Effect of a Gravity-Compensating Orthosis on Reaching After Stroke: Evaluation of the Therapy Assistant WREX Bridget T. Iwamuro, BS, Erik G. Cruz, MS,

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Effect of a Gravity-Compensating Orthosis on Reaching After Stroke: Evaluation of the Therapy Assistant WREX Bridget T. Iwamuro, BS, Erik G. Cruz, MS, Lauri L. Connelly, MS, OTR/L, Heidi C. Fischer, MS, OTR/L, Derek G. Kamper, PhD Archives of Physical Medicine and Rehabilitation Volume 89, Issue 11, Pages 2121-2128 (November 2008) DOI: 10.1016/j.apmr.2008.04.022 Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 Modifications to existing design to create Therapy Assistant WREX: (A) wheelchair mount, (B) pronation/supination DOF, and (C) lockable joints. Archives of Physical Medicine and Rehabilitation 2008 89, 2121-2128DOI: (10.1016/j.apmr.2008.04.022) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Individual using Therapy Assistant WREX. Archives of Physical Medicine and Rehabilitation 2008 89, 2121-2128DOI: (10.1016/j.apmr.2008.04.022) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 Shows target locations from top (A) and side (B) views. The open circle denotes starting hand position, and the star indicates shoulder location. Archives of Physical Medicine and Rehabilitation 2008 89, 2121-2128DOI: (10.1016/j.apmr.2008.04.022) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 Differences between free reaching and reaching with the Therapy Assistant WREX across target height (1–3) and target horizontal abduction (1–4). (A) Fraction of reach (FOR) difference indicates subjects positioned their hands closer to the target during reaches employing the Therapy Assistant WREX (plot shows FOR with – FOR without Therapy Assistant WREX). (B) The movement duration at which peak speed occurred decreased when using the Therapy Assistant WREX (plot shows time to peak speed within movement without – time to peak speed within movement with Therapy Assistant WREX). (C) The use of the Therapy Assistant WREX decreased average jerk across target locations (plot shows jerk without – jerk with Therapy Assistant WREX). abd., Abduction; add., adduction. Archives of Physical Medicine and Rehabilitation 2008 89, 2121-2128DOI: (10.1016/j.apmr.2008.04.022) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 5 Example of the reduction in biceps and anterior deltoid EMG when using the Therapy Assistant WREX (B) as opposed to free reaching (A). Note that the speed profile has greatly improved in terms of smoothness and the number of peaks. Archives of Physical Medicine and Rehabilitation 2008 89, 2121-2128DOI: (10.1016/j.apmr.2008.04.022) Copyright © 2008 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions