Stroke Rehabilitation Engineering:Robotic TherapyBy: Dana Demers

What is a Stroke?

• When a blood clot blocks an artery or a blood vessel breaks, and interrupts blood flow

• Brain cells die and brain damage occurs-up to 2 million cells per minute

• Speech, movement, and memory are areas commonly affected

• Stroke is the third leading cause of death in US

2 Types of Stroke

Ischemic Stroke• Arteries are blocked by

blood clots or gradual buildups of plaque and fatty deposits

• 87% of strokes

Hemorrhagic Stroke• More harmful• When a blood vessel in the

brain leaks blood into the brain

• 13% of strokes, yet over 30% of deaths

Introducing Robotic Therapy

• In the past, researchers believed not much could be done to regain brain function after the first few months after stroke

• Traditional care was physical therapy led by nurse a few hours per week

• After months of no progress, doctors and patients would lose hope and accept fact that nothing could be done

MIT-Manus

• One of the first robotic systems for stroke therapy

• Created by Hermano Igo Krebs

• More intense and fast paced than traditional therapy

MIT-Manus• Uses a robotic joystick which guides the hand• Patients see commands on a computer screen,

resembles a video game• One of the ‘games’ requires patient to attempt to

move toward object on screen• If they move in the wrong direction or can’t move at

all, robot nudges to the right direction• A different system of the Manus works by recording

movement in order to repeatedly guide patient through exercise

• Is able to adjust resistance and record the amount of force patient is applying on their own

MIT Anklebot

• Another robotic device created by MIT• Similar to hand-arm devices to help aid stroke

patients with damage to lower legs• Goal of Anklebot was to improve balance and

efficiency of joints and prevent further injuries

MIT Anklebot

MIT Research• Researchers have proved that improvements CAN be made

with upper body function and quality of life even years after initial incident

• Did this by comparing robotic therapy with human therapy• Both groups worked the same amount of hours, same

repetitive motions, and achieved the same results• However, the long hours at that fast pace is an unrealistic

expectation of the average physical therapist• Robotic therapy is also cost efficient – did not affect

healthcare costs per patient, which can make it available to more people

HWARD• Recent study conducted by Steven Cramer in San

Diego, California evaluated the Hand Wrist Assistive Rehabilitation Device

• Patient sat in front of computer monitor, hand secured by splint and three straps, while examiner used software on a separate monitor to control robot

• Contained joint angle sensors – measure movement of limbs

• Gave instructions on screen, if patient couldn’t finish motion robot would assist

The HWARD Experiment

• Active non-assist mode – when the subject does all the work with no assistance from the robot

• Active assist mode – the robot would assist patient when they had trouble or could not finish a movement

• RESULTS – at the end of the study it was shown that patients benefited more from the active assist treatment

The HWARD Experiment

Advantages of Robotic Therapy• Can provide therapy for long periods of time in

consistent and precise manner• Can be programmed to change functions with a

single click• Can measure and track progress• One day could be mass-produced, so patients can

have them in their homes• Telerehabilitation – robot can be connected and

supervised through the internet by human therapist; patient doesn’t have to leave comfort of their home