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New approaches in the rehabilitation of upper extremity motor functions in SCI and stroke


T. Keller

ETH Zürich, Special Series on Rehabilitation Engineering ,Automatic Control Laboratory.

The improvement of upper extremity motor functions is one of the more important goals in the rehabilitation of subjects with a central nervous system (CNS) lesion as it increases their independence in daily life activities. The applied treatments or techniques have to take into account the special natures of the different pathologies of unilateral brain injury, e.g. stroke, or spinal cord injury (SCI). Specific treatments and the needed technology are still in development. Two different promising approaches are presented in this talk: neuroprostheses (NP) for grasping and computer assisted isometric training. NP for grasping are systems that generate finger movements by electrically stimulating the motor nerves of the actuating muscles. In order to have the possibility to apply this technology as early as possible in rehabilitation we have developed a system that uses surface stimulation technology combined with flexibly adjustable stimulation patterns and control schemes. Results from 11 SCI subjects have shown that depending on the neurological level of lesion and the impairment scale (ASIA) the NP for grasping can improve the subjects’ grasp performance either by using it in a functional training therapy or as a permanent aid. The transfer of this technology to subjects affected by hemiparetic stroke could be successfully shown in cases of moderate function loss. More severely affected subjects first need an improvement of their reaching capabilities. It could be shown that abnormal movement synergies are often most debilitating with respect to functional recovery following stroke. The result of these abnormal muscle synergies is a coupling between shoulder abduction and elbow flexion which significantly reduces a stroke subject’s reaching space when he/she lifts up the weight of the impaired arm against gravity. With an individually adapted computer assisted training paradigm, which uses visualized torque feedback the subject can learn to correct for the abnormal torque patterns and increase his/her reaching space. In an eight week training the subjects (n=8) learned to progressively deviate from their abnormal torque synergies.

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(05)Plenary/Invited/Honorary Lecture

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