ROBOTICS FOR REHABILITATION THERAPY

这个子项目是众多研究子项目之一

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of this project is to develop an upper extremity robotic training system for use by people with stroke to practice arm and hand movement in the clinic or at home. The goal of the present study is to perform preliminary tests on a robotic orthosis that will assist, perturb, and measure naturalistic arm motion as part of the training system. The present study will test the robotic orthosis in a protected UCI environment. The orthosis is a modified version of the Wilmington Robotic Exoskeleton (WREX), which is a passive antigravity exoskeleton that uses rubber bands to make the arm feel weightless (Figure 1). WREX was originally designed by Dr. Tariq Rahman (Rahman et al. 1995) for use as an assistive device for children with muscular dystrophy. Children who are too weak to move their arm against gravity can self-feed and throw a ball, for example, by placing their arm in the orthosis. Previously the WREX design has been scaled by our laboratory for use as a movement training device to be used by adults with stroke (named "Training WREX" or "T-WREX"). The robotic orthosis used in this study is a pneumatically actuated version of T-WREX, called "Pneu-WREX". In Phase I of the present study, we will quantify how assisting or resisting the arm with the Pneu-WREX actuated orthosis affects the ability to move the arm after stroke, in the UCI General Clinical Research Center (GCRC) Human Performance Lab. In Phase II of the study, we will measure the therapeutic effect of Pneu-WREX by comparing movements of the subject's arm before and after an eight-week therapy session and also with movement of the arm of subjects who will receive a matched duration of conventional rehabilitation therapy with an occupational therapist. Each year in the U.S. over 400,000 people survive a stroke (www.strokeassociation.org 2002). Approximately 80% of acute stroke survivors lose arm and hand movement skills (Gresham et al. 1979). Movement impairments are typically treated with intensive, hands-on physical and occupational therapy for several weeks after the initial brain injury. Unfortunately, due to economic pressures on the U.S. health care system, stroke patients are receiving less therapy and going home sooner. Even as formal therapy declines, a growing body of evidence suggests that both acute and chronic stroke survivors can improve movement ability with intensive, supervised training. This evidence comes in part from studies of constraint-induced therapy (Wolf et al. 1989; Taub et al. 1999; Liepert et al. 2000), repetitive movement training (Butefisch et al. 1995; Dickstein et al. 1997; Feys et al. 1998), and robot-assisted therapy (Aisen et al. 1997; Volpe et al. 1999; Kahn et al. 2001; Lum et al. 2002). Our working hypothesis is that intensive, guided practice is the primary stimulus of the observed recovery in these training techniques. If so, an important goal for rehabilitation engineering is to develop technology that allows the burgeoning U.S. stroke population to achieve such practice without continuous supervision from a therapist. References Aisen ML, Krebs HI, Hogan N, McDowell F, Volpe B (1997) The effect of robot-assisted therapy and rehabilitative training on motor recovery following stroke. Arch. Neurol. 54: 443-446 Butefisch C, Hummelsheim H, Denzler P, Mauritz K (1995) Repetitive training of isolated movement improves the outcome of motor rehabilitation of the centrally paretic hand. Journal of the Neurological Sciences 130: 59-68 Dickstein R, Heffes Y, Laufer Y, Abulaffio N, Shabtai E (1997) Repetitive practice of a single joint movement for enhancing elbow function in hemiparetic patients. Perceptual and motor skills 85: 771-785 Feys H, De Weerdt W, Selz B, Cox Steck G, Spichiger R, Vereeck L, Putman K, Van Hoydonck G (1998) Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke 29: 785-792 Gresham GE, Phillips TF, Wolf PA, McNamara PM, Kannel WB, Dawber TR (1979) Epidemiologic profile of long term disability in stroke: The Framingham study. Arch. Phys. Med. and Rehab. 60: 487-491 Kahn LE, Zygman M, Rymer WZ, Reinkensmeyer DJ (2001) Effect of robot-assisted and unassisted exercise on functional reaching in chronic hemiparesis. Proceedings 23rd Annual IEEE Engineering in Medicine and Biology Conference, Istanbul, Turkey, October 25-28: 39-44 Liepert J, Bauder H, Wolfgang H, Miltner W, Taub E, Weiller C (2000) Treatment-induced cortical reorganization after stroke in humans. Stroke 31: 1210-1216 Lum PS, Burgar CG, P.C. S, Majmundar M, Van der Loos M (2002) Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper limb motor function following stroke. Arch. Phys. Med. Rehabil. 83: 952-959 Rahman T., Ramanathan R., Seliktar R., Harwin W. (1995), "A Simple Technique to Passively Gravity-Balance Articulated Mechanisms" Trans. of the ASME- J of Mechanical Design, Vol. 117, No 4, pp. 655-658, December Reinkensmeyer DJ, Kahn LE, Averbuch M, McKenna-Cole AN, Schmit BD, Rymer WZ (2000b) Understanding and treating arm movement impairment after chronic brain injury: Progress with the ARM Guide. Journal of Rehabilitation Research and Development 37: 653-662 Taub E, Uswatte G, Pidikiti R (1999) Constraint-induced movement therapy: a new family of techniques with broad application to Volpe B, Krebs H, Hogan N, Edelsteinn L, Diels C, Aisen M (1999) Robot training enhanced motor outcome in patients with stroke maintained over 3 years. Neurology 53: 1874-1876 Wolf S, Lecraw D, Barton L, Jann B (1989) Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol 104: 125-132 www.strokeassociation.org (2002) American Stroke Association.