Constraint Induced Movement Therapy

Traditional rehabilitation interventions have been only partially successful in achieving motor recovery in this patient population. Therefore, a number of interventions have been recently proposed in an attempt to improve functional outcomes. Intensive upper limb exercise [159], functional electrical stimulation
[160], robotic therapy [161, 162], virtual reality [163], and constraint induced movement therapy
[164, 165] are some of the approaches recently investigated to improve motor recovery in patients post stroke. Unfortunately, clinical outcomes of upper limb rehabilitation are still unsatisfactory in a large percentage of patients chronically [166].
The process of motor recovery after stroke starts in the inpatient and outpatient settings

Furthermore it has been considered also the need of developing measures that capture the impact of rehabilitation interventions on the patients’ functional ability in real-life conditions, like the home and community settings [162, 172].
An emerging therapeutic approach called Constraint-Induced Movement Therapy (CIMT) has been shown to prevent and/or reverse learned non-use following stroke [1 pr]. CIMT involves constraining the unaffected limb thereby forcing the patient to use their affected limb. In this way the neuroplasticity is stimulated and the motor function is improved, simply forcing the use of the affected limb [2 pr]. CIMT is intended for stroke survivors who retain the ability to flex the wrist and move their arm and fingers.
Chronic stroke patients in CIMT trials have shown impressive functional movement recovery in the upper limb that appears to carry over from clinic settings to their homes and communities [173 sh]. A host of assessment tools have been used by CIMT researchers to measure upper limb motor control

In the past the research on robotic therapy for upper limb was based on end-effector robots. These robots allow the user to hold at one point the machine, generating the force at the interface. In these robots the joints do not match the human limb joints. This is a simple solution, easy to design and adjust to fit several patient arms, but it is difficult determining the posture of the upper limb with just one interface hand-machine. Furthermore in this kind of solutions it is difficult to control the torque generation, the isolation of the movement at a single joint is not easy and at last just few movements can be executed for the limited range of motion of the robot. Examples of end-effector robots include MT-MANUS [4,5 sa], the MIME [6 sa] and the GENTLE/s [7 sa].
In the last years, robotic therapy has moved towards exoskeleton robots. Exoskeletons have a structure more suitable for the human upper limb, with robot and human joints that match their axes. These robots can be attached to the limb at multiple locations, for operating side by side with it. Sometimes this fact sometimes could make more difficult to apply the same robot to different arm lengths. It may