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VA USING ROBOTS IN REHAB -- Researchers hope
that
relearning and repeating the correct motions,
with help
from the robots, will rewire sections of
damaged brain.
Marine veteran Rich Griffiths of
Branford works with an MIT Manus robotic assisted therapy system
at the VA hospital in West Haven. (photo: Peter Casolino /
Register) |
Story here...
http://www.nhregister.com/site/
news.cfm?newsid=18276403&BRD=1
281&PAG=461&dept_id=7559&rfi=6
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Robots in rehab
Abram Katz, Register Science Editor
It’s hard to argue with these robots.
They’re at the Veterans Affairs Connecticut Healthcare System in West
Haven and know how human hands, wrists, arms and shoulders are supposed
to move.
Normally, brains can direct fingers to pick up a pen, sign a check or
button a shirt without a moment’s thought.
But, about 700,000 Americans suffer strokes every year, when blood clots
or narrowed blood vessels deprive parts of the brain of oxygen. They can
result in a variety of impairments.
Stroke is the leading cause of disability among adults in the United
States, and treatment is usually curtailed after six months to a year.
Whatever’s degraded or lost remains that way.
Consequently, about 40 percent of stroke patients are left with moderate
or severe impairments. In the majority of strokes, arms and hands are
affected.
Correctly performing muscles and tendons in these limbs accomplish many
of the jobs necessary for independence — from feeding, washing, and
dressing to paying bills, operating a computer, using a telephone and
turning pages.
Researchers at the West Haven veterans center and in three others across
the country, hope that stroke patients who use the robots will regain a
significant degree of function. The VA is financing the $5 million
study.
The machines were developed at the Massachusetts Institute of
Technology. Their intolerance of deviation is important.
Patients in the "VA robots in chronic stroke study" are instructed to
move cursors on computer screens by manipulating a series of devices.
Researchers hope that relearning and repeating the correct motions, with
help from the robots if necessary, will rewire sections of damaged
brain. Neural circuits may circumvent the injured cells, or strengthen
weak links.
"Stroke is the leading cause of morbidity and people are left feeling
that they are not whole," said Dr. Daniel Federman, principal robot
investigator at the West Haven VA.
The machinery should address arm weakness following a stroke, he said.
Patients hold a joystick to move a cursor. If movement is direct, the
robot neither helps nor hinders.
However, if the cursor strays, the robot gently moves the arm back into
the correct position. The robot will not permit movement in the wrong
direction, no matter how hard a human pushes.
Dr. Albert C. Lo, a neurologist at the West Haven VA and who is the
study’s chairman, said that of the stroke victims who experience
lingering problems, 85 percent involve the arm and hand. One reason is
that a large portion of the brain is devoted to the many nerves in the
fingers and hands, and the complex set of muscles that control movement.
Lo said the robots are a new therapy that might help people who
otherwise might be overlooked.
Federman said, "By combining the visual and spacial with movement,
perhaps we can reconfigure the brain."
The brain could either reroute signals or repair damage, Lo said. "We
want to know if the therapy works first. Then we’ll figure out why."
One robot is configured so that the subject puts his lower arm into a
brace and his hand is strapped to a control handle. Motion is restricted
to two dimensions. The control moves a cursor. Changing images on the
screen require the subject to move the cursor. The robot helps as
necessary.
Another screen cursor robot is designed to flex the wrist. Again, the
arm is strapped in and the hand fixed to a cylindrical control. The
exercise requires wrist motion akin to shaking hands, as well as
rotating a door knob. A third, larger robot, requires motion of the
elbow and shoulder.
The robots compare where the hands or arms are in space with where the
subject is trying to move them. The machinery corrects "wrong"
movements.
A key to the therapy is repetition, which is suited to robots, Lo said.
The VA hopes to enroll 120 subjects for the study at centers in West
Haven, Baltimore, Seattle, and Gainseville, Fla. So far, 20 veterans
have enrolled.
Strokes in potential participants must be verified by magnetic resonance
imaging or CT scans. Subjects must be 18 or older with moderate to
severe arm or hand weakness. They must be able to follow a three-step
command in English and be willing to forego any other type of
rehabilitation while in the study.
People whose limbs are contracted and fixed are not eligible, nor are
people who experience pain when the required motions are performed.
People in other upper limb clinical trials are also excluded.
Participants will be divided into three groups. One will work with the
robots. A second will receive the usual care, and a third will undergo
intensive physical therapy and care.
Therapy will last three months and the study should be completed in
three years.
If the robots work for stroke rehabilitation, they might be employed to
treat other neurological disorders and injuries, Lo said.
MIT has been working on the robotic system for about 11 years. The
machines have significantly improved stroke victims in smaller studies
at the Spaulding Rehabilitation Hospital in Boston, dating to 2000.
Meanwhile, MIT is working on additional robots for leg therapy.
Veterans interested in participating in the study can learn more by
calling the VA center in West Haven at 932-5711, ext. 3826 or ext. 4146.
Abram Katz can be reached at
akatz@nhregister.com or 789-5719.
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Larry Scott --
