Repetitive Facilitative Exercise and Rehabilitation Robot for Poststroke Hemiplegia

Abstract

Repetitive facilitative exercise（RFE）is an exercise therapy developed to recover motor control and function in hemiparetic limbs or fingers after a stroke. The neuroscientific basis of RFE focuses on reconstructing and strengthening motor‒descending pathways by“realizing the intended movement by facilitation technique”（Hebb’s law）and its“concentrated repetition”（use‒dependent neuroplasticity）. The benefits of RFE have been verified in clinical trials including randomized controlled trials. To further functional recovery, we have also developed several combination therapies using various physical agents. If hemiplegia is accompanied by spasticity,“direct application of vibratory stimuli（DAViS）or botulinum treatment may be applied to first control the spasticity, and then, RFE is performed. Conversely, when voluntary‒motor control is weak, RFE targeting the agonist muscles, is performed under low‒amplitude continuous neuromuscular electrical stimulation（NMES）or functional vibratory stimulus（FVS）. Based on our experiences and knowledge, we developed a new rehabilitation robot through industry‒academia and medical‒engineering collaborations. The robot has been used for stroke rehabilitation clinically. This robot is expected to reduce the burden on therapists, and increase the amount of training for patients with stroke.