Robot Therapy for Stroke Victims May Assist in Regaining Mobility

By FRANK BYRT, DOW JONES NEWSWIRES, August 31, 2005

BOSTON -- Robots could help Stanley Schaffer, an 82-year-old stroke victim, play the piano again.

Not movie robots such as Star Wars' R2D2, but a group of machines created by Massachusetts Institute of Technology scientists that are playing a role in helping stroke victims regain mobility by retraining paralyzed limbs and stimulating new brain activity.

"Robotic therapy represents a paradigm shift" in rehabilitative methods since it introduces technology into what has heretofore been a hands-on process, said one of the developers, Neville Hogan, a professor of mechanical engineering and brain and cognitive sciences at MIT.

He and his associate, Professor Hermano Igo Krebs, began work on the subject in 1989.

Their first machine, introduced in 1999, aids in the recovery of arm and shoulder movement. Now, systems are available for the wrist and hand, and last month the Baltimore Veterans Administration Medical Center began testing their "Anklebot" for use in rehabilitating the ankle and lower leg.

The MIT scientists hope to create a "gym" where stroke victims visit multiple robotic stations during therapy sessions. They add that there are likely other applications for robotic systems, such as speeding recovery from orthopedic surgery. But, for now, they are focused on stroke victims as their numbers are growing rapidly.

About 700,000 people are expected to suffer a stroke this year, and about 75% will survive, according to the American Heart Association. They will join an estimated 5 million people already dealing with some form of stroke-related disability.

The number afflicted is seen only getting larger. The risk of stroke roughly doubles in each decade after age 55, and given the number of aging baby boomers in that bracket there are likely to be many more people in need of rehabilitative therapy in the next few years.

Under current methods, victims work one-on-one with a physical therapist and repeat a series of exercises based on the therapist's judgment.

Robotic therapy machines give stroke victims a customized routine based on prior interaction and can take them through as many as 1,500 repetitions within a typical one-hour session. The machines keep patients absorbed in their effort because the exercises are presented as part of a video game.

In the wrist system, for example, a patient's lower arm is held in place in a bracket by Velcro strips while the injured hand is wrapped around a joy stick that is used to maneuver an on-screen object in the video game. In one, the goal is to get a ball that is on top of a swaying table into a hole in the center of it.

If the patient is too weak to move their arm or wrist, the system gently guides them through the desired range of motion and then, as they progress, the movements and games get tougher. Improvement comes from the progressive resistance of the exercises rebuilding atrophied muscle, as well as through the retraining of the brain, Mr. Hogan said.

It was thought previously that most of a stroke victim's recovery came within the first four weeks or so after the event and then virtually ended. "But we've found that that's not necessarily true," Mr. Hogan said, as patients who began using the robotic therapy continued to show signs of marked improvement even three years later and the improvement lasted.

In addition, in a study of 300 patients, those reporting chronic pain dropped to 25% from 50% after six weeks of therapy.

Mr. Hogan said robotic therapy is meant to be used as an adjunct to the methods of physical therapists by improving their productivity. It is not meant to replace them. In any event, full recovery from a stroke is unlikely, Mr. Hogan said, so the minimum recovery goal for some victims is functional independence -- that is, the ability to attend to one's personal needs without assistance.

Interactive Motion Technologies Inc., Cambridge, Mass., is a closely held company that has commercialized the MIT efforts. Robert Parlow, its chief executive, said the company has sold about 45 systems, and 80% of them have been the shoulder-arm system. There is a lot of clinical data on the shoulder-arm system, making it an easier sell to rehabilitation hospitals or research centers, Mr. Parlow said.

System prices range from $5,500 to about $80,000. Mr. Parlow said insurers have yet to reimburse care providers for their use of robotic therapy. Acceptance has been slow in coming as it is with any innovation, Mr. Hogan said, but as more clinical studies are completed, and there are several close to that stage, that should change. But Mr. Schaffer, a Scarsdale, N.Y., man involved in a clinical trials program at Burke Rehabilitation Center, in White Plains, N.Y., is already sold on them. He reports improvement has come long after the damage done by his stroke in November 2003.

"I can feel it," he said, and the machines back him up. They show his arm and leg movements have improved by 10% to 20% since he started the program June 21. That has him looking forward to tickling the ivories again.

Hi Michelle,

Thank you for sharing...very interesting article.    It's always interesting to read about new technological advancements, especially in the medical field.    The first thing that came to my mind was that the cost would prohibit some from accessing the robots.  Hopefully, with continual positive outcomes and statistics, insurance companies will see the benefits of the robots and maybe even one day consider these robots an "option" if a doctor feels a patient can benefit by including them as a part of a patient's rehabilitation process.    I guess these robots can be added to the long list of other things we'd also like to see covered by health insurance companies...

Thanks again for sharing.  ;

Take care,
Shan