Robot-Assisted Therapy and Motor Learning: An Active Learning Program for Stroke

Little is known about how individuals learn to utilize robot-trained movements during upper
extremity (UE) activities in the home and community and whether specific instruction can
enhance motor learning and carry-over.. Systematic reviews of robot-assisted therapy for the
paretic UE confirm gains in motor capacity as measured by clinical assessments, but provide
little evidence of improved UE performance during daily tasks and occupations. These findings
may be attributed to the limited availability of rehabilitation robots to train the paretic
hand and a primary focus on intensity of practice with little regard for other principles of
motor learning and experience-dependent neuroplasticity. These principles, including the
salience of training tasks, transfer of acquired skills to similar activities, and active
engagement and problem solving, are key to task-oriented training paradigms in stroke (e.g.
constraint-induced movement therapy) but have not been well integrated into robot-assisted
therapy protocols. The transfer of robot-trained movements to UE activities within the home
and community needs further exploration before widespread use in rehabilitation practice is
expected.

Inclusion Criteria:

- Moderate UE hemiparesis (i.e. some ability to move shoulder, elbow & hand and initial
score on the Fugl-Meyer Assessment (FMA) between 21-50/66))

- Intact cognitive function to understand and actively engage in the ALPS robotic
therapy procedures (Montreal Cognitive Assessment Score >/=26/30)12 during initial
evaluation visit

Exclusion Criteria:

- No more than moderate impairments in paretic UE sensation, passive range of motion,
and pain that would limit ability to engage in therapy

- Increased muscle tone as indicated by score of >/= 3 on the Modified Ashworth Scale;

- Hemispatial neglect or visual field loss measured by the symbol cancellation subtest
on the Cognitive Linguistic Quick Test 13

- Aphasia sufficient to limit comprehension and completion of the treatment protocol

- Currently enrolled or has plans to enroll in other upper limb therapy/research during
the study period

- Contraindications for robot-assisted therapy including recent fracture or skin lesion
of paretic UE