Rationale of an integrated robotic approach for upper limb functional rehabilitation

Upper limb motor impairment often causes long-term disability in stroke patients and implies limitations in activities of daily living. Several studies tested robotic devices for proximal or distal upper limb rehabilitation and reported results principally focused on specific treated district without significant global effects. We propose a novel approach that integrates a hand distal effector in task-oriented arm training for upper limb functional rehabilitation. Four chronic stroke patients underwent to an intensive rehabilitative treatment using a robotic device that provides arm weight support and assistance of the hand closing/opening within specific setting in virtual reality. After treatment improvements in upper limb functional scales and in kinematic and pressure assessments were observed, highlighting effects on global upper limb motor performance and distal motor control. Furthermore a decrease in resting motor threshold and a reduction in silent period recorded from unaffected hemisphere were evident, suggesting a potential cortical reorganization.