Robotic-Assisted Rehabilitation of the Upper Limb After Acute Stroke

Department of Rehabilitation Medicine, University of Padova, School of Medicine, Padova, Italy.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 02/2007; 88(2):142-9. DOI: 10.1016/j.apmr.2006.10.032
Source: PubMed


To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb.
A single-blind randomized controlled trial, with an 8-month follow-up.
Neurologic department and rehabilitation hospital.
Thirty-five patients with acute (< or =1 wk of onset), unilateral, ischemic embolic, or thrombotic stroke.
Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (n=17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (n=18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli.
The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS).
Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (P< or =.05) and biceps (P<.05) scores, the FMA for the proximal upper arm (P<.05), the FIM instrument (P<.05), and the FIM motor score (P<.01); these gains were also sustained at the 3- and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted.
Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb.

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    • "For instance, bilateral arm training, one of the active neurorehabilitation treatments, shows less effectiveness when being compared with other treatments [13]. Stretch can prevent secondary deformities in certain degree, and robot can provide the high-intensity, accuracy and task-specific movements with repetitions, both of which might contribute to reduce the spasticity and improving the joint mobility [14] [15], although some clinic studies showed inconsistencies in results [16] [17]. In our case, the patient got little improvement from regular rehabilitation including passive stretch, Constraint-induced movement therapy (CMIT) and bilateral arm training. "
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    ABSTRACT: Selective dorsal rhizotomy is an effective method to reduce spasticity of the lower limbs. However, functional outcomes in the upper limb following selective dorsal rhizotomy at the cervical level has not been reported. Here we report the clinical course after selective dorsal rhizotomy at the cervical level in a patient with hemiplegic spasticity caused by brain injury. The selective dorsal rootlets at the cervical level were sectioned under electrophysiological monitoring. The patient was followed for 1 year to evaluate the outcome of surgery. The spasticity in the upper limb was reduced and the passive range of motion and function of movement improved. However, the effectiveness and the safety of operation should be studied further in clinical trials.
    Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 01/2015; 2(1). DOI:10.1016/j.inat.2014.12.003
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    • "Only the experimental group improved in all noted measures of functional recovery. Similar to Aisen et al. (1997), Masiero, Celia, Rosati and Armani (2007) also tested the effectiveness of robotic guidance for the rehabilitation of patients with hemiplegia. They compared a control group to a robot-training group. "
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    ABSTRACT: Background: Robotic guidance has been shown to facilitate motor skill acquisition, through altered sensorimotor control, in neurologically impaired and healthy populations. Objective: To determine if robot-guided practice and online visual feedback availability primarily influences movement planning or online control mechanisms. Methods: In this two-experiment study, participants first performed a pre-test involving reaches with or without vision, to obtain baseline measures. In both experiments, participants then underwent an acquisition phase where they either actively followed robot-guided trajectories or trained unassisted. Only in the second experiment, robot-guided or unassisted acquisition was performed either with or without online vision. Following acquisition, all participants completed a post-test that was the same as the pre-test. Planning and online control mechanisms were assessed through endpoint error and kinematic analyses. Results: The robot-guided and unassisted groups generally exhibited comparable changes in endpoint accuracy and precision. Kinematic analyses revealed that only participants who practiced with the robot exhibited significantly reduced the proportion of movement time spent during the limb deceleration phase (i.e., time after peak velocity). This was true regardless of online visual feedback availability during training. Conclusion: The influence of robot-assisted motor skill acquisition is best explained by improved motor planning processes.
    Neurorehabilitation 10/2014; 35(4). DOI:10.3233/NRE-141168 · 1.12 Impact Factor
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    • "The two randomized controlled trials tested two different robotic protocols in comparison to standard rehabilitation treatment, one using the robot in addition to the traditional treatment [8], one in partial substitution to the standard rehabilitation programme, with a dose-matched approach [9, 12]. Both protocols lasted 5 weeks and included two daily sessions of robotic treatment for five days a week. "
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    ABSTRACT: Stroke is the first cause of disability. Several robotic devices have been developed for stroke rehabilitation. Robot therapy by NeReBot is demonstrated to be an effective tool for the treatment of poststroke paretic upper limbs, able to improve the activities of daily living of stroke survivors when used both as additional treatment and in partial substitution of conventional rehabilitation therapy in the acute and subacute phases poststroke. This study presents the evaluation of the costs related to delivering such therapy, in comparison with conventional rehabilitation treatment. By comparing several NeReBot treatment protocols, made of different combinations of robotic and nonrobotic exercises, we show that robotic technology can be a valuable and economically sustainable aid in the management of poststroke patient rehabilitation.
    BioMed Research International 04/2014; 2014:265634. DOI:10.1155/2014/265634 · 1.58 Impact Factor
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