The value of robotic systems in stroke rehabilitation Expert Review of Medical Devices Downloaded from informahealthcare.com by Washington University Library on 10/07/14 For personal use only.
Expert Rev. Med. Devices 11(2), 187–198 (2014)
Stefano Masiero*1, Patrizia Poli1, Giulio Rosati2, Damiano Zanotto3, Marco Iosa4, Sefano Paolucci4 and Giovanni Morone4,5 1
Department of Neuroscience, Unit of Rehabilitation, University of Padua, Padua, Italy 2 Department of Innovation in Mechanics and Management, University of Padua, Padua, Italy 3 University of Delaware, Newark, DE, USA 4 Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy 5 School of Doctorate, University of Padua, Padua, Italy *Author for correspondence: Tel.: +39 049 821 1270 Fax: +39 821 796 [email protected]
In this paper, we discuss robot-mediated neurorehabilitation as a significant emerging field in clinical medicine. Stroke rehabilitation is advancing toward more integrated processes, using robotics to facilitate this integration. Rehabilitation approaches have tremendous value in reducing long-term impairments in stroke patients during hospitalization and after discharge, of which robotic systems are a new modality that can provide more effective rehabilitation. The function of robotics in rehabilitative interventions has been examined extensively, generating positive yet not completely satisfactory clinical results. This article presents stateof-the-art robotic systems and their prospective function in poststroke rehabilitation of the upper and lower limbs. KEYWORDS: activities of daily living • motor learning • neurorehabilitation • plasticity • robot-assisted training • stroke
Stroke that is caused by an ischemic or hemorrhagic intracranial vascular event is a leading cause of disability in the USA and Europe . The WHO estimates that stroke events will increase by 30% between 2000 and 2025 in Europe . Hemiparesis and hemiplegia are the most common outcomes of stroke, leading to deficits in movement in the limbs that are contralateral to the side of the brain that is affected by the stroke. The main clinical characteristics in hemiparetic patients are weakness of specific muscles, abnormal muscle tone, abnormal postural adjustments, lack of mobility, incorrect timing of components within a pattern, abnormal movement synergies, loss of interjoint coordination and loss of sensation. Due to residual arm impairments and inability to perform activities of daily living (ADLs), stroke has a significant social impact: 38% of severely affected patients experience partial recovery of dexterity compared with complete recovery in 11.6% . Regarding the recovery of mobility, a 2008 study demonstrated that on discharge from a rehabilitation hospital, approximately half of stroke patients remain in a wheelchair,