Robotics combined with electrical stimulation: hybrid support of arm and hand for functional training after stroke

Reach, grasp and release is part of many functional movements. Graying of society leads to more stroke victims and fewer health care professionals. Technology might be a solution to support certain rehabilitation therapies in future health care. Robotic systems have been developed for support of arm and hand movements and functional electrical stimulation (FES) has been applied to activate arm and hand muscles. Therapeutic effects of both techniques have been shown similar to conventional therapies. In addition, the application of these technologies allows for more frequent training with less physical effort for therapists. The aim of this thesis is to develop and evaluate methods for control of an automated hybrid rehabilitation system combining robotics for reach assistance and FES for grasp and release to allow functional arm and hand training. By the use of an automated system for stroke rehabilitation, which is also applicable in the patient's home, therapy can be intensified even further. For successful application of a hybrid system, solutions for individual components have first been explored and in collaboration with project partners a prototype robotic arm manipulator was developed and evaluated. This system was combined with FES support for grasp and release for training of functional tasks. The system was evaluated during passive functional movement tasks in healthy subjects and severe chronic stroke subjects. The system was successful during passive arm and hand tasks In healthy subjects. To be conclusive on post stroke applicability of the current system, additional evaluation in a broader range of stroke subjects is required. A passive subject will be the most demanding situation for the system and was therefore used as evaluation setting. In the final chapter, possible directions for active user involvement, detection of user intention and training in a home environment allowing for intensive training were discussed. This thesis demonstrates the technical feasibility of an automated rehabilitation system, which combines robotics and FES. The technologic possibilities of combining robotics and FES in a subject specific approach presented here will contribute to a sustainable health-care system, while maximizing functional independence of stroke survivors.