Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

Annick A A Timmermans, Henk A M Seelen, Richard D Willmann, Herman Kingma, Annick A A Timmermans, Henk A M Seelen, Richard D Willmann, Herman Kingma

Abstract

Background: It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning.

Methods: A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997-2007).

Results: One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems.

Conclusion: This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.

Figures

Figure 1
Figure 1
Declarative model of motor recovery after stroke. (CC = corticortical).
Figure 2
Figure 2
Schematic presentation of types of augmented feedback sources for motor performance.
Figure 3
Figure 3
Schematic presentation of extrinsic feedback components for motor performance. (FB = feedback, BW = bandwidth).

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