Table Of ContentDavid J. Reinkensmeyer
Volker Dietz
Editors
Neurorehabilitation
Technology
Second Edition
123
Neurorehabilitation Technology
David J. Reinkensmeyer • Volker Dietz
Editors
Neurorehabilitation
Technology
Second Edition
Editors
David J. Reinkensmeyer Volker Dietz
University of California at Irvine Spinal Cord Injury Center
Irvine University Hospital Balgrist
California Zürich
USA Switzerland
ISBN 978-3-319-28601-3 ISBN 978-3-319-28603-7 (eBook)
DOI 10.1007/978-3-319-28603-7
Library of Congress Control Number: 2016948440
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Preface to the S econd Edition
When I want to discover something , I begin by reading up everything that has been
done along that line in the past – t hat ’ s what all these books in the library are for. I
see what has been accomplished at great labor and expense in the past. I gather
data of many thousands of experiments as a starting point , a nd then I make thou-
sands more .
Attributed to Thomas Edison
T he aim of this book is to provide a current overview of the ongoing revo-
lution in neurorehabilitation technology. This revolution began in the late
1980s when several research groups, apparently beginning with a group at
MIT, made the observation that robotic technologies could enhance rehabili-
tation movement training by automating parts of it. Seminal work in neuro-
plasticity emerging at the same time observed for the fi rst time that the
nervous system retains a highly distributed capacity to alter its connectivity in
response to repetitive sensory motor input even following severe damage and
aging. Partially automating repetitive movement training was thus imagined
as a way to increase movement therapy dose, improving recovery without
increasing health care costs.
Thirty years later, tens and perhaps hundreds of companies worldwide
now sell rehabilitation robotic technology. The most successful company is
likely the Swiss company Hocoma. With the development of the gait orthosis
‘Lokomat’ in the early 1990s, Hocoma emerged as a spin-off from the
Balgrist University Hospital in Zürich. It is now established well with over
1000 installations of its Lokomat gait orthosis, Armeo arm orthoses, and
other technologies (its products and their evaluation are necessarily the focus
of several chapters in the book). The number of papers published in rehabili-
tation robotics has increased from a few per year to over 1000 annually.
Systematic reviews of tens of randomized controlled trials now affi rm robotic
training as a benefi cial supplement to conventional training.
Yet the benefi ts provided by these devices are incremental for most patients
and the cost high enough to limit their use mainly to fl agship rehabilitation
facilities. We are perhaps at a stage of invention similar to that of the light
bulb in 1878. The best light bulbs in 1878 lasted only 13 h, despite the light
bulb having been invented in 1802 by Humphry Davy. It would take Thomas
Edison several more years of experimental and theoretical work to increase
the average light bulb life to over 1000 h, thus producing one of the most
impactful technologies of all time.
v
vi Preface to the Second Edition
This second edition of N eurorehabilitation Technology details what might
be described as the ongoing Edisonian process of improving neurorehabilita-
tion technology. World leaders in their fi elds have taken the time to step back
from their work, evaluate the state of the art in their fi eld, and trace the devel-
opment of their own work in creating this state of the art. In their chapters,
they detail improved knowledge of motor impairment and neuroplasticity
mechanisms; this knowledge is fundamental for a principled approach to neu-
rorehabilitation technology design. They describe how they have not only
incorporated robotic devices into their clinical practice, but then further
refi ned these technologies based on their clinical experience. They highlight
the potential of combination therapies with drugs, electrical stimulation, and
brain-computer interfaces, to increase functional benefi ts achievable beyond
hard limits set by neural destruction. And they describe the beginnings of the
second wave of innovation in neurorehabilitation technology now occurring,
this time driven by the worldwide emergence of wearable sensing, actuation,
and computing for consumer health markets.
New chapters selected for the second edition include motor challenge in
neurorehabilitation, neural coupling in neurorehabilitation after stroke, clini-
cal application of robots for children, overground exoskeletons for locomo-
tion recovery, virtual reality and computer gaming for rehabilitation, wearable
sensors, and brain-computer interfaces for rehabilitation therapy. Chapters
published in the fi rst edition have also been updated and reorganized to refl ect
the ongoing revolution. Volker and I hope that this book will inspire the next
generation of innovators—clinicians, neuroscientists, and engineers—to
move neurorehabilitation technology forward, thus benefi tting the next gen-
eration of people with a neurologic impairment.
T he editors thank Barbara Lopez-Lucio for her excellent technical support
editing this book.
Irvine , USA David Reinkensmeyer
Zurich , Switzerland Volker Dietz
Contents
Preface to the Second Edition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Introduction: Rationale for Machine Use . . . . . . . . . . . . . . . . . . . . . . xvii
Part I Basic Framework: Motor Recovery, Learning, and Neural
Impairment
1 Learning in the Damaged Brain/Spinal Cord:
Neuroplasticity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Andreas Luft , Amy J. Bastian , and Volker Dietz
2 Movement Neuroscience Foundations
of Neurorehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Robert L. Sainburg and Pratik K. Mutha
3 Designing Robots That Challenge to Optimize
Motor Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
David A. B rown , Timothy D. Lee , David J. Reinkensmeyer ,
and Jaime E. Duarte
4 Multisystem Neurorehabilitation in Rodents
with Spinal Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Grégoire Courtine , Rubia van den Brand , Roland R. Roy ,
and V. Reggie Edgerton
5 Sensory-Motor Interactions and Error Augmentation . . . . . . . 79
James L. Patton and Felix C. Huang
6 Normal and Impaired Cooperative Hand Movements:
Role of Neural Coupling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Miriam Schrafl -Altermatt and Volker Dietz
7 Clinical Assessment and Rehabilitation of the Upper Limb
Following Cervical Spinal Cord Injury . . . . . . . . . . . . . . . . . . . 107
Michelle Louise Starkey and Armin Curt
Part II Human-Machine Interaction in Rehabilitation Practice
8 Application Issues for Robotics . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Markus Wirz and Rüdiger Rupp
vii
viii Contents
9 The Human in the Loop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Alexander C. Koenig and Robert Riener
10 Robotic and Wearable Sensor Technologies
for Measurements/Clinical Assessments . . . . . . . . . . . . . . . . . . . 183
Olivier Lambercy , Serena Maggioni , Lars Lünenburger ,
Roger Gassert , and Marc Bolliger
11 Clinical Aspects for the Application of Robotics in Locomotor
Neurorehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Volker Dietz
12 Clinical Application of Robotics and Technology
in the Restoration of Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Alberto Esquenazi , Irin C. Maier , Tabea Aurich Schuler ,
Serafi n M. Beer , Ingo Borggraefe , Katrin Campen , Andreas R. Luft ,
Dimitrios Manoglou , Andreas Meyer-Heim , Martina R. Spiess ,
and Markus Wirz
13 Standards and Safety Aspects for Medical Devices in the Field
of Neurorehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Burkhard Zimmermann
14 Clinical Application of Rehabilitation Technologies in Children
Undergoing Neurorehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . 283
Hubertus J. A. van Hedel and Tabea Aurich (-Schuler)
Part III Robots for Upper Extremity Recovery
15 Restoration of Hand Function in Stroke and Spinal
Cord Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Derek G. K amper
16 Forging Mens et Manus: The MIT Experience in Upper
Extremity Robotic Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Hermano I go Krebs , Dylan Edwards , and Neville Hogan
17 Three-Dimensional Multi-degree- of-Freedom
Arm Therapy Robot (ARMin) . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Tobias Nef , Verena Klamroth-Marganska , Urs Keller ,
and Robert Riener
18 Implementation of Impairment- Based Neurorehabilitation
Devices and Technologies Following Brain Injury . . . . . . . . . . . 375
Jules P. A. Dewald , Michael D. Ellis , Ana Maria Acosta ,
Jacob G. McPherson , and Arno H. A. Stienen
Part IV Robotics for Locomotion Recovery
19 Technology of the Robotic Gait Orthosis Lokomat . . . . . . . . . . 395
Robert Riener
Contents ix
20 Beyond Human or Robot Administered
Treadmill Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Hermano Igo Krebs , Konstantinos Michmizos , Tyler Susko ,
Hyunglae Lee , Anindo Roy , and Neville Hogan
21 Toward Flexible Assistance for Locomotor Training: Design
and Clinical Testing of a Cable- Driven Robot for Stroke,
Spinal Cord Injury, and Cerebral Palsy . . . . . . . . . . . . . . . . . . . 435
Ming Wu and Jill M. Landry
22 Robot-Aided Gait Training with LOPES . . . . . . . . . . . . . . . . . . 461
Edwin H. F. van Asseldonk and Herman van der Kooij
23 Robotic Devices for Overground Gait
and Balance Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Joseph M. Hidler , Arno H. A. Stienen , and Heike Vallery
24 Using Robotic Exoskeletons for Over-Ground
Locomotor Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493
Arun Jayaraman , Sheila Burt , and William Zev Rymer
25 Functional Electrical Stimulation Therapy: Recovery
of Function Following Spinal Cord Injury and Stroke . . . . . . . 513
Milos R. Popovic , Kei Masani , and Silvestro Micera
26 Passive Devices for Upper Limb Training . . . . . . . . . . . . . . . . . 533
Arthur Prochazka
27 Upper-Extremity Therapy with Spring Orthoses . . . . . . . . . . . 553
David J. Reinkensmeyer and Daniel K. Zondervan
28 Virtual Reality for Sensorimotor Rehabilitation Post
Stroke: Design Principles and Evidence . . . . . . . . . . . . . . . . . . . 573
Sergi Bermúdez i Badia , Gerard G. Fluet , Roberto Llorens ,
and Judith E. Deutsch
29 Wearable Wireless Sensors for Rehabilitation . . . . . . . . . . . . . . 605
Andrew K. Dorsch , Christine E. King , and Bruce H. Dobkin
30 BCI-Based Neuroprostheses and Physiotherapies
for Stroke Motor Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . 617
Colin M. McCrimmon , Po T. Wang ,
Zoran Nenadic , and An H. Do
Epilogue: What Lies Ahead? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633
