeleton that supports the subject’s arm against gravity and magnifies residual active movement of the hemiparetic arm in three-dimensional space
It includes a pressure sensitive handgrip that detects grasp pressure and allows for grasp and release as well as reach and retrieval functions
Relevant Research
Housman et al (2009)

23 subjects with chronic hemiparesis secondary to ischemic or hemorrhagic stroke
3 one-hour sessions per week for a total of 36 sessions
Assessed every 9 sessions, using specific evaluation exercises
Subjects required at least grade 2 muscle
Significant improvement on all functional and activity scales without significant changes in muscle tone

Colomer et al (2012)

Spinal cord injury
Traumatic brain injury
Severe cognitive deficiency
Severe spasticity of the affected upper extremity
Severe shoulder pain
Shoulder joint subluxation
Severe postural instability
Severe visual problems
Clinical Benefits
Demonstrates remaining function of affected upper extremity
Client engages in intensive functional exercises
Active intensive repetition of rehabilitative movements
Functionally significant tasks such as reaching and grasping
Level of difficulty can be modified to appropriately challenge the user
T-WREX (Therapy Wilmington Robotic Exoskeleton). Prototype of the Armeo Spring
34 Adult stroke survivors
3 one-hour sessions per week for 8-9 weeks
Control group performed supported arm movements using a table and a towel to reduce friction
Significant but modest improvements compared to control group
Subjects reported significant preference for T-WREX

Additional Resources
Liepert, J., Bauder, H., Wolfgang, H., Miltner, W., Taub, E., & Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke, 31, 1210–1216. http://stroke.ahajournals.org/content/31/6/1210.full.pdf+html
Masiero, S., Celia, A., Rosati, G. & Armani, M. (2007). Robotic-assisted rehabilitation of the upper limb after acute stroke. Archives of Physical Medicine and Rehabilitation, 88(2), 142-149. http://www.sciencedirect.com/science/article/pii/S0003999306014821
Colmer et al, 2012
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