Page 327 - Handbook of Biomechatronics

320 Borna Ghannadi et al.

their lifetime; 15 million people are suffering from stroke every year.
Following these trends, it is estimated that 23 million stroke cases will hap-
pen in 2030 (Mendis, 2013). Thus, procedures to rehabilitate this long-term
disability are essential (Broeren et al., 2004; Oujamaa et al., 2009; Turolla
et al., 2013; Hatem et al., 2016). Studies have reported that following a
stroke upper extremity motor defects have the highest prevalence among
movement disorders (Bansil et al., 2012; Mehrholz et al., 2012). Therefore,
rehabilitation approaches for upper extremity motor control and function
recovery are of importance. Consequently, this chapter will focus on upper
extremity movement disorders in poststroke patients.
Neurological complications of stroke are various (Fulk et al., 2014)
and need to be considered in rehabilitation therapy. Some of these compli-
cations are:
1. Hemispheric behavioral differences: Stroke patients may show different
behaviors in doing a task. Those with right hemiplegia have difficulty
accomplishing consecutive tasks; these patients may need some assistance
in their therapy. On the other hand, patients with left hemiplegia have
task perception problems, and they overestimate their abilities. Fluctu-
ations in doing a task are common among them. To address the wrong
perception, safety issues should be considered carefully.
2. Perceptual dysfunction: It is common among left hemiplegia patients, and
can be revealed as one of these symptoms: body scheme, spatial relation,
and agnosia. The body scheme is the difficulty in realizing the relation-
ship between body parts. The spatial relation is having trouble in per-
ceiving the relationship between body and other objects. The agnosia
is the problem in distinguishing incoming information, which can be
visual, auditory, or tactile.
3. Osteoporosis and fracture risk: Because of the lack of physical activity, these
patients may get osteoporosis. Osteoporosis is a bone disease for which
the mass of bone will decrease and cause fractures.
There are two main types of training for stroke rehabilitation: unilateral
and bilateral (Wu et al., 2013). Unilateral training is a therapy for the sin-
gle impaired limb. Constraint-induced therapy, which is an intensive use of
the impaired limb while constraining the unaffected limb, is a kind of
unilateral training therapy. Taking into account bimanual daily activities
like hand washing, the idea of getting more help from undamaged neural
pathways, and case-dependent use of unilateral training, has led to bilat-
eral training theory. Bilateral training is used for symmetric, asymmetric,
and complementary movements of both impaired and unimpaired limbs