Robotic technologies and rehabilitation: New tools for upper-limb therapy and assessment in chronic stroke

Laboratory of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico, Rome, Italy.
European journal of physical and rehabilitation medicine (Impact Factor: 1.9). 03/2011; 47(2):223-36.
Source: PubMed


The use of robotic technology for assessment has the potential to provide therapists with objective, accurate, repeatable measurements of subject's functions. However, despite the increasing number of clinical studies examining the effect of robotic training on stroke rehabilitation, body functions and structures assessment is typically carried out through traditional human-administered clinical impairment scales.
The paper aims at providing a complete set of kinematic and dynamic indices for an objective measure of the effect of robot-aided therapy, and testing their correlation with clinical scales.
An intervention pilot study applying robotic therapy was carried out.
The clinical study was focused on outpatients and was carried out at Università Campus Bio-Medico of Rome, Italy.
Fifteen community-dwelling persons with chronic stroke met inclusion criteria and volunteered to participate.
Upper limb robotic therapy was administered to patients. Kinematic and dynamic performance indices were extracted from position and force data recorded with the InMotion2 robot. A linear regression analysis was carried out to study correlation with clinical scales to extract a core set of performance indicators.
Robotic outcome measures showed a significant improvement of kinematic motor performance; the improvement of dynamic components was significant only in resistive motion and highly correlated with Motor Power.
Preliminary results showed that arm motor functions and strength of the paretic arm can be objectively measured by means of the proposed bunch of robotic measures. Correlation with Motor Power was high, while correlation with Fugl-Meyer was moderate.
An improvement of clinical body functions assessment is expected in terms of objective, accurate and repeatable measurements of subject's performance during recovery.

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    • "Previous studies proposed a metric for assessing the forces exerted by post-stroke subjects during robot-aided rehabilitation treatment, based on the force directional error [11]. Biomechanical parameters [12] are commonly used in robot-aided assessment [13], [14], [15], [16].The innovation of our method relies on the analysis of the amplitude of the forces applied by the patients at the robot's end-effector during the execution of specific reaching movements in different directions. "
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    ABSTRACT: The aim of this article is to propose a methodology for analysing different recovery mechanisms in subacute and chronic patients through evaluation of biomechanical parameters. Twenty-five post-stroke subjects, eight subacute and seventeen chronic, participated in the study. A 2-DoF robotic system was used for upper limb training. Two clinical scales were used for assessment. Forces and velocities at the robot's end-effector during the execution of upper limb planar reaching movements were measured. Clinical outcome measures show a significant decrease in motor impairment after the treatment both in chronic and subacute patients (MSS-SE, p<0.001; FM, p<0.05). Movement velocity increases after the robot-aided treatment in both groups. Mean values of forces exerted by subacute patients are lower than those observed in chronic patients, both at the beginning and at the end of robotic treatment, as in the latter the pathological pattern is already structured. Our results demonstrate that the monitoring of the forces exerted on the end-effector during robot-aided treatment can identify the specific motor recovery mechanisms at different stages. If the pathological pattern is not yet structured, rehabilitative interventions should be addressed toward the use of motor re-learning procedures; on the other hand, if the force analysis shows a strong pathological pattern, mechanisms of compensation should be encouraged.
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