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: 2.44). 02/2007; 88(2):142-9. DOI: 10.1016/j.apmr.2006.10.032
Source: PubMed

ABSTRACT 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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    ABSTRACT: Acute post-stroke rehabilitation protocols include passive mobilisation as a means to prevent contractures. Frequent and continual exercise can be impractical, due to clinical task scheduling and logistics. A device (SHADE) that provides repetitive passive motion to a flaccid ankle by using shape memory alloy actuators could be of great help in addressing this problem. To comply with the large displacements and forces required by the work-out range of motion, a suitable actuator was designed as a cartridge of approximately 150mmx20mmx15mm, containing 2.5m of 0.25mm-diameter NiTi wire. During tests, this actuator was activated by Joule’s effect employing a 7s current input at 0.7A. This provided 10N through 76mm displacement. Cooling and reset by natural convection took 30s. A prototype of SHADE was assembled with two thermoplastic shells hinged together at the ankle and strapped on the frontal aspect of the shin and on the foot. Two actuators were fixed on the upper shell while an inextensible thread connected each NiTi wire to the foot shell. A dedicated software switched on and off a 30Vdc-generator providing sufficient power to get shape recovery in 7s. Martensite detwinning, caused by foot weight, occurred in 30s. The passive ankle motion (PROM) generated by SHADE was evaluated optoelectronically on three flaccid patients (58±5y/o); acceptability was assessed by a questionnaire presented to further three flaccid patients (44±11.5y/o) who used SHADE for 1 week, 30min a day. SHADE was well accepted by all patients, produced good PROM and caused no pain. Actuator displacement self-adapted to account for patients’ changing ankle rigidity. The rate of dorsiflexion was comparable with self-imposed movement in patient with residual active control, while the slow plantarflexion speed (driven by wire cooling) ensured muscle stretching for around 70% of the cycle. The results prove that suitable limb mobilisation can be produced by SMA actuators.
    SMST 2008/ The International Conference on Shape Memory and Superelastic Technologies American Society for Metals; 09/2008


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