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A Better Grip on Life with Robotics

March 19, 2018
Fasoli works with patient Tom Clarke at Spaulding Rehabilitation.
Fasoli works with patient Tom Clarke at Spaulding Rehabilitation.

For people who have lost mobility in their hands and arms, simple tasks such as opening a refrigerator or picking up a glass can seem impossible. One powerful solution, Susan E. Fasoli, ScD, OTR/L, says, is robot-assisted therapy.

“I’ve always been interested in trying to identify therapy interventions that are most effective in helping people with stroke recover movement,” Fasoli, an associate professor of occupational therapy at the MGH Institute since 2014, says of her work.

 

Another robot is an exoskeleton that’s strapped onto a patient’s arm and looks like half of a health club’s upper body weight machine. It also connects to a monitor featuring games that prompt patients to move their weaker arm and hand after stroke. These are not the kind of flashy robots one might see in Hollywood. Picture instead a machine that looks like a high-tech armrest and a set of finger levers. The levers are connected to a monitor that displays video games. Playing these games helps patients work on the isolated finger movements it takes to do routine tasks like type at a keyboard or grip a pencil.

What makes robotic therapy unique is its ability to provide highly repetitive movement therapy. Patients can complete up to 1,000 movements in an hour-long therapy session, far more than during traditional therapy. Robots can support the weight of a patient’s arm or assist with motion, making it easier to practice. And, like their movie-star cousins, therapeutic robots have a fun factor: their video games are motivating and help patients focus on accomplishments instead of doubts. “The goal isn’t just to reduce motor impairment,” says Fasoli. “The goal is to increase function.”

Fasoli currently is conducting a robotic therapy pilot study at Spaulding Rehabilitation Hospital, funded by an MGH Institute faculty research fellowship grant. In addition to receiving intensive robot therapy, participants are taught to use cognitive strategies, like problem solving and guided discovery, to improve use of their weaker arm and hand during everyday activities, like opening a door or grasping a cup handle. “Our initial findings suggest that this combined treatment approach has great potential to improve participant outcomes and optimize functional use of the weaker arm at home and in the community after a stroke,” she says. Fasoli’s work has not gone unnoticed. This past fall, she received the Catherine Anne Trombly Award for Contribution to Occupational Therapy Education and Research from the Massachusetts Association for Occupational Therapy, given to “an exceptional occupational therapy educator and/or researcher who has made outstanding contributions to the profession.” She also was a faculty member and speaker at the International Symposium on Wearable & Rehabilitation Robotics in Houston, and presented in February at the World Congress of Neurorehabilitation in Mumbai India. But the real satisfaction, she says, comes from patient responses.

“I often hear from them that they go home, use the problem-solving strategies we’ve practiced when using their weaker arm, and tell me, ‘I had no idea I could do that’,” Fasoli says. “It’s such a great feeling to know that they’re more satisfied with their performance and better able to accomplish activities that are important in their lives.”