Neurorehabilitation research laboratory at the Providence VAMC.

MEDICINE & HEALTH/RHODE ISLAND Although there has been tremendous progress in treating neurological injuries and disorders, there remains ample opportunity to improve recovery and to restore function in chronic and progressive conditions, particularly during the acute and subacute phases. As our understanding of neuroplasticity has advanced along with technology, attention has focused on novel methods to augment more traditional procedures to reverse impairment and regain function. The field of rehabilitative therapy has recently seen an explosion in the development of robotic technology for rehabilitation. A MEDLINE search for therapeutic robotics yields only 15 results prior to 1990, but as of September 16, 2009, there were 2095 results. The consequent technological and methodological advances have been particularly exciting. These devices provide high-volume, repetitive, reproducible, safe therapy and also allow for reliable, instrumented outcomes of motor performance. One of the best examples of such devices with a large quantity of pilot human data is the MITManus (InMotion Technologies, Inc., Watertown, MA), which includes modules for shoulder, elbow and hand. Other upper-extremity robotics include the ARM Guide, the MIME, the InMotion Shoulder-Elbow Robot, and the BiManu-Track. There also exist computeraided non-robotic therapy orthotics such as the T-WREX, which allows upper-extremity movement with 5 degrees of freedom and passively eliminates the force of gravity via a system of elastics and metal linkages. For the lower extremities, there exist gait training devices such as the Lokomat (Hocoma, Zurich, Switzerland), a body weight-supported treadmill with robotic orthotics which guide the legs through an idealized gait cycle. The Lokomat has been used in research interventions for neurological disorders such as spinal cord injury, stroke, and multiple sclerosis. As with the upper extremity, there also exist more focused devices Neurorehabilitation Research Laboratory at the Providence VAMC