Robot-assisted stroke therapy to be tested at four VAMCs
From: VA Research Currents - 10/2006 - page 1

Therapy that uses robots to help chronic stroke patients move their affected
upper limbs will be compared with intensive non-robotic therapy in a new VA
clinical trial involving 158 veterans at the West Haven, Seattle, Gainesville
and Baltimore VA medical centers. 

The trial, which kicked off last month, is the first to be funded jointly by
VAs Rehabilitation Research and Development Service and its Cooperative
Studies Program. The chairperson is Albert Lo, MD, PhD, of West Haven. 

The study will feature a robot called the MIT-Manus, developed at the
Massachusetts Institute of Technology. Patients sit at a table with their
affected arm attached to the robot. They follow prompts on the screen - or
instructions from a therapist - and try to perform a task with their arm. The
robot senses their movement and helps as needed. 

'Power steering' for the arms 

"These are videogame-like tasks," said neurologist George Wittenberg, MD,
PhD, principal investigator for the Baltimore site. "The patients are moving
a cursor from one place to another, or guiding a symbol on the screen through
a maze, and using their arms to control the movement of the cursor. The
robots provide 'power steering' for the arms - just enough assistance to
allow people to move."  

Adds Wittenberg: "The design of the robotic therapy, in at least some of the
control paradigms, actually mimics what therapists do - the so-called
hand-over-hand therapy, where the therapist is asking the person to move, but
then provides assistance and support where needed. The difference has to do
with the intensity and the duration of therapy thats possible with the
robot."  

The goal is to help restore motor function. In previous research with the
robots, patients produced "short, fragmentary movements," said Wittenberg,
that over time became longer and smoother. In one study, patients in the
robot-assisted group improved twice as much as those in the usual-care group. 

The therapy relies on neuroplasticity - the ability of the adult brain to
"rewire" itself. When neurons die because of a stroke, other brain cells -
prompted by assisted body movements - apparently begin compensating for the
lost function. Researchers have been working to identify the best therapies
to exploit this phenomenon, and find out how long after a stroke it remains
active. 

"The older thinking was that approximately a year after a stroke, there
wasnt any useful neuroplasticity and that further therapy wouldnt have any
further effects on motor function," noted Wittenberg. "But there have now
been several studies using a variety of techniques that have shown gains
after that one-year time period, and there is evidence that there is
plasticity that still goes on long after a stroke."  

Participants in the new study will be at least six months post-stroke, and
will receive 12 to 14 weeks of therapy, one hour three times per week. In the
non- robotic arm of the study, therapists will help patients with stretching,
guided reaching, and other activities to achieve the same functional goals as
those using the robots. In real-world practice, patients at this stage after
a stroke are typically receiving little, if any, formal therapy. 

If the robots shine in the new VA study, they could be well on their way to
becoming a regular part of stroke therapy in clinics across the nation.
According to study chairman Lo, "If robotic training proves beneficial, it
will make more widely available high-quality, evidence-based rehabilitative
care at a time when there is a shortage of experienced therapists and a
progressively growing rehabilitative need for veterans and all Americans."  

From:
http://www.research.va.gov/resources/pubs/docs/va_research_currents_oct_06.pdf

Photo caption: Sharon Turner, a patient at the Baltimore VA Medical Center,
receives therapy with the MIT Manus. 

Links:
A Helping Arm
http://www.technologyreview.com/read_article.aspx?id=16029&ch=nanotech

Clinical Trials News: Using Robots to Regain Ground after a Stroke
http://www.usnews.com/usnews/health/articles/061018/18healthweb.htm

MIT robot aids therapy of stroke victims
http://web.mit.edu/newsoffice/2000/manus.html

Robotic physical therapy improves movement long after stroke
http://www.eurekalert.org/pub_releases/2002-02/aha-rpt020102.php


