What is the current role of rehabilitation robots in upper limb post stroke therapy?Hughes A-M1, Burridge JH1, Freeman C2, Chappell P2, Lewin P2, Rogers E2

University of Southampton UK 1 School of Health Professions 2 School of Electronics and Computer Science

MethodSearches were conducted across the OVID databases: Amed (1985-2005), Cinahl (1982-2005), Embase (1980-2005) and Medline (1966 – 2005). Additional information was found by searching PEDRO, and COCHRANE and liaising with companies and teams involved in research in the UK, Ireland, and the Massachusetts Institute of Technology in the US (a world leader in the field).

The number of papers published concerning robots in therapy has increased rapidly as shown in Graph 1. 57 upper limb stroke specific papers from 1966-2005 can be categorized into clinical trials of which there are 2 reviews (Prange et al., 2006; Teasell et al., 2005), discussion and design papers. For the 22 clinical trials the findings were:Subject numbers varied from 1 to 56.Total robot exposure varied from 4 to 36 hours.18 different outcome measures were used (13 clinical and 5 robot).

Conclusion• The proportion of papers published using robots in upper limb post stroke therapy is small in comparison to therapy in general.

• Robots are regarded as having a role in assessment and treatment of patients. However, medium scale trials of 160 patients have only just begun in the USA using InMotion 2 robots seen below.

• The 2 clinical trial reviews agreed that robot aided therapy improves motor control of the proximal upper limb but disagreed concerning functional improvements.

• Future work needs to clarify the relationship between impairment and function, and the classification of outcome measures, as these both have important implications for the role of robots.

References:

Coote, S. & Stokes, E. K. 2003, Robot mediated therapy: attitudes of patients and therapists towards the first prototype of GENTLE/s system, Technology and Disability, vol. 15, pp. 27-34.

Intercollegiate working Party for Stroke 2004, National Clinical Guidelines for Stroke, Royal College of Physicians, London.

Lee, M., Rittenhouse, M., & Abdullah, H. A. Design issues for therapeutic robot systems: results from a survey of physiotherapists. Journal of Intelligent and Robotic Systems 42, 239-252. 2005.

Prange, G. B., Jannink, M. A., Groothuis-Oudshoorn, C. G. M., Hermens, H., & IJzerman, M. J. 2006, Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke, Journal of Rehabilitation Research & Development, vol. 43, no. 2, pp. 171-184.

Teasell, R., Foley, N., Salter, K., Bhogal, R. S., Bayona, N., Jutai, J., & Speechley, M. Evidence Based Review of Stroke Rehabilitation. 2005 Internet Communication

0100200300400500

Number of Papers

1966-1980

1981-1985

1986-1990

1991-1995

1996-2000

2001-2005

Time (Years)

Graph 1: Number of papers published on robots in therapy against time

search strings: (robot$ or mechatronic) and (therap$ or rehabil$) then adding (upper limb$ or upper extremit$ or arm$) and (cerebrovascular accident or CVA or stroke$ or hemipleg$).

Results

Challenges• Does robot aided therapy really improve function?• What are the user perspectives of robots in rehabilitation?

The few previous potential user perspective studies have mostly looked at the perspectives of the health professional, and more specifically only the physio/physical therapist (Lee, Rittenhous, & Abdullah, 2005) (Coote & Stokes, 2003).

IntroductionThe UK Stroke Guidelines suggest “Robot-assisted movement therapy should be considered as an adjunct to conventional therapy” for chronic patients with a deficit in arm function (Intercollegiate working Party for Stroke, 2004). Our interdisciplinary study funded by EPSRC (EP/C51873X/1) aims to investigate the feasibility of using Iterative Learning Control mediated by electrical stimulation for upper limb rehabilitation post stroke. The objective is to extend the patient’s ability to perform tasks with their arm, supported by the robot. By adjusting the level of stimulation in response to their performance, tasks are altered so that patients are always working at their limit – while motivated by their success. As a background to this study a review was conducted to explore the role of robots in upper limb post stroke therapy.

Picture 1:

Reading University - Gentle Robot

Picture 4:

Massachusetts Institute of Technology - InMotion 2 Robot

Pictures 2 & 3 : Southampton University - ILC Robot