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Rehabilitation Robotics and Movement Therapy—Implications for Manual Therapy

Natcher Conference Center
National Institutes of Health
June 9–10, 2005

Hermano Igo Krebs, Ph.D., Principal Research Scientist & Lecturer, Massachusetts Institute of Technology, Mechanical Engineering Department, Adjunct Assistant Research Professor of Neuroscience, The Winifred Masterson Burke Medical Research Institute, Weill Medical College of Cornell University, New York

In “Why Michael Couldn’t Hit,” Harold Klawans (Freeman Press, 1996) raises an interesting question about brain plasticity: why can a superstar professional athlete in a sport, say basketball, only achieve mediocre competence in another sport, say baseball? It appears that the motor control system gets “hardwired” to perform one task seamlessly, but not another, and that there are particular periods of massive organization of the motor control system. Outside these “windows of opportunity,” plasticity still occurs, albeit of a much smaller and subtle proportion. But what about an adult “broken” brain following a stroke? There may be a “window of opportunity” that might allow us to maximize motor neuro-recovery. Our efforts have been concentrated on applying robotics and information technology to determine how to augment therapy, harness plasticity so that this window (if it exists) might be fully exploited.

In this presentation, I will review results using rehabilitation robots developed at MIT during clinical trials with 96 stroke inpatients at the Burke Rehabilitation Hospital (White Plains, NY) and 110 persons with chronic impairment after stroke at the Burke Rehabilitation Hospital (White Plains, NY), Spaulding Rehabilitation Hospital (Boston, MA), and the Baltimore VA Medical Center (Baltimore, MD). Results suggest that robot-aided training enhances recovery; and that this effect is not due to a general physiological improvement—in fact, it appears to be limb- and muscle-group specific. Results also suggest the reduction in the incidence of shoulder and hand pain as well as tone. We will review existing technology and new technology under development, including algorithms for evaluating patients’ performance and different modalities of robot-aided therapy being investigated. We will also discuss how rehabilitation robotics afforded new insights into the process of neuro-recovery and how the same evidence-based tools, which were applied to movement therapy, might allow a natural segue into manual therapy.

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