Abstract
Stroke is the leading cause of permanent disability in the United States despite advances in prevention and novel interventional treatments. Randomized controlled studies have demonstrated the effectiveness of specialized post-stroke rehabilitation units, but administrative orders have severely limited the length of stay, so novel approaches to the treatment of recovery need to be tested in outpatients. Although the mechanisms of stroke recovery depend on multiple factors, a number of techniques that concentrate on enhanced exercise of the paralyzed limb have demonstrated effectiveness in reducing the motor impairment. For example, interactive robotic devices are new tools for therapists to deliver enhanced sensorimotor training for the paralyzed upper limb, which can potentially improve patient outcome and increase their productivity. New data support the idea that for some post-stroke patients and for some aspects of training-induced recovery, timing of the training may be less important than the quality and intensity of the training. The positive outcome that resulted in the interactive robotic trials contrasts with the failure to find a beneficial result in trials that used a noninteractive device that delivered continuous passive motion only. New pilot data from novel devices to move the wrist demonstrate benefit and suggest that successive improvement of the function of the arm progressing to the distal muscles may eventually lead to significant disability reduction. These data from robotic trials continue to contribute to the emerging scientific basis of neuro-rehabilitation.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Volpe BT, Ferraro M, Krebs HI, Hogan N: Robotics in the rehabilitation treatment of patients with stroke. Curr Atheroscler Rep 2002, 4:270–276.
Krebs H, Palazzolo JJ, DiPietro L, et al.: Rehabilitation robotics: performance-based progressive robot-assisted therapy. Autonomous Robots 2003, 15:7–20.
Krebs HI, Volpe BT, Ferraro M, et al.: Robot-aided neurorehabilitation: from evidence-based to science-based rehabilitation. Top Stroke Rehabil 2002, 8:54–70.
Volpe BT, Krebs HI, Hogan N: Is robot-aided sensorimotor training in stroke rehabilitation a realistic option? Curr Opin Neurol 2001, 14:745–752.
Volpe BT, Krebs HI, Hogan N: Robot aided sensorimotor training in stroke rehabilitation. In Ischemic Stroke, Advances in Neurology. Edited by Barnett HJ, Bogousslavsky J, Meldrum H. Lippincott, Williams & Wilkins: Philadelphia; 2003:429–434.
Hogan N, Krebs H, Rohrer B, et al.: Technology for recovery after stroke. In Recovery After Stroke. Edited by Bogousslavsky J, Barnes M, Dobkin B. Cambridge: Cambridge University Press; 2004.
Ferraro M, Palazzolo JJ, Krol J, et al.: Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke. Neurology 2003, 61:1604–1607.
Liebesman J, Cafarelli E: Physiology of range of motion in human joints: A critical review. Crit Rev Phys Rehabil Med 1994, 6:131–160.
Lewis GN, Byblow WD: Modulations in corticomotor excitability during passive upper-limb movement: is there a cortical influence? Brain Res 2002, 943:263–275.
Stinear JW, Byblow WD: Disinhibition in the human motor cortex is enhanced by synchronous upper limb movements. J Physiol 2002, 543(pt 1):307–316.
Ziemann U, Muellbacher W, Hallett M, Cohen LG: Modulation of practice-dependent plasticity in human motor cortex. Brain 2001, 124(pt 6):1171–1181.
O’Driscoll SW, Giori NJ: Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev 2000, 37:179–188.
Geurts AC, Visschers BA, van Limbeek J, Ribbers GM: Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome. Scand J Rehabil Med 2000, 32:4–10.
Jorgensen HS, Nakayama H, Raaschou HO, et al.: Outcome and time course of recovery in stroke. Part II: time course of recovery. The Copenhagen Stroke Study. Arch Phys Med Rehabil 1995, 76:406–412.
Dromerick AW, Edwards DF, Hahn M: Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke? Stroke 2000, 31:2984–2988.
Lum PS, Burgar CG, Shor PC, et al.: Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. Arch Phys Med Rehabil 2002, 83:952–959.
Fasoli SE, Krebs HI, Stein J, et al.: Effects of robotic therapy on motor impairment and recovery in chronic stroke. Arch Phys Med Rehabil 2003, 84:477–482.
Hogan N, Krebs HI, Sharon A, Charnnarong J: Interactive robot therapist. MIT #5 1995, 466:213.
Aisen ML, Krebs HI, Hogan N, et al.: The effect of robot-assisted therapy and rehabilitative training on motor recovery following stroke. Arch Neurol 1997, 54:443–446.
Volpe BT, Krebs HI, Hogan N, et al.: A novel approach to stroke rehabilitation: robot-aided sensorimotor stimulation. Neurology 2000, 54:1938–1944.
Ferraro M, Demaio JH, Krol J, et al.: Assessing the motor status score: a scale for the evaluation of upper limb motor outcomes in patients after stroke. Neurorehabil Neural Repair 2002, 16:283–289.
Fugl-Meyer AR, Jaasko L, Leyman I, et al.: The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975, 7:13–31.
Ellenbecker TS, Mattalino AJ, Elam E, Caplinger R: Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography. Am J Sports Med 2000, 28:161–167.
Gerber C, Ganz R: Clinical assessment of instability of the shoulder. With special reference to anterior and posterior drawer tests. J Bone Joint Surg Br 1984, 66:551–556.
Yoldas EA, Faber KJ, Hawkins RJ: Translation of the glenohumeral joint in patients with multidirectional and posterior instability: awake examination versus examination under anesthesia. J Shoulder Elbow Surg 2001, 10:416–420.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Volpe, B.T., Ferraro, M., Lynch, D. et al. Robotics and other devices in the treatment of patients recovering from stroke. Curr Atheroscler Rep 6, 314–319 (2004). https://doi.org/10.1007/s11883-004-0064-z
Issue Date:
DOI: https://doi.org/10.1007/s11883-004-0064-z