title: Rehabilitation robotics for the upper extremity: review with new directions for orthopaedic disorders.
abstract: The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics may be integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with UE disorders, specifically emphasizing the wrist and hand. Clinical application of a task-oriented approach may be accomplished using commercially available haptic robotic device to focus on training of grasp and manipulation tasks.
authors.affiliation: a Department of Physical Therapy , University of Scranton , Scranton , PA , USA.
authors.forename: Renée M
authors.initials: RM
authors.lastname: Hakim
authors.affiliation: a Department of Physical Therapy , University of Scranton , Scranton , PA , USA.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Tunis
authors.affiliation: b Department of Physical Therapy , Daemen College , Amherst , NY , USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Ross
mesh_terms: D005081:Exercise Therapy / Q000379:methods*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D009473:Neuronal Plasticity / Q000502:physiology; D020127:Recovery of Function; D012371:Robotics; D034941:Upper Extremity / Q000503:physiopathology*; D000076142:Virtual Reality; D014953:Wrist / Q000503:physiopathology
keywords: Robotics; experience-dependent neuroplasticity; orthopaedic disorders; task-specificity; upper extremity