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Volume 42 Number 6, November/December 2005
Pages 717 — 722

Abstract - Robotic upper-limb neurorehabilitation in chronic stroke patients

Leah R. MacClellan, MSPH;1* Douglas D. Bradham, DrPH;1-2 Jill Whitall, PhD;3 Bruce Volpe, MD;4-6
P. David Wilson, PhD;1 Jill Ohlhoff, BA;3 Christine Meister, OTR;7 Neville Hogan, PhD;6,8 Hermano I.
Krebs, PhD;4,6 Christopher T. Bever Jr, MD9-10

1Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD; 2Department of Veterans Affairs (VA), Health Services Research and Development Service, VA Medical Center (VAMC), Baltimore, and Cooperative Studies Coordinating Center, VAMC, Perry Point, MD; 3Department of Physical Therapy, University of Maryland School of Medicine, Baltimore, MD; 4Department of Neurology and Neurosciences, Weill Medical College of Cornell University, New York, NY; 5Burke Medical Research Institute, White Plains, NY; 6Department of   Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA; 7Department of Physical and Occupational Therapy, VAMC, Baltimore MD; 8Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA; 9Department of Neurology, University of Maryland School of Medicine, Baltimore, MD; 10Department of Neurology, VAMC, Baltimore, MD
Abstract — This pilot study tested the effectiveness of an intense, short-term upper-limb robotic therapy for improvement in motor outcomes among chronic stroke patients. We enrolled 30 subjects with upper-limb deficits due to stroke of at least 6 mo duration and with a Motor Power Assessment grade of 3 or less. Over 3 wk, 18 sessions of robot-assisted task-specific therapy were delivered with the use of a robotic exercise device that simulates a conventional therapy known as skateboard therapy. Primary outcome measures included reliable, validated impairment and disability measures of upper-limb motor function. Statistically significant improvements were observed for severely impaired participants when we compared baseline and posttreatment outcomes (p < 0.05). These results are important because they indicate that improvement is not limited to those with moderate impairments but is possible among severely impaired chronic stroke patients as well. Moderately and severely impaired patients in our study were able to tolerate a massed-practice therapy paradigm with intensive, frequent, and repetitive treatment. This information is useful in determining the optimal target population, intensity, and duration of robotic therapy and sample size for a planned larger trial.
Key words: elbow flexion, MIT-Manus, motor impairment, motor skills, neuromotor recovery, neurorehabilitation, outcome measures, rehabilitation, robot-assisted therapy, robotics, shoulder abduction, stroke, therapy.

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