Neurology 2000;54:1938-1944
© 2000 American Academy of Neurology
Articles
A novel approach to stroke rehabilitation
Robot-aided sensorimotor stimulation
B. T. Volpe, MD,
H. I. Krebs, PhD,
N. Hogan, PhD,
L. Edelstein, OTR,
C. Diels, MA and
M. Aisen, MD
From the Department of Neurology and Neuroscience (Dr. Volpe), Cornell University Medical College, Burke Institute of Medical Research, White Plains, NY; the Mechanical Engineering Department (Drs. Krebs and Hogan), Newman Laboratory, and Brain and Cognitive Sciences Department (Dr. Hogan), Massachusetts Institute of Technology, Boston; Rehabilitation Research and Development (Dr. Aisen), Department of Veterans Administration, Washington, DC; and the Burke Rehabilitation Hospital (L. Edelstein and C. Diels), White Plains, NY.
Address correspondence and reprint requests to Dr. B.T. Volpe, Cornell University Medical College, Department of Neurology and Neuroscience, Burke Institute of Medical Research, 785 Mamaroneck Avenue, White Plains, NY 10605; volpe{at}rockvax.rockefeller.edu
OBJECTIVE: In patients with stroke, the authors tested whether additional sensorimotor training of the paralyzed or paretic upper limb delivered by a robotic device enhanced motor outcome.
METHODS: Fifty-six patients with stroke and hemiparesis or hemiplegia received standard poststroke multidisciplinary rehabilitation, and were randomly assigned either to receive robotic training (at least 25 hours) or exposure to the robotic device without training. Outcomes were assessed by the same masked raters, before treatment began and at the end of treatment, with the upper extremity component of the Fugl-Meyer Motor Assessment, the Motor Status score, the Motor Power score, and Functional Independence Measurement.
RESULT: The robot treatment and control group had comparable clinical characteristics, lesion size, and pretreatment impairment scores. By the end of treatment, the robot-trained group demonstrated improvement in motor outcome for the trained shoulder and elbow (Motor Power score, p < 0.001; Motor Status score, p < 0.01) that did not generalize to untrained wrist and hand. The robot-treated group also demonstrated significantly improved functional outcome (Functional Independence Measurement–Motor, p < 0.01).
CONCLUSION: Robot-delivered quantitative and reproducible sensorimotor training enhanced the motor performance of the exercised shoulder and elbow. The robot-treated group also demonstrated improved functional outcome. When added to standard multidisciplinary rehabilitation, robotics provides novel therapeutic strategies that focus on impairment reduction and improved motor performance.
Key words: Robotics—Robot—Aids—Stroke—Motor recovery.
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