Stroke is the leading cause of disability, despite continued advances in prevention and treatment techniques based on novel delivery of new fibrinolytic drugs. Improved medical treatment of the complications caused by acute stroke has contributed to decreased mortality, but 90% of the survivors have significant neurological deficits. Reducing the degree of permanent disability remains the goal of poststroke neuro-rehabilitation programs, and new approaches to impairment reduction through managing sensorimotor experience may contribute further to altering disability. Recent reports from a number of laboratories using enhanced sensorimotor training protocols, particularly those with robotic devices, have indicated modest success in reducing impairment and increasing motor power in the exercised limb of patients with stroke when compared with control individuals. Whether arming the therapist with new tools, especially robotic devices, to treat impairment is a realistic approach to modern interdisciplinary rehabilitation raises questions regarding the added value of impairment reduction, and under what conditions should scientific and clinical development of robotic studies continue.
aBurke Medical Research Institute, White Plains, New York, bWeill Medical College of Cornell University, Department Neurology and Neuroscience, NY, NY, cMassachusetts Institute of Technology, Mechanical Engineering Department, Newman Laboratory for Biomechanics and Human Rehabilitation, Massachusetts, and dMassachusetts Institute of Technology, Brain and Cognitive Sciences Department, Cambridge, MA, USA
Correspondence to Bruce T. Volpe, Burke Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA Fax: +1 914 597 2796; e-mail: firstname.lastname@example.org