Using technology to optimize recovery in upper limb stroke rehabilitation

Abstract

A skilled therapist working one-to-one with a patient for one or two hours a day may be an ideal environment to optimize recovery of upper limb function following stroke and is likely to be superior to technologies that ‘replace the therapist’. Repeated studies have found that there is no single therapeutic approach that is more effective than any other, but intensity is critical. The recent Randomized Controlled Trial of the MIT Manus, published by Lo et al, found that robot therapy was not superior to intensive conventional therapy. Given that one-to-one intensive therapy is unaffordable can technology be used to improve outcome and if so how? The key factors appear to be: increasing intensity of practice; motivating patients to maximize engagement, effort and compliance; performance of functional and relevant tasks; increasing Central Nervous System (CNS) excitability and early intervention. The evidence that technologies can be used to deliver on these key factors will be discussed and in particular the evidence and potential for combined therapies such as electrical stimulation (both peripheral and transcranial direct current stimulation [tDCS]) with robot therapy will be presented