Robot-assisted movement training for the stroke-impaired arm: Does it matter what the robot does?

Robot-assisted movement training improves arm movement ability following acute and chronic stroke. Such training involves two interacting processes: the patient trying to move and the robot applying forces to the patient's arm. A fundamental principle of motor learning is that movement practice improves motor function; the role of applied robotic forces in improving motor function is still unclear. This article reviews our work addressing this question. Our pilot study using the Assisted Rehabilitation and Measurement (ARM) Guide, a linear robotic trainer, found that mechanically assisted reaching improved motor recovery similar to unassisted reaching practice. This finding is inconclusive because of the small sample size (n = 19), but suggest that future studies should carefully control the amount of voluntary movement practice delivered to justify the use of robotic forces. We are optimistic that robotic forces will ultimately show additional therapeutic benefits when coupled with movement practice. We justify this optimism here by comparing results from the ARM Guide and the Mirror Image Movement Enabler robotic trainer. This comparison suggests that requiring a patient to generate specific patterns of force before allowing movement is more effective than mechanically completing movements for the patient. We describe the engineering implementation of this "guided-force training" algorithm.