Upper Extremity Rehabilitation using Robotics

 Description 

There are mainly two types of robotic devices for upper limb rehabilitation: the end-effector-based and the exoskeleton- based robots. The main advantage of the upper limb robot on the basis of the end-effector system is that it adapts to patients with different body sizes. In contrast, the exoskeleton upper limb robot required various modifications in different patients because they needed an optimal joint adaptation to work correctly (REFERENCE)

Indication 

The hand serves very important role with functionality. It is used in everyday activities such as eating, dressing, object manipulation and handwriting. Therefore re-training reach and grasping skills is critical to improving quality of life, hand therapy is used to relearn basic skills (REFERENCE). Rehabilitation robotic systems for upper extremities have the potential to deliver large doses of motor training in a cost-effective manner (REFERENCE) Clinical testing has be shown that robotic hand training can improve movement ability and performance on functional scales, in chronic stroke patients.

Key Evidence 

Stroke and Spinal Cord Injuries 

Several robotic machines have shown to be effective in patients with stroke. For example, the Armeo Spring (Figure 1) helps to recover function in the hemiparetic arm, forearm and wrist in patients who have experienced a stroke and have consequent hemiparesis. The Armeo Spring is an adjustable suspension system for the upper limb that connects to virtual reality (VR), which has settings with several degrees of complexity 4. The system is an exoskeleton that supports the patient’s arm and magnifies any residual active movement of the hemiparetic arm in 3-dimensional space 4. Distally, it detects grasp pressure and the sensitivity may be adjusted depending on the patient’s condition 4. VR settings are designed to bring varying levels of difficulty in the velocity, direction and moving area 4. The system provides information about specific movement parameters (strength, range of motion, and coordination) to allow for proper adjustment of the difficulty level for the patient during the recovery process 4. A study of the effects of the Armeo spring system and the benefits in subacute spinal cord injury patients showed that there is significant improvement in the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) sensibility scores of subjects with partial hand function at baseline 1.

Specific to the fingers and hand, the Amadeo is another robotic system that has shown to be useful in those recovering from stroke. A randomized control trial conducted on acute stroke patients looked at the effectiveness of robot- assisted hand therapy using the Amadeo Robotic System by Tyromotion. Amadeo Robot is an end-effector based system that has five degrees of freedom and provides the motion of one or all five fingers through a passive rotational joint placed between the fingertip and an entity that moves laterally (the thumb has two passive rotational joints) 2. All five translational degrees of freedom are independent and provide an almost entire coverage of the fingers’ workspace 2. The interface between the human hand and the machine is achieved thanks to elastic bands or plasters and the wrist is restrained from movement by a Velcro strap 2. The Amadeo treatment composed of:
1) Continuous passive therapy
2) Assisted movement therapy
3) Balloon training (active training in a virtual environment by carrying out target oriented tasks) 2.

Comparable to traditional Occupational Therapy methods, patients within the robotic therapy group made significant improvements in Fugl-Meyer Scale (FM), and Box and Block Test (BB) at the end of treatment (4/5 weeks) and maintained improvements after a 3-month follow-up 2. This result is very important because the gain achieved is not exercise or time dependent, but could be secondary to reorganization of brain structures 2.