Passive devices for upper limb training

Abstract

About five million people in North America alone have weak or paralyzed upper limbs (UL) due to stroke or spinal cord injury. Motor rehabilitation can improve hand and arm function in many of these people, but in the current healthcare climate, the time and resources devoted to physical and occupational therapy after injury are inadequate. This represents an opportunity for technology to be introduced that can take over some of the supervisory functions of therapists, provide entertaining exercise therapy, and allow remote supervision of exercise training performed in the home. Over the last 10 years, many research groups have been developing robotic devices for exercise therapy, as well as other methods such as electrical stimulation of muscles. Robotic devices tend to be expensive, and recent studies have raised some doubt as to whether assistance to movements is even necessary, as motor gains evidently depend largely on the efforts made by the participant. This chapter reviews the evidence for spontaneous recovery, the means and mechanisms of conventional exercise therapy, the role of robotics, and the advent of affordable passive devices and voluntarily triggered functional electrical stimulation. It is argued that exercise therapy on passive devices, in some cases remotely supervised over the Internet and augmented with functional electrical stimulation, is now an affordable and important modality of occupational and physical therapy. Quantitative UL function tests performed with these devices can provide crucial guidance on the selection of patients most likely to benefit from training and exercise, maximizing the meaningful use of scarce healthcare resources.