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InMotion Arm Robot:improving quality of life
Recovering everyday function
After years of living with movement disabilities patients and their doctorsdiscover that there is hope. What was thought to have been permanentcan be restored. The coordinated shoulder, elbow and hand movementsrequired for accurate reaching and grasping are retrained.
Rethinking recovery
In-Motion Robot-assisted therapy engages the patient to "retrain thebrain". The patient is actively expressing and experiencing thousands ofinteractive movement repetitions, leading to the achievement of meaning-ful movement in everyday arm function even years post onset.
A new therapeutic strategy; evidence based technology which is proven tobe effective and safe. Currently used by leading clinicians and research-ers worldwide.
Reach for recovery
NEW InMotion Products!
InMotion Adjustable Workstation•••••••••••••••••••••••••••••••••••••••••••••
The new InMotion Arm/Shouler robot workstation offers height adjust-ments and ample knee space to accommodate children andadults who use wheelchairs. The height manually adjusts from22"-34" allowing both standing or sitting positioning.
The station also includes a comfort contoured ergonomi-cally designed chair with shoulder and waist straps for
correct patient positioning.
With a table top area of 36" x 48",it provides a large surface withthe additional benefit of upperarm support.
The workstation is ADA compli-ant with ease of access for most
patients.
The InMotion Hand Robot provides active (motor-driven) grasp and release features.
The innovative Hand Robot now comes standard withthe InMotion Shoulder-Elbow Robot allowing en-hanced functional movement by the patient.
<1NMOT1ONROBOTSFOR REHABILITATION
InMotion Robot Therapy••••••••••••••••••••••••••••
Watertown, MA - May 13, 2010 - Patients with long-term stroke reportedreduced impairment, disability, and improved quality of life following InMotionrobot-assisted therapy, according to a Veterans Administration (VA) led studypublished in the May 13,2010 issue of The New England Journal of Medicine.
"There are nearly 6 Million stroke patients in the U.s. with chronic deficits;' saysDr. Albert Lo, a neurologist at the Providence VA Medical Center who led thestudy. "We've shown that with the right therapy, they can see improvements inmovement, everyday function and quality of life:'
The study demonstrates that InMotion robots are safe and effective clinicaltools they can assist a Physical or Occupational therapist achieve the intense level of exercise necessary to achieve neuro-plastic change and motor recovery following stroke, even years post-stroke. "Robotics and automation technology are idealfor these kinds of highly repetitive tasks. We've used robotic technology to create a tool for the therapist to afford this kindof high-intensity therapy while maintaining the therapist supervisory role, deciding what is right for a particular patient'sneeds and tailoring therapy according to findings from the patient evaluation tools provided with the robots" says HermanoIgo Krebs, principal research scientist in MIl's Department of Mechanical Engineering and inventor of InMotion robots.
"The study results also challenge the notion that physical therapy only benefits stroke patients within the first sixmonths after stroke" says Lo.
The VA-led randomized clinical trial, conducted at 4 hospitals, involved 127 patients with moderate to very severe armimpairment six months or more after stroke. Patients were placed into three study groups: usual care, intensive comparisontherapy administered using conventional techniques, and intensive robot-assisted therapy.
At 36 weeks, patients in the two intensive groups demonstrated significantly more improvement in function, movementand quality of life than patients receiving usual care. These patients received hour-long treatment sessions three times perweek and completed 1,024 exercise repetitions in each session.
Patients in the robot-assisted therapy group completed the exercises using four different types of InMotion upper-extremityrobots. The robots guide patients through exercise using video game-like software programs and the robot arm assists theperson with movement only when they are unable to initiate or complete the motion themselves.
Professor Neville Hogan and Hermano Igo Krebs, from the Newman Laboratory for Biomechanics andHuman RE!habilitation, invented the InMotion Robots and have been involved in over a decade and halfof research using this kind of interactive robotics.
Patients randomized to the intensive comparison therapy by a therapist also received very intensive arm exercise,comparable to the 1,024 movements per 1-hour therapy, something that is typically not practical in everydaycare (typical exercise repetitions are closer to 40 movements per session).
Even more surprising, this better care did not cost the VA any more than usual care: "better carefor the same cost:'
------------------------InMotion Robots at Braintree, MA Rehab Hospital
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"As therapists we think, 'How do I tapinto the motor control theory - gettingpatients to do a high number of repeti-tions in an engaging activity? How manytimes can I ask them to reach for a conewhile sitting on a mat?'" said Dan Par-kinson, PT, Director of Clinical Servicesat Braintree Rehabilitation Hospital,provider of acute inpatient and outpa-tient rehabilitation in Braintree, Mass.and surrounding communities.
Solution:Robotic Therapy
Always looking for the latest proventechnologies in rehabilitation, Brain-tree Rehab purchased the InMotionshoulder-elbow robot, wrist robot andhand robot to augment its arsenal ofevidence-based treatment tools. Theywere drawn to the InMotion therapy ro-bots for a few reasons - one of the mostsignificant being the ability to provideactive-assisted motion for the patient.The robot can 'back off' proportionateto the patient's changing ability to moveindependently. Because the machinehelps to stabilize the affected arm,movement is more fluid and controlled."You don't get frustrated that your arm isallover the place," said Rich Vartanian,
a physical therapist and stroke survivorwho uses the InMotion robots during hisown outpatient therapy. In addition, atherapist can see how much assistancethe patient needs, helping to assessimprovement.
Working with the InMotion robot re-quires attention, eye-hand coordination,and coordination of the affected arm,but patients are often so engrossed inthe game - for example, a game of on-screen ping-pong - they end up doinga few hundred repetitions of a particularmovement - a result that is challengingto elicit during traditional therapy. "I'mnot saying we've abandoned cones andbean bags, but the InMotion robots helpus get to the high number of repetitionswhile keeping patients motivated," saidParkinson.
Patients with various neurological condi-tions, from stroke to spinal cord to braininjuries, work with the robots. Beth Lus,OT, occupational therapy clinical advisorat Braintree Rehab, has even used itwith patients with flaccidity. Lus alsouses it with patients who have neglector attention issues. "There have beenpatients who do not attend well withother therapy, but I've put them on therobot and they can focus on the task for20 minutes," Lus said.
Vartanian has noticed functional gainsaround the house -- unloading the dish-washer, folding clothes, and openingbottles. And Parkinson likes to tell of a42-year-old woman who was 21 yearspost-stroke.
Hypertonia had severely affected herleft arm, but she had learned to com-pensate with the other side. She hadworked with the robot for some timewhen one night she walked into herbedroom. Her husband, walking behindher, started shouting, "You turned on thelight! You turned on the light!" Subcon-sciously, she had turned on the lightwith her affected arm rather than com-pensating by turning her body to use theother side.
" InMotion robots help usget to the high number ofrepetitions while keeping
patients motivated. "
Braintree believes that their investmentin InMotion and other rehab technol-ogy has made a favorable impact onthe hospital. "It is hard to attribute anyspecific initiative to inpatient volumegrowth, however Braintree believesevidence-based technology has helpedto increase admissions of neurologicpatients for both inpatient and outpatientprograms", says Parkinson. 'Technol-ogy has also helped with our therapistrecruitment and retention. Our clinicalstaff is excited about contributing to thedevelopment of clinical applications forrehab technology. Braintree is proudthat we can offer patients such innova-tive treatment."
Founded in 1975, Braintree rehabilitation Hospital has gained recognition as a world-class healthcare provider. Braintreeoffers a wide variety of specialty programs at its acute Inpatient Rehabilitation Hosptial in Braintree, MA, satellite rehabilitationhospital locate"d at Medtrowest Medical Center in Natik, MA and multiple community-based outpatient clinics. Braintree is aleading provider of Nuerorehabilitation services such as Stroke, Brain Injury, Parkinson's Disease, Multiple Sclerosis and Spi-nal Cord Injury. The Join Commission awarded the hospital Disease Specific Care Certification for its Stroke and Brain Injuryprograms.-------------------------
THE ART & SCIENC~EHABlLITATION
Rancho Robotics for Rehabilitation
Are you a survivor of stroke, traumatic brain injury, cerebral palsy,spinal cord injury, multiple sclerosis or neurological condition?
'!he young man a60ve fias gainea tfie a6iCity to 6egin ariving a powerwfieeCcfiair ana to use utensiCs tofeea fiimsefJ. J{e fias participatea in approxjmatefy si:(j;eenro6otic training sessions at 1(ancfio.
Rancho offers innovative programs including traditional therapies and advanced robotic trainingwhich treat body and mind deficits for adults and children.
Comprehensive Wellness, Drivers Training and Life Skills Programs are also available.
Amy Salinas, MS, OTR/L, CBIS, PAMDirector, Rancho Robotics for Rehabilitation
7601 E. Imperial Highway Downey, Ca 90242562.401.6275 [email protected]
Rancho Robotics for Rehabilitation
On May 19, 2009 I was driving my car when I had a sudden headache. I had a stroke. Iunderwent surgery to relieve the bleeding and treat three blood clots. I spent six weeksrecovering in an acute rehab hospital.
After traditional inpatient and outpatient rehabilitation, I participated in sixteen robotictraining sessions.
• HoUf my grantftfaugfiter on my rap to reaa to fier• rrum figfit switclies on ana off• HoUf onto tfie steerine wfieeCwfiife an:vine• Hug peopfe witfi 60tfi arms• jlssist witfi carryine o6jects
I have also gained noticeable arm improvements in:• 1@nee of motion• ~aucea tigfitness• ~aucea pain
"Robot-Assisted Therapy for Long-Term Upper-LimbImpairment after Stroke"
Albert La, M.D., et al.The New England Journal of Medicine, May 13, 2010
FREQUENTLYASKED QUESTIONS
Why is this research so important?"We've shown that with the right therapy, [stroke patients] can see improvementsin movement, everyday function and quality of life - this is giving stroke survivorsnew hope." Dr. Albert Lo, Principal Investigator. The implications for stroke recoveryand study design were so powerful that this was the first article ever published in theprestigious NEJM on the topic of rehabilitation.
Why were InMotion Robots selected for the study?The unique assist-as-needed exercise delivered by InMotion robots is the optimal way to
drive recovery through neuro-plastic remapping of sensory-motor pathways. InMotioninteractive robotics actively engage neurologically injured patients in repetitive tasks that
reinforce normal movement patterns and improve everyday function, even years postinjury.
Is InMotion interactive robot-assisted therapy an established practice?Yes, many leading rehabilitation hospitals and VA hospitals are using InMotion Robotsevery day to improve arm function following stroke, brain injury and other neurologicaldiagnoses. The NEJM article, the 1A level of evidence cited in Stroke*, and over 15years of prior research gives a large evidence base for the treatment effectiveness.
*"ComprehensiveOverview of Nursingand InterdisciplinaryRehabilitationCare of the StrokePatient:A ScientificStatementfrom the American heartAssociation, Miller,et.al, Stroke
2010;412402-2448
What improvements in functional abilities do patients or therapists report?Some examples of new abilities using the affected arm following robot-assisted therapy:
Put on a shirt or jacket Hold a shopping bagPush a door open Pick up a laundry basket
Turn on a light switch Do household choresPick up a cup of coffee Put a leash on a dog
What treatment methods were compared? Patients were randomly assigned to threestudy groups: 1) usual VA care 2) intensive InMotion robot-assisted therapy and 3)
(robot) intensity- matched treatment delivered by a therapist. Patients in both the robot-assisted and the intensity-matched treatment group received 1024 exercise repetitions$ per session, a level of intensity that is only practical with robot assistance.
Yes The study enrolled sixty-five percents (65%) of interested Veterans. Only those withmild impairments due to stroke, or those unable to travel for the duration of the study
were excluded.
This study involved a very severe population, and many had only trace shouldermovement (Fugl-Meyer Assessment (FMA) Scores ranging 7 to 38 out of a possible 66points). About 1/3 had multiple strokes. Average time post onset was 4.7 years. Finally,
most were too severe to be candidates for modified constraint-induced therapy
Yes, after the 36 week study period the robot-assisted group out-performed BOTH theintensive therapy and usual care groups. The robot-assisted therapy group Fugl-MeyerAssessment Score (FMA) gain was 5 points greater than the usual care group. And, asignificant number of the robot-assisted participants showed much higher FMA gains
ranging above 6 points.
"Usual VA Care"Was Not Typical CareRobot-assisted care was superior despite the fact that "usual care" in the VA study
averaged 3.6 hours of upper limb therapy per week. By contrast, the large majority ofpatients in third party payer settings receive little if any rehabilitation beyond the first yearpost-stroke. The VA considered the advantages of robot-assisted and (robot) intensity-
matched care so great that they discontinued usual care midway through the study.
Is robotic therapy cost effective?Yes, the TOTAL cost to the VA was roughly the same between the usual care and the
robot-assisted therapy groups. Despite the cost of the robotic equipment, the robot-assisted group experienced significant reduction in cost and use of other medical
services compared to the usual care group.
Differentiate your stroke programwith the new standard of care
NMOTIONROBOTSF()H REHABH.lTATtON
80 Coolidge Hill Rd Watertown, MA 02426Tel: 617926-4800 Fax: 617 926-4808
www.interactive-motion.com
Clinical ResearcJh With In'Motion Robots
•
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-'-, - .. ,"t;
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IMT tec'lnology has undergone more than a decade of clinical InvCSligatl0nsInvolvln~ more than 600 patients.
There is compelling evidence from clinical evaluations involving IMT technologylrlat interactive robotic therapy significantly enhances motor recovery
In a multi-center, randomized, controlled trial involvin~1 127 :;,troke patient~, W!tll mod,:::rav:to severe upper-limb impairment, InMotion robot-assisted therapy patients demOrl'Slrclledsignificant improvement in arm movement, function and qUcllity of liTe
\LO A C , etal "Robot-Assisted Therapy for Long-Term Upper·Limb Impairment after Stroke", New Englano .'ourne! 01Medicine, :;,621772, May 13, 2010.)
In a clinical study involving 56 stroke inpatients, the motor skills of the robot-treatedgroup improved significantly more than the control group An analysis of impairmenlmeasures showed that (1) interactive robotic therapy significantly reduu.:d mOlO'Impairment of the treated limbs, and (2) added to con'/entional therapy Imer~ICllve[(Jbotic therapy provided about double the impairment reduction.
Volpe, 8 T, Krebs, HI, Hogan, N :::delsteln, OL, olels, C and Aisen, M , A novel apDroach '0 srJoyt;;' r,,'h:;;':.>,:,r.'!\:e,";obot-aldecl sensorimotor stimulation, Neurology, 54 (2000) 1938--44 )
Patients from an early clinical 2Tudy were rec21led up to three years later, and It wasfound that patients who rece:ved robotic therapy sustained their improvement over thosewho did not. Moreover, sub.;equent follow-up studies re-examining these patients alsoconfirmed the finding.
(JOlpe, 8T , Krebs, H.I., Hogan, N., Edelsteinn, L., Diels, C.M. a"d Aisen, M.L .. RobOI tralnln£ enhanced mo,or (lulUY"'-
.n 0811pnts wltr, stroke maintained over 3 years, Neurology, 53 (1999) 1874-6)
i ·JOlp0.. 8 T . Krebs, H I., Hogan, N., "Is robot-aided sensorimotor training In stroke rol,aL)"lailon a reali:;"c (,,-,:,(,:-.-
Curmnt Oplnl' In Ji1Neurology, LJPPJi1colt \lVil/iams & \lVilkins, 14:745- 752, 2001)
A multi-center VA study of 127 patients with long-term upper-limb impairment from astroke that occurred at least 6 months before enrollment (average brr.e of 4.7 years 3:?/:lowith multiple strokes) found that "The improvements .. provide evidence of potentiallong-term b(~nefits of rehabilitation and challenge the widely held clinical belief that gainsIn motor fur,ction are not possible for long term stroke survivors."
! i_o. p, C . etal , 'Robot-Assisted Therapy for I_ong- Teml Upper-limb Imp81m1enl after Stroke". Nevil EnglancJ ,i,ju.-:-:':'. 1 •
M/Jc;,c,ne. 3621772, May 13,2010)
Patients who had suffered a single unilateral stroke one to five years earlier, and whowere demonstrated to be in a "stable phase," showed significant improvement afterreceiving robotic therapy three times a week for six weeks.
These findings also suggest that such patients have a potential for further recoverywhich conventional therapy has been unable to tap into.
IFasoil, S D, Krebs, H I, Stem, J, Frontera, W.R. and Hogan, N, Effects of RobotiC Thci'ap'~ \·n '\'I(J,(';
impaulI,en, and Recovery in Chronic Stroke, Archives o/Physica! MedlclI1e and K'eiw!Ji/lla(/OI1, S-:i(~rn::,,:--.S2 )
l.Fas,)i,. S [, KiCbs, H i., Stcln, 1., Frontera, \V.R., Hughes. R-, and Hogan, N., "RobotiC Thcrapy (or Ch,onlc t\.IOi(;;
impal""cnts aftcr Stroke Follow-Up Results." Archives 0/ Physical MediCine and Rehabrl,(a(lol1. 85 1106-11 I I. ~0()J 'j
tFer-aro. Ivl .. Palazzolo, 11., Krol, 1, Krebs, H.I., Hogan, N, Volpe, B.T., "Robot Aided Scnsorlmotor Arm Tril1n':1f..improves Outcome in Pallents With Chronic Stroke," Neurology, 61: 1604- I 607, 2003.)
12 children ages 5-12 With cerebral palsy and upper limb hemiplegia rec81vecJ rot)(;li,~.therapy (\!Vlce a week for 8 weeks. The children showed significant Ir"nprovem(~nl In IC;i.,.!,
Quality of Upper Extremity Skills Test (Quest) and Fugl-Meyer f-\sscssment Scores
A "questionnaire administered to the children's parents also showed slgnlflcan~Improvement in "how much" and "how well" the children used the paretic cHili dUrliinfunctional tasks at home
(rasa/I. SE.. rrClgala-Pinkham, Yo., Hughes, R , Hogan, N., Krebs. HI.. Stein, J, "Upper Limb RoboliC Therapy iOIChildren with Hemiplegia, "Arnencen Journal of REhabilitation, 87: 11929-936 (2008)
A pilot ~tudy of two patients with incomplete spinal cord injuries, level C4-6 that hadoccurred greater than two years ago, was conducted at Burke Rehabilitation HospitalPatients received treatment in the shoulder-elbow robot for 18 sessions over 6 weekswith one arm followed by 18 sessions over 6 weeks with the other arm Patients showedchanges greater than 10% in Fugl-Meyer Scores and 20% in the Motor Power scalesThe study also showed that while one arm was treated both arms showed comparableImprovement.
("rebS,HI, Dlpletro,L, Levy-Tzedek,S, Fasoli,S, Rykman,A, Zipse,J, fawcen,J. Steln,J, PQlzncrH, L(.) ,- '/'_11i)f:: 6;Hogan,N, ",Q, Paradigm Shift for Rehabilitation Robotics." IEEE-EMBS Magazine, 27461-70 (2003'1
A pilot study of two MS patients at the West Haven VA Medical Center has shown trattreatment with the InMotion AnkleBot twice a week for twelve total sessions resulted Insignificant improvement in torque production at the ankle and movement accuracyAlthough the training did not include gait activities the researchers noted cerry o'/srImprovement in gait function when measured through six minute walk tests
(Krebs.HI, Dlp,etro,L, Levy-Tzedek,S, Fasoli,S, Rykman,A, Zipse,J, Fawcen,J, Steln.J. POI~n~r.j-l. La. f.... \'Oll)r; !:','Hogan,N, "A Paradigm Shift for Rehabilitation Robotics," IEEE-EMBS Magazme. 27~61-70 (2008)
~NW10TjON ROBOTIC THERAPY?
1 the repetitive exercise I which may evoke and enhance a neuro-plastic recovery prOC8<::S
whereby new neural pathways replace some of the neural pathways lost due ;0 br2'liInJury;
:z (he continuously interactive nature of robotic therapy, which ensures patient partlclpatlor.by assisting only as needed;
(he 3daplive nature of robotic therapy, which adjusts the degree of movement challengeand rot)otic assistance to accommodate each patient's individual needs and presentabilities:
,1 the number of movements provided by the robot. which far exceeds any dosage i;,;'imlgrH be admlrllstered by a human therapist:
:J the benefiCial coupling of movements Vvlth sensory information - from both the VISUcl;
display and the robot arm itself - which shows the goal, the desired path to follow i',,::,current hand position, and measures of movement q:Jality; and
6 the fact that all movements are successful due to the robot assistance; the robot cJoesntlet the brain experience grossly inappropriate responses to it's motor commands
Aisen, M L , Krebs, H I., McDowell, F.; Hogan, N.; Volpe, 8T, "The Effect of Robot AssistedTherapy and Rehabilitative Training on Motor Recovery Following a Stroke"; Arch of Ncuiol54 .143-446, (1997)
Krebs, H I.; 8rashers-Krug, T.; RaUCh, SL; Savage, C.R.; Hogan, N.; Rubin, R H, Fischma:,A J , Alpert, NM; "Robot-Jl,ided Functional Imaging: Application to a Motor Learning SlU(~'i",!--{uman Brain Mapping; John Wiley & 'Sons, 6:59-72; (1998)
'<rebs, HI, Hogan, N , Alsen, M.L.; Volpe, 8T; "Robot-Aided Neuro-Rehabilitation", IEf.E-'i'l ansael,ons on Rehabilitation Engineering, 6.175-87: (1998)
Krebs, HI, Hogan, N , Aisen, ML.; Volpe, B.T., "Quantization of Continuous Arm Movements Ii:
Humans With Brain Injury", Proc. Nat. Acad. of Science 964645-4649, (1999)
Hogan, N, Doeringer, J.A; Krebs, H.I; "Arm Movement Control is both Co,tlnuous and Olscreie'Cognitive Studies; 8ulletin of the Japanese Cognitive Science Society, 6 3254-273, (1999)
Volpe, B T , Krebs, HI, Hogan, N, Edelstein, L , Diels, C.M, Aisen, M L, "Robot TrainingE:ihanced Motor Outcome in Patients with Stroke maintained over 3 years", Neurology 5~12;0 (1999)
Kiebs f I I , Volpe 8 T, Alsen, M L, Hogan, hJ , "RobOtiC I'....pplicatlons ill Neuromoto,F~erlab;lltatlon", Topics In Splflal Cord Injury Pehabllitation, 53, pp50-63, (1999)
Volpe, 8 T , Krebs, H I, Hogan, N, Edelstein, L, Diels, C.M., Aisen, M .. ",6.. Novel/.\,pprO.3ctl ,0
Stroke Rehabilitation. Robot Aided Sensorymotor Stimulation", Neurology, 541938-194<\. \ ;00(';
Krebs, HI, Volpe, 8T, Aisen, M.L., Hogan, N.; "Increasing Productivity and Quality of CareRobot-Aided Neurorehabilitation", VA Journal of Rehab!1 Res and Oev, 3713639-652, (2000)..Krebs. HI. Volpe, 8 T, Palazzolo, J; Rohrer, 8; Ferraro, M ; Fasoll, S , Edeistelll, L . Hogan :":"F<obc)~-,L\lcJedNeuro-Rehabilltation In Stroke Interim Results on the FolloVv-up of 76 Pallen,) c;::con MovE'Jnent PerfOriilanCe Indices". In Mourllr rv10khtari (ed), IntegratiOn of ASSlslrve T,~c,";i1,)::::~
'II [tie Informalion Age: 10S Press, .AS~·istlveTechnology Researc-, ,Series, f\rn';;l(:;r,j2Jrrl.:2()(l I \
IKrebs, H 1, Hogan, N., Hening, W., Adc.movich, S, Poizner, H; "Procedural Motor Learning InParkinson's Disease"; Exp. Brain Res i41 :425-437 (2001).
Krebs, HI: Volpe, B.T.; Ferraro, M.; Fasoli, S; Palazzolo, J.; Rohrer, B; Edelstein, L , Hogan, !~."Robot-Aided Neuro-Rehabilitation: From Evidence-3ased to Science-Based Rehabilitation":Topics in Stroke Rehabilitation; 84:5L1 ·70, (2002)
r!r..Jgan N "~,keletal Muscle Impedance in the Contrc,1 of Motor Actions"; Journal of Mech2nlCS in,'\!leOICllle 21()(j Biology 2(3 & 4):359-37::: (2002)
i=-~ohrer8 , Fasoli, S., Krebs, HI , Hug;les, R, Volpe, B. Frontera, W R , Stein, J . Hoger" f..J"Movement Smoothness Changes dUring Stroke Recovery", J Neurosci, 22.18 8297 -o30~(2002)
Malfait, N, Shiller, D.M ; Ostry, D.J ; "Transfer of Motor Learning Across Arm Configurations"Journal of Neuroscience; 22(22):9656-9660, November 15, (2002).
I:::lsoli, S D , Krebs, HI, Stein, J, Frontera, W.R and Hogan, N , Effects of RobotiC Ther'apy 0"Motor Impallment and Recovery In Chronic Stroke, Archives of Physical MedlcJrle ijnd RUle!).34477-82 (2003)
Krebs, HI, Volpe, B.T., Aisen, ML., Hening, W ,Adamovich, S., Poizner, H , Subrah~n8nY2n. v,Hogan, N , Robotic Applications in Neuromotor Rehabilitation, Roborica, 21 3-11 (200:3)
Hogan, N, Krebs, HI, Rohrer, B, Fasoli, S, Stein, J, Volpe, BT, Technology for Recovery oft.erStroke, In JBogousslavsky, MP Barnes, B. Dobkin (Eds.), Recovery after Stroke, Camb!lrjgr~r::>ress(2003).
Krebs, HI, Palazzolo, JJ, Dipietro, L., Ferraro, M.,·Krol, J, Rannekleiv, K, Volpe B T , HoganN , Rehar)llltation Robotics: Performance-based Progressive Robot-Assisted Therapy.-~u!onomous Robots, Kluwer Academics 157 -20 (2003)
f--:erraro, M ; Palazzolo, J.J , Krol, J; Krebs, HI, Hogan, N; Volpe, B.T , Robot AidedSensorimotor Arm Training Improves Outcome in Patients with Chronic Strok.e Neurol'J9.v0'11604-1607 (2003).
i-Ienriques, 0, Soechting, J.; "Bias and sensitivity in the haptic perception of geometry", b'p3ratn Res (2003) 15095-108
Krebs, HI; Celestino, J.; Williams, 0; Ferraro, M.; Volpe, B.T.; Hogan, N; "A Wrist Ey.l'2nSlon IeMIT·MANUS;" In Z Bien and D. Stefanov (Eds.): Advances in Human-Friendly RobotiCtechnologies for Movement Assistance / Movement Restoration for People With Oisabil!liC'sSpringer-Verlag (2004)
i:;;lsoli, SO, Krebs. HI, Stein, J, Frontera, WR, Hughes R, and Hogan, N, RobotiC Th2r2r-~.. lorChronic Motor Impairments after Stroke: Follow-Up Results, ArchPhysMedRehab 8511 06-1 ~1 .12004 )
.~~.,
Fasoli, SO, Krebs, H.I , Ferraro, M, Hogan, N, and VoJ~e, B.T , Does Shorter RehabilllO(IOn
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on Motor System Plasl:ily, Recovery, and Rehab,·,tallOn, Restorative Neurology & Ncurosc,(2G0L1)
KrebS, H I. Volpe, B T, Lennlnhan, L, Fasoli, S, lynch, 0, Dominick, L , Hogan N .. "N(,:.=-s ()o:
r~.ehablillatlon Robotics end StrOke," In. F. Lofaso, il, Roby-Brami, J.F. Ravclud (Eds )Tr=:chnoiog,cal Innovations and Hancf'cap, Frison R:jche, pp 177 -194 (200.1)
,!o;pe S T , Ferraro, M , Lynch, D, Christos, P, Kr~)I, J, Trudell, C, Krebs. HI, Hogan ~J .'RubollCS and Oltier 00vlces In ti,e -,-reatment of F'atlents Recovering from Stroke," Cur;:Jnneroscler Rep, 6 314-319 (2004')
Krebs. HI, Ferraro, M, Buerger, SP, Newbery, ~"1.J.,Makiyama, A., Sandmann, M , Lynch. D\'/olpe, B T , Hogan, N., "Rehabilitation Robotics: Pilot Trial of a Spatial Extension for MIT-fv1a:lusJournal of NeuroEngineering and Rehabilitation, E;:omedcentral, 15 (2004)
Stein, J, Krebs, H.I., Frontera, W.R, Fasoli, S.E., Hughes, R, Hogan, N., "Companso~i of T,,\(.Techniques of Robot-Aided Upper Lirnb Exercise Training After Stroke." Arneocan JournalPI:yS'CCJI Medicine Ref,abllJlation, 839720-728 (2004).
J.
ROhrer, 8, Fasoll, S, I<rebs, H,I, Volpe, B, Frontera, W.R, Stein, J, Hogan, N, "SubmovementsGrow L2rger, Fewer, and More Blended During Str,pke Recovery," Motor Control, 8.472-<'183(200.1) ,I
"
Fasoll, S E, Krebs, H.I., Hogan, N., "Robotic Technology and Stroke Rehabilitation. Transi8:w,<;Research Into Practice," Topics in Stroke Rehabilitation, 114: 11-19, (2004)
Stein, J . Hughes, R, Fasoli, S., Krebs, HI., Hogan, N, "Clinical Applications of Robots InRehabilitation," Cot/cal Reviews in Physical and Rehabilitation Medicine, 17 (3). 217 -230 (:::'r.'C~,
Dipietro, L , Ferraro, M, Palazzolo, JJ, f<rebs, H.I, Volpe, 8T, Hogan, N , "CustomizedI,teractlve Robotic Treatment for Stroke: ErvlG-Triggered Therapy," IEEE Transaction Neu/(I,Sysrems and RehabilllatlOn EnQ,lneering, 13:3:325-334 (2005),
Finley, fV1 1\., Fasoli, S E, Dipietro, L., Ohlhoff, J., I'vlacClellan, L, Meister, C, Whltall, J , M?C":'~1R bever, C T, Krebs, H.I., Hogan, N., "Short Duration Upper Extremity Robotic Therapy I;~
Stroke Patients with Severe Upper Extremity Motor Impairment," VA Journal RehabJiilainJnResearch and Development, 42(5)683-692 (2005).
Daly ,J , Hogan, N , Perepezko, E" Krebs, H,I" Rogers, J" Goyal, K" Dohring, M , f:redrlckSGnE ~Jethery, J , Ruff, R, "Re'sponse To Upper Limb Robotics and Functional NeuromuscularStimulation Following Stroke," VA Journal of Rehabilitation Research and Development Ij2(6!72~-,35 (2005) ,
MacClellan, L R , Bradham, D.D" Whitall, J, Volpe, 8, Wilson, P 0, Ohlhoff, J ,Meister CHogan, N, Krebs, HI, Bever, C1" " Robotic Upper Extremity Neuro-Rehabilltatlon In ChrQi->ICStrokei"patlents," VA Journal of Rehabilitation Research and Development 42(6) 717 -722 \ 2005,
Krebs, HI, Hogan, N; Durfee, W,; Herr, H.; f-<ehabilitation Robotics, Orthotics, and ProsllietlcsCr,apter 48, In M.E. Selzer, S. Clarke, L.G. Cohen, PW Duncan, F H. Gag2 (Eds): TextLJOok 0:
ai1el Stroke ., In Bogousslavski, J., Barnes, M P., Dobkin, B. (eds), Recovery arter Stroke, Chepter
::'0. Cambridge University Press 2003
Krebs, HI; Celestino, J.; Williams, 0; Ferraro, M.; Volpe, B.T,; Hogan, N.; "A Wnst ExtenSion wMIT-MANUS;" In Z Bien and D. Stefanov (Eds); Advances In Human-Friendly Robol:CTechnologies for Movement Assistance / Movement Restoration for People Wllh D,sabJl
W~~cO~l~~b-th~ ifobo_tm~Lap~!
~ April 20th, 2010 by David E. Williams Qfthe Health business blog
.~~s~tten, th~ Ne~ Englcrt1dJournal ofl'y~edici~e article (!ioDoc-Assisted TheralJv [or Long-TermUODer-Llmb ImDazrm,ent after Stroke) clarms qUIte modest results for robot thera B tw hI h h l' ~ l1-.~- 'fth '. . - , . py. e een me:J21es,t oug ,~Ie p_owe~ LUlltS0 e J..;Jllpendmgrobot revolution. (The article is free and IcncouIage you to read It.)
~es:arch~rs recruited Veterans A<:l,no~stratiO'n(VA) patients who'd suffered strokes an average of 5yealS ec:rber. Volun1eers were randorruzed to 12 weeks of robot-assisted therapy, intensivecompa.1J.son therapy, or usual care (medical management and some rehabilitation servic~s available to
,,-' .._---- .._---------'-,_ .. _--- .. -- ., _."._----_ .._-----_ ..,-- '--'-'.-.-'---,--_.
all patients), The primary outcome was change in motor function at 12 weeks as measured by theFugl-Meyer score. Patients were also evaluated after Q, 24 apd 36 weeks,
Results showed that robot-assisted therapy did not significantly improve motor function at 12 weekscompared to usual care or intensive therapy, although there was significant improvement on theStroke Impact Scale (SIS). At 36 weeks robot-assisted therapy and intensive therapy perfo!TD.edabQ'J~the saIne, and both were superior to usual care.
So what's the big deal? Actually a few tbings:
• Intensive therapy -whether performed by a robot or a hUJ:J:.Cin-dem.onstrated its superiority tousual care. The intensive therapy delivered by therapists ii'l tills trial was so intensive: >1000movements in a session compared to 45 for typical stroke treatment -that it's really onlyavailable under controlled conditions with a researcher standing over the therapist with astopwatch. If you want this l<..indof intensive' therapy for ycurself you'd beneT hire someO!2ewit-h a whip (or bnng John Hen.:::Y,backfrom the dead' and~ake the harruner om ofbs t:.ar:.d).
• A close read of Table 2 (Changes in Primary and Se..£.QQ.Q§ryOl1tcomes at 12 Weeks) strO!2g!ysuggests better results for the robots thdn the authors are willing to claim explicitly. The le.5:side of the table measures robot-assisted therapy 'Is. usual care. The right colUlT'..D.srneaS'lrerobot-assisted therapy 'Is. intensive comparison therapy. The performance of the robot gTQl!~' ismuch better on the right side of the table than the left. If we compare the robot numbers O!ltheright with the usual care numbers on the le~ the cOIDJnrrisQuslook much betteT for the robots,including a 5 point improvement on the Fugl-Meyer score (which is extremely impressive forsomeone 5 years after a stroke). .
So why is the table set out this way? It appears that patients were only e!lIolled L'1usual care fc:the [lIst 16 months of recruitment, whereas the recruitment period for rob01-assisted and~ntensive l;herapy cOIl,tinued for 24 months. I don't understand why the usual care recr'IJitrDe!2twas stopped -perhaps the study was on a tight budget? In any case it's likely that the therapls'(c;operating the robots fonowed a lea..ruing CUri''; du.ring the study and were betteT able to opeTattthe TObots in the second part of the study thaD.the fi...;rst,willch is the portion of the studyanalyzed on the left side of the table. The authors state that the robot manufacturer (ImtTaCti'/eMotion Tecl-moloszies) had "no role in the st1;ldy,"willch could mean the therapists had to figt!.:tom the robot for themselves and would not neve been as good at first.
The fact that tlois information is presented int21.esame table appears to be a tacita.cknowledgment that the researchers also beJieve in the GOmpa..risonI a..rnsuggesting .
. L'r.bor savings were large. One-hoW' sessions required or:0y.15 minutes of contact wit.l-J. t.l-J.etheraDist fOTthe rot,ot versus 60 minutes fOT,the intensive comnanson theranv. Th?T hi'l.~
~espite ~e ~$10.K cost ofusing,t1le robot. That means the robot group patients used only one-~~ of tb,:.medlcal resour:ces of the ,usual care group ($5K versus $15K) while makingSl.gmfica.:r:l.rmprovements ill health status. That's incredibly g00d news and must have been abig surpnse to the researchers. ".
"
An a~companying editorial (BrClin .Repc:ir c:fter Stroke) acknowledEes the accomplishments of thisstudy and emphasizes the broader rmpllcatlOns. ' ."
In the ?igge~ picture, the potential. for robotic therapy after snoke remains enormous.RobOTICdeVlces can provide therapy in differ:ent functional modes, a point that was not
-ex~~db,yL-;- et ai Rob~ts work~'~-;onsistent"and p-;;ecisern?JIDer and over-lOng- ."periods vYithout fatigue. They can modulate timing, content, and intensity of training inreproducible ways, with a reduced need for human oversight. Robotic devices can alsomeasure the performance of patients during therapy. In addition, robot- based therapy caninterface with computers in brain-stimulation treatment or to provide simultaneouscognitive training.
You C31"1 also check out a yideq, of the robot in action.
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