The document discusses enhancing motor recovery in stroke patients through rehabilitation technology (RT), emphasizing the importance of neuroplasticity and therapeutic intensity. It outlines various RT methods, including virtual reality and robotics, alongside a review of relevant studies demonstrating their efficacy. Key recommendations include a multidisciplinary approach to rehabilitation, personalized care plans, and integrating RT with conventional therapies to maximize recovery potential.

1. HOW DO WE ENHANCE
MOTOR RECOVERY
BY USING
REHABILITATION
TECHNOLOGY?
Bala S Rajaratnam
PhD, M.App.Sc (PT)
Principal Physiotherapist

2. Put on your thinking cap.
I would like to share with you
criteria to use technology
toward enhancing motor
recovery for my clients who
have experienced stroke.

3. OUTLINE
1. Stroke is a Huge Problem
2. Define Rehabilitation Technology (RT)
3. List of latest RT and review of studies.
4. What enhances motor recovery?
5. Our healthcare institution rehabilitation journey.

4. STROKE REHABILITATION
Population of Singapore: 5,791,901 Number of stroke survivors: 854,305
1. Stroke is a Huge Problem

5. PRINCIPLES OF
NEUROPLASTICITY
USE IT OR LOSE IT (NUDO 2003)
More Repetitions
At 6/12 post stroke, 50-70% of clients continue to have arm motor deficits, 30% are unable to
walk without assistance and 46% have cognitive deficits
(Young and Forster, 2002, Go et al., 2013, American Heart Association, 2014).
REHABILITATION
TECHNOLOGY
NICE guidelines
Evidence suggests that increasing rehabilitation intensity early after stroke
results in improved outcomes, but the evidence for this is not robust.

6. WHAT IS
REHABILITATION
TECHNOLOGY?
https://www.encyclopedia.com/medicine/encyclopedias...and.../rehabilitation-technology
Definition:
Rehabilitation technology is a PROFESSION that USES
TECHNOLOGY to help PEOPLE WITH PHYSICAL
DISABILITIES increase their independence
PROFESSION USES TECHNOLOGY PEOPLE WITH PHYSICAL DISABILITIES
PEOPLE WITH PHYSICAL DISABILITIES
2. Define Rehabilitation Technology

7. LIST OF LATEST RT
(FROM PROF LEVIN PRESENTATION AT WORLD CONGRESS OF PHYSICAL THERAPIST, SINGAPORE 2015)
3. List of latest RT and review of studies.

8. Motor
Coordination
Isolation
Movement
Regulate
Muscle tone
Improved Task Performance
Mental practice
Meaningful task specific training(MTST)
SENSORY MOTOR REHABILITATION
Task-specific Constrained
Induced Therapy
VIRTUAL REALITY
Sensorimotor approaches
ROBOTICS
Neurodevelopment approach
NMES/FES/Electromyogram
biofeedback (EMG-BFB)
4. What enhances motor
recovery?
Adapted from
1. Levin MF (2015) New technologies for stroke rehabilitation.
Presented World Conference of Physical Therapist, Singapore
2. Brewer L et al (2013). Stroke rehabilitation: recent advances and
future therapies. QJM: An International Journal of Medicine;
106:11–25
KEY: NOVEL THERAPIES

9. BEST PRACTICE GUIDELINE
UK National Clinical Guideline Centre and commissioned by the
National Institute for Health and Clinical Excellence (NICE), contains a
comprehensive list of recommendations on ELEVEN interventions
used in stroke rehabilitation
(Ref: National Institute for Health and Clinical Excellence. Stroke Rehabilitation: Clinical Guideline Draft. http://www.nice.org.
uk/nicemedia/live/11950/56129/56129.pdf).
Utilise a multidisciplinary stroke team Setting goals for rehabilitation
Increase Intensity of stroke rehabilitation Address Cognitive functioning
Address Emotional functioning
Manage Swallowing
Ensure Long-termhealth and social support

10. OUR HEALTHCARE INSTITUTION JOURNEY
Goal: Personalised Rehabilitation

12. REVIEW OF STUDIES
Laver et al (2002) Cochrane review: virtual reality for stroke
rehabilitation. Eur J Phys Rehabil Med. 2012 Sep;48(3):523-
30.
RESULTS:
Nineteen studies with a total of 565 participants were included in the
review. Variation in intervention approaches and outcome data collected
limited the extent to which studies could be compared. Virtual reality was
found to be significantly more effective than conventional therapy in
improving upper limb function (standardised mean difference, SMD)
Kwakkel G et al (2008)Effects of robot-assisted therapy on
upper limb recovery after stroke: a systematic review.
Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):111-21.
RESULTS:
Meta-analysis showed a nonsignificant heterogeneous SES in terms of
upper limb motor recovery. Sensitivity analysis of studies involving only
shoulder-elbow robotics subsequently demonstrated a significant
homogeneous SES for motor recovery of the upper paretic limb. No
significant SES was observed for functional ability (ADL).

13. BALANCE TUTOR

15. G-EO SYSTEM
G-EO System is based on the end-effector
principle designed to interact with the
environment. It consist of a hybrid serial-parallel
robot and a programable footplate for permanent
foot attachment at its end-effector.
It minimize the therapeutic effort needed for
relearning walking and also stair climbing.

16. G-EO SYSTEM:
DOES IT MAXIMIZE THE EFFICIENCY OF WALKING?
Video G-EO system

17. Evidences indicate the following:
1. Activity in the ankle flexor and extensor
muscles were reduced throughout most of the
gait phase 1.
2. The antagonistic tibialis anterior muscle was
remarkably less active during the swing phase
2.
1. Hidler JM,Wall AE: Alterations in muscle activation patterns during robotic-assisted walking. Clin Biomech., vol.20,
pp.184-93, 2005.
2. Hesse S and Werner C. Connecting research to the needs of patients and clinicians. Brain Research Bulletin., vol.78,
pp.26–34, 2009.
???

18. MORONE G ET AL (2017). ROBOT-ASSISTED GAIT TRAINING
FOR STROKE PATIENTS: CURRENT STATE OF THE ART AND
PERSPECTIVES OF ROBOTICS. NEUROPSYCHIATRIC DISEASE AND TREATMENT:13 1303–1311.

19. By Gartner Group

20. TAKE HOME MESSAGE
• Lack of evidence yet Rehabilitation Technology is a growing field of
research with promising early results
• Create rehabilitation technology enhanced therapy team
• Evaluate clients’ motivation to accept Rehabilitation Technology
• Integrate Rehabilitation Technology with standard (conventional) therapy
• Customized rehab care plan during standard therapy session
• From the start, plan to wean client off Rehabilitation Therapy
• Embrace Rehabilitation Technology for selected clients
Goals to use Rehabilitaton Technology are:
Productivity element
Maximize recovery potentials