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Beyond Human or Robot Administered Treadmill Training

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Neurorehabilitation Technology

Abstract

The demand for rehabilitation services is growing apace with the graying of the population. This situation creates both a need and an opportunity to deploy technologies such as rehabilitation robotics, and in the last decade and half, several research groups have deployed variations of this technology. Results so far are mixed with the available evidence demonstrating unequivocally that some forms of robotic therapy can be highly effective, even for patients many years post-stroke, while other forms of robotic therapy have been singularly ineffective. The contrast is starkest when we contrast upper-extremity and lower-extremity therapy. In fact, 2010 Stroke Care Guidelines of the American Heart Association and of the Veterans Administration/Department of Defense (VA/DoD) endorsed the use of the rehabilitation robotics for upper-extremity post-stroke care but concluded that lower-extremity robotic therapy is much less effective and declared “still in its infancy.” We submit that the contrasting effectiveness of upper- and lower-extremity therapies arises from neural factors, not technological factors. Though, no doubt, it might be improved, the technology deployed to date for locomotor therapy is elegant and sophisticated. Unfortunately, it may be misguided, providing highly repeatable control of movement but ultimately doing the wrong thing. The technology we have deployed to date for upper-extremity therapy is firmly based on an understanding of how upper-extremity behavior is neurally controlled and derived from decades of neuroscience research. The limitations of lower-extremity robotic therapy lie not in the robotic technology but in its incompatibility with human motor neuroscience. In this chapter, we briefly review the evidence supporting such negative views, and based on our experience with upper-extremity robotic therapy, we describe what we are presently investigating to revert and work toward a future endorsement of the American Heart Association and VA/DoD for rehabilitation robotics for lower-extremity post-stroke care.

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Acknowledgment

Portions of this chapter were exc­erpted from previously publications. This work was supported in part by NIH grant #1 R01-HD045343, the Veterans Administration Baltimore Medical Center “Center of Excellence on Task-Oriented Exercise and Robotics in Neurological Diseases” B3688R, the Cerebral Palsy International Research Foundation (CPIRF) and the Niarchos Foundation, and Toyota Motor Corporation’s Partner Robot Division. H. I. Krebs and N. Hogan are co-inventors in several MIT-held patents for the robotic technology. They hold equity positions in Interactive Motion Technologies, Watertown, MA, USA, the company that manufactures this type of technology under license to MIT.

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Authors and Affiliations

  1. Department of Mechanical Engineering, MIT – Massachusetts Institute of Technology, 77 Massachusetts Ave., Office 3-137, 02139, Cambridge, MA, USA

    Hermano Igo Krebs

  2. Department of Neurology, University of Maryland at Baltimore, 10 North Greene St., Room BC-101, 21201, Baltimore, MD, USA

    Anindo Roy

  3. Department of Mechanical Engineering, MIT – Massachusetts Institute of Technology, 77 Massachusetts Ave., 02139, Cambridge, MA, USA

    Panagiotis K. Artemiadis

  4. Department of Mechanical Engineering, MIT – Massachusetts Institute of Technology, 77 Massachusetts Ave, Room 3-147, 02139, Cambridge, MA, USA

    Jooeun Ahn

  5. Department of Mechanical Engineering, MIT – Massachusetts Institute of Technology, 77 Massachusetts Ave, Room 3-146, 02139, Cambridge, MA, USA

    Neville Hogan

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  1. Hermano Igo Krebs
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Correspondence to Hermano Igo Krebs .

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Editors and Affiliations

  1. Uniklinik Balgrist, Forchstr. 340, Zürich, 8008, Switzerland

    Volker Dietz

  2. , ARTORG Center for Biomedical Engineering, Universität Bern, Murtenstrasse 21, Bern, CH-3010, Switzerland

    Tobias Nef

  3. Rehabilitation Institute of Chicago, Illinois, 60611, USA

    William Zev Rymer

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Krebs, H.I., Roy, A., Artemiadis, P.K., Ahn, J., Hogan, N. (2012). Beyond Human or Robot Administered Treadmill Training. In: Dietz, V., Nef, T., Rymer, W. (eds) Neurorehabilitation Technology. Springer, London. https://doi.org/10.1007/978-1-4471-2277-7_14

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  • DOI: https://doi.org/10.1007/978-1-4471-2277-7_14

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