Stroke is one of the leading causes of long-term disability. Strokes can have a wide-ranging impact on physical and mental abilities, with mild strokes impacting one limb or the ability to speak, whereas severe strokes often result in paralysis on the opposite side of the body from where the stroke occurred.
Fortunately, there are ways to help those recovering from a stroke and fighting for their independence regain some physical function when traditional treatments don’t work.
One such way is through robotics therapy for stroke rehabilitation that facilitates neuroplasticity and fosters neurogenesis which can be used to help with speech therapy programs as well as mobility challenges.
2,400 rehabilitation robots were sold in 2018, an 83% increase over 2017, according to the IFR’s World Robotics 2019 – Service Robots.
Stroke rehabilitation robotics have the potential to be a game changer for stroke recovery, but there are a number of challenges that must be considered before we can use this technology on a wide scale.
One of the major limitations on using robotics is cost, as most robots are not cheap. Moreover, the cost and use of robots in hospitals may prevent some patients from receiving this type of therapy which could very well help with their recovery.
Another limitation is that for patients who their strokes have paralyzed, it is not clear whether robots can improve motor function in these patients.
How Can Robotics Help With Stroke Rehabilitation
Robotics can be used to help stroke victims regain motor function of their limbs during the early phase after a stroke has occurred. In a study looking at patients who were given robotic therapy, they either sat in front of robotic arms or they used their own arms but were supported by robotic arm braces that could help support the arm weight.
Robots have been found to be more effective than conventional therapy for restoring active and passive range of motion of the upper and lower limbs after limb immobilization following stroke.
Benefits Of Robotics For Stroke Rehabilitation
A new study has found that robot-assisted gait robotic training may help chronic stroke patients improve their movement. The randomized controlled trial found that patients who received robot-assisted training had better motor function than those who did not.
This is the first study to demonstrate how training with a robot can aid chronic stroke patients with their motor function. One facility claimed that utilising the exoskeleton increased treatment output by 300%.
Robotic assisted rehabilitation is a promising new treatment for chronic stroke patients. In a recent study, patients who received robot assisted arm training showed significant improvements in upper limb motor function.
This type of therapy is an effective way to improve the quality of life for chronic stroke patients.
1. Rehabilitation Robots Can Help Improve Motor Function
Robotics are able to recover the function of users’ limbs which has been lost due to paralysis. A successful rehabilitation robot can be used in several ways including for rehabilitation, as a stand-alone tool which improves motor function and allows therapists to observe and teach the patient, or as an add-on to existing therapy programs.
Studies have shown that patients who are paralyzed after strokes at the most severely affected areas are able to use their fingers better by using touch feedback from a robotic system versus touch feedback from a traditional rubber hand.
2. Robotics Allow Patients To Regain Movement
A rehabilitation robot utilizes sensors that track the motion of different body parts. The robot then gives sensory feedback to the patient and helps guide them through exercises based on what they are trying to achieve.
This allows therapists to guide patients through rehabilitation exercises, including walking, in a specific and structured manner rather than leaving it up to the patient as they often do in traditional therapy sessions.
One study showed that robotic motion capture not only improved motor recovery but also promoted neural plasticity and neurogenesis in rats who had suffered from strokes. Another study found that patients who received robotic therapy twice a week for four weeks had better motor function at the end of treatment than those who didn’t receive any robotic therapy.
3. Robotics Help With Speech Therapy
Robotics can be used in conjunction with speech therapy. Rehabilitation robots taken out of the clinic can be used to interact with the patient and simulate speech patterns, allowing therapists to use multiple options of how to look at the patient’s behavior and compare this to how they respond to speech therapy.
This type of system is helpful for patients who have lost the ability to speak because it allows therapists to interact with them in a flexible manner that can easily adjust based on what their individual needs are.
Upper extremity spasticity affected 17% to 40% of stroke survivors, making it harder for them to conduct activities of daily living (ADL) (Hsieh et al., 2017; Pollock et al., 2014).
One study found that 80 percent of patients who had lost the ability to speak after stroke improved their communication abilities after using robotic therapy in conjunction with traditional therapy when compared those who received traditional therapy alone.
4. Robotic Systems Can Help With Walking Techniques
A rehabilitation robot can be used to break down a complex task such as walking into smaller parts and then teach the patient how to do it. It can do this through visual, auditory or kinesthetic feedback which allows the patient to see how they are performing each step, hear how they sound performing each step and feel how their body is moving as they walk.
This type of feedback allows the patient to slowly build up their skills and improve motor function slowly but surely instead of overloading them with all of these new concepts at once.
5. Rehabilitation Robots Can Help Patients Learn New Skills
Rehabilitation robots can also be used to help patients learn new skills. Research has found that groups of stroke patients who are given rehabilitation therapy twice a week for four weeks have better motor function at the end of treatment than those who don’t receive any robotic therapy.
Some studies have found that stroke victims who have been given robot therapy with visual feedback have improved more than those who received traditional therapy alone; meanwhile, other studies found that stroke victims could improve their speech when they were given robotic therapy with auditory feedback rather than visual.
6. Robotic Systems Can Help With Balance
Robotics can also help patients who have suffered from strokes improve their balance. One study found that stroke victims were able to regain their balance after using a robotic system.
They did this task less slowly than they did before using the robot and they also had improved muscle activation in their lower limbs compared to those who hadn’t used a robot.
Another study found that patients who were given robot therapy had higher muscle activation of the lower limbs and upper limbs than those who weren’t given robotic therapy.
7. Robotic Systems Can Help With Postural Control
Robotics can be used to help stroke patients improve their balance by helping them learn how to pick up objects and put them back down safely.
While there are several existing tools that can help stroke patients with the pose they take when they pick up an object, they tend to make the patient’s movements more rigid, which makes it harder for them to perform tasks like picking up a cup of coffee.
33% to 66% of patients fail to regain functional use of their upper limbs six months after their stroke (Kwakkel & Kollen, 2013).
Another study found that robotic therapy more often helped stroke victims walk in a more upright manner and take shorter strides than those who were given traditional therapy without robotic assistance.
Risks Of Robotics For Stroke Rehabilitation
Adult stroke rehabilitation typically involves intensive therapy for acute stroke patients. However, recent studies have shown that robot assisted therapy can be beneficial for stroke survivors.
This therapy can aid survivors in regaining function and enhancing their quality of life, but it is often more extensive than regular therapy. Five years after the stroke began, sadly, just a third of survivors have a good functional prognosis.
1. Workload On Therapists
The use of robots for rehabilitation often means that more time has to be spent on therapists, and this is a concern. It is recommended in the stroke unit context to have a therapist:patient ratio higher than one.
This may be difficult if robotic devices are used with greater frequency due to the additional training and supervision required.
2. Limited Functional Gains During The Early Phase After Stroke
Although rehabilitation robots can help patients regain movement, they tend to not show functional gains during the early phase after stroke when compared with conventional therapy.
Functional gains are especially poor during the first 3 months after stroke, where traditional therapy often shows improvements which then wane out until 1 year post-stroke and beyond.
3. Narrow Therapeutic Window And Long-Term Effects Of Therapy In Stroke
In the early phase after stroke, the nervous system is still very sensitive and it is important to help patients during the rehabilitation process. If patients are not given proper therapy early on, it may be very difficult for them to improve their mobility later on.
This means that there is a narrow therapeutic window for rehabilitation robots coupled with human therapists in order for patients to regain movement after stroke.
In terms of long-term effects, studies have found no significant differences between robotic therapy and traditional therapy when it comes to functional gains during the first year after a stroke has occurred.
4. Larger Financial And Professional Costs
There is often a higher workload on therapists during robotic therapy as opposed to traditional therapy, which means it could mean more therapists are needed.
It may be difficult to find enough therapists in certain locations, especially when there are long waiting lists for therapists. Robotics requires additional hardware and software for the robots, which can add to the cost of the system.
In the future, robotic systems will likely be able to help stroke patients regain motor function during the early phase of rehabilitation. They will also likely be able to help patients retain and improve their motor function significantly over the course of rehab, since in the early phase after stroke there is often little improvement.
Because of this, stroke-related issues place a heavy strain on patients and their families. There will likely be more robotic assistance available to stroke patients in the future and this could help increase patient recruitment into robotic rehabilitation programs, which could allow more people with stroke to use robotics for therapy.
There may be specific types of therapy that are better suited to using robot assistance such as balance/posture and robot assisted gait training, as these are areas where traditional therapy doesn’t work as well as it could.