J Korean Med Sci.  2017 Oct;32(10):1568-1575. 10.3346/jkms.2017.32.10.1568.

Recovery of Proprioception in the Upper Extremity by Robotic Mirror Therapy: a Clinical Pilot Study for Proof of Concept

• Nam HS
• Koh S
• Beom J
• Kim YJ
• Park JW
• Koh ES
• Chung SG
• Kim S

• KMID: 2400426
• DOI: http://doi.org/10.3346/jkms.2017.32.10.1568

Abstract

A novel robotic mirror therapy system was recently developed to provide proprioceptive stimulus to the hemiplegic arm during a mirror therapy. Validation of the robotic mirror therapy system was performed to confirm its synchronicity prior to the clinical study. The mean error angle range between the intact arm and the robot was 1.97 to 4.59 degrees. A 56-year-old male who had right middle cerebral artery infarction 11 months ago received the robotic mirror therapy for ten 30-minute sessions during 2 weeks. Clinical evaluation and functional magnetic resonance imaging (fMRI) studies were performed before and after the intervention. At the follow-up evaluation, the thumb finding test score improved from 2 to 1 for eye level and from 3 to 1 for overhead level. The Albert's test score on the left side improved from 6 to 11. Improvements were sustained at 2-month follow-up. The fMRI during the passive motion revealed a considerable increase in brain activity at the lower part of the right superior parietal lobule, suggesting the possibility of proprioception enhancement. The robotic mirror therapy system may serve as a useful treatment method for patients with supratentorial stroke to facilitate recovery of proprioceptive deficit and hemineglect.

Keyword

Robotic Exoskeleton; Neurorehabilitation; Proprioception; Stroke; Hemiplegia

MeSH Terms

Arm
Brain
Clinical Study
Exoskeleton Device
Follow-Up Studies
Hemiplegia
Humans
Infarction, Middle Cerebral Artery
Magnetic Resonance Imaging
Male
Methods
Middle Aged
Neurological Rehabilitation
Parietal Lobe
Pilot Projects*
Proprioception*
Stroke
Thumb
Upper Extremity*

Figure

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  Fig. 1 A 56-year-old male chronic stroke patient is performing the robotic mirror therapy by moving his intact (right) arm while the hemiplegic (left) arm is moved by the 2-axis robot symmetrically.

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  Fig. 2 Co-plots for the validation process for synchronicity and symmetricity between the intact arm and the hemiplegic arm by optical motion tracker show near zero values throughout the process indicating high synchronicity.

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  Fig. 3 The fMRI study of the patient. The BOLD signal increased in the lower part of the right superior parietal lobule, left PMC, and left cerebellum during the passive left wrist ROM exercise after 10 sessions of robotic mirror therapy (P < 0.005, A: before, B: after). The signal increased mainly in the right prefrontal cortex and left cerebellum during the active ROM exercise after 10 sessions of robotic mirror therapy (P < 0.005, C: before, D: after). The activation pattern during active left wrist ROM in a normal subject is shown (P < 0.050, E). Minimum cluster size for all activations shown is 32 voxels. fMRI = functional magnetic resonance imaging, BOLD = blood oxygen-level dependent, PMC = premotor cortex, ROM = range of motion.

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