Implementation of Impairment-Based Neurorehabilitation Devices and Technologies Following Brain Injury

The implementation of electromechanical devices for the quantification and treatment of movement impairments (abnormal muscle synergies resulting in a loss of independent joint control, hypertonia, and associated spasticity and paresis) stemming from brain injury is the main topic in this chapter. The specific requirements for the use of robotic and sensing devices to quantify these impairments as well as treat them effectively both in the clinic and at home (Telerehabilitation) are discussed. A case is made that these devices not only allow the clinician to quantitatively control task practice and dosage but more importantly, allow for direct targeting of specific impairments, such as the loss of independent joint control (Dewald et al. in Top Stroke Rehabil 8(1):1–12, 2001), as well as the monitoring of the expression of such impairments during activities of daily living in the home setting. Acceptance of these new technologies is dependent on proof of their effectiveness in the reduction of movement impairments and activity limitations, as opposed to compensation, and ultimately on the carryover of benefits to activities of daily living and quality of life. Furthermore, the need of a concerted effort to simplify these new technologies, once essential treatment ingredients have been determined, is seen as being a key component for their acceptance in the clinic on a large scale. Finally, it is crucial that we demonstrate that electromechanical and sensing technologies augment existing rehabilitative care and serve to reduce treatment time and costs while maintaining, and even improving, functional outcomes. This is a requirement for future technology development, especially in a health care environment where rehabilitation services have become less accessible and telerehabilitation from home may be the only option for some.