Assessing and Inducing Neuroplasticity With Transcranial Magnetic Stimulation and Robotics for Motor Function

TMS is administered to a patient. TMS uses a small but strong and focused magnetic pulse that is administered through a stimulating coil, usually composed of copper strips with a plastic casing, held on the surface of the head.

Motor recovery at 3 months poststroke, as assessed through several functional outcome measures, correlated highly with CNS reorganization as measured with TMS over the motor cortex. For this figure, following systematic mapping of motor-evoked responses from TMS over a grid centered on motor cortex, the region of cortex from each patient that induced movement of the contralateral hand was overlaid on the Montreal Neurological Institute template brain in Matlab. Adapted from Ro et al.³⁰

A robotic lower-arm exoskeleton provides sensing and actuation for elbow flexion and extension, wrist pronation and supination, and radial-ulnar deviation.⁵²

A haptic (force-feedback) joystick can allow for therapeutic interactions with virtual environments, displayed via a computer screen.⁶⁹ Position data recorded via the robotic joystick are monitored by the computer, and resultant force commands are displayed to the patient. In such a system, assistance forces can be implemented via the actuators of the robotic device.