Effect Of Robotic-Assisted Movement Therapies In Essay.

Effect Of Robotic-Assisted Movement Therapies In Essay.

 

Patients with Post-Stroke Hemiparetic Upper Limb

Abstract
The US and Europe are both experiencing the coming of age of an elderly population which is prone to strokes and will need health care focused on post-stroke therapies. The most promising therapies are robot-assisted motion exercises coupled with Non-invasive Brain Simulations (NBS) such as Transcranial Magnetic Simulation (TMS). At this time the most attractive combination for both effective and affordable therapy is the use of simply designed, easily manipulated robot systems coupled with TMS. Since 2003 the area of neurorehabilitation has been growing with many effective and exciting designs in robotics. It hasn’t been very long that the strategy of introducing ways to measure plasticity and to help encourage brain plasticity has been getting more attention. This literature review focuses on three key articles that demonstrate the progression in the state of the research. Other articles have been reviewed to use as comparisons for methodology and results. Also the implementation of simple robotics to computer modelled therapy has been addressed. The research is varied and offers hope for post-stroke victims to possibly one day recover their Activities of Daily Life (ADL). The job of the physical therapist is becoming more complicated both due to the hard work and the knowledge of technology which is now necessary.
(Robot-assisted therapy, stroke rehabilitation, impaired movement, brain plasticity, post stroke patients, stroke recovery)Effect Of Robotic-Assisted Movement Therapies In Essay.

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Effects of Robotic-Assisted Movement Therapy in Patients with Hemiparetic Post-Stroke Upper Limb

Health care professionals are expecting larger numbers of stroke patients as a demographic shift continues to trend upwards with a growing elderly population. Post-stroke patients often suffer upper limb disabilities such as finger, hand, wrist, elbow, and shoulder paralysis. These disabilities can be successfully improved with physical therapy.

Helping the patients in rehabilitation is a one-on-one activity and time consuming for the therapist. In order to relieve workload problems as more patients enter the health care system robotic systems have been developed. The robot-assisted rehabilitations systems have become a regular part of post-stroke therapy.

Robotic systems are used in hospitals and health clinics; smaller systems can be used in the patients’ homes. Some systems have been designed especially to be portable and easy to set up for the patient’s convenient use in the home. Carrera et al. (2011) have designed a system that is light, easy to use and small enough to store after use in the patients home.

A heart attack (or stroke) occurs when blood and oxygen cannot reach the brain; so it is also a brain attack according to the National Stroke Association. Loureiro et al. (2003) confirms that the neurons are killed in the part of the brain that does not receive oxygenated blood. Therefore neural damage and muscle damage are connected; neurorehabilitation has become important and even expected by patients. A small stroke may only weaken a patient’s arm, but a larger stroke can paralyze one side of the body, inhibit speech, and/or paralyze one arm. (Natl. Factsheet). A chronic stroke is when movement problems are occurring up to 6 months and longer after the stroke (Edwards 2009). Strokes can cause permanent motor activity disabilities and neural brain damage making Activities of Daily Living (ADL) very difficult.

Huang and Krakauer (2009) report that up to one third of stroke survivors experience permanent movement impairment and one-fifth need nursing home care or some type of institutional care even three months after their stroke. Half of the stroke victims who are 65 years and older and have experienced an ischemic (artery blockage) stroke have hemiparesis. (Huang & Krakauer 2009)
Hemiparesis is the condition of ‘general weakness, motor control abnormalities, and spasticity’ that afflicts post-stroke patients (Edwards 2009). Edwards (2009) predicts that future health care strategies should plan for large numbers of patients suffering both from strokes (cerebrovascular disease) and from neurodegenerative diseases.Effect Of Robotic-Assisted Movement Therapies In Essay.

Robotic theory hypothesizes that robotic neurorehabilitation has the potential to speed recovering of movement and brain control more successfully than either conventional neurorehabilitation or spontaneous biology. Huang and Krakauer (2009) say the reasons are (a) robotics are easy to use, (b) robotic systems are easily adaptable, (c) it’s possible to make reliable measurements, and (d) it is possible to help the patient perform repetitive tasks for long time periods and/or with strong force.

Non-invasive Brain Stimulation (NBS) such as Transcranial Magnetic Stimulation (TMS) has been shown to facilitate the balancing of brain activity between the brain-damaged side and the non-affected side after a stroke (Colombo 2005). TMS coupled with robotic-assisted therapy has shown positive results (O’Malley and Lev, 2006).Effect Of Robotic-Assisted Movement Therapies In Essay.

This literature review addresses robot-assisted upper body therapy use and robot-assisted neurological therapies particularly TMS. The theoretical question is, “Are NBS coupled with robot-assisted motion therapies showing consistently positive results?” The hypothesis is that NBS coupled with robotic-assisted therapy offers a more effective and a higher quality recovery for post-stroke patients.Effect Of Robotic-Assisted Movement Therapies In Essay.

Methodology

A variety of methodologies have been developed to gain high quality rehabilitation while at the same time increasing the rate of recovery of upper limb immobility post-stroke. The following paragraphs describe three key research studies that are representative of upper limb robotic-assisted neurorehabilitation research from 2003 to 2009.

Participants and timing of stroke

Fasoli et al. (2003) researched the use of constraint induced movement therapy (CIMT) which engages both motor and neural functions. Cesqui et al. (2008) compared results from the classic type robotic-assisted therapy to the Divergent Force (DF); a counterforce therapy which is designed to enhance error rather than measure error-free motion. Masiero et al. (2007) studied the advantages or disadvantages of the robotics system, NeReBot, which gives 3°-of-freedom during upper limb repetitive therapy and is coupled with visual stimuli.Effect Of Robotic-Assisted Movement Therapies In Essay.

There may be an optimum time for patients to start therapy after a stroke. Masiero et al. (2007) used participants with the least amount of time from stroke experience to therapy in this review; thirty-five participants who had experienced strokes one week or less before the start of a study. Fasoli et al. (2003) used twenty participants who each had experienced a single, unilateral stroke with continuing hemiparesis even after one to five years.

The fifteen participants in the DF study Cesqui et al. (2008) were not chosen on the basis of time from stroke occurrence, but because they were each afflicted with severe arm immobility problems.

Interventions

In a research study by Fasoli et al. (2003) the elbow and shoulder of the hemiparetic affected arm was exercised. After the participants reached predetermined targets during six weeks of sessions, therapy three times a week was randomly assigned to either sensorimotor or progressive-resistive robotic-assisted therapy Fasoli et al. (2003). Patients were asked to do reaching exercises in order to accomplish a goal along a one dimensional plane. (Fasoli et al. 2003)

Masiero et al. (2007) randomly chose two study groups from thirty-five participants. Members of both groups received the standard rehabilitation therapy but the experimental group was given an extra 4 hours/week of sensorimotor robotic assisted therapy. The control group used the therapy for 30 minutes, twice a week using the unaffected arm and hand. Masiero et al. (2007) research study used NeReBot which assists the patients in elbow and shoulder movement coupled with visual stimuli.

Fifteen patients took part in the Cesqui et al. (2008) study; eight male and seven female post-stroke patients with mild to severe arm immobility problems. Three two-week sessions were offered; the first for one hour therapy sessions for 10 days, the second two week period consisted of a break for resting and the last two-week period repeated the one hour therapy sessions for 10 days. Cesqui et al. (2008)

Critical Analysis

Results

Non-invasive Brain Stimulation (NBS) Fasoli et al. (2003) found that participants improved significantly from the start to the finish of the experiment using CIMT; the progress-resistive group had improved wrist and hand motion while the sensorimotor group showed no change. Park et al. (2004) used CIMT while gauging changes in TMS. Park et al. (2004) found that the oxy-haemoglobin concentration shifts towards a better balance between the affected and the unaffected side of the brain. After two weeks the research demonstrated increased TMS motor map area and other indications that TMS could be useful for encouraging recovery; their findings did not correspond with results of earlier research.
O’Malley and Levin (2006) reported in a literature review that the coupling of TMS and robotic-assisted motion therapy to encourage brain plasticity and movement recovery as well as assess movement recovery worked well. Also activities of daily life (ADL) demonstrated greater improvement with TMS than without. O’Malley and Levin (2006) determined that the main positive reasons for pairing robotics and TMS was that they both give positive recovery results, cost is low, and results are easy to assess. Fegni (Cromie 2005) using TMS had success in improving movement with short sessions of dose; he found the more sessions the greater improvement. Approximately a 50% improved reaction time was measured in ten participants after three sessions; the participants had experienced a stroke within 1 year of the experiment. Edwards (2009) suggested that the use of non-invasive brain stimulation (NBS) used with robotics can offer accurate data for assessment and also be incorporated into the therapy.Effect Of Robotic-Assisted Movement Therapies In Essay.

Robotic systems Cesqui et al. (2008) found that the more movement a participant had upon entering an experiment the larger the improvement; hand path movement in particular improved. The Masiero et al. (2007) using the NeReBot positive results for the shoulder/elbow but not for the wrist flexors. MacClellan et al. (2005) used a short term robotic assisted therapy with positive results for chronic patients experiencing low to high severity. Mahoney et al. (2003) learned that simple robotic system designs can be more effective in mimicking natural movement and gaining more improvement.Effect Of Robotic-Assisted Movement Therapies In Essay.

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