Robotic therapy: the tipping point.

The last two decades have seen a remarkable shift in the neurorehabilitation paradigm. Neuroscientists and clinicians moved away from the perception that the brain is static and hardwired to a new dynamic understanding that plasticity is a fundamental property of the adult human brain and might be harnessed to remap or create new neural pathways. Capitalizing on this innovative understanding, the authors introduced a paradigm shift in the clinical practice in 1989 when they initiated the development of the Massachusetts Institute of Technology-Manus robot for neurorehabilitation and deployed it in the clinic in 1994 (Krebs et al. 1998). Since then, the authors and others have developed and tested a multitude of robotic devices for stroke, spinal cord injury, cerebral palsy, multiple sclerosis, and Parkinson disease. Here, the authors discuss whether robotic therapy has achieved a level of maturity to justify its broad adoption in the clinical realm as a tool for motor recovery.