Development of robots for rehabilitation therapy: the Palo Alto VA/Stanford experience.

TLDR

Personal assistant robots have been developed for over 25 years, and recently robots have been proposed for delivering rehabilitation therapy. The study summarizes the development and clinical testing of three mechatronic post‑stroke therapy systems at VA Palo Alto/Stanford, describing the guiding philosophy and experiences. The systems enable bimanual, mirror‑image, patient‑controlled therapeutic exercise. Proof‑of‑concept was demonstrated with a 2‑DOF elbow/forearm manipulator, and subsequent trials with a second‑generation planar forearm robot in 19 hemiplegic and control subjects confirmed reliable interaction forces; a 3‑D robot‑assisted therapy trial in 21 chronic stroke patients showed greater Fugl‑Meyer motor recovery than traditional therapy.

Abstract

For over 25 years, personal assistant robots for severely disabled individuals have been in development. More recently, using robots to deliver rehabilitation therapy has been proposed. This paper summarizes the development and clinical testing of three mechatronic systems for post-stroke therapy conducted at the VA Palo Alto in collaboration with Stanford University. We describe the philosophy and experiences that guided their evolution. Unique to the Palo Alto approach is provision for bimanual, mirror-image, patient-controlled therapeutic exercise. Proof-of-concept was established with a 2-degree-of-freedom (DOF) elbow/forearm manipulator. Tests of a second-generation therapy robot producing planar forearm movements in 19 hemiplegic and control subjects confirmed the validity and reliability of interaction forces during mechanically assisted upper-limb movements. Clinical trials comparing 3-D robot-assisted therapy to traditional therapy in 21 chronic stroke subjects showed significant improvement in the Fugl-Meyer (FM) measure of motor recovery in the robot group, which exceeded improvements in the control group.