Robotic therapy: the tipping point

Abstract

The last two decades have seen a remarkable shift in the neurorehabilitation paradigm. Neuroscientists and clinicians moved away from the perception that the brain is static and hardwired to a new dynamic understanding that plasticity is a fundamental property of the adult human brain and might be harnessed to remap or create new neural pathways. Capitalizing on this innovative understanding, the authors introduced a paradigm shift in the clinical practice in 1989 when they initiated the development of the Massachusetts Institute of Technology-Manus robot for neurorehabilitation and deployed it in the clinic in 1994 (Krebs et al. 1998). Since then, the authors and others have developed and tested a multitude of robotic devices for stroke, spinal cord injury, cerebral palsy, multiple sclerosis, and Parkinson disease. Here, the authors discuss whether robotic therapy has achieved a level of maturity to justify its broad adoption in the clinical realm as a tool for motor recovery.

Figure 1

VA-Robotics Outcomes. The left column shows the comparison of the first half of the robot training (RT) group with the usual care (UC). The right column shows the comparison of the robot and intensive comparison training (ICT) groups.

Figure 2

Illustration of the Impact of Fixed-Model Selection on the Estimates of 36-Week Outcomes

Figure 3

Clinical Results of Robotic Therapy in Stroke Using Lokomat. Top row shows the results with chronic stroke (enrollment > 6 months post stroke) and the bottom row shows results of subacute stroke trials (enrollment between 3 and 6 months’ post-stroke). Dark gray = conventional gait training, Light gray = Lokomat gait training. * indicates statistically significant between-group differences (p < 0.05).