7.10.2007

Robots For STroke Patients

There are two lines of research that could lead to the use of more robots in long term rehabilatative care. The first is pioneered by Japan -- the idea that robots will serve as helpers for the elderly as fewer young people are available to do the task. This thinking has largely driven humanoid robotic development by Honda and others.

The other line I find interesting is the use of robotic aids for rehab and assistance to the disabled. This can take the form of Dean Kamen's fantastic IBOT system -- a wheel chair that allows patients to climb stairs and look eye to eye with people standing. Another example is a robotic brace that sense weak muscle reflexes and amplifies them so stroke patients can relearn and perform simple tasks. Such relearning can restore function to limbs, and help patients regain independence, according to the New York Times.

"This is an area that’s exploding,” said Hermano Igo Krebs, a principal research scientist at M.I.T. and one of the first scientists to envision robot-assisted therapy for stroke patients and others with brain injuries and neurological disorders. “There are now a hundred groups around the world working on this. In 5 to 10 years, I expect we’ll see these kinds of devices in all major clinics and rehab hospitals in the developed world, and even in patients’ homes.” ...

A small study of the Myomo device and associated treatment, conducted with Spaulding Rehabilitation Hospital in Massachusetts and published in April in The American Journal of Physical Medicine and Rehabilitation, found that patients who exercised with the arm brace for 18 hours over about six weeks experienced a 23 percent improvement in upper extremity function. The device has been approved by the Food and Drug Administration and is expected to reach the market in the next few months.

Dr. Krebs notes that for stroke patients, a large body of evidence now suggests that repeated practice with an impaired limb can foster plastic changes in the brain. In other words, it can help the brain forge new connections between neurons or strengthen existing ones. For patients whose strokes have damaged part of the motor cortex and subcortex, this means that movement therapy may help the brain to use other, nearby neurons — or even neurons in the opposite brain hemisphere — to complete a movement.

It is not yet clear whether movement therapy using a surface-controlled device like the Myomo brace will benefit these patients, said Dr. Irene M. Estores, a specialist in spinal cord injury and in physical medicine and rehabilitation at that hospital. But in the long run, the device (and others like it) could also prove useful as a “power assist” that patients wear every day.

A renewed ability to flex and extend at the elbow would be especially important to patients who also cannot walk and who may otherwise have to rely on a mouth stick to move their wheelchairs, Dr. Estores added.


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