Accurate assessment and impairment-specific rehabilitation training with novel robotic devices for acute/sub-acute stroke survivors

Abstract

Stroke is the main cause of adult disability in the US, with nearly 800,000 cases each year. With the rate of new cases increasing, there is a growing need for effective and precise rehabilitation. Robotic guided therapy has been employed ever more frequently in recent years. Although promising results have been achieved, there is more improvement needed to make robotic rehabilitation the new precision rehabilitation standard. We believe that significant gains could be achieved by conducting accurate assessment of impairment and initiating therapy during the acute phase post stroke, when the neuroplastic mechanism in the human brain is most effective. However, the absence of well‐defined protocols and clinic-ready devices has limited the delivery of early guided precision rehabilitation in the acute stroke care setting. In an effort to address these problems, in Chapter 2 we seek to accurately assess the complex changes that stroke induces across the multiple joints in the upper extremities, looking at passive, active and somatosensory properties. In Chapter 3 we will present the development of a new device, the FlexiArm an arm-hand exoskeleton designed for acute and subacute stroke rehabilitation. Finally, in the fourth chapter we will present a new facilitated neurorehabilitation strategy for acute patients post stroke based on our novel occlusion enhanced therapy. Through this work we have gained a deeper understanding the effects of stroke on the upper extremities. We have developed a series of rehabilitation robots designed to be portable and lightweight, suitable for acute stroke rehabilitation. We finally explored occlusion/reperfusion techniques applied to acute and subacute subjects and developed a new rehabilitation protocol to facilitate recovery of stroke survivors with severe impairment.