Technologies and combination therapies for enhancing movement training for people with a disability

A key working hypothesis of rehabilitation science is that use-dependent plasticity perseveres through motor system injuries and diseases. This hypothesis drives intensive, ongoing efforts to optimize rehabilitation experiences for people with a movement disability, so as to best promote use-dependent plasticity. In the past twenty years, there has been an increasing recognition that technologies, including robotics, orthotics, wearable sensors, computer vision, computer gaming, electrical stimulation, virtual reality, machine learning, and computational modeling, can play an important role in these efforts [1-5]. In this section, we first review the rationale for developing this new technology for rehabilitation therapy, then, using examples from robot-assisted therapy, we briefly characterize the state of the field in meeting its promise. In the following sections we then review approaches to improve these technologies, drawing on examples from European research, followed by a brief discussion of attempts to combine these technologies with biologic therapeutics.There are three primary motivations for developing new technology for rehabilitation therapy. First, improved technology has the potential to allow more therapy with less supervision, improving rehabilitation cost-benefit profiles. This objective can be expressed as developing technology that optimally promotes use-dependent plasticity while lowering the cost of therapy. Second, technology has the potential to more accurately quantify therapy, including patient characteristics that predict therapy success, the dose and content of therapy, and clinical outcomes. This quantification property of technology is important for improving the mechanistic understanding of rehabilitation science, clinician decision-making, and patient feedback and motivation. Third, technology has the potential to allow entirely new types of therapy. One example is the concept of providing continuous therapy with wearable devices. Reh