Robot-Aided Sensorimotor Therapy with Telerehabilitation in Subacute and Chronic Stroke – Therapy Scheduling
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Stroke survivors often develop considerable lower extremity motor and sensory impairments, affecting mobility and contributing to a slow and asymmetric gait post stroke. Physical therapy techniques, including both passive mobilization of the impaired joint and active movement therapy, can promote cortical plasticity post-stroke and help achieve maximal functional outcomes. However, there is currently a lack of characterization of the improvement and decay processes associated with this type of therapy. Currently the decision on time distribution and number of therapy sessions is arbitrary. The dose of rehabilitation therapy is largely controlled by treating clinicians, and restricted by various factors such as available funds, and insurance coverage. Therapy is often concluded when the patient reaches a “plateau” in performance. However, this plateau may actually be the patients consolidating their post stroke practice experience rather than achieving optimal recovery. To achieve optimal recovery following stroke it is important to describe quantitatively the effect of a therapy session, to be able to define the optimal dose and time distribution of therapy. In addition, there is a lack of innovative technologies that can extend the benefits of rehabilitation into home and community settings. Telerehabilitation can provide treatment in the home and allow for daily evaluations of outcome without the need to visit the clinic or lab.
The aims of this study are to develop a rehabilitation robot with a telerehabilitation and game interface that will be suitable for a home or outpatient setting. We also will develop methods of characterizing the time course of improvement and decay following therapy to develop an optimized schedule of therapy delivery and then test this protocol.