Robot-based hand motor therapy after stroke

TLDR

Robots can improve motor status after stroke, yet hand‑focused robotic interventions have received limited attention. The study aimed to determine whether a hand‑wrist robot improves motor function and to assess the specificity of therapy effects on brain reorganization. Subjects with chronic stroke and moderate right arm/hand weakness underwent three weeks of intensive active‑movement therapy that emphasized repetition, attention, speed, force, precision, timing, and virtual reality games. Significant improvements were observed in hand motor function, with ARAT scores rising from 34 to 38 and Fugl‑Meyer scores from 45 to 52 (P<0.0005 and P<0.0001), greater gains when robotic assistance was provided in all sessions, and task‑specific increases in sensorimotor cortex activation during the practiced grasp task.

Abstract

Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization. Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34 +/- 20 to 38 +/- 19, P< 0.0005) and arm motor Fugl-Meyer score (45 +/- 10 to 52 +/- 10, P < 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions. The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.