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BioMed Research International
Volume 2017, Article ID 8905637, 11 pages
https://doi.org/10.1155/2017/8905637
Review Article

Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges

1The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
2Rehabilitation Bioengineering Laboratory, Volterra, Italy
3Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
4Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France

Correspondence should be addressed to Stefano Mazzoleni; ti.asipannatnas@inelozzam.onafets

Received 3 January 2017; Revised 12 July 2017; Accepted 10 August 2017; Published 13 September 2017

Academic Editor: Erwin van Wegen

Copyright © 2017 Stefano Mazzoleni et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.