Robotic technologies and rehabilitation: new tools for upper-limb therapy and assessment in chronic stroke.
ABSTRACT 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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ABSTRACT: Stroke is a leading cause of disability, significantly impacting the quality of life (QOL) in survivors, and rehabilitation remains the mainstay of treatment in these patients. Recent engineering and technological advances such as brain–machine interfaces (BMI) and robotic rehabilitative devices are promising to enhance stroke neurorehabilitation, to accelerate functional recovery and improve QOL. This review discusses the recent applications of BMI and robotic-assisted rehabilitation in stroke patients. We present the framework for integrated BMI and robotic-assisted therapies, and discuss their potential therapeutic, assistive and diagnostic functions in stroke rehabilitation. Finally, we conclude with an outlook on the potential challenges and future directions of these neurotechnologies, and their impact on clinical rehabilitation.06/2014; 2(2). DOI:10.1007/s40141-014-0051-4
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ABSTRACT: Friedreich's ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients' dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive.Journal of NeuroEngineering and Rehabilitation 04/2015; 12(1):41. DOI:10.1186/s12984-015-0032-6 · 2.62 Impact Factor
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ABSTRACT: In this paper, we demonstrate that healthy adults respond differentially to the administration of force feedback and the presentation of scientific content in a virtual environment, where they interact with a low-cost haptic device. Subjects are tasked with controlling the movement of a cursor on a predefined trajectory that is superimposed on a map of New York City's Bronx Zoo. The system is characterized in terms of a suite of objective indices quantifying the subjects' dexterity in planning and generating the multijoint visuomotor tasks. We find that force feedback regulates the smoothness, accuracy, and duration of the subject's movement, whereby converging or diverging force fields influence the range of variations of the hand speed. Finally, our findings provide preliminary evidence that using educational content increases subjects' satisfaction. Improving the level of interest through the inclusion of learning elements can increase the time spent performing rehabilitation tasks and promote learning in a new context.PLoS ONE 12/2013; 8(12):e83945. DOI:10.1371/journal.pone.0083945 · 3.53 Impact Factor