Extension of the MIME Robotic System for Stroke Rehabilitation
Extension of the MIME Robotic System for Stroke Rehabilitation
The goal of this project is to develop and test a new robotic system to accommodate practice
 of tasks requiring reach, grasp and release of objects. Our previous work has shown that the
 MIME robot is safe and effective for improving reach in stroke subjects. But adequate control
 of hand movements is critical to a functional upper limb, and is often resistant to
 conventional therapeutic interventions. Many stroke survivors have residual ability to flex
 the fingers, but extension is often limited and impeded by increased passive stiffness in
 flexors, abnormal levels of increased tone in flexors and weakness in extensors. In a recent
 study, 38% of stroke survivors reported that impaired hand function was the most disabling
 motor impairment they faced.
Research Design:

 We hypothesize that: 1) Gains in proximal arm function (shoulder, elbow) immediately after
 robotic training will be greater than after dose-matched conventional therapy; 2) Unlike in
 previous studies, gains in hand function immediately after robotic training will be greater
 than after dose-matched conventional therapy.

 Methodology:

 In the first year of the study, we will develop a robotic system with the ability to assist
 hand movement. Since many stroke survivors in the subacute and chronic recovery stages have
 residual ability to flex the fingers but severely limited finger extension, we will build a
 hand exoskeleton that can apply precise extension forces to the digits of the hand. This
 exoskeleton will be integrated with the ARMin III arm exoskeleton so that tasks such as arm
 reach, grasp of an object and release of the object can be trained. In the last 2 years of
 the project, we will perform a pilot clinical trial comparing this new training paradigm to
 dose-matched conventional therapy in chronic stroke survivors. Outcome measures will be taken
 before training and immediately after training.
Inclusion Criteria:

 -  An ischemic or hemorrhagic stroke more than 6 months prior to entry into the study;

 -  trace ability to move the wrist and fingers in extension;

 -  voluntary shoulder elevation to approximately 45 deg;

 -  be between the ages of 21 and 90.

 Exclusion Criteria:

 -  Have cognitive deficits that could negatively affect their ability to complete
 protocols as evidenced by a score of 24 or less on the Folstein Mini - Mental State
 Examination (Bleeker, 1988);

 -  have excessive pain in any joint of the affected extremity that could limit ability to
 cooperate with the protocols;

 -  have an upper extremity injury or conditions prior to stroke that could limit
 participation;

 -  have severe hemispatial neglect.

 -  have a full score of 24 on the distal section of the Fugl-Myer test (FM) (Fugl-Meyer
 1975); and

 -  have severe sensory loss.