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, spasticity, and paralysis) resulting from brain injury is the main topic in this chapter. The specific requirements for the use of robotic devices to quantify these impairments as well as treat them effectively are discussed. A case is made that electromechanical 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. Top Stroke Rehabil. 8(1):1-12, 2001), that are informed by a body of scientific evidence. 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 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 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 healthcare environment where rehabilitation services have become less accessible.