Brain Advance Access originally published online on December 20, 2007
Brain 2008 131(2):425-437; doi:10.1093/brain/awm311
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Robot-based hand motor therapy after stroke
Department of Neurology and Department of Anatomy & Neurobiology, University of California, Irvine, USA
Correspondence to: Steven C. Cramer, MD, University of California, Irvine Medical Center, 101 The City Drive South, Building 53 Room 203, Orange, CA 92868-4280, USA E-mail: scramer{at}uci.edu
Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization. Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34 ± 20 to 38 ± 19, P< 0.0005) and arm motor Fugl-Meyer score (45 ± 10 to 52 ± 10, P < 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions. The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.
Key Words: stroke; motor therapy; functional MRI; generalization
Abbreviations: IP, interphalangeal; MCP, metacarpophalangeal
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Received July 13, 2007. Revised November 27, 2007. Accepted November 28, 2007.
*Present Address: Department of Engineering, Santa Ana College, Santa Ana, CA, USA