Evaluation of robot assisted neuro-rehabilitation

上肢功能障碍是脑卒中所致残疾的重要组成部分， 导致成年人长期残疾。不断发展的研究表明， 康复干预可以改善受损手臂的功能，即使是在持续丧失之后。 的功能。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，我们现在已经证明，机器人辅助康复可以 在一项随机、单盲试验中，与传统治疗相比， 职业治疗对机器人训练和约束诱导疗法的研究表明， 关于功能任务的具体培训可以促进将培训成果转化为改进的 功能我们建议研究增加功能训练课程的价值（我们参考 到任务训练或TTT的过渡）到机器人训练。一项已发表的研究表明， 机器人训练诱导皮层运动地图的变化。我们将对大脑皮层 运动兴奋性在我们的患者训练前后调查这个问题。标准 确定机器人训练的最大益处的方法尚未开发。一种方法 在治疗过程中进行常规上肢评估， 这将大大增加治疗时间。机器人记录提供给 在每次训练期间，我们将检查这些数据是否可以用于 持续评估患者获益。主要假设：每次给药后立即进行TTT 机器人训练课程比机器人辅助训练带来更大的功能改善 单独用于因轻偏瘫性卒中导致的慢性上肢功能障碍患者。 次级机制假说：机器人训练导致皮质运动改变 通过经颅磁刺激检测的兴奋性。次要临床假设： 机器人运动学数据将反映在训练中看到的功能变化， 这些信息可以在临床上用于确定患者何时达到最大益处 机器人训练为了检验这些假设，我们提出了一个随机，单盲 试验比较了36-60分钟的机器人训练课程与36次训练课程， 15分钟机器人训练和15分钟TTT训练。结果将包括上臂 功能评估，经颅磁刺激和机器人产生的结果 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