1. David Reinkensmeyer, Ph.D.
ROBOTIC THERAPY FOR FORCE TRAINING OF THE UPPER EXTREMITY IN CHRONIC HEMIPARETIC STROKE
Leonard Kahn, M.S.
W. Zev Rymer, M.D., Ph.D.
David Reinkensmeyer, Ph.D.

2. WHICH ONE(S)?? Visual distortion
Proprioceptive neuromuscular facilitation
Bobath technique
Task-specific reeducation
Bilateral imitation
Resistive
WHICH ONE(S)??
Destabilizing
Active assist
Peg-in-groove
Passive constrained
Isometric
Stabilizing
Passive

3. Background - Rehabilitators for UE
MIT – MANUS: planar assistance in acute stroke
MIME: bimanual and 3-D assistance in chronic stroke
ARM Guide: linear assistance throughout workspace in chronic stroke
MIT - MANUS
MIME
ARM Guide

4. Rationale
ARM Guide results
Reaching along Guide
Performance of ADLs

5. Free Reaching Results
Data adapted from Lum et al., Arch. PM&R, 2002

6. Aims & Hypotheses Aims: Hypotheses: Guided force training…
to implement force guided training using the ARM Guide
to compare force guided training with traditional therapy and free reaching therapy for restoring UE function
Hypotheses: Guided force training…
accounts for the difference between the MIME and ARM Guide free reaching outcomes
will be more effective than free reaching exercises and conventional therapy in promoting arm movement recovery

7. Subject Population 7 6 5 4 3 2 1 Chedoke-McMaster Scale
Normal unimpaired movement 7 6 5 4 3 2 1
Chronic hemiparesis (> 6 months post injury)
Absence of impairment or injury to ipsilesional arm
Absence of visual neglect or visuo-perceptual disturbance
Moderately impaired
N = 30
Severely impaired
N = 30 60
Complete hemi-paralysis

8. Therapy group 1 – conventional therapy
scapular/shoulder alignment
passive & active assisted ROM
task-oriented re-education
1 hr/day, 3 days/wk, 8wks

9. Therapy group 2 – free reaching therapy
-22.5 0
22.5 1 2 5” 3
-14” 4 5
-25”

10. Therapy group 3 – Guided Force TrainingS F A M
adaptive assistance

11. Expected Results Improved free reach extent from first ARM Guide study
Better results for robot therapy group than free reaching and NDT group
Ultimately, greater functional gains in guided force training group

12. Early results – adaptive assistance
early trial
late trial

13. Early results – supported reaching
Reach distance [cm]
Free reaching
Guided force