RehabWire - Volume 7, Number 2, March 2005

Where is the future of rehabilitation headed? RehabWire for March features projects and research articles on robotics and their role in disability and rehabilitation.

NIDRR Projects: Research in the New Millennium.

University of Pittsburgh Brain Injury Model System (UPBI), University of Pittsburgh (H133A020502) led by Ross D. Zafonte, DO. A. Cate Miller, PhD, Project Officer.
Abstract: The project evaluates the impact of selected innovations in technology on service delivery, functional outcome, and as a therapeutic intervention for persons with TBI. It addresses the shortcoming in wheelchair design for persons with brain injury by evaluating a unique, personalized powered mobility system. Collaboration with the Robotics Institute at Carnegie Mellon University allows researchers to perform a randomized trial evaluating the efficacy of virtual reality and robotics for persons with TBI. Finally, the project uses intelligent navigation technology to implement and evaluate a web-based virtual case manager support structure for persons with TBI and their families.
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Selective Dynamic Strength Training to Enhance Upper Limb Coordination Following Stroke, Northwestern University (H133G030143) led by Julius Dewald, PT, PhD. Theresa San Agustin, MD, Project Officer.
Abstract: This study investigates the use of a novel selective dynamic strengthening protocol, which incorporates a two-joint robotic device to overcome gravity induced abnormal movement synergies following hemiparetic stroke. The specific objectives are the evaluation and demonstration of the usefulness and effectiveness of this selective dynamic robot-supported training regime for enhancement of quality of life of stroke survivors. The evaluation and training paradigm provides quantitative outcome measures, which can be used to reliably track a patient’s progress using technology that is easy to implement with no risk of injury. The long-term goals of this study are the technological development and implementation of a simple, user-friendly, robot-supported therapeutic intervention accessible to consumers in both in- and out-patient clinics.
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RRTC on Technology Promoting Integration for Stroke Survivors: Overcoming Social Barriers, Rehabilitation Institute Research Corporation (H133B031127) led by Elliot J. Roth, MD. Thomas Corfman, Project Officer.
Abstract: This project develops and evaluates a sequence of robotic training and assistive devices that are designed with the idea of promoting efficient function in the workplace or at home, and with the further intent that they form a basis for the development of appropriate technologies to allow people with disabilities ready access to existing facilities in the community.
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Gait Abnormalities in Individuals with Stroke: Implications to Rehabilitation, Rehabilitation Institute Research Corporation (H133G040065) led by Yasin Y. Dhaher, PhD. Kristi E. Wilson, PhD, Project Officer.
Abstract: This project assesses hip kinematics using standard motion analysis technology during overground walking, and kinetics measured during constrained (i.e., sagittal plane restricted) simulated treadmill walking using an instrumented robotic gait orthosis. These behaviors are compared to static measures of both volitional and reflex (stretch) measurements at the hip, knee, and ankle joints of the affected limb. Such measurements are performed in individuals with chronic stroke to identify factors that contribute to abnormal frontal plane behaviors. In individuals with acute stroke, research characterizes the mechanisms underlying development of abnormal frontal plane kinematics throughout the natural recovery and rehabilitation processes. Finally, by providing specific gait retraining paradigms at the initial and chronic stages of injury, the project determines the mutability of abnormal gait kinematics throughout the recovery process.

man in therapeutic robotic walker

RERC on Rehabilitation Robotics and Telemanipulation: Machines Assisting Recovery from Stroke (MARS), Rehabilitation Institute Research Corporation (H133E020724) led by W. Zev Rymer, MD, PhD. Thomas Corfman, Project Officer.
Abstract: This program centers its research and development on restoring function in hemispheric stroke survivors. Five projects assess five different approaches that have the potential to improve performance of the upper extremity, and one project attempts to restore locomotion. These projects include: (1) robotic therapy for force training of the upper extremity in chronic hemiparetic stroke; (2) gait restoration in hemiparetic stroke patients using goal-directed, robotic-assisted treadmill training; (3) development of a robotic system with an augmented reality interface for rehabilitation of brain-injured individuals; (4) rehabilitation of finger extension in chronic hemiplegia; and (5) a home-based telerehabilitation system for improving functional hand and arm movement recovery following stroke.
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RERC on Spinal Cord Injury: Keep Moving: Technologies to Enhance Mobility and Function for Individuals with Spinal Cord Injury, Los Amigos Research and Education Institute, Inc. (LAREI) (H133E020732) led by Samuel Landsburger, ScD; Robert Waters, MD. Theresa San Agustin, MD, Project Officer.
Abstract: This RERC improves the lives of individuals with SCI by promoting their health, safety, independence, and active engagement in daily activities. Activities include monitoring trends and evolving product concepts that represent future directions for technologies in SCI and conducting research to advance the state of knowledge. An active Mobile Arm Support for adults allows those with limited arm function greater independence. The shoulder-preserving wheelchair, gait training robotic assist device, and adaptive exercise equipment are all specifically geared to preserve or enhance mobility in individuals with SCI.
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New Research: Selections from REHABDATA

Fasoli, S. E., Krebs, H. I., Stein, J., Frontera, W. R., Hughes, R., Hogan, N. (2004) Robotic therapy for chronic motor impairments after stroke: Follow-up results. Archives of Physical Medicine and Rehabilitation, 85(7), 1106-1111. NARIC Accession: J48122.
Abstract: Study evaluated the effects of robotic therapy on motor impairment and recovery of the affected upper limb more than 1 year after stroke. Subjects received 1 hour of robotic therapy 3 times weekly for 6 weeks. Two types of therapy were provided (sensorimotor and progressive-resistive) consisting of goal-directed, planar reaching tasks to exercise the affected shoulder and elbow. Baseline clinical evaluations were conducted during a 1-month observation period before robotic therapy using the Modified Ashworth Scale, the Fugl-Meyer Assessment (FMA), the Motor Status Scale, (MSS), and the Medical Research Council motor power score. The same evaluation tools were used to assess the effects of robotic therapy after 3 and 6 weeks of intervention and at the 4-month follow-up. Analysis revealed significant improvements from admission to discharge on the FMA, the MSS, and the motor power score. No significant differences were found among pre-treatment clinical evaluations. The findings suggest that robotic therapy can produce improvements in motor abilities in people with chronic impairments that are sustained 4 months after training ends.

Anson, D. (Ed.) (2004) RESNA 27th international annual conference: Technology and disability: Research, design, practice, and policy. NARIC Accession: O15728.
Abstract: Proceedings of the annual conference of RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America, includes over 200 presentations on all facets of assistive technology (AT) through workshop sessions, scientific platform sessions, interactive poster presentations, integrated demonstrations, and a symposium on AT outcomes. The program has three conference tracks: practice, research, and public policy. Within each track, the scientific papers are grouped according to the following categories: (1) computer applications and communications; (2) job and environmental accommodations, including ergonomics; (3) outcomes and quantitative measurement; (4) seating and wheeled mobility; (5) technology for cognitive and sensory impairments: (6) public policy; and (7) other, including: technology transfer, rural rehabilitation, robotics, and telerehabilitation. The winning papers for the Student Scientific Paper and Student Design competitions are also included. The papers presented at this conference are available on CD-ROM.

Stein, J. (2004) Motor recovery strategies after stroke. Topics in Stroke Rehabilitation, 11(2), 12-22. NARIC Accession: J47671.
Abstract: Article describes a number of exercise techniques that have been incorporated into traditional stroke rehabilitation and have been shown to improve motor function after stroke. These strategies include: constraint induced movement therapy, robot-aided rehabilitation, virtual reality, treadmill training, biofeedback, functional electrical stimulation, exercise intensity, and acupuncture. Medications to enhance recovery, growth factors, and stem cells have been proposed as possible adjunctive treatments.

Cooper, R. A. (2004) Bioengineering and spinal cord injury: A perspective on the state of the science. Journal of Spinal Cord Medicine, 27(4) 351-364. NARIC Accession: J46885.
Abstract: Article reviews the application of advances in bioengineering research within the assistive technology (AT) industry for people with spinal cord injury (SCI). Current research and development activities include wheelchair technology and transportation safety, seating and soft-tissue biomechanics; neuroprostheses; robotic systems for gait training and manipulation; computer access and environmental control systems; and accessibility of the built environment. Advances in power electronics, telecommunications, controls, sensors, and flexible manufacturing have just begun to be applied AT for people with SCI. Project Number: H133N000019.

Kulyukin, V., Gharpure, C., De Graw, N., Pavithran, S. (2004) A robotic guide for the visually impaired in indoor environments. In D. Anson (Ed.), Proceedings of the RESNA 27th International Conference: Technology and Disability: Research, Design, Practice and Policy. Arlington, VA: RESNA Press. NARIC Accession: O15815.
Abstract: Paper describes an assisted navigation system for people with visual impairment that consists of a mobile robotic guide and small sensors embedded in the environment. Several aspects of assisted navigation are discussed that were observed in the pilot study in which 5 individuals with visual impairment interacted with the robotic guide in indoor environments. This paper was presented at the 2004 annual conference of RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America and is available on CD-ROM.

Kulyukin, V., Sute, P., Gharpure, C., Pavithran, S. (2004) Perception of audio cues in robot-assisted navigation. In D. Anson (Ed.), Proceedings of the RESNA 27th International Conference: Technology and Disability: Research, Design, Practice, and Policy. Arlington, VA: RESNA Press. NARIC Accession: O15816.
Abstract: This research examines the preferences for method of input and output among individuals using a robotic guide to navigate an unfamiliar indoor environment. Five individuals with visual impairment participated in experiments testing audio perception, speech recognition, and speech understanding of the system. Results did not indicate a clear preference for speech or audio icons; however, speech appeared to be a better output medium than input. This paper was presented at the 2004 annual conference of RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America and is available on CD-ROM.

Zhang, D., Mokhtari, M. (Ed.) (2004) Toward a human-friendly assistive environment. Assistive Techology Research Series, 14. NARIC Accession: R08566.
Abstract: Volume compiles information presented at the 2nd International Conference on Smart Homes and Health Telematics, which focused on the usability of various assistive technologies by elderly adults and people with disabilities. Presentations are organized into the following chapter topics: human-machine interface, Smart home and healthcare, context awareness and activity monitoring, communications for health telematics, and personal assistive devices and robotics.