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FDA Approve S Robotic Device to Help Stroke Patients

t hospital. But in the long run, the device (and others like it) could also prove useful as a power assist that patients wear every day.

A renewed ability to flex and extend at the elbow would be especially important to patients who also cannot walk and who may otherwise have to rely on a mouth stick to move their wheelchairs, Dr. Estores added.

Veterans Administration is sponsoring a large multicenter trial of new devices for the shoulder, elbow, wrist and hand, which began last November.

These devices generally do not take cues from electrical muscle activity, as the Myomo brace does, but depend instead on the observed motion (or lack of motion) of patients limbs. This means they can be used by patients with no electrical activity in a paralyzed limb. Dr. Hermano Igo Krebs, a pioneer in the field, notes that for stroke patients, a large body of evidence now suggests that repeated practice with an impaired limb can foster plastic changes in the brain. In other words, it can help the brain forge new connections between neurons or strengthen existing ones. For patients whose strokes have damaged part of the motor cortex and subcortex, this means that movement therapy may help the brain to use other, nearby neurons or even neurons in the opposite brain hemisphere to complete a movement.

The goal is to make neurons talk to each other again, said Dr. Krebs, adding that even patients who cannot move initially may benefit from making an attempt, then seeing and feeling the intended movement carried through with the aid of the robot. This experience, it turns out, may be a crucial part of the relearning process.

Robotic devices are also well suited to repetitive movement therapy because they can do the same thing two million times with perfect consistency, said Dr. Steven C. Cramer, a neurologist at the University of California.

His team uses computer games to make the practice less tedious. In one app
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