Page 328 - Handbook of Biomechatronics

Upper Extremity Rehabilitation Robots: A Survey 321

(Stoykov and Corcos, 2009). In symmetric movements of the upper
extremity, arms are moved in the same way. In asymmetric movements,
arm movements are opposing. In complementary movements, both arms
are performing a combinatory task.
Although unilateral and bilateral training approaches are different, they
are pursuing the same goal. Recent studies (Wu et al., 2013; van Delden
et al., 2013) have stated that there are no significant outcomes that can make
one method of training superior to the other. The procedures of these train-
ing methods are developed by motor learning theories. These theories are
sometimes contradicting and are not fully determined; some of the available
ones are (Brewer et al., 2007; Muratori et al., 2013; Hatem et al., 2016):
• Implicit or explicit learning: Implicit learning is unconscious during indirect
task execution, while explicit learning is directed. Bobath concept training
can be defined as an implicit learning exercise; it facilitates voluntary
movement by handling specific points of the patient’s body.
• Massed or variable practice: Massed practice (repetitive task training) is repet-
itive single task accomplishment, while variable practices (task-oriented
training and goal-directed training) are for training multiple tasks. In the
task-oriented (task-specific) training, a real-life practice is provided to
reacquire a specific skill. The goal-directed (client-centered) training is a
type of task-specific training in which the practice is defined based on
the directed goals of the patient and therapist.
• Feedback distortion or assistance: Feedback distortion is magnifying move-
ment errors instead of assisting the patient to reduce the errors.
• Real-world practice: This can be done by virtual reality methods that are
enhanced by visual, auditory, or tactile feedback.
Although it has been found that therapy is effective in the treatment of
movement disorders, therapy hours per patient have decreased because of
economic burdens (Reinkensmeyer et al., 2002). Studies have shown that
comprehensive and optimal stroke care can decrease the associated costs sig-
nificantly (Krueger et al., 2012; Blacquiere et al., 2017). This optimal care
can be achieved by implementing new technologies. That is why the design
and development of biomechatronic devices (i.e., rehabilitation robots) have
gained more importance.
To show the need for rehabilitation robots, we should survey the goals of
therapy (Reinkensmeyer, 2009; Richards and Malouin, 2015; Hatem et al.,
2016):
• Increase activity: It is done by the use of Thera-bands, pegboards, and
blocks in conventional therapy.