Service Robotics: Robot-Assisted Training for Stroke Rehabilitation

摘要

Stroke, a cerebrovascular accident, is a leading cause of permanent disability in adults, with clinical symptoms such as weakness, spasticity, contracture, loss of dexterity, and pain at the paretic side. Approximately 70% to 80% of people who sustain a stroke have limb impairment and require continuous long-term medical care to reduce their physical impairment 1, 2 . In the absence of direct repair on the damaged brain tissues after stroke, neurological rehabilitation is an arduous process, because poststroke rehabilitation programs are usually time-consuming and labor-intensive for both the therapist and the patient in one-to-one manual interaction. Recent technologies have made it possible to use robotic devices as assistance by the therapist, providing safe and intensive rehabilitation with repeated motions to persons after stroke 3, 4 . The most commonly reported motion types provided by developed rehabilitation robots are: 1) continuous passive motion, 2) active-assisted movement, and 3) active-resisted movement 5 . During treatment with continuous passive motion, the movements of the patient's limb(s) on the paretic side are guided by the robot system while the patient stays in a relaxed condition. This type of intervention was found to be effective in temporarily reducing hypertonia in chronic stroke 6 , and in maintaining joint flexibility and stability for persons after stroke in the early stage (within 3 weeks of onset) 5 . However, passive movement did not significantly benefit motor improvement. In activeassisted robotic treatment (or interactive robotic treatment), the rehabilitation robot would provide external assisting forces when the patient could not complete a desired movement independently. For chronic stroke (>1 year after stroke), it has been found that with voluntary attempts by the patients, the interactive robotic treatments were more effective for motor functional improvement than treatments using continuous passive motions 5, 7 . Robotic treatment with active-resisted motion involved voluntarily completing movements against programmed resistance 8 . It has been found that repetitive practice of hand and finger movements against loads resulted in greater improvements in motor performance and functional scales than Bobath-based treatment 9 , transcutaneous electric nerve stimulation, and suprathreshold electric stimulation on hand and wrist muscles 10 . In robotic therapy, repeated practice against opposing force mainly improved the muscle force from www.intechopen.com