Upper Extremity Rehabilitation using Robotics

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 Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, et al. Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia [Internet]. 2013;28(5):261–7. Available from: files/160/495v28n05a90209825pdf001.pdf%5Cn http://www.ncbi.nlm.nih.gov/pubmed/22727271. 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 Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, et al. Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia [Internet]. 2013;28(5):261–7. Available from: files/160/495v28n05a90209825pdf001.pdf%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/22727271. Distally, it detects grasp pressure and the sensitivity may be adjusted depending on the patient’s condition Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, et al. Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia [Internet]. 2013;28(5):261–7. Available from: files/160/495v28n05a90209825pdf001.pdf%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/22727271. VR settings are designed to bring varying levels of difficulty in the velocity, direction and moving area Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, et al. Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia [Internet]. 2013;28(5):261–7. Available from: files/160/495v28n05a90209825pdf001.pdf%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/22727271. 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 Colomer C, Baldoví A, Torromé S, Navarro MD, Moliner B, Ferri J, et al. Efficacy of Armeo® Spring during the chronic phase of stroke. Study in mild to moderate cases of hemiparesis. Neurologia [Internet]. 2013;28(5):261–7. Available from: files/160/495v28n05a90209825pdf001.pdf%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/22727271. 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 Zariffa J, Kapadia N, Kramer JLK, Taylor P, Alizadeh-Meghrazi M, Zivanovic V, et al. Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population. IEEE Int Conf Rehabil Robot [Internet]. 2011;50(3):220–6. Available from: http://dx.doi.org/10.1038/sc.2011.104.

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) Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557. All five translational degrees of freedom are independent and provide an almost entire coverage of the fingers’ workspace Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557. 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 Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557. 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) Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557.
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 Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557. This result is very important because the gain achieved is not exercise or time dependent, but could be secondary to reorganization of brain structures Sale P, Mazzoleni S, Lombardi V, Galafate D, Massimiani MP, Posteraro F, et al. Recovery of hand function with robot-assisted therapy in acute stroke patients: a randomized-controlled trial. Int J Rehabil Res [Internet]. 2014;37(3):236–42. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24769557.

Hocoma. ArmeoSpring Movie (English). Available from: https://www.youtube.com/watch?v=zE-NmOw-uY4

Tyromotion. AMADEO Finger-Hand-Rehabilitation (English). Available from: https://www.youtube.com/watch?v=KA37ws_6-XM&t=13s<ref/>fckLR%7C}