Robotic Exoskeletons for Upper Extremity Rehabilitation

In 2003, 700,000 persons in the United States suffered a cerebral vascular accident (CVA), or stroke, with the total number of survivors estimated at 5.5 million. The total cost for rehabilitation and lost revenue in 2006 was 57.9 billion (Thom, Haase et al. 2006). Stroke commonly causes significant residual physical, cognitive, and psychological impairment (Gresham 1990). As the geriatric population increases and more effective therapies for acute stroke management emerge, there will be more survivors living with disabilities. In addition to greater numbers of survivors, there has been an increase in the number of more moderately affected survivors (Wolf, D'Agostino et al. 1992), which has increased the demand for stroke rehabilitation in an era of health care cost containment. Efforts to prevent stroke must, therefore, be balanced with pragmatic efforts to prevent disability and maximize quality of life for stroke survivors. Persons with hemiparesis following stroke constitute the largest group of patients receiving rehabilitation services in this country. The current consensus regarding rehabilitation of patients with some voluntary control over movements of the paretic limb is that they be encouraged to use the limb in functional tasks and receive training directed toward improving strength and motor control, relearning sensorimotor relationships, and improving functional performance (Gresham, Alexander et al. 1997). Given such recommendations, the research community has responded with efforts to improve the effectiveness of rehabilitative treatment of motor disability resulting from stroke.