Potential of Robots as Next-Generation Technology for Clinical Assessment of Neurological Disorders and Upper-Limb Therapy

By Scott, Stephen H.; Dukelow, Sean P. | Journal of Rehabilitation Research & Development, April 2011 | Go to article overview

Potential of Robots as Next-Generation Technology for Clinical Assessment of Neurological Disorders and Upper-Limb Therapy


Scott, Stephen H., Dukelow, Sean P., Journal of Rehabilitation Research & Development


INTRODUCTION

Over the last 100 years, radical changes have occurred in the assessment and treatment of disease. Blood tests now provide a wealth of information on the function of many organs, genetic testing can predict some diseases, and imaging techniques provide detailed quantitative information on the anatomical structure of the body. Substantial changes have also occurred in the treatment of disease. These include advances in pharmacological interventions and biomedical devices such as cardiac pacemakers, prosthetic limbs, and cochlear implants to ameliorate the effects of dysfunction. These advances reflect the transfer of knowledge and increased use of technology from basic research to clinical practice.

Not all fields of medicine have been equally influenced by technology. With the exception of advances in structural and functional imaging, neurological assessment is still largely based on a clinician's perceptual decisions when monitoring the behavioral performance of the patient, such as testing the briskness of the muscle stretch reflex with a hammer tap or observing the range of motion and movement of a joint. This reliance on subjective assessment tools reflects the keen ability of the human perceptual system to observe even subtle differences between normal and abnormal behavior and the difficulty to develop technologies to replicate this ability of human observation. Although assessment tools have evolved to quantify sensory, motor, and cognitive deficits using clinician-based measurement systems, these approaches remain inherently subjective.

Correspondingly, rehabilitation approaches for neurological disorders such as for stroke or traumatic brain injury remain largely based on one-on-one interactions between patient and therapist. Rehabilitation approaches vary widely across practitioners with little evidence to support why one approach is better than another [1-3].

The result is a vicious circle between neurological assessment and neurorehabilitation: the lack of sensitive tools to quantify dysfunction makes demonstrating the effectiveness of novel therapeutic approaches difficult, and limited improvement by existing treatments as measured by current assessments implies no need for better assessment tools.

Our purpose with this review is to suggest that the time may be right for a profound change in neurological assessment and neurorehabilitation, particularly related to stroke and traumatic brain injury. Our hypothesis is that robotic technologies can provide a radically new and effective approach to clinical assessment of brain function and rehabilitation. This approach also takes advantage of advances in our understanding of brain function to develop a range of behavioral tasks to assess the various brain circuits that support sensory, motor, and cognitive function. As well, it highlights how these same technologies can be used for rehabilitation in subjects following stroke.

Over the last 40 years, our understanding of how the brain supports sensory, motor, and cognitive function has substantially increased [4-5]. Behavioral studies on humans have identified how we use sensory input to the brain to perceive the world around us, make decisions, and guide our highly skilled and flexible motor actions. Anatomical tracing techniques highlight the anatomical connectivity among different brain regions. Neurophysiological studies in awake, behaving animals have uncovered how neural activity in various brain regions correlates with various sensory, motor, and cognitive functions. In turn, clinical research on various patient groups have highlighted how damage in even small portions of the brain can have a profound impact on brain processing.

The culmination of these studies forms several basic principles about brain function. First, sensory and motor systems work together to permit us to move and interact in the environment and create our perception of the world. …

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