From Futuristic to Technology Forefront: The Value of Robotics in Rehabilitation
Robotic technologies are becoming more common in hospitals and outpatient clinics internationally as robotic therapy systems become more advanced and affordable. If you run a clinic, work as a rehabilitative therapist, or are interested in conducting research in rehabilitative medicine the prospect of integrating robotics into your practice may have peaked your interest. You may ask yourself why integrate robotics into your intervention plan?
What are the different types of upper extremity robotic therapy devices?
The two major types of upper extremity robotic devices are end-effector based systems and exoskeleton systems. Some major benefits of end-effector robots include faster setup time and greater adaptability to patient size.
UE robots can support the rehab continuum moving from passive range of motion (PROM), active-assistive range of motion (AAROM), and active range of motion (AROM). Devices may also use haptic sensory technologies or provide visual, auditory, or proprioceptive feedback.
What are the potential benefits of UE robotic therapy?
Robotic technologies are motivational and may provide a sensory-rich environment allowing for task-oriented practice that a typical hospital environment may not be able to provide. They have potential to provide a sense of autonomy for patients early in the continuum of stroke rehabilitation. UE robotic systems can also allow for errorless learning opportunities and correction of compensatory movements by isolating normative movement patterns. Repetitive task-specific movements can be provided at a high level of intensity graded by the therapist with the added benefit of preventing therapist physical strain during intervention. The potential for increasing productivity (ie not needing a second person to perform gravity eliminated movements or treating more than one patient at the same time) are a major draw of robotic therapy systems. Robot-assisted therapy systems can offer a wide range of task-oriented games and activities with detailed task grading options.
What's the current evidence?
There is level 1A evidence that robotic therapy combined with conventional therapy may improve UE motor function and level 1 A evidence that sensorimotor training provided by either a robotic device or therapist may improve manual muscle test scores (Foley et al., 2016). A recent study by Lo in 2010 found that differences in Fugl-Meyer UE motor function scores were not clinically significant between patients receiving high intensity traditional therapy and robot-assisted therapy. This suggests that robotic therapy in concert with high intensity therapy has the potential to increase upper extremity function. Current research in rehabilitation supports that robotic therapy can improve performance of ADLs and range of motion (GaYeong, 2017). An evidence-based review by GaYeong in 2017 found that Robots with greater degrees of freedom when compared with limited one-dimensional movement are more effective for upper extremity motor function.
Could robot-assisted therapy solve dilemmas in current research?
Recent research in animal studies suggests that while the average patient session provides 32 motor repetitions, close to 300 repetitions are necessary to maximize functional gains 5-30 days following stroke (Krakauer, 2015). As therapists we know that that the principles of neuroplasticity such as repetition, duration, and time drive motor learning outcomes (Kleim, 2008). We also know that constraint-induced movement therapy can provide significant gains in ADLs, UE function, strength, and social participation (Wolf et al., 2006). Robot-assisted therapy devices like the BURT may provide the early intensity necessary to make significant functional gains in the rehab continuum. Robot-assisted therapies use the principles of CIMT treatments which require forced use of the upper extremity while at the same time reducing therapist strain during task-oriented activities.
Robot-assisted therapy can provide a sense of excitement and motivation for patients that may not otherwise be engaged in therapy during a typical session of OT. In addition to promoting patient engagement, robot-assisted therapy devices open the door to a new platform of gravity-eliminated therapeutic exercises. Robotic therapy platforms such as the BURT offer therapists a new clinical tool to aid in maximizing patient outcomes and provide an extra set of hands when working with patients with motor impaired neurological diagnoses.
Article by Holly Mitchell, MOT, OTR/L
Foley et al., 2016. Upper Extremity Interventions.
Lo et al., 2010. An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke.
GaYeong et al., 2017. Is robot-assisted therapy effective in upper extremity recovery in early stage stroke? – a systematic literature review.
Kleim (2008). Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage
Krakauer (2012). Getting Rehabiliation Right: What Can We Learn from Animal Models.
Wolf (2006). The EXCITE Trial: Attributes of the Wolf Motor Function Test in Patients with Subacute Stroke