Upper Limb Rehabilitation After Stroke Through Functional Task Focused Intervention
Stroke results in abnormal muscle synergies, weakness, and spasticity in the affected upper limb, which results in decreased performance of activities of daily living (ADL) and reliance on compensation strategies. Recent clinical reviews have shown the success of functionally motivated clinical intervention, and have shown that recovery of joint coordination is possible and may aid in recovery of real world use of the affected limb. Rehabilitation robots and other devices have become increasingly prevalent for administering arm rehabilitation therapy. The following research shows the benefits of technologies that assist with functional task focused therapy for stroke victims. The research on functional therapy technology was broken into three components. 1) A device, Hand Spring Operated Movement Enhancer (HandSOME), was developed to allow for functional training with real and virtual objects. This device was tested in a cross-sectional study with eight chronic stroke subjects, and significantly improved active range of motion (p<0.001) and functional grasp (p=0.002).2) A mode of therapy that focuses on normal joint coordination was developed, Time Independent Functional Task Training (TIFT). This mode was validated with thirty-seven neurologically normal subjects and nine stroke subjects. The mode showed improvements over conventional robotic training modalities in reduction of wall interaction torque, and increased amount of active arm joint coordination during training. 3) Finally, the integrated system of the HandSOME device and TIFT modality with the ARMin III robot was use to training eleven chronic stroke subjects in eight 1.5 hour sessions. After training the subjects significantly improved in Action Research Arm Test score (p=0.01) showing that the therapy improved the subjects' ability to manipulate objects. Overall, the therapeutic system shows potential for improving functional use of the affected arm after stroke.
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