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In motion

  1. 1. InMotion Arm Robot:improving quality of lifeRecovering everyday functionAfter years of living with movement disabilities patients and their doctorsdiscover that there is hope. What was thought to have been permanentcan be restored. The coordinated shoulder, elbow and hand movementsrequired for accurate reaching and grasping are retrained.Rethinking recoveryIn-Motion Robot-assisted therapy engages the patient to "retrain thebrain". The patient is actively expressing and experiencing thousands ofinteractive movement repetitions, leading to the achievement of meaning-ful movement in everyday arm function even years post onset.A new therapeutic strategy; evidence based technology which is proven tobe effective and safe. Currently used by leading clinicians and research-ers worldwide. Reach for recovery
  2. 2. NEW InMotion Products! InMotion Adjustable Workstation ••••••••••••••••••••••••••••••••••••••••••••• The new InMotion Arm/Shouler robot workstation offers height adjust- ments and ample knee space to accommodate children and adults who use wheelchairs. The height manually adjusts from 22"-34" allowing both standing or sitting positioning. The station also includes a comfort contoured ergonomi- cally designed chair with shoulder and waist straps for correct patient positioning. With a table top area of 36" x 48", it provides a large surface with the additional benefit of upper arm support. The workstation is ADA compli- ant with ease of access for most patients. The InMotion Hand Robot provides active (motor- driven) grasp and release features. The innovative Hand Robot now comes standard with the InMotion Shoulder-Elbow Robot allowing en- hanced functional movement by the patient.
  3. 3. <1NMOT1ON ROBOTS FOR REHABILITATION InMotion Robot Therapy •••••••••••••••••••••••••••• Watertown, MA - May 13, 2010 - Patients with long-term stroke reported reduced impairment, disability, and improved quality of life following InMotion robot-assisted therapy, according to a Veterans Administration (VA) led study published in the May 13,2010 issue of The New England Journal of Medicine. "There are nearly 6 Million stroke patients in the U.s. with chronic deficits; says Dr. Albert Lo, a neurologist at the Providence VA Medical Center who led the study. "Weve shown that with the right therapy, they can see improvements in movement, everyday function and quality of life: The study demonstrates that InMotion robots are safe and effective clinical tools they can assist a Physical or Occupational therapist achieve the intense level of exercise necessary to achieve neuro- plastic change and motor recovery following stroke, even years post-stroke. "Robotics and automation technology are ideal for these kinds of highly repetitive tasks. Weve used robotic technology to create a tool for the therapist to afford this kind of high-intensity therapy while maintaining the therapist supervisory role, deciding what is right for a particular patients needs and tailoring therapy according to findings from the patient evaluation tools provided with the robots" says Hermano Igo Krebs, principal research scientist in MIls Department of Mechanical Engineering and inventor of InMotion robots. "The study results also challenge the notion that physical therapy only benefits stroke patients within the first six months after stroke" says Lo. The VA-led randomized clinical trial, conducted at 4 hospitals, involved 127 patients with moderate to very severe arm impairment six months or more after stroke. Patients were placed into three study groups: usual care, intensive comparison therapy administered using conventional techniques, and intensive robot-assisted therapy. At 36 weeks, patients in the two intensive groups demonstrated significantly more improvement in function, movement and quality of life than patients receiving usual care. These patients received hour-long treatment sessions three times per week and completed 1,024 exercise repetitions in each session. Patients in the robot-assisted therapy group completed the exercises using four different types of InMotion upper-extremity robots. The robots guide patients through exercise using video game-like software programs and the robot arm assists the person with movement only when they are unable to initiate or complete the motion themselves. Patients randomized to the intensive comparison therapy by a therapist also received very intensive arm exercise, comparable to the 1,024 movements per 1-hour therapy, something that is typically not practical in everyday care (typical exercise repetitions are closer to 40 movements per session). Even more surprising, this better care did not cost the VA any more than usual care: "better care for the same cost: Professor Neville Hogan and Hermano Igo Krebs, from the Newman Laboratory for Biomechanics and Human RE!habilitation, invented the InMotion Robots and have been involved in over a decade and half of research using this kind of interactive robotics.
  4. 4. ------------------------ InMotion Robots at Braintree, MA Rehab Hospital ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• a physical therapist and stroke survivor Hypertonia had severely affected her who uses the InMotion robots during his left arm, but she had learned to com- own outpatient therapy. In addition, a pensate with the other side. She had therapist can see how much assistance worked with the robot for some time the patient needs, helping to assess when one night she walked into her improvement. bedroom. Her husband, walking behind her, started shouting, "You turned on the Working with the InMotion robot re- light! You turned on the light!" Subcon- quires attention, eye-hand coordination, sciously, she had turned on the light and coordination of the affected arm, with her affected arm rather than com- but patients are often so engrossed in pensating by turning her body to use the "As therapists we think, How do I tap the game - for example, a game of on- other side. into the motor control theory - getting screen ping-pong - they end up doing patients to do a high number of repeti- a few hundred repetitions of a particular tions in an engaging activity? How many movement - a result that is challenging times can I ask them to reach for a cone " InMotion robots help us to elicit during traditional therapy. "Im while sitting on a mat?" said Dan Par- get to the high number of not saying weve abandoned cones and kinson, PT, Director of Clinical Services repetitions while keeping bean bags, but the InMotion robots help at Braintree Rehabilitation Hospital, us get to the high number of repetitions patients motivated. " provider of acute inpatient and outpa- while keeping patients motivated," said tient rehabilitation in Braintree, Mass. Parkinson. and surrounding communities. Patients with various neurological condi- Solution: tions, from stroke to spinal cord to brain Braintree believes that their investment Robotic Therapy injuries, work with the robots. Beth Lus, in InMotion and other rehab technol- OT, occupational therapy clinical advisor ogy has made a favorable impact on Always looking for the latest proven at Braintree Rehab, has even used it the hospital. "It is hard to attribute any technologies in rehabilitation, Brain- with patients with flaccidity. Lus also specific initiative to inpatient volume tree Rehab purchased the InMotion uses it with patients who have neglect growth, however Braintree believes shoulder-elbow robot, wrist robot and or attention issues. "There have been evidence-based technology has helped hand robot to augment its arsenal of patients who do not attend well with to increase admissions of neurologic evidence-based treatment tools. They other therapy, but Ive put them on the patients for both inpatient and outpatient were drawn to the InMotion therapy ro- robot and they can focus on the task for programs", says Parkinson. Technol- bots for a few reasons - one of the most 20 minutes," Lus said. ogy has also helped with our therapist significant being the ability to provide active-assisted motion for the patient. recruitment and retention. Our clinical The robot can back off proportionate staff is excited about contributing to the to the patients changing ability to move development of clinical applications for Vartanian has noticed functional gains rehab technology. Braintree is proud independently. Because the machine around the house -- unloading the dish- that we can offer patients such innova- helps to stabilize the affected arm, washer, folding clothes, and opening tive treatment." movement is more fluid and controlled. bottles. And Parkinson likes to tell of a "You dont get frustrated that your arm is 42-year-old woman who was 21 years allover the place," said Rich Vartanian, post-stroke. Founded in 1975, Braintree rehabilitation Hospital has gained recognition as a world-class healthcare provider. Braintree offers a wide variety of specialty programs at its acute Inpatient Rehabilitation Hosptial in Braintree, MA, satellite rehabilitation hospital locate"d at Medtrowest Medical Center in Natik, MA and multiple community-based outpatient clinics. Braintree is a leading provider of Nuerorehabilitation services such as Stroke, Brain Injury, Parkinsons Disease, Multiple Sclerosis and Spi- nal Cord Injury. The Join Commission awarded the hospital Disease Specific Care Certification for its Stroke and Brain Injury programs.-------------------------
  5. 5. THE ART & SCIENC~EHABlLITATION Rancho Robotics for Rehabilitation Are you a survivor of stroke, traumatic brain injury, cerebral palsy, spinal cord injury, multiple sclerosis or neurological condition? !he young man a60ve fias gainea tfie a6iCity to 6egin ariving a powerwfieeCcfiair ana to use utensiCs tofeea fiimsefJ. J{e fias participatea in approxjmatefy si:(j;eenro6otic training sessions at 1(ancfio. Rancho offers innovative programs including traditional therapies and advanced robotic training which treat body and mind deficits for adults and children. Comprehensive Wellness, Drivers Training and Life Skills Programs are also available. Amy Salinas, MS, OTR/L, CBIS, PAM Director, Rancho Robotics for Rehabilitation 7601 E. Imperial Highway Downey, Ca 90242 562.401.6275 562.401.6271
  6. 6. Rancho Robotics for RehabilitationOn May 19, 2009 I was driving my car when I had a sudden headache. I had a stroke. Iunderwent surgery to relieve the bleeding and treat three blood clots. I spent six weeksrecovering in an acute rehab hospital.After traditional inpatient and outpatient rehabilitation, I participated in sixteen robotictraining sessions. • HoUf my grantftfaugfiter on my rap to reaa to fier • rrum figfit switclies on ana off • HoUf onto tfie steerine wfieeCwfiife an:vine • Hug peopfe witfi 60tfi arms • jlssist witfi carryine o6jectsI have also gained noticeable arm improvements in: • 1@nee of motion • ~aucea tigfitness • ~aucea pain
  7. 7. "Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke" Albert La, M.D., et al. The New England Journal of Medicine, May 13, 2010 FREQUENTLYASKED QUESTIONS Why is this research so important? "Weve shown that with the right therapy, [stroke patients] can see improvementsin movement, everyday function and quality of life - this is giving stroke survivorsnew hope." Dr. Albert Lo, Principal Investigator. The implications for stroke recoveryand study design were so powerful that this was the first article ever published in theprestigious NEJM on the topic of rehabilitation. Why were InMotion Robots selected for the study?The unique assist-as-needed exercise delivered by InMotion robots is the optimal way to drive recovery through neuro-plastic remapping of sensory-motor pathways. InMotioninteractive robotics actively engage neurologically injured patients in repetitive tasks that reinforce normal movement patterns and improve everyday function, even years post injury. Is InMotion interactive robot-assisted therapy an established practice? Yes, many leading rehabilitation hospitals and VA hospitals are using InMotion Robots every day to improve arm function following stroke, brain injury and other neurological diagnoses. The NEJM article, the 1A level of evidence cited in Stroke*, and over 15 years of prior research gives a large evidence base for the treatment effectiveness. *"ComprehensiveOverview of Nursing and InterdisciplinaryRehabilitationCare of the Stroke Patient:A Scientific Statementfrom the American heart Association, Miller,, Stroke 2010;412402-2448 What improvements in functional abilities do patients or therapists report?Some examples of new abilities using the affected arm following robot-assisted therapy: Put on a shirt or jacket Hold a shopping bag Push a door open Pick up a laundry basket Turn on a light switch Do household chores Pick up a cup of coffee Put a leash on a dogWhat treatment methods were compared? Patients were randomly assigned to three study groups: 1) usual VA care 2) intensive InMotion robot-assisted therapy and 3) (robot) intensity- matched treatment delivered by a therapist. Patients in both the robot- assisted and the intensity-matched treatment group received 1024 exercise repetitions $ per session, a level of intensity that is only practical with robot assistance.
  8. 8. Yes The study enrolled sixty-five percents (65%) of interested Veterans. Only those with mild impairments due to stroke, or those unable to travel for the duration of the study were excluded. This study involved a very severe population, and many had only trace shouldermovement (Fugl-Meyer Assessment (FMA) Scores ranging 7 to 38 out of a possible 66points). About 1/3 had multiple strokes. Average time post onset was 4.7 years. Finally, most were too severe to be candidates for modified constraint-induced therapy Yes, after the 36 week study period the robot-assisted group out-performed BOTH theintensive therapy and usual care groups. The robot-assisted therapy group Fugl-Meyer Assessment Score (FMA) gain was 5 points greater than the usual care group. And, a significant number of the robot-assisted participants showed much higher FMA gains ranging above 6 points. "Usual VA Care"Was Not Typical Care Robot-assisted care was superior despite the fact that "usual care" in the VA study averaged 3.6 hours of upper limb therapy per week. By contrast, the large majority ofpatients in third party payer settings receive little if any rehabilitation beyond the first year post-stroke. The VA considered the advantages of robot-assisted and (robot) intensity- matched care so great that they discontinued usual care midway through the study. Is robotic therapy cost effective? Yes, the TOTAL cost to the VA was roughly the same between the usual care and the robot-assisted therapy groups. Despite the cost of the robotic equipment, the robot- assisted group experienced significant reduction in cost and use of other medical services compared to the usual care group. Differentiate your stroke program with the new standard of care NMOTION ROBOTS F()H REHABH.lTATtON 80 Coolidge Hill Rd Watertown, MA 02426 Tel: 617926-4800 Fax: 617 926-4808
  9. 9. Clinical ResearcJh With InMotion Robots , .....".".,-.7 ... .. y. - --, - . . ,"t; .~ .. ;f;. •IMT teclnology has undergone more than a decade of clinical InvCSligatl0nsInvolvln~ more than 600 patients.There is compelling evidence from clinical evaluations involving IMT technologylrlat interactive robotic therapy significantly enhances motor recovery In a multi-center, randomized, controlled trial involvin~1 127 :;,troke patient~, W!tll mod,:::rav: to severe upper-limb impairment, InMotion robot-assisted therapy patients demOrlSlrclled significant improvement in arm movement, function and qUcllity of liTe LO A C , etal "Robot-Assisted Therapy for Long-Term Upper·Limb Impairment after Stroke", New Englano .ourne! 01 Medicine, :;,621772, May 13, 2010.) In a clinical study involving 56 stroke inpatients, the motor skills of the robot-treated group improved significantly more than the control group An analysis of impairmenl measures showed that (1) interactive robotic therapy significantly reduu.:d mOlO Impairment of the treated limbs, and (2) added to con/entional therapy Imer~ICllve [(Jbotic therapy provided about double the impairment reduction. Volpe, 8 T, Krebs, HI, Hogan, N :::delsteln, OL, olels, C and Aisen, M , A novel apDroach 0 srJoyt;; r,,h:;;:.>,:,r.!:e," ;obot-aldecl sensorimotor stimulation, Neurology, 54 (2000) 1938--44 )
  10. 10. Patients from an early clinical 2Tudy were rec21led up to three years later, and It wasfound that patients who rece:ved robotic therapy sustained their improvement over thosewho did not. Moreover, sub.;equent follow-up studies re-examining these patients alsoconfirmed the finding.(JOlpe, 8T , Krebs, H.I., Hogan, N., Edelsteinn, L., Diels, C.M. a"d Aisen, M.L .. RobOI tralnln£ enhanced mo,or (lulUY"-.n 0811pnts wltr, stroke maintained over 3 years, Neurology, 53 (1999) 1874-6)i ·JOlp0.. 8 T . Krebs, H I., Hogan, N., "Is robot-aided sensorimotor training In stroke rol,aL)"lailon a reali:;"c (,,-,:,(,:-.-Curmnt Oplnl In Ji1Neurology, LJPPJi1colt lVil/iams & lVilkins, 14:745- 752, 2001)A multi-center VA study of 127 patients with long-term upper-limb impairment from astroke that occurred at least 6 months before enrollment (average brr.e of 4.7 years 3:?/:lowith multiple strokes) found that "The improvements .. provide evidence of potentiallong-term b(~nefits of rehabilitation and challenge the widely held clinical belief that gainsIn motor fur,ction are not possible for long term stroke survivors." C . etal , Robot-Assisted! i_o. p, Therapy for I_ong- Teml Upper-limb Imp81m1enl after Stroke". Nevil EnglancJ ,i,ju.-:-::. 1 •M/Jc;,c,ne. 3621772, May 13,2010)Patients who had suffered a single unilateral stroke one to five years earlier, and whowere demonstrated to be in a "stable phase," showed significant improvement afterreceiving robotic therapy three times a week for six weeks. These findings also suggest that such patients have a potential for further recovery which conventional therapy has been unable to tap into. IFasoil, S D, Krebs, H I, Stem, J, Frontera, W.R. and Hogan, N, Effects of RobotiC Thciap~ ·n I(J,(; impaulI,en, and Recovery in Chronic Stroke, Archives o/Physica! MedlclI1e and Keiw!Ji/lla(/OI1, S-:i(~rn::,,:--. S2 ) l.Fas,)i,. S [, KiCbs, H i., Stcln, 1., Frontera, V.R., Hughes. R-, and Hogan, N., "RobotiC Thcrapy (or Ch,onlc t.IOi(;; impal""cnts aftcr Stroke Follow-Up Results." Archives 0/ Physical MediCine and Rehabrl,(a(lol1. 85 1106-11 I I. ~0()J j tFer-aro. Ivl .. Palazzolo, 11., Krol, 1, Krebs, H.I., Hogan, N, Volpe, B.T., "Robot Aided Scnsorlmotor Arm Tril1n:1f.. improves Outcome in Pallents With Chronic Stroke," Neurology, 61: 1604- I 607, 2003.) 12 children ages 5-12 With cerebral palsy and upper limb hemiplegia rec81vecJ rot)(;li,~. therapy (!Vlce a week for 8 weeks. The children showed significant Ir"nprovem(~nl In IC;i.,.!, Quality of Upper Extremity Skills Test (Quest) and Fugl-Meyer f-sscssment Scores A "questionnaire administered to the childrens parents also showed slgnlflcan~ Improvement in "how much" and "how well" the children used the paretic cHili dUrliin functional tasks at home
  11. 11. (rasa/I. SE.. rrClgala-Pinkham, Yo., Hughes, R , Hogan, N., Krebs. HI.. Stein, J, "Upper Limb RoboliC Therapy iOI Children with Hemiplegia, "Arnencen Journal of REhabilitation, 87: 11929-936 (2008) A pilot ~tudy of two patients with incomplete spinal cord injuries, level C4-6 that had occurred greater than two years ago, was conducted at Burke Rehabilitation Hospital Patients received treatment in the shoulder-elbow robot for 18 sessions over 6 weeks with one arm followed by 18 sessions over 6 weeks with the other arm Patients showed changes greater than 10% in Fugl-Meyer Scores and 20% in the Motor Power scales The study also showed that while one arm was treated both arms showed comparable Improvement. ("rebS,HI, Dlpletro,L, Levy-Tzedek,S, Fasoli,S, Rykman,A, Zipse,J, fawcen,J. Steln,J, PQlzncrH, L(.) ,- /_11i)f:: 6; Hogan,N, ",Q,Paradigm Shift for Rehabilitation Robotics." IEEE-EMBS Magazine, 27461-70 (20031 A pilot study of two MS patients at the West Haven VA Medical Center has shown trat treatment with the InMotion AnkleBot twice a week for twelve total sessions resulted In significant improvement in torque production at the ankle and movement accuracy Although the training did not include gait activities the researchers noted cerry o/sr Improvement in gait function when measured through six minute walk tests (Krebs.HI, Dlp,etro,L, Levy-Tzedek,S, Fasoli,S, Rykman,A, Zipse,J, Fawcen,J, Steln.J. POI~n~r.j-l. La. f.... Oll)r; !:, Hogan,N, "A Paradigm Shift for Rehabilitation Robotics," IEEE-EMBS Magazme. 27~61-70 (2008) ~NW10TjON ROBOTIC THERAPY?1 the repetitive exercise which may evoke and enhance a neuro-plastic recovery prOC8<::S I whereby new neural pathways replace some of the neural pathways lost due ;0 br2li InJury;:z (he continuously interactive nature of robotic therapy, which ensures patient partlclpatlor. by assisting only as needed; (he 3daplive nature of robotic therapy, which adjusts the degree of movement challenge and rot)otic assistance to accommodate each patients individual needs and present abilities:
  12. 12. ,1 the number of movements provided by the robot. which far exceeds any dosage i;,;i mlgrH be admlrllstered by a human therapist::J the benefiCial coupling of movements Vvlth sensory information - from both the VISUcl; display and the robot arm itself - which shows the goal, the desired path to follow i,,::, current hand position, and measures of movement q:Jality; and6 the fact that all movements are successful due to the robot assistance; the robot cJoesnt let the brain experience grossly inappropriate responses to its motor commandsAisen, M L , Krebs, H I., McDowell, F.; Hogan, N.; Volpe, 8T, "The Effect of Robot AssistedTherapy and Rehabilitative Training on Motor Recovery Following a Stroke"; Arch of Ncuiol54 .143-446, (1997)Krebs, H I.; 8rashers-Krug, T.; RaUCh, SL; Savage, C.R.; Hogan, N.; Rubin, R H, Fischma:,A J , Alpert, NM; "Robot-Jl,ided Functional Imaging: Application to a Motor Learning SlU(~i",!--{uman Brain Mapping; John Wiley & Sons, 6:59-72; (1998) <rebs, HI, Hogan, N , Alsen, M.L.; Volpe, 8T; "Robot-Aided Neuro-Rehabilitation", IEf.E- il ansael,ons on Rehabilitation Engineering, 6.175-87: (1998) Krebs, HI, Hogan, N , Aisen, ML.; Volpe, B.T., "Quantization of Continuous Arm Movements Ii: Humans With Brain Injury", Proc. Nat. Acad. of Science 964645-4649, (1999) Hogan, N, Doeringer, J.A; Krebs, H.I; "Arm Movement Control is both Co,tlnuous and Olscreie Cognitive Studies; 8ulletin of the Japanese Cognitive Science Society, 6 3254-273, (1999) Volpe, B T , Krebs, HI, Hogan, N, Edelstein, L , Diels, C.M, Aisen, M L, "Robot Training E:ihanced Motor Outcome in Patients with Stroke maintained over 3 years", Neurology 5~ 12;0 (1999) Kiebs f I I , Volpe 8 T, Alsen, M L, Hogan, hJ , "RobOtiC I.... pplicatlons ill Neuromoto, F~erlab;lltatlon", Topics In Splflal Cord Injury Pehabllitation, 53, pp50-63, (1999) Volpe, 8 T , Krebs, H I, Hogan, N, Edelstein, L, Diels, C.M., Aisen, M .. ",6.. Novel/.,pprO.3ctl ,0 Stroke Rehabilitation. Robot Aided Sensorymotor Stimulation", Neurology, 541938-194<. ;00(; Krebs, HI, Volpe, 8T, Aisen, M.L., Hogan, N.; "Increasing Productivity and Quality of Care Robot-Aided Neurorehabilitation", VA Journal of Rehab!1 Res and Oev, 3713639-652, (2000) .. Krebs. HI. Volpe, 8 T, Palazzolo, J; Rohrer, 8; Ferraro, M ; Fasoll, S , Edeistelll, L . Hogan :": "F<obc)~-,LlcJed Neuro-Rehabilltation In Stroke Interim Results on the FolloVv-up of 76 Pallen,) c;::c on MovEJnent PerfOriilanCe Indices". In Mourllr rv10khtari (ed), IntegratiOn of ASSlslrve T,~c,";i1,)::::~
  13. 13. II [tie Informalion Age: 10S Press, .AS~·istlveTechnology Researc-, ,Series, frn;;l(:;r,j2Jrrl. :2()(l I IKrebs, H 1, Hogan, N., Hening, W., Adc.movich, S, Poizner, H; "Procedural Motor Learning InParkinsons Disease"; Exp. Brain Res i 41 :425-437 (2001).Krebs, HI: Volpe, B.T.; Ferraro, M.; Fasoli, S; Palazzolo, J.; Rohrer, B; Edelstein, L , Hogan, !~."Robot-Aided Neuro-Rehabilitation: From Evidence-3ased to Science-Based Rehabilitation":Topics in Stroke Rehabilitation; 84:5L1 ·70, (2002) r!r..Jgan N "~,keletal Muscle Impedance in the Contrc,1 of Motor Actions"; Journal of Mech2nlCS in ,!leOICllle 21()(j Biology 2(3 & 4):359-37::: (2002) i=-~ohrer 8 , Fasoli, S., Krebs, HI , Hug;les, R, Volpe, B. Frontera, W R , Stein, J . Hoger" f..J "Movement Smoothness Changes dUring Stroke Recovery", J Neurosci, 22.18 8297 -o30~ (2002) Malfait, N, Shiller, D.M ; Ostry, D.J ; "Transfer of Motor Learning Across Arm Configurations" Journal of Neuroscience; 22(22):9656-9660, November 15, (2002). I:::lsoli, S D , Krebs, HI, Stein, J, Frontera, W.R and Hogan, N , Effects of RobotiC Therapy 0" Motor Impallment and Recovery In Chronic Stroke, Archives of Physical MedlcJrle ijnd RUle!). 34477-82 (2003) Krebs, HI, Volpe, B.T., Aisen, ML., Hening, W ,Adamovich, S., Poizner, H , Subrah~n8nY2n. v, Hogan, N , Robotic Applications in Neuromotor Rehabilitation, Roborica, 21 3-11 (200:3) Hogan, N, Krebs, HI, Rohrer, B, Fasoli, S, Stein, J, Volpe, BT, Technology for Recovery Stroke, In JBogousslavsky, MP Barnes, B. Dobkin (Eds.), Recovery after Stroke, Camb!lrjgr~ r::>ress(2003). Krebs, HI, Palazzolo, JJ, Dipietro, L., Ferraro, M.,·Krol, J, Rannekleiv, K, Volpe B T , Hogan N , Rehar)llltation Robotics: Performance-based Progressive Robot-Assisted Therapy. -~u!onomous Robots, Kluwer Academics 157 -20 (2003) f--:erraro, M ; Palazzolo, J.J , Krol, J; Krebs, HI, Hogan, N; Volpe, B.T , Robot Aided Sensorimotor Arm Training Improves Outcome in Patients with Chronic Strok.e NeurolJ9.v 011604-1607 (2003). i-Ienriques, 0, Soechting, J.; "Bias and sensitivity in the haptic perception of geometry", bp 3ratn Res (2003) 15095-108 Krebs, HI; Celestino, J.; Williams, 0; Ferraro, M.; Volpe, B.T.; Hogan, N; "A Wrist Ey.l2nSlon Ie MIT·MANUS;" In Z Bien and D. Stefanov (Eds.): Advances in Human-Friendly RobotiC technologies for Movement Assistance / Movement Restoration for People With Oisabil!liCs Springer-Verlag (2004) i:;;lsoli, SO, Krebs. HI, Stein, J, Frontera, WR, Hughes R, and Hogan, N, RobotiC Th2r2r-~.. lor Chronic Motor Impairments after Stroke: Follow-Up Results, ArchPhysMedRehab 8511 06-1 ~ 1 . 12004 ) .~ ~., Fasoli, SO, Krebs, H.I , Ferraro, M, Hogan, N, and VoJ~e, B.T , Does Shorter RehabilllO(IOn
  14. 14. Hogan, N , Krebs, H.I.; "Interactive Robots for Nel o-Rehabilitation," In Platz (ed), Speclai IS;jj(=on Motor System Plasl:ily, Recovery, and Rehab,·,tallOn, Restorative Neurology & Ncurosc,(2G0L1)KrebS, H I. Volpe, B T, Lennlnhan, L, Fasoli, S, lynch, 0, Dominick, L , Hogan N .. "N(,:.=-s ()o:r~.ehablillatlon Robotics end StrOke," In. F. Lofaso, il, Roby-Brami, J.F. Ravclud (Eds )Tr=:chnoiog,cal Innovations and Hancfcap, Frison R:jche, pp 177 -194 (200.1),!o;pe S T , Ferraro, M , Lynch, D, Christos, P, Kr~)I, J, Trudell, C, Krebs. HI, Hogan ~J . RubollCS and Oltier 00vlces In ti,e -,-reatment of Fatlents Recovering from Stroke," Cur;:Jnneroscler Rep, 6 314-319 (2004)Krebs. HI, Ferraro, M, Buerger, SP, Newbery, ~"1.J.,Makiyama, A., Sandmann, M , Lynch. D/olpe, B T , Hogan, N., "Rehabilitation Robotics: Pilot Trial of a Spatial Extension for MIT-fv1a:lusJournal of NeuroEngineering and Rehabilitation, E;:omedcentral, 15 (2004)Stein, J, Krebs, H.I., Frontera, W.R, Fasoli, S.E., Hughes, R, Hogan, N., "Companso~i of T,,(.Techniques of Robot-Aided Upper Lirnb Exercise Training After Stroke." Arneocan JournalPI:ySCCJI Medicine Ref,abllJlation, 839720-728 (2004). J.ROhrer, 8, Fasoll, S, I<rebs, H,I, Volpe, B, Frontera, W.R, Stein, J, Hogan, N, "SubmovementsGrow L2rger, Fewer, and More Blended During Str,pke Recovery," Motor Control, 8.472-<183(200.1) ,I "Fasoll, S E, Krebs, H.I., Hogan, N., "Robotic Technology and Stroke Rehabilitation. Transi8:w,<;Research Into Practice," Topics in Stroke Rehabilitation, 114: 11-19, (2004)Stein, J . Hughes, R, Fasoli, S., Krebs, HI., Hogan, N, "Clinical Applications of Robots InRehabilitation," Cot/cal Reviews in Physical and Rehabilitation Medicine, 17 (3). 217 -230 (:::r.C~,Dipietro, L , Ferraro, M, Palazzolo, JJ, f<rebs, H.I, Volpe, 8T, Hogan, N , "CustomizedI,teractlve Robotic Treatment for Stroke: ErvlG-Triggered Therapy," IEEE Transaction Neu/(I,Sysrems and RehabilllatlOn EnQ,lneering, 13:3:325-334 (2005), Finley, fV1 1., Fasoli, S E, Dipietro, L., Ohlhoff, J., IvlacClellan, L, Meister, C, Whltall, J , M?C":~1 R bever, C T, Krebs, H.I., Hogan, N., "Short Duration Upper Extremity Robotic Therapy I;~ Stroke Patients with Severe Upper Extremity Motor Impairment," VA Journal RehabJiilainJn Research and Development, 42(5)683-692 (2005). Daly ,J , Hogan, N , Perepezko, E" Krebs, H,I" Rogers, J" Goyal, K" Dohring, M , f:redrlckSGn E ~Jethery, J , Ruff, R, "Response To Upper Limb Robotics and Functional Neuromuscular Stimulation Following Stroke," VA Journal of Rehabilitation Research and Development Ij2(6!72~- ,35 (2005) , MacClellan, L R , Bradham, D.D" Whitall, J, Volpe, 8, Wilson, P 0, Ohlhoff, J ,Meister C Hogan, N, Krebs, HI, Bever, C1" " Robotic Upper Extremity Neuro-Rehabilltatlon In ChrQi->IC Strokei"patlents," VA Journal of Rehabilitation Research and Development 42(6) 717 -722 2005, Krebs, HI, Hogan, N; Durfee, W,; Herr, H.; f-<ehabilitation Robotics, Orthotics, and Prosllietlcs Cr,apter 48, In M.E. Selzer, S. Clarke, L.G. Cohen, PW Duncan, F H. Gag2 (Eds): TextLJOok 0:
  15. 15. ai1el Stroke ., In Bogousslavski, J., Barnes, M P., Dobkin, B. (eds), Recovery arter Stroke, Chepter ::0. Cambridge University Press 2003 Krebs, HI; Celestino, J.; Williams, 0; Ferraro, M.; Volpe, B.T,; Hogan, N.; "A Wnst ExtenSion w MIT-MANUS;" In Z Bien and D. Stefanov (Eds); Advances In Human-Friendly Robol:C Technologies for Movement Assistance / Movement Restoration for People Wllh D,sabJl![les Springer-Verlag 2004. Hogar1, N . Krebs, H I; Interactive Robots for Neuro-Rehabilitation; In Platz (ed), Specl::;:! Issue en Motor System Plasticity, Recovery, and Rehabilitation, R,estorative Neurology arid NF;:wIJsclenv::- 2004 Krebs. HI. Volpe, BT, Lenninhan, L, Fasoli, S., Lynch, 0., Dominick, L , Hogan, N , "NOlCS IJo; Rehabilitation Robotics and Stroke," In. F. Lofaso, A. Roby-Brami, J F Ravaud IEds! Technological Innovations and Handicap, Frison Roche, 177-194, 2004. Krebs, H I; Hogan, N; Durfee, W.; Herr, H.; "Rehabilitation Robotics, Orthotics, and ProsthetiCS. III Selzer, M E, Clarke, S., Cohen, L.G , Duncan, PW, Gage, F,H, (Eds), Textbook of Neur21 Repair and Rehabilitation; Chapter 48, Cambridge University Press 2006 Klebs, HI. I-logan, N. "Robotic Rehabilitation Therapy," Editor Metin Aka) Wyl:.;.oyEncycIIJDecC of Biomedical Engineering 2006 Stelil. J. Hughes, R, Fasoll. SE. Krebs. H I. Hogan, N, "Technolog1cal P,es fOI f-.i1r.:r:~r i-;ecovery. ::::hapter 19 In Stroke Recovery and Rehabilitation, Demos Press 2008 INTERACTIVE MOTION TECHNOLOGIES, INC 80 COOLIDGE HILL RD WATERTOWN, Tv1A02472 617-926-4800 INFO@ INTERACTIVE-MOTION.COM---_._-----_.Interactive __ ._--------------------------------_._--_. Motion Technologies, Inc. © : ,
  16. 16. W~~cO~l~~b-th~ ifobo_tm~Lap~!~ April 20th, 2010 by David E. Williams Qfthe Health business blog.~~s~tten, th~ Ne~ Englcrt1d Journal ofly~edici~e article (!ioDoc-Assisted TheralJv [or Long-TermUODer-Llmb ImDazrm,ent after Stroke) clarms qUIte modest results for robot thera B tw hI h h l ~ l1-.~- fth . . - , . py. e een me:J21es,t oug ,~Ie p_owe~ LUlltS0 e J..;Jllpendmg robot revolution. (The article is free and IcncouIage you to read It.)~es:arch~rs recruited Veterans A<:l,no~stratiOn(VA) patients whod suffered strokes an average of 5yealS ec:rber. Volun1eers were randorruzed to 12 weeks of robot-assisted therapy, intensivecompa.1J.son therapy, or usual care (medical management and some rehabilitation servic~s available to .. _---- .. ,,- _----------,_ .. _--- .. -- ., _."._----_ .._-----_ ..,-- ---.-.----,--_. all patients), The primary outcome was change in motor function at 12 weeks as measured by the Fugl-Meyer score. Patients were also evaluated after Q, 24 apd 36 weeks, Results showed that robot-assisted therapy did not significantly improve motor function at 12 weeks compared to usual care or intensive therapy, although there was significant improvement on the Stroke Impact Scale (SIS). At 36 weeks robot-assisted therapy and intensive therapy perfo!TD.edabQJ~ the saIne, and both were superior to usual care. So whats the big deal? Actually a few tbings: • Intensive therapy -whether performed by a robot or a hUJ:J:.Cin- dem.onstrated its superiority to usual care. The intensive therapy delivered by therapists iil tills trial was so intensive: > 1000 movements in a session compared to 45 for typical stroke treatment -that its really only available under controlled conditions with a researcher standing over the therapist with a stopwatch. If you want this l<..ind intensive therapy for ycurself youd beneT hire someO!2e of wit-h a whip (or bnng John Hen.:::Y,backfrom the dead and~ake the harruner om ofbs . • A close read of Table 2 (Changes in Primary and Se..£.QQ.Q§ry Ol1tcomes at 12 Weeks) strO!2g!y suggests better results for the robots thdn the authors are willing to claim explicitly. The le.5: side of the table measures robot-assisted therapy Is. usual care. The right colUlT..D.srneaS lre robot-assisted therapy Is. intensive comparison therapy. The performance of the robot gTQl!~ is much better on the right side of the table than the left. If we compare the robot numbers O!lthe right with the usual care numbers on the le~ the cOIDJnrrisQuslook much betteT for the robots, including a 5 point improvement on the Fugl-Meyer score (which is extremely impressive for someone 5 years after a stroke). . So why is the table set out this way? It appears that patients were only e!lIolled L1 usual care fc: the [lIst 16 months of recruitment, whereas the recruitment period for rob01-assisted and ~ntensive l;herapy cOIl,tinued for 24 months. I dont understand why the usual care recrIJitrDe!2t was stopped -perhaps the study was on a tight budget? In any case its likely that the therapls(c; operating the robots fonowed a lea..ruing CUri; du.ring the study and were betteT able to opeTatt the TO bots in the second part of the study thaD.the fi...;rst, willch is the portion of the study analyzed on the left side of the table. The authors state that the robot manufacturer (ImtTaCti/e Motion Tecl-moloszies) had "no role in the st1;ldy,"willch could mean the therapists had to figt!.:t om the robot for themselves and would not neve been as good at first. The fact that tlois information is presented int21.esame table appears to be a tacit a.cknowledgment that the researchers also beJieve in the GOmpa..risonI a..rnsuggesting . . Lr.bor savings were large. One-hoW sessions required or:0y.15 minutes of contact wit.l-J. t.l-J.e theraDist fOTthe rot,ot versus 60 minutes fOT,the intensive comnanson theranv. Th?T hil.~
  17. 17. ~espite ~e ~$10.K cost ofusing,t1le robot. That means the robot group patients used only one- ~~ of tb,:.medlcal resour:ces of the ,usual care group ($5K versus $15K) while making Sl.gmfica.:r:l. rmprovements ill health status. Thats incredibly g00d news and must have been a big surpnse to the researchers. ". "An a~companying editorial (BrClin .Repc:ir c:fter Stroke) acknowledEes the accomplishments of thisstudy and emphasizes the broader rmpllcatlOns. ." In the ?igge~ picture, the potential. for robotic therapy after snoke remains enormous. RobOTIC deVlces can provide therapy in differ:ent functional modes, a point that was not -ex~~db,yL-;- et ai Rob~ts work~~-;onsistent"and p-;;ecisern?JIDer and over-lOng- ." periods vYithout fatigue. They can modulate timing, content, and intensity of training in reproducible ways, with a reduced need for human oversight. Robotic devices can also measure the performance of patients during therapy. In addition, ro bot- based therapy can interface with computers in brain-stimulation treatment or to provide simultaneous cognitive training. You C31"1 also check out a yideq, of the robot in action. Posted in Devices, Economics, Research, Techno~ogx. ;-:-; Comments» No Please note: Comment moderation is enabled and may delay your comment. There is no need to resubmit your COD:1J,lJeill, Health Business Blog t;l;rJ;jOjj~l