Robot assisted stroke rehabilitation and the research funding crisis
I, Rob-OT, does not compute: the rise of the machine in post-stroke occupational therapy and the funding power-cut causing it to malfunction.
Exploration? Investigation? Call it what you will, but occupational therapy research is as boundless as the profession itself and no less when it comes to robot-assisted stroke rehabilitation.
Yet researchers globally are in a funding crisis currently, caused largely by a shift in public donating towards covid-linked causes.
In response, and for the first time, the Stroke Association this year switched out its annual Make May Purple stroke awareness campaign for a ‘Save Research’ appeal, recognising the intrinsic value of evidence ineffective healthcare provision.
The UK charity has been forced to halve its 2021 research budget due to the drop in donations despite 1 in 5 researchers reporting extra funding needs due to the pandemic’s impact. [1]
So, to help highlight why research funding is so vital, we’ve carried out a small survey ourselves of some of the latest occupational therapy discoveries driving robot-assisted stroke rehab:
Racing robots
Opportunities to set robots against humans in rehabilitation races are proving too much to pass up for researchers worldwide – and with good reason.
Evidence of the benefits of robot-assisted therapy is growing.
The latest issue of Topics in Stroke Rehabilitation provides more of it, based on a trial by occupational therapy researchers at China’s Xuzhou Medical University.
The team wanted to find out whether robotic assistance in post-stroke upper limb rehabilitation:
- Benefitted occupational therapy sessions, such as reducing method monotony and therapist-patient exhaustion.
- Boosted quality of life in terms of independence.
- Enhanced upper limb function training.
The machine contender was a robotic, height-adjustable workstation with four upper limb rehab modes: passive, assistive, active and resistive.
Over six weeks, 50 stroke patients, divided into two teams led by occupational therapists (OTs) or robot-assisted OTs, were trained for 50 to 70 minutes a day, five days a week.
And, encouragingly, team rob-OT won ‘the race’, with better results including ‘significant improvements in upper limb function. [2]
The soft robot helped open their paralyzed finger joints by more than 50 degrees on average. [3] 
Gripping stuff
Researchers in Korea have been getting a grip on reinforcing finger strength and motor skills in post-stroke patients.
A team at Handong Global University in Pohang have developed a wearable ‘soft robot’ for stroke patients with finger joint paralysis on one side of their body.
Incorporated in gloves, the robot measures the finger positions of the unaffected hand and triggers symmetric movements on the paralysed hand using pneumatic force.
And when ten patients were enlisted to trial the gloves during occupational therapy sessions, there were high fives all round.
“The soft robot helped open their paralyzed finger joints by more than 50 degrees on average,” the team reported.
It also provided quantitative data about a patient’s finger paralysis that could not be detected via the usual qualitative assessments. [3]
There is a need to look beyond the ‘one-size-fits-all’ approach, where a single [upper extremity] modality is applied to a group of post-stroke individuals. [4]
Fish and grips
‘SUPER’researchers in Canada sent chronic stroke patients on a virtual fishing trip to land answers about whether robot assistance improved their upper extremity function.
The 28 trial participants received a dozen one-hour sessions over four weeks of perSonalisedUpper Extremity Rehabilitation (SUPER), combining robotics, virtual reality (VR) activities and neuromuscular electrical stimulation (NMES).
The robot-assisted activity was a virtual underwater fishing game that encouraged the player to test their maximal voluntary arm extension.
The VR session was based on a grocery shopping task and included 30-minutes of NMES.
When the trial ended, around two-thirdsof those who took part had improved upper extremity function, prompting plans for future SUPER studies, along with a recommendation for more varied therapy options.[4]
The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. [5]
Scot bot barriers
It’s all very well developing robot-assisted devices to enhance stroke rehab, but what if stroke survivors don’t want to use them?
Lanarkshire OT Gillian Sweeney was among a research team trying to answer that crucial question amid low uptake of robot-aided interventions among NHS Scotland’s clinical practices.
Cross-sectional online surveys of OTs’ opinions and semi-structured interviews with stroke patients were carried out.
And the recurring reasons recorded included:
- Inadequate staffing.
- Lack of training and resources.
- Patient motivation.
The study, published in the British Journal of Occupational Therapy, concludes with a call for further research into the impact of patient motivation on intervention uptake. [5]
Upper-limb robot-assisted therapy has been established as a safe and feasible treatment to complement rehabilitation after neurological injuries, such as stroke. [6]
Neu-robot
Swiss rehabilitation researchers and members of Zurich’s Institute of Robotics and Intelligent Systems enrolled 33 stroke survivors in a head-to-head between neurocognitive therapy for hand function and a robot-assisted alternative.
The goal was to work out whether the robot-assisted therapy - provided after a neurocognitive combo of motor training and somatosensory and cognitive tasks - decreased upper limb motor impairment to the same degree as conventional neurocognitive therapy.
And the results, recorded at the end of intervention at week 8 and again at week 32, established that motor recovery in the robot-aided group was non-inferior to (or, no worse than) that achieved by conventional therapy. [6]
*FYI: ICRADRRWR 2021
For more on robots in healthcare, ICRADRRWR 2021 is the place to be this month!
Despite the pandemic and an acronym sounding like a malfunctioning text to speech converter, the 2021 International Conference on Robotic Assistive Devices, Rehabilitation Robots and Wheelchair Robots (ICRADRRWR) will be fully up and running – but digitally.
The two-day event showcases the latest research, innovations, trends, challenges, and solutions in the three fields and plays host to leading scientists, researchers, and scholars worldwide. [7]
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