ROBOTIC DEVICES FOR UPPER LIMB REHABILITATION

PHINOJ K. ABRAHAM MOTh (neuroscience)

Occupational Therapist

Hamad General Hospi tal , Doha, Qatar

26 t h Apri l 2016

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OBJECTIVES To discus the NEEDS of robotic based

rehabilitation

To review the existing CATEGORIES of robotic devices for upper limb

To review the clinical utility & efficacy of robotic based upper extremity rehabilitation

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WHY ROBOTIC BASED REHAB ?

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REHAB ROBOTS An upper limb rehabilitation robot is an external

device that assists or guides movement with the intention of improving function

Presents virtual reality (VR) games and tasks to the patient that can be adjusted to level of ability, interest and specific movement problems

Jane Burridge

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THEORETICAL / POTENTIAL BENEFITS ‘…the most important advantage of robotic systems is

their ability to provide intensive repetitive training without over- burdening therapists’

(Brochard S, Robertson J, Medee B, Remy-Neris O, 2010 )

‘.. Another advantage is the ability to provide more motivating training context, by means of a computer gaming environment with quantitative feedback to motivate practice’

(Reinkensmeyer DJ, Boninger ML)

Appropriate for all levels of ability Cost effectiveness ?

(AC Lo - 2010)

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TYPES OF REHAB ROBOTS

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APPLICATION FIELD

Rehab Robots

Support ADL Therapeutic Maciejasz et al.: 2014

Loureiro RCV

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TYPE OF ASSISTANCETy

pe o

f Dev

ices Active

Passive

Hapatic

CoachingMaciejasz et al.: 2014

A device able to move limbs.

A device unable to move limbs, but may

resist the movement when exerted in the

wrong direction.A device that interfaces with the

user through the sense of touch.

A device that track the movement

and provide feedback

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Active + coaching device

Passive device

Passive device (MEM-MRB)

Hepatic device

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TYPE OF MECHANICAL DESIGN

Dev

ices

End effector based

Exoskeleton based

Planar based

Maciejasz et al.: 2014

Contacts a subject’s limb

only at its most distal part.

A device with a mechanical

structure that mirrors the skeletal structure

of the limbA device, usually end-effector

Based, moving in a specific plane.

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EFFICACY OF ROBOT BASED REHAB

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AUTHOR’S CONCLUSIONS‘…We found that when the duration/intensity of conventional therapy (CT) is matched with that of the robot-assisted therapy (RT), no difference exists between the intensive CT and RT groups in terms of motor recovery, activities of daily living, strength, and motor control.

However, depending on the stage of recovery, extra sessions of RT in addition to regular CT are more beneficial than regular CT alone in motor recovery of the hemiparetic shoulder and elbow of patients with stroke

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AUTHOR’S CONCLUSIONSThere is strong (Level 1a) evidence that sensorimotor training with robotic devices improves upper extremity functional outcomes, and motor outcomes of the shoulder and elbow.

There is strong (Level 1a) evidence that robotic devices do not improve motor outcomes of the wrist and hand.

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AUTHOR’S CONCLUSIONS Electromechanical and robot-assisted arm and hand

training improved activities of daily living in people after stroke and function and muscle strength of the affected arm.

adverse events seldom described these devices can be applied as a rehabilitation tool,

but we still do not know when or how often they should be used.

The quality of the evidence was low to very low.

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REVIEW CONCLUSIONS ‘…there are a number of smaller pilot studies,

there are only few larger clinical trials’ Other considerations include

randomization, inclusion of a control group, reproducible descriptions of the intervention

being tested.

Development of rehabilitation robots for clinical use needs to occur hand

in hand with well-conducted clinical trials to provide evidence of efficacy

while also taking into account costs

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SUMMARY & IMPLICATIONS

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SUMMARY & IMPLICATIONS Robot-assisted arm and hand training may improve the motor

outcomes of the shoulder, elbow and performance in ADL Robotic assisted therapy in addition to conventional therapy

may be more beneficial than regular CT alone Adverse events seldom described ‘Passive and non-actuated robotic systems are less complex,

safer and cheaper than their active counterparts.’ The passive device lacks the ability to perform movement.

They can be an option for the training of moderately impaired arm/hand

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REFERNCES1. Maciejasz et al.: A survey on robotic devices for upper limb

rehabilitation. Journal of NeuroEngineering and Rehabilitation 2014 11:3.

2. Lo AC: Clinical designs of recent robot rehabilitation trials. Am J Phys Med Rehabil 2012;91(Suppl):S204YS216.

3. Jane Burridge; BASP National Trainees Educational Meeting. Retrieved from http://www.basp.ac.uk/Portals/2/BASP%20Feb%202013%20Robots%20J%20Burridge.pdf

4. EBRSR 2013, Retrieved from http://www.ebrsr.com/sites/default/files/Module-10-upper-extremity_FINAL_16ed.pdf

5. Norouzi-Gheidari N, Archambault PS, Fung J. Effects of robot-assisted therapy on stroke rehabilitation in upper limbs: Systematic review and meta-analysis of the literature. J Rehabil Res Dev. 2012;49(4):479–96. http://dx.doi.org/10.1682/JRRD.2010.10.0210

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THANKS