Participation in intensive and repetitive task-oriented training promotes recovery of upper limb function after stroke. However, a large proportion of stroke survivors have severe paresis and are thus unable to participate in task-oriented practice because of a lack of underlying movement. Although one intervention option is robotic therapy, functional gains have been inconsistently reported in the literature, and robotic therapy remains largely prohibitive because of cost and lack of availability. More recently, a nonrobotic device, the SMART (Sensori-Motor Active Rehabilitation Training) Arm, was developed to enable stroke survivors with severe paresis to undertake intensive and repetitive practice of reaching.
Features of the SMART Arm design aim to make task-oriented practice possible. For instance:
- the device minimizes the degrees of freedom to be controlled;
- the hand is stabilized in a splint that is attached to a track, constraining the reaching movement to a straight-line trajectory that is consistent with a normal pattern of movement for reaching;
- the device can be used with electrical stimulation to augment movement through the full range of reaching;
- continuous real-time visual and auditory feedback on the performance of reaching is provided via an interactive computer training program to engage and motivate the user; and
- the device allows manipulation of a number of training elements, such as load, repetitions, and track elevation, to incrementally increase task difficulty.