Evaluation of robot assisted neuro-rehabilitation

上肢功能障碍是中风所致残疾的重要组成部分，居首位 成年人长期残疾的原因。一项不断发展的研究表明，具体的 康复干预可以改善受损手臂的功能，即使在遭受持续损失后也是如此 功能的一部分。我们和其他人已经证明，机器人辅助康复可以减少手臂 与基线相比的减损。我们现在已经证明了机器人辅助康复可以 与常规试验相比，在随机、单盲试验中减少手臂损伤 职业治疗。对机器人训练和约束诱导治疗的研究表明 关于职能任务的具体培训可以增强，以将培训成果转化为改进 功能。我们建议研究增加功能训练课程的价值(我们指的是 过渡到任务训练或TTT)到机器人训练。一项已发表的研究表明， 机器人训练会引起大脑皮层运动图的变化。我们将对大脑皮层进行研究 对我们患者训练前后的运动兴奋性这一问题进行调查。标准 确定机器人训练的最大效益还没有开发出来。一种方法 是在治疗过程中进行常规的上肢评估，但 这将大大增加治疗师的时间。机器人记录提供给 我们将检查这些数据是否可用于 评估患者利益的持续基础。基本假设：TTT紧随其后 机器人训练课程比机器人辅助训练带来更大的功能改善 适用于偏瘫所致慢性上肢功能障碍患者。 第二机械假说：机器人训练导致大脑皮层运动改变 经颅磁刺激检测的兴奋性。第二临床假说： 机器人运动学数据将反映在训练中看到的功能变化，这 临床上可以使用信息来确定患者何时达到最大益处 从机器人训练中脱身。为了检验这些假设，我们提出了一个随机、单盲的 36-60分钟机器人训练课与36节45分钟训练课的对比试验 几分钟的机器人训练和15分钟的TTT训练。结果将包括上臂 功能评估、经颅磁刺激结果和机器人生成 运动学数据。 第1页

Upper extremity dysfunction is an important part of the disability caused by stroke, the leading cause of long term disability in adults. An evolving body of research suggests that specific rehabilitation interventions can improve functioning in an impaired arm even after sustained loss of function. We and others have shown that robot assisted rehabilitation can reduce arm impairment compared to baseline. We have now shown that robot assisted rehabilitation can reduce arm impairment in a randomized, single-blind trial compared to conventional occupational therapy. Studies of robotic training and also constraint-induced therapy suggest that specific training on functional tasks may enhance to translation of training gains into improved function. We propose to study the value of adding a functional training session (which we refer to as transition to task training or TTT) to robotic training. One published study suggests that robotic training induces changes in cortical motor maps. We will conduct studies of cortical motor excitability in our patients before and after training to investigate this issue. Criteria for determining the maximum benefit of robotic training have not yet been developed. One approach would be to conduct conventional upper extremity evaluations during the course of therapy but that would significantly increase therapist time. The robots record the assistance provided to patients during each training session and we will examine whether that data might be used on an ongoing basis to evaluate patient benefit. Primary hypothesis: TTT immediately following each robotic training session leads to greater functional improvement than robot- assisted training alone for patients with chronic upper extremity dysfunction due to hemi-paretic stroke. Secondary mechanistic hypothesis: Robotic training results in alterations in cortical motor excitability as detected by transcranial magnetic stimulation. Secondary clinical hypothesis: Robot kinematic data will reflect the functional changes seen in the training and that this information can be used clinically to determine when a patient has reached maximum benefit from robotic training. In order to test these hypotheses we propose a randomized, single-blind trial comparing 36-60 minute robotic training sessions with 36 training session consisting of 45 minutes of robotic training and 15 minutes of TTT training. Outcomes will include upper arm functional assessments, the results of transcranial magnetic stimulation and robot generated kinematic data. Page 1