title: Motions or muscles? Some behavioral factors underlying robotic assistance of motor recovery.
abstract: Robotics and related technologies have begun to realize their promise to improve the delivery of rehabilitation therapy. However, the mechanism by which they enhance recovery remains unclear. Ultimately, recovery depends on biology, yet the details of the recovery process remain largely unknown; a deeper understanding is important to accelerate refinements of robotic therapy or suggest new approaches. Fortunately, robots provide an excellent instrument platform from which to study recovery at the behavioral level. This article reviews some initial insights about the process of upper-limb behavioral recovery that have emerged from our work. Evidence to date suggests that the form of therapy may be more important than its intensity: muscle strengthening offers no advantage over movement training. Passive movement is insufficient; active participation is required. Progressive training based on measures of movement coordination yields substantially improved outcomes. Together these results indicate that movement coordination rather than muscle activation may be the most appropriate focus for robotic therapy.
authors.affiliation: Newman Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. neville@mit.edu
authors.forename: Neville
authors.initials: N
authors.lastname: Hogan
authors.forename: Hermano I
authors.initials: HI
authors.lastname: Krebs
authors.forename: Brandon
authors.initials: B
authors.lastname: Rohrer
authors.forename: Jerome J
authors.initials: JJ
authors.lastname: Palazzolo
authors.forename: Laura
authors.initials: L
authors.lastname: Dipietro
authors.forename: Susan E
authors.initials: SE
authors.lastname: Fasoli
authors.forename: Joel
authors.initials: J
authors.lastname: Stein
authors.forename: Richard
authors.initials: R
authors.lastname: Hughes
authors.forename: Walter R
authors.initials: WR
authors.lastname: Frontera
authors.forename: Daniel
authors.initials: D
authors.lastname: Lynch
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Volpe
mesh_terms: D001519:Behavior / Q000502:physiology; D005081:Exercise Therapy; D006801:Humans; D009068:Movement; D018908:Muscle Weakness / Q000209:etiology* / Q000534:rehabilitation*; D012371:Robotics; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation