Optimizing Stroke Rehabilitation Through Robotic Assessments

A stroke can happen at any point across the lifespan, often leaving individuals with chronic motor, sensory, and cognitive impairments. A limitation to improving stroke rehabilitation is the inability to measure specific impairments in an objective and quantitative manner, leaving clinicians unable to identify impairments and track responses to treatment. Traditional clinical measures are based on observing and scoring movements on an ordinal scale. As a result, clinical assessments can be subjective, lack resolution, and are limited to only assessing what can be readily observable to the trained eye. The use of robotics for assessment addresses many of these shortcomings and is the focus of the work in the NeuroRehabilitation Across the Lifespan (NeuRAL) Lab directed by Rachel Hawe, PT, DPT, PhD. 

The NeuRAL Lab focuses on measuring sensorimotor deficits in individuals with stroke across the lifespan, including children with cerebral palsy due to a stroke early in life. The motivation of the lab is that if we can better measure sensorimotor impairments post-stroke, we can better understand the neural mechanisms behind abnormal movements and target interventions to specifically address the deficits an individual exhibits. The NeuRAL Lab uses a robotic device called the Kinarm Exoskeleton, shown above. The Kinarm system consists of bilateral robotic exoskeleton arms that support the participant’s arms in the horizontal plane. This allows for individuals with severe weakness to still move within the system. Participants can actively move their arms, or the Kinarm can provide assistance or resistance to movements. Participants then interact with a virtual reality display in which visual stimuli are projected into the same plane as their arms. The Kinarm measures the kinematics of the arm movements, and an integrated gaze tracker also detects where participants are looking. Members of the NeuRAL Lab design and program different “tasks” that are used to assess specific behaviors and impairments. Tasks involve different visual stimuli and forces that participants interact with by moving their limbs.

neural lab

The main focus of the lab is on coordination between the two arms. While most activities we do in daily life require the use of both arms, most clinical assessments, and treatments post-stroke focus only on the more affected arm. Hawe and her team are developing a comprehensive set of robotic tasks examining different aspects of bilateral coordination. Tasks include reaching targets with each arm independently, controlling a cursor cooperatively with both arms to trace a path, and stretching a haptic spring between the two hands The goal of this work is to be able to assess individuals on a comprehensive set of bilateral tasks to determine where they have deficits to then focus therapies. Another area of focus in the lab is how vision guides movements in typically developing children and children with hemiparetic cerebral palsy. The lab has created a virtual maze task where participants move their arms through a maze to reach a goal target. Using gaze tracking, they can see where participants look before they start moving (motor planning) and during the movement (movement execution). This line of research will give insight into the interplay between the visual, proprioceptive, and motor systems.

neural lab robotic task

Hawe and her team are optimistic that through improved measures offered by robotics, stroke rehabilitation can become more targeted, thus improving outcomes for the 800,000 Americans who have a stroke each year.

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