Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke

DOI 10121201WNL000009596300970682003611604-1607 Neurology

M Ferraro J J Palazzolo J Krol et al patients with chronic stroke

Robot-aided sensorimotor arm training improves outcome in

This information is current as of December 8 2003

httpwwwneurologyorgcontent61111604fullhtmllocated on the World Wide Web at

The online version of this article along with updated information and services is

0028-3878 Online ISSN 1526-632Xsince 1951 it is now a weekly with 48 issues per year Copyright All rights reserved Print ISSN

reg is the official journal of the American Academy of Neurology Published continuouslyNeurology

tients with prior thalamic DBS (P Pollak personalcommunication 1999)

With thalamotomy patients are exposed to ahigher initial risk of complications3 However pa-tients with DBS require continued effectively func-tioning hardware One group has followed 49patients with ET and 12 patients with PD with tha-lamic DBS for a mean of 40 months12 Of the pa-tients with ET five lost benefit after initial tremorimprovement with stimulation (possibly due to toler-ance) Of the patients with PD one lost benefit overtime and required pallidotomy while anotherrsquos non-tremor symptoms of PD immobilized him despite on-going tremor control Device complications werecommon and necessitated additional surgical proce-dures in approximately 40 of patients In contrastanother group evaluated a similar cohort at 6 to 7years finding ongoing benefit in almost all patients(despite disease progression in patients with PD) notolerance and only one hardware complication9

With thalamic DBS many patients derive long-term benefit with contralateral tremor subsiding insome patients However for patients with ET toler-ance to stimulation may compromise long-term effi-cacy For disabling parkinsonian tremor we suggestpallidal or subthalamic procedures instead of tha-lamic DBS All patients must be advised of the risksof perioperative and delayed hardware complica-

tions Longer-term follow-up on larger numbers ofpatients is needed to determine the long-term utilityof thalamic DBS

References1 Koller W Lyons K Wilkinson S Troster A Pahwa R Long term safety

and efficacy of unilateral deep brain stimulation of the thalamus inessential tremor Mov Disord 200116464ndash468

2 Lyons K Koller W Wilkinson S Pahwa R Long-term safety and effi-cacy of unilateral deep brain stimulation of the thalamus for parkinso-nian tremor J Neurol Neurosurg Psychiatry 200171682ndash684

3 Schuurman PR Bosch DA Bossuyt PM et al A comparison of continu-ous thalamic stimulation and thalamotomy for suppression of severetremor N Engl J Med 2000342461ndash468

4 Koller W Pahwa R Busenbark K et al High frequency unilateralthalamic stimulation in the treatment of essential and parkinsoniantremor Ann Neurol 199742292ndash297

5 Fahn S Tolosa E Marin E Clinical rating scales for tremor In Jank-ovic J Tolosa E eds Parkinsonrsquos disease and movement disordersBaltimore Urban and Schwarzenberg 1998

6 Fahn S Elton RL members of the UPDRS Development CommitteeUnified Parkinsonrsquos Disease Rating Scale In Fahn S Marsden CDGoldstein M Calne DB eds Recent development in Parkinsonrsquos dis-ease Vol 2 Florham Park NJ Macmillan 1987153ndash163

7 Oh MH Hodaie M Kim SH Alkhani A Lang AE Lozano AM DBSelectrodes used for lesioning proof of principle Neurosurgery 200149363ndash367

8 Henderson JM OrsquoSullivan DJ Pell M et al Lesion of thalamiccentromedian-parafascicular complex after chronic deep brain stimula-tion Neurology 2001561576ndash1579

9 Rehncrona S Johnels B Widner H Tornqvist A-L Hariz M Sydow OLong-term efficacy of thalamic deep brain stimulation for tremordouble-blind assessments Mov Disord 200318163ndash170

10 Kumar R Sime E Halket E Lozano AM Lang AE Comparative effectsof unilateral and bilateral subthalamic nucleus deep brain stimulationNeurology 199953561ndash566

Robot-aided sensorimotor arm trainingimproves outcome in patients with

chronic strokeM Ferraro OTR JJ Palazzolo MS J Krol OTR HI Krebs PhD N Hogan PhD and BT Volpe MD

AbstractmdashThirty patients with chronic stroke received 6 weeks of sensorimotor robotic training in a pilot study thattargeted motor function of the affected shoulder and elbow The impairment and disability scores were stable during a2-month observationmeasurement period improved significantly by program completion and remained robust in the3-month follow-up Task-specific motor training attenuated a chronic neurologic deficit well beyond the expected period forimprovement after stroke

NEUROLOGY 2003611604ndash1607

Current outcome results from the study of patientsrecovering from stroke have demonstrated that mostgains occur within the first 3 months1 These data

were based on general poststroke treatment princi-ples rather than the task-specific approach to treat-ment that has been stimulated by the optimistic

From the Department of Neurology and Neuroscience (Drs Krebs and Volpe M Ferraro and J Krol) Burke Institute of Medical Research Weill MedicalCollege Cornell University White Plains NY and Newman Laboratory (Drs Krebs and Hogan JJ Palazzolo) Mechanical Engineering Department andBrain and Cognitive Sciences Department (Dr Hogan) Massachusetts Institute of Technology Cambridge MASupported by the Burke Medical Research Institute the Langeloth Foundation and the US Public Health Service (NIH HD 37397)Drs N Hogan and HI Krebs are co-inventors in the MIT-held patent for the robotic device used to treat patients in this work They hold equity positions inInteractive Motion Technologies Inc the company that manufactures this type of technology under license to MITReceived April 11 2003 Accepted in final form August 13 2003Address correspondence and reprint requests to Dr BT Volpe Department of Neurology and Neuroscience Burke Institute of Medical Research WeillMedical College Cornell University 785 Mamaroneck Ave White Plains NY 10605 e-mail bvolpeburkeorg

1604 Copyright copy 2003 by AAN Enterprises Inc

findings in animal models of recovery as well as in anumber of focused clinical training programs2-6 Be-cause there is little precedent that impairmentmight be altered in patients with chronic stroke andmoderate to severe hemiparesis we report an uncon-trolled pilot trial to test the effect of task-specifictreatment delivered by robotic training protocols onproximal arm motor outcome

Methods Thirty-four stroke survivors responded to a localnewspaper advertisement to participate in a study to test whetherrobotic training improved motor function in the affected upperlimb The patients were between ages 39 and 81 (average SEM648 23 years) and had hemiparesis or hemiplegia of the upperand lower extremity after a single stroke identified by neuroimag-ing that had occurred at least 8 months prior to the initial assess-ment (average 1299 147 days) Sensory or visual fieldimpairment aphasia or cognitive impairment was not an exclu-sion criterion but the patients needed to be able to follow simpleinstructions The patients participated in 18 sessions each lasting1 hour that occurred three times a week The interactive robotfeatures have been discussed at length elsewhere78 A key featureof this device is the low near isotropic inertia and reduced frictionin the robot arm so that when appropriate it can ldquoget out of thewayrdquo The patients moved the robot arm easily and if a patientcould not move the robot arm it guided the limb to provide anadaptive sensorimotor experience The institutional review boardsof the Burke Rehabilitation Hospital and the Massachusetts Insti-tute of Technology approved the protocol Written informed con-sent was obtained from all patients

Measuring therapists were different from treating therapistsAll patients had six evaluations three baseline evaluations 2months prior to the start of training and a midpoint dischargeand follow-up evaluation 3 months after training The measuringtherapist assessed the motor impairment with standardized andreliable scales the FuglndashMeyer Scale for ShoulderElbow and Co-ordination (F-M SEC 4266) FuglndashMeyer Scale for WristHand(F-M WH 2466) Motor Power Scale for ShoulderElbow (MPmaximum score 70) Motor Status Scale for ShoulderElbow(MSS SE maximum score 40) and Motor Status Scale forWristHand (MSS WH maximum score 42)69 Spasticity wasassessed using the Modified Ashworth Scale in which passivemovements were graded on a scale from 0 to 5 across nine musclegroups (total score 45) None of the patients had returned totheir prior occupation however most of the patients ambulatedindependently with a cane or an orthosis and had achieved asubstantial measure of self-care independence We used the totalFunctional Independence Measure (FIM) to measure disabilitybefore and after robotic training Attempts to use disability mea-

Table 1 Clinical characteristics of the patients

Characteristics Moderate n 13 Severe n 17

Mean SEM age y 691 32 615 31

Gender 7 M6 F 8 M9 F

Mean SEM stroke torehab d

1234 178 1348 226

Disabled limb 7 R6 L 9 R8 L

Canadian NeurologicalScale max 115

59 05 26 03

NIH Stroke Scalemax 34

116 10 192 08

Type of strokehemorrhagicischemic

013 512

Neglect present 1 1

Subcortex alone 7 0

Cortex alone 1 0

Subcortex and cortex 4 16

Brainstem 0 0

Table 2 Motor impairment disability and spasticity outcomes after task-specific outpatient training

SeverityImpairment

measureF-M SECmax 42

MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40

Moderate n 12 CNS 4NIHSS 15

Before treatment 170 13 372 25 246 16 96 19 78 14

After treatment 225 13 454 17 279 14 118 22 109 20

Follow-up 3 mo 245 09 465 19 275 17 142 23 126 23

Severe n 16 CNS 4NIHSS 15


After treatment 109 09 237 20 140 12 30 08 27 06

Follow-up 3 mo 125 09 263 22 140 12 41 10 27 17

Severity

Disability andspasticitymeasure

FIM uppermax 42

FIM lowermax 35

FIMsphinctermax 14

FIMcognitionmax 35

Ashworthmax 45



After treatment 363 12 302 05 138 02 341 06 69 11



After treatment 291 26 252 18 133 03 313 12 88 12

Values are means SEM

Significant change see text

For motor impairment F-M SEC and WH FuglndashMeyr Scale for ShoulderElbow and Coordination and for WristHand for disabilityFIM Functional Independence Measure and subscale reflecting self-care and upper limb function ambulation and lower limb func-tion sphincterndashbowel and bladder control language and social communication and cognition for spasticity Modified Ashworth ScaleMP Motor Power Scale MSS SE and WH Motor Status Scale for ShoulderElbow and WristHand CNS Canadian NeurologicalScale NIHSS NIH Stroke Scale

December (1 of 2) 2003 NEUROLOGY 61 1605

sures like the Action Research Arm Test or the ChedochendashMcMaster Scale were frustrated by the generally poor hand andwrist function We used historical records to derive the CanadianNeurologic and the NIH Stroke Scale estimates of stroke severityBoth scales correlated significantly with the admission motor im-pairment scores (F-M SEC MP MSS SE p 0001) and we usedthese scores to segment the group into moderate and severe Weused a repeated measure analysis of variance (SPSS 115 Chi-cago IL) with age as a covariate and stroke severity as thebetween-group variable to test for significant motor and disabilityoutcome change and we used Bonferroni corrections for contrastsespecially across the pretreatment measurements and both para-metric (t-tests) and nonparametric (2) analysis for the clinicalcomparisons

Results Thirty patients completed the training andwere also evaluated 3 months later Four patients hadrecurrent illness or severe emotional problems that prohib-ited them from participating beyond the admission evalua-tion The clinical characteristics (table 1) demonstratedthat age gender duration of stroke side of injury andpresence of neglect were comparable but the severely in-jured group more often had subcortical and cortical dam-age and hemorrhage than the moderately injured group(p 0001)

Both the moderate and the severe group demonstratedimproved motor function and power in the trained shoul-der and elbow as reflected in significant change on boththe F-M SEC and MP (table 2) There was a main effect forboth impairment measures (F 54 p 0002 F 48p 0004) There was an additional significant interactionindicating that on the F-M SEC the moderate group hadgreater improvement (F 28 p 005) For the moderateand severe group the pairwise comparisons between ad-mission and discharge for the two impairment measuresF-M SEC and MP were significant (p 00001) Therewere modest improvements for both groups on the MSSSE MS WH F-M WH and Ashworth Scales Impor-tantly there were no significant changes during the firstthree evaluations on any of the impairment scales sug-gesting all the patients were in a stable phase of theirillness (table 3) Similar analysis of the FIM on each sub-scale failed to demonstrate a main effect over time butremarkably there was a significant interaction on the FIMupper (extremity) subscale (F 75 p 001) suggestingthat the moderate group demonstrated a significant im-provement compared with the severe group

Discussion In this pilot study of 30 patients withchronic stroke and stable motor impairment of theproximal upper limb task-specific training signifi-cantly reduced impairment whether the stroke wasmoderate or severe These results are consistentwith our past results in patients with acute stroke10

and with other recent reports of the success of task-specific training for impairment reduction in pa-tients with chronic stroke34 These data support acall for larger randomized controlled studies to testwhether task-specific training protocols may furtherreduce impairment in patients with chronic stroke

In patients who have learned optimal compensa-tory techniques an unrelenting focus on impairmentreduction may further reduce disability For the firsttime in experiments with task-specific robot train-ing we report a significant reduction in disability forthe moderate group Although testimonials from thisuncontrolled pilot study must be interpreted cau-tiously the general impression of the patients withmoderate damage is that the training improved thestrength of the affected limb in a variety of func-tional tasks and those with severe damage re-marked that they had become more ldquoawarerdquo of theiraffected limb Notably only two patients displayedsigns of neglect apparent on examination by extinc-tion to double simultaneous visual stimulation Asthe training focused on shoulder and elbow mobilitythe lack of improvement in wrist and hand functionwas expected Reduction of impairment in the wristand hand would likely increase dramatically thefunctional use of a paretic arm Whether additionalimpairment reduction will occur after task-specifictraining of antigravity or distal motor behavior andwhether it will continue to contribute to disabilityreduction need to be investigated

References1 Jorgensen HS Nakayama H Raaschou HO et al Outcome and time

course of recovery in stroke Part II time course of recovery The Copen-hagen Stroke Study Arch Phys Med Rehabil 199576406ndash412

2 Nudo RJ Wise BM SiFuentes F Milliken GW Neural substrates forthe effects of rehabilitative training on motor recovery after ischemicinfarct Science 19962721791ndash1794

Table 3 Patients with chronic stroke had stable impairment measurements during three assessments over a 2-mo interval

SeverityPretreatment measures

interval 2 moF-M SECmax 42

MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40

Moderate n 12 Initial 160 13 372 26 237 18 102 20 80 13

Repeat 1 175 16 369 24 255 18 91 20 75 15

Repeat 2 176 18 375 28 247 16 96 20 80 15

Severe n 16 Initial 79 08 177 20 109 10 08 04 13 03

Repeat 1 84 06 172 18 114 11 10 05 13 04

Repeat 2 82 07 171 19 115 12 10 04 12 03

An average of these three measurements prior to treatment composes the before treatment scores noted in table 2 Values are means SEM

F-M SEC and WH FuglndashMeyr Scale for ShoulderElbow and WristHand MP Motor Power Scale MSS SE and WH Motor Sta-tus Scale for ShoulderElbow and WristHand

1606 NEUROLOGY 61 December (1 of 2) 2003

3 Lum PS Burgar CG Shor PC Majmundar M Van der Loos M Robot-assisted movement training compared with conventional therapy tech-niques for the rehabilitation of upper-limb motor function after strokeArch Phys Med Rehabil 200283952ndash959

4 Fasoli SD Krebs HI Stein J Frontera WR Hogan N Effects of robotictherapy on motor impairment and recovery in chronic stroke Arch PhysMed Rehabil 200384471ndash482

5 Dromerick AW Edwards DF Hahn M Does the application ofconstraint-induced movement therapy during acute rehabilitation re-duce arm impairment after ischemic stroke Stroke 2000312984ndash2988

6 Volpe BT Krebs HI Hogan N Is robot-aided sensorimotor training in strokerehabilitation a realistic option Curr Opin Neurol 200114745ndash752

7 Krebs HI Hogan N Aisen ML Volpe BT Robot-aided neurorehabilita-tion IEEE Trans Rehabil Eng 1998675ndash87

8 Hogan N Krebs HI Sharon A Charnnarong J inventors MIT5466213 assignee Interactive robot therapist USA November 141995

9 Ferraro M Demaio JH Krol J et al Assessing the motor status score ascale for the evaluation of upper limb motor outcomes in patients afterstroke Neurorehabil Neural Repair 200216283ndash289

10 Volpe BT Krebs HI Hogan N Edelstein L Diels C Aisen M A novelapproach to stroke rehabilitation robot-aided sensorimotor stimulationNeurology 2000541938ndash1944

Diagnostic value of sural nerve matrixmetalloproteinase-9 in diabetic

patients with CIDPS Jann MD MA Bramerio MD S Beretta MD S Koch CA Defanti MD KV Toyka MD and

C Sommer MD

AbstractmdashPatients with diabetes mellitus (DM) may develop chronic inflammatory demyelinating polyneuropathy(CIDP) which may be difficult to distinguish from diabetic neuropathy (DNP) Here the authors show that immunoreac-tivity for matrix metalloproteinase-9 on sural nerve biopsies may help to identify CIDP-DM In a pilot study on 10CIDP-DM patients with IV immunoglobulins and tight glycemic control the CIDP-DM patients had a better outcome thanDNP patients treated with tight glycemic control only


Some diabetic patients develop a peripheral neurop-athy undistinguishable from chronic inflammatorydemyelinating polyneuropathy (CIDP)1 It is impor-tant to recognize these patients because they maypotentially benefit from immunosuppressive thera-py2 The clinical suspicion of CIDP in a diabetic pa-tient arises in the presence of prominent motorsymptoms and subacute worsening3 However differ-entiating CIDP in patients with diabetes mellitus(DM) from diabetic neuropathy (DNP) may be diffi-cult Matrix metalloproteinases (MMP) are involvedin the pathogenesis of inflammatory demyelinatingdiseases of the central and peripheral nervous sys-tems45 We hypothesized that MMP-9 immunoreac-tivity on sural nerve biopsies might provide anadditional marker helping to differentiate CIDP-DMfrom DNP

Patients and methods Ten diabetic patients with a peripheralneuropathy fulfilling the clinical and electrophysiologic criteria forCIDP6 and five patients with a severe sensorimotor DNP from theDepartments of Neurology and Diabetology of Niguarda HospitalMilan Italy were prospectively followed up CIDP was suspectedin diabetic patients if they had a history of subacute worsening

and presented with progressive proximal and distal limb weak-ness and only mild involvement of sensory modalities The pres-ence of demyelination was then confirmed by electrophysiologyAll patients had reduced motor nerve conduction velocities absentF waves or prolonged F-wave latencies and partial conductionblocks Five patients with CIDP recruited in the Department ofNeurology in Wuumlrzburg according to the same criteria6 served ascontrols for the MMP-9 immunohistochemistry Patient data aresummarized in table 1

All DM patients were examined by the same neurologist andthe CIDP control group by two neurologists DM patients wereevaluated using a Neuropathy Symptom Scale (NSS) and a Neu-rologic Disability Scale (NDS)7 All patients underwent nerve con-duction studies and needle electromyography Laboratory testswere performed to rule out other identifiable causes of neuropathy(see table 1)

Sural nerve biopsies were taken for diagnostic purposes atNiguarda (DNP and CIDP-DM) and at Wuumlrzburg (CIDP) afterinformed consent Semithin sections were prepared according tostandard methods Myelinated fiber density and G ratio (axonaldiameterfiber diameter) were evaluated at 1000 magnificationwith the assistance of a microscope-mounted video camera andBioquant TCW95 version 20 image analysis software (RampM Bio-metrics Nashville TN) using random systematic sampling Aminimum of 400 myelinated fibers or 25 of the total endoneurialarea of one cross-section was sampled from each biopsy Digitizedmyelinated fibers were included if they had an area of at least 2m2

Immunohistochemistry was performed on deparaffinized 7-m

From the Departments of Neurology (Drs Jann and Defanti) and Pathology (Dr Bramerio) Niguarda Hospital and Department of Neurology (Dr Beretta)Vimercate Hospital Milan Italy and Department of Neurology (Drs Toyka and Sommer S Koch) University of Wuumlrzburg GermanySupported by intramural funds of the University of WuumlrzburgReceived March 13 2003 Accepted in final form August 13 2003Address correspondence and reprint requests to Dr C Sommer Neurologische Universitaumltsklinik Josef-Schneider-Str 11 D-97080 Wuumlrzburg Germanye-mail sommermailuni-wuerzburgde

Copyright copy 2003 by AAN Enterprises Inc 1607


M Ferraro J J Palazzolo J Krol et al stroke

Robot-aided sensorimotor arm training improves outcome in patients with chronic


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tients with prior thalamic DBS (P Pollak personalcommunication 1999)

With thalamotomy patients are exposed to ahigher initial risk of complications3 However pa-tients with DBS require continued effectively func-tioning hardware One group has followed 49patients with ET and 12 patients with PD with tha-lamic DBS for a mean of 40 months12 Of the pa-tients with ET five lost benefit after initial tremorimprovement with stimulation (possibly due to toler-ance) Of the patients with PD one lost benefit overtime and required pallidotomy while anotherrsquos non-tremor symptoms of PD immobilized him despite on-going tremor control Device complications werecommon and necessitated additional surgical proce-dures in approximately 40 of patients In contrastanother group evaluated a similar cohort at 6 to 7years finding ongoing benefit in almost all patients(despite disease progression in patients with PD) notolerance and only one hardware complication9

With thalamic DBS many patients derive long-term benefit with contralateral tremor subsiding insome patients However for patients with ET toler-ance to stimulation may compromise long-term effi-cacy For disabling parkinsonian tremor we suggestpallidal or subthalamic procedures instead of tha-lamic DBS All patients must be advised of the risksof perioperative and delayed hardware complica-

tions Longer-term follow-up on larger numbers ofpatients is needed to determine the long-term utilityof thalamic DBS

References1 Koller W Lyons K Wilkinson S Troster A Pahwa R Long term safety

and efficacy of unilateral deep brain stimulation of the thalamus inessential tremor Mov Disord 200116464ndash468

2 Lyons K Koller W Wilkinson S Pahwa R Long-term safety and effi-cacy of unilateral deep brain stimulation of the thalamus for parkinso-nian tremor J Neurol Neurosurg Psychiatry 200171682ndash684

3 Schuurman PR Bosch DA Bossuyt PM et al A comparison of continu-ous thalamic stimulation and thalamotomy for suppression of severetremor N Engl J Med 2000342461ndash468

4 Koller W Pahwa R Busenbark K et al High frequency unilateralthalamic stimulation in the treatment of essential and parkinsoniantremor Ann Neurol 199742292ndash297

5 Fahn S Tolosa E Marin E Clinical rating scales for tremor In Jank-ovic J Tolosa E eds Parkinsonrsquos disease and movement disordersBaltimore Urban and Schwarzenberg 1998

6 Fahn S Elton RL members of the UPDRS Development CommitteeUnified Parkinsonrsquos Disease Rating Scale In Fahn S Marsden CDGoldstein M Calne DB eds Recent development in Parkinsonrsquos dis-ease Vol 2 Florham Park NJ Macmillan 1987153ndash163

7 Oh MH Hodaie M Kim SH Alkhani A Lang AE Lozano AM DBSelectrodes used for lesioning proof of principle Neurosurgery 200149363ndash367

8 Henderson JM OrsquoSullivan DJ Pell M et al Lesion of thalamiccentromedian-parafascicular complex after chronic deep brain stimula-tion Neurology 2001561576ndash1579

9 Rehncrona S Johnels B Widner H Tornqvist A-L Hariz M Sydow OLong-term efficacy of thalamic deep brain stimulation for tremordouble-blind assessments Mov Disord 200318163ndash170

10 Kumar R Sime E Halket E Lozano AM Lang AE Comparative effectsof unilateral and bilateral subthalamic nucleus deep brain stimulationNeurology 199953561ndash566

Robot-aided sensorimotor arm trainingimproves outcome in patients with

chronic strokeM Ferraro OTR JJ Palazzolo MS J Krol OTR HI Krebs PhD N Hogan PhD and BT Volpe MD

AbstractmdashThirty patients with chronic stroke received 6 weeks of sensorimotor robotic training in a pilot study thattargeted motor function of the affected shoulder and elbow The impairment and disability scores were stable during a2-month observationmeasurement period improved significantly by program completion and remained robust in the3-month follow-up Task-specific motor training attenuated a chronic neurologic deficit well beyond the expected period forimprovement after stroke


Current outcome results from the study of patientsrecovering from stroke have demonstrated that mostgains occur within the first 3 months1 These data

were based on general poststroke treatment princi-ples rather than the task-specific approach to treat-ment that has been stimulated by the optimistic

From the Department of Neurology and Neuroscience (Drs Krebs and Volpe M Ferraro and J Krol) Burke Institute of Medical Research Weill MedicalCollege Cornell University White Plains NY and Newman Laboratory (Drs Krebs and Hogan JJ Palazzolo) Mechanical Engineering Department andBrain and Cognitive Sciences Department (Dr Hogan) Massachusetts Institute of Technology Cambridge MASupported by the Burke Medical Research Institute the Langeloth Foundation and the US Public Health Service (NIH HD 37397)Drs N Hogan and HI Krebs are co-inventors in the MIT-held patent for the robotic device used to treat patients in this work They hold equity positions inInteractive Motion Technologies Inc the company that manufactures this type of technology under license to MITReceived April 11 2003 Accepted in final form August 13 2003Address correspondence and reprint requests to Dr BT Volpe Department of Neurology and Neuroscience Burke Institute of Medical Research WeillMedical College Cornell University 785 Mamaroneck Ave White Plains NY 10605 e-mail bvolpeburkeorg

1604 Copyright copy 2003 by AAN Enterprises Inc






Mean SEM age y 691 32 615 31



1234 178 1348 226



59 05 26 03


116 10 192 08


013 512

Neglect present 1 1

Subcortex alone 7 0

Cortex alone 1 0


Brainstem 0 0


SeverityImpairment


MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40



After treatment 225 13 454 17 279 14 118 22 109 20

Follow-up 3 mo 245 09 465 19 275 17 142 23 126 23



After treatment 109 09 237 20 140 12 30 08 27 06

Follow-up 3 mo 125 09 263 22 140 12 41 10 27 17

Severity


FIM uppermax 42

FIM lowermax 35

FIMsphinctermax 14

FIMcognitionmax 35

Ashworthmax 45



After treatment 363 12 302 05 138 02 341 06 69 11



After treatment 291 26 252 18 133 03 313 12 88 12

















MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40


Repeat 1 175 16 369 24 255 18 91 20 75 15

Repeat 2 176 18 375 28 247 16 96 20 80 15

Severe n 16 Initial 79 08 177 20 109 10 08 04 13 03

Repeat 1 84 06 172 18 114 11 10 05 13 04

Repeat 2 82 07 171 19 115 12 10 04 12 03














C Sommer MD

















References


Citations









Reprints







Mean SEM age y 691 32 615 31



1234 178 1348 226



59 05 26 03


116 10 192 08


013 512

Neglect present 1 1

Subcortex alone 7 0

Cortex alone 1 0


Brainstem 0 0


SeverityImpairment


MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40



After treatment 225 13 454 17 279 14 118 22 109 20

Follow-up 3 mo 245 09 465 19 275 17 142 23 126 23



After treatment 109 09 237 20 140 12 30 08 27 06

Follow-up 3 mo 125 09 263 22 140 12 41 10 27 17

Severity


FIM uppermax 42

FIM lowermax 35

FIMsphinctermax 14

FIMcognitionmax 35

Ashworthmax 45



After treatment 363 12 302 05 138 02 341 06 69 11



After treatment 291 26 252 18 133 03 313 12 88 12

















MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40


Repeat 1 175 16 369 24 255 18 91 20 75 15

Repeat 2 176 18 375 28 247 16 96 20 80 15

Severe n 16 Initial 79 08 177 20 109 10 08 04 13 03

Repeat 1 84 06 172 18 114 11 10 05 13 04

Repeat 2 82 07 171 19 115 12 10 04 12 03














C Sommer MD

















References


Citations









Reprints














MPmax 70

MSS SEmax 40

F-M WHmax 42

MSS WHmax 40


Repeat 1 175 16 369 24 255 18 91 20 75 15

Repeat 2 176 18 375 28 247 16 96 20 80 15

Severe n 16 Initial 79 08 177 20 109 10 08 04 13 03

Repeat 1 84 06 172 18 114 11 10 05 13 04

Repeat 2 82 07 171 19 115 12 10 04 12 03














C Sommer MD

















References


Citations









Reprints












C Sommer MD

















References


Citations









Reprints








References


Citations









Reprints


Documents

Robot-aided sensorimotor arm training improves outcome in patients with chronic stroke