(Inside MossRehab Spring 2014) - At MossRehab’s Stroke and Neurological Disease Center, survivors of stroke are increasingly receiving help from clinicians of the mechanical variety—rehabilitation robots. These devices are helping individuals with stroke strengthen and restore arm movements, and are enhancing MossRehab’s reputation as a national leader in robotic rehabilitation.
“Used in conjunction with conventional stroke therapy treatments, robotic interventions can help patients increase the intensity and duration of precisely performed movements through the employment of adjustable assistance and resistance settings,” explains Alberto Esquenazi, MD, chief medical officer at MossRehab.
Robots help improve therapy by providing precise training that is frequent and intense. It’s this combination that helps stroke survivors build on their brain plasticity and recover higher levels of function. Evidence suggests that plasticity can be evoked in the adult brain even long after stroke.
Wide Selection
One of the keys to the success of robotic therapy for stroke survivors at MossRehab is the wide selection of devices made available.“Because no single robot works to improve all movements controlled by shoulders, elbows, wrists and fingers, we rely on a variety of unique clinical robots,” says Dr. Esquenazi.
MossRehab is home to some of the most complex and leading-edge upper limb robots available. The list includes the recently introduced Tyromotion collection—consisting of specialized arm, hand and finger rehabilitation robots called Diego®, Pablo®, Amadeo(R) and Tymo®. MossRehab patients also have access to the Armeo®Power, Armeo®Spring and the ReoGo which are used to initiate neuroplasticity and continue functional gains.
“Having tested and adopted several commercially available robots, we’re actively engaged in the development of clinical research, training protocols and clinical applications,” says Dr. Esquenazi. “In fact, MossRehab conducted the original U.S. clinical trials for the ReoGo. We are first in the nation to offer the entire Tyromotion collection, making MossRehab one of America’s most experienced providers of multiple integrated robotic applications.”
Understanding the nuanced benefits of each robot requires clinicians to first understand the unifying characteristic of all robots; they are designed to repeat motions.
“To promote proximal arm and elbow control through the robotic execution of lots of repetitive, passive or active motions, I recommend ReoGo and the ArmeoSpring. For digit motions, we use Amadeo,” says MossRehab Occupational Therapist Joseph Padova, OTR/L. “The implication for therapy is that with motor control for stroke survivors it is important to provide the opportunity to repeat the desired movement patterns frequently in carefully structured activities. These robots provide a way for us to do this, without fatigue factors that therapists can experience when trying to provide the guidance and handling of the limb over long periods of time.”
Padova, in conjunction with the Einstein Society, used some of this understanding to help design the RELEASTM hand splint, which is the first functional hand splint that allows wearers who meet specific criteria to use the impaired hand during activities of daily living after a stroke.“As a therapist, it is important to understand that robotics is not a replacement for the skills, judgments and teachings of the therapist,” Padova adds. “Rather, it is a tool that a therapist can combine with other techniques to maximize functional outcomes.”
Playing Games
Although robots are valuable therapy tools for therapists, they can be highly engaging for patients because the robotic tools are often paired with intuitive and interactive cognitive challenging gaming software.
“People really like games, computers and virtual interaction—it’s becoming a huge part of contemporary society,” explains Occupational Therapist Melissa Muller, OTD, OTR/L. “At MossRehab, our robots don’t just support current evidence-based practice concepts, such as mass practice activities, task-oriented activities, visual feedback during movement patterns, and reeducation of movement patterns post-stroke, they also reflect contemporary interests."
Muller notices particularly positive outcomes among patients with stroke who use Pablo and Tymo from the Tyromotion collection.
“The gaming software facilitates left and right scanning, saccades, and attention among clients with visual perceptual deficits. In terms of hemiparesis or weakness, the Pablo is a graded system and uses visual feedback and cause-and-effect interactions with the system to allow for distal or proximal movement patterns. The visual feedback helps its users understand and grade any active movement that they have available at any given time.” says Muller. “I generally like robotic interventions that allow for volitional movement.”
As always, MossRehab has one eye on the future.
“We are presently helping with the development of a muscle-activated trigger for the initiation of movement for the Amadeo and the Armeo Power,” says Dr. Esquenazi. “The patient may have paralysis but some muscle activity can be detected with special EMG sensors, which help us measure the electrical activity of the muscles.”
MossRehab's current research efforts suggest that robots have an even greater potential to provide the added benefits still wanted by so many patients post-stroke, as well as clinicians