Innovative Post-stroke Rehab

University researchers devise intuitive upper-extremity machine

When someone suffers a stroke, one of the most frustrating consequences is the effect on their upper extremities. Loss of arm and hand function, movement, and strength are common after a stroke, as well as pain and spasticity.

This loss of function can have a serious negative impact on the life of the patient, along with their well-being and self-worth. One team of engineers at the Cockrell School of Engineering at The University of Texas at Austin decided it was time to improve the recovery process for stroke patients through rehabilitation technology.

This desire came to fruition through HARMONY, which, according to the medical engineering team, is a “first-of-its-kind, two-armed robotic rehabilitation exoskeleton that could provide a new method of high-quality, data-driven therapy to patients suffering from spinal and neurological injuries.”

A Need for Innovation

Assistant Professor
Ashish Deshpande, PhD

“My philosophy in this is that I wanted to design a tool that assists therapists and allows them to do more, and to make better progress with their patients,” said Ashish Deshpande, PhD, mechanical engineering researcher at The University of Texas at Austin, and creator of the device.

Deshpande got into the technology field to improve healthcare and to better the lives of human beings. He identified a particular need for innovation in stroke therapy. “And within that,” he added, “there was a specific need for innovation in arm and shoulder rehabilitation, since most stroke patients suffer in the upper body.”

Seeing this need, Deshpande and a group of graduate students from the university’s Rehabilitation and Neuromuscular Robotics (ReNeu) Lab went on to design the device to deliver a full upper-body rehabilitation program with “natural motion and tunable pressure and force,” which makes the exoskeleton feel weightless to the user.

Not only does it provide full upper-body therapy, but it can give therapists the ability to track and analyze the data, which in turn lets them deliver precise therapy for each patient’s needs.

“I strongly believe in human intervention,” Deshpande acknowledged. “The robots are not going to deliver therapy autonomously — but they can do parts of it autonomously so that they are programmed by the staff. There are many open questions in how folks recover after stroke. When we use the advantage of technology, we can identify how people recover and use the robots to deliver therapy in collaboration with the therapists.”

A Unique Technology

One of the most exciting aspects that sets this tool apart from other technologies is its capacity for full upper-extremity rehabilitation. According to the Cockrell School, the machine accommodates the whole upper body, while existing technologies only focus on one arm, limiting the possibilities for bilateral training.

“This simulates every degree of freedom in the upper extremity,” said Roger Parthasarathy, MD, board-certified physical medicine and rehabilitation physician and assistant professor of medicine at The University of Texas at Austin Dell Medical School. “It can handle wrist motion, elbow flexion extension, degrees of freedom of the shoulder — so this is not a robot that only does one limb or one joint; it’s all across the board.”stroke rehab robotics

“Shoulder mechanics is unique, and HARMONY allows for much wider range of motion and natural range of motion,” explained Deshpande. He added that though most stroke patients are affected in one arm, this technology will allow therapists to measure the function of the unaffected arm to see where the other extremity should be following physical rehabilitation.

The technology could particularly benefit the outpatient client who can’t afford endless therapy visits. “There’s an unfortunate reality that roughly $2,000 is way too insufficient to rehabilitate someone after they suffer from a major stroke,” Parthasarathy emphasized. “If they have personal resources beyond that, then you’re able to continue therapy. But if not, you don’t get more therapy. This can be life-changing for those individuals who don’t currently have access to other finances.”

The Current Status

Previously, engineers at the University of Texas at Austin were studying the device’s efficacy on the rehabilitation of patients with spinal cord injury. Now, the process of studying stroke patients is underway.

“We are about to begin a case study with stroke subjects,” Deshpande told ADVANCE. “We hope to find efficacy in HARMONY delivering shoulder and arm therapy. It’s in the beginning stages, but this should all be done within 2016.”

After the studies are over, Parthasarathy said it will be time to compare and contrast the abilities of the device to the abilities shown through traditional therapy. “Once we figure out the potential applications, we have to compare that to how this compares to traditional, therapist-driven rehabilitation,” he explained, adding that the other application the team needs to look at is home use. “We want to know: Can patients use this on their own time?” he said.

The Ultimate Goal

The engineering team has specific aspirations when it comes to how this technology can shape the future of physical and occupational therapy. For Parthasarathy, it’s about giving the patient the tools they need to make a full recovery, no matter their financial situation.

“As a clinician, I would hope that this would lead to patients being able to use this in their home,” he said. “Technology is getting cheaper and cheaper every day. The phone I am currently using would have cost thousands of dollars 30 years ago, but now it’s much less. So potentially, I’d like to think this could be used by patients in their home.”

For Deshpande, it was a desire to help therapists make their job easier and more efficient. “It is a lower load on the therapists, so potentially HARMONY can help therapists treat more patients at the same time.”

Deshpande added that the machine can allow therapists to deliver more therapy to patients. “Another way is that you can design subject-specific therapy with the technology,” he continued. “Therapists have control over each extremity with precision, which would be beneficial to the therapist and the patient.” The device can also help therapists monitor the data to see whether the therapy regimen is working.

“I think therapists agree we need to do more,” Deshpande concluded. “They are already so busy, so if we can marry the expertise and human knowledge with the technology, we have the ability to deliver things that humans cannot.”