[Show abstract][Hide abstract] ABSTRACT: Objective: The aim of this systematic review was to identify appropriate selection criteria of clinical scales for future trials, starting from those most commonly reported in the literature, according to their psychometric properties and International Classification of Functioning, Disability and Health (ICF) domains. Data sources: A computerized literature research of articles was conducted in MEDLINE, EMBASE, CINALH, Pub-Med, PsychINFO and Scopus databases. Study selection: Clinical trials evaluating the effects of elec-tromechanical and robot-assisted gait training trials in stroke survivors. Data extraction: Fifteen independent authors performed an extensive literature review. Data synthesis: A total of 45 scales was identified from 27 studies involving 966 subjects. The most commonly used outcome measures were: Functional Ambulation Category (18 studies), 10-Meter Walking Test (13 studies), Motricity Index (12 studies), 6-Minute Walking Test (11 studies), Riv-ermead Mobility Index (8 studies) and Berg Balance Scale (8 studies). According to the ICF domains 1 outcome measure was categorized into Body Function and Structure, 5 into Activity and none into Participation. Conclusion: The most commonly used scales evaluated the basic components of walking. Future studies should also in-clude instrumental evaluation. Criteria for scale selection should be based on the ICF framework, psychometric prop-erties and patient characteristics.
Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 10/2013; 45(45):987-996. · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Constraint-induced movement therapy (CIMT) is a rehabilitation approach for arm paresis consisting of an intensive schedule of treatment (6 h/d). The high demand of resources for CIMT is a critical issue for its implementation in the Italian health system.
To compare the effects of a reduced-intensity modified CIMT (mCIMT) program that included splinting the unaffected arm for 12 hours daily with the effects of a conventional rehabilitation program for arm paresis in patients with stroke.
Sixty-six participants with hemiparesis (3-24 months poststroke) who could extend the wrist and several fingers at least 10° were randomly assigned to mCIMT or conventional rehabilitation. Each group underwent 10 (2 h/d) treatment sessions (5 d/wk for 2 weeks). Patients were assessed with the Wolf Motor Function Test (WMFT-FA and WMFT-T), the Motor Activity Log (MAL-AOU and MAL-QOM), and the Ashworth Scale before and after treatment and 3 months later.
Between-groups analysis showed that the mCIMT group overall had greater improvement than the control group in terms of the WMFT-FA (P = .010), MAL-AOU (P < .001), and MAL-QOM (P < .001). Differences between groups were significant both after treatment (P < .01) and at the 3-month follow-up (P < .01), although 40% of participants did not complete the 3-month assessment. Furthermore, the mCIMT group showed a greater decrease of Ashworth Scale score than the control group at 3 months (P = .021).
Two hours of CIMT may be more effective than conventional rehabilitation in improving motor function and use of the paretic arm in patients with chronic stroke.
Neurorehabilitation and neural repair 06/2012; 26(9):1035-45. · 4.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A randomized controlled trial, involving 35 post-acute hemiparetic patients, demonstrated that a four-week treatment of cycling induced by functional electrical stimulation (FES-cycling) promotes motor recovery. Analyzing additional data acquired during that study, the present work investigated whether these improvements were associated to changes in muscle strength and motor coordination. Participants were randomized to receive FES-cycling or placebo FES-cycling. Clinical outcome measures were: the Motricity Index (MI), the gait speed, the electromyography activation of the rectus femoris and biceps femoris, and the mechanical work produced by each leg during voluntary pedaling. To provide a comparison with normal values, healthy adults also carried out the pedaling test. Patients were evaluated before, after training, and at follow-up visits. A significant treatment effect in favor of FES-treated patients was found in terms of MI scores and unbalance in mechanical works, while differences in gait speed were not significant (ANCOVA). Significant improvements in the activation of the paretic muscles were highlighted in the FES group, while no significant change was found in the placebo group (Friedman test). Our findings suggested that improvements in motor functions induced by FES-cycling training were associated with a more symmetrical involvement of the two legs and an improved motor coordination.
IEEE transactions on neural systems and rehabilitation engineering: a publication of the IEEE Engineering in Medicine and Biology Society 04/2012; 20(3):320-30. · 2.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate if adding paediatric robotic-assisted gait training (RAGT) to task-oriented physiotherapy (TOP) in children with Cerebral Palsy (CP) could improve gross motor abilities and gait compared to intensive TOP. Nineteen ambulatory children with Bilateral Spastic CP were assigned to two 10-week training groups. 9 children had 20 sessions of RAGT and 20 sessions of TOP, the other 10 children had 40 sessions only of TOP. The Gross Motor Function Measure, 6-Minute Walk Test and 3D Gait Analysis were assessed prior to, at the end of, and 3 months after the end of the treatment. After the training and during the follow up, both groups improved their Gross Motor Function Measure scores, maintained their gait pattern and had unchanged 6-Minute Walk Test results. No between group differences were found in any outcome measures. In conclusion, compared to intensive TOP alone, the addition of RAGT to TOP was demonstrated to be equally effective at improving gross motor abilities and maintaining gait pattern over time. The robotic rehabilitation allows care-providers to administer a standardized, controlled, dosed therapy, and appears to increase patient's motivation.
Biomedical Robotics and Biomechatronics (BioRob), 2012 4th IEEE RAS & EMBS International Conference on; 01/2012
[Show abstract][Hide abstract] ABSTRACT: The restoration of walking ability is crucial for maximizing independent mobility among patients with stroke. Leg cycling is becoming an established intervention to supplement ambulation training for stroke patients with problems of unbalance and weakness. The aim of the study was to explore the feasibility of a biofeedback pedaling treatment and its effects on cycling and walking ability in chronic stroke patients. Three patients were included in the study. The training consisted of a 2-week treatment of 6 sessions, during which a visual biofeedback helped the participants in maintaining a symmetrical pedaling. Participants were assessed before, after training and at follow-up, by means of a pedaling test and gait analysis. Outcome measurements were the unbalance during pedaling, the temporal, spatial and symmetry parameters during walking. An intra-subject statistical analysis (ANOVA, p<;0.05) showed that all patients significantly decreased pedaling unbalance after treatment and maintained the improvements at follow-up. The training induced some gait pattern modifications in two patients: one significantly improved mean velocity and gait symmetry, while the other one reduced the compensation strategy of the healthy leg. The results demonstrated the feasibility of the treatment. If further trials on a larger and controlled scale confirmed the same results, this treatment, thanks to its safety and low price, could have a significant impact as a home-rehabilitation treatment.
IEEE ... International Conference on Rehabilitation Robotics : [proceedings]; 06/2011
[Show abstract][Hide abstract] ABSTRACT: This study assessed if transfer of the extensor hallucis longus is a valid alternative treatment to split transfer of the tibialis anterior tendon in adult hemiplegic patients without overactivity of the tibialis anterior. One group of 15 patients had overactivity of tibialis anterior in the swing phase, and underwent the split transfer. A further group of 14 patients had no overactivity of tibialis anterior, and underwent transfer of extensor hallucis longus. All patients had lengthening of the tendo Achillis and tenotomies of the toe flexors. All were evaluated clinically and by three-dimensional gait analysis pre- and at one year after surgery. At this time both groups showed significant reduction of disability in walking. Gait speed, stride length and paretic propulsion had improved significantly in both groups. Dorsiflexion in the swing phase, the step length of the healthy limb and the step width improved in both groups, but only reached statistical significance in the patients with transfer of the extensor hallucis longus. There were no differences between the groups at one year after operation. When combined with lengthening of the tendo Achillis, transfer of the extensor hallucis longus can be a valid alternative to split transfer of the tibialis anterior tendon to correct equinovarus foot deformity in patients without overactivity of tibialis anterior.
Journal of Bone and Joint Surgery - British Volume 09/2010; 92(9):1262-6. · 2.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to identify on healthy subjects the correlation between motor performances and brain activation maps, by the simultaneous use of functional magnetic resonance imaging (fMRI) and optoelectronic motion analysis system. The specific goal was to individuate how amplitude affects the related cerebral flow maps in active, passive and electrical stimulated (FES) movements. Ankle DorsiFlexion (ADF) was chosen as analyzed task because of its importance in the gait cycle. Firstly FES compatibility with fMRI images acquisition was assessed, both for the safety of the subject and of the device, and for mutual disturbances evaluation. We identified the experimental protocol so as to optimize the measured cerebral maps and the repeatability of the results. Intra-subject analysis of movement parameters along with brain activation mapping was performed. First level analysis to compare different execution modalities have been studied and preliminary qualitative results are reported. The long term application is the exploitation of the combined system in the evaluation of neurological patients where the definition of the motor tasks could be only partially accomplished depending on the patient residual functionality.
[Show abstract][Hide abstract] ABSTRACT: A compliant brace (EDGES) promoting spastic elbow relaxation was designed to investigate the potentialities of pseudoelastic
NiTi in orthotics. By exploiting its peculiar characteristics, EDGES could improve elbow posture without constraining movements
and thus avoiding any pain to the patient. A commercial Ni50.7-Ti49.3 alloy heat treated at 400°C 1h+WQ was selected for this application. A prototype of EDGES was assembled with two thermoplastic
shells connected by polycentric hinges. Four 2-mm-diameter NiTi bars were encastred in the upper-arm shell and let slide along
tubular fixtures on the forearm. Specially designed bending tests demonstrated suitable moment-angle characteristics. Two
post-stroke subjects (aged 62 and 64, mild elbow flexors spasticity) wore EDGES for 1 week, at least 10h a day. No additional
treatment was applied during this period or the following week. A great improvement (20°±5°) of the resting position was
observed in both patients as early as 3h after starting the treatment. Acceptability was very good. A slight decrease in
spasticity was also observed in both subjects. All the effects disappeared 1week after discontinuation. EDGES appears to
be a good alternative to traditional orthoses in terms of acceptability and effectiveness in improving posture, especially
whenever short-term splinting is planned.
Journal of Materials Engineering and Performance 08/2009; 18(5):805-813. · 0.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Body weight supported treadmill training assisted with a robotic driven gait orthosis is an emerging clinical tool helpful to restore gait in individuals with loss of motor skills. However, the autonomic response during this rehabilitation protocol is not known. The aim of the study was to evaluate the autonomic response during a routine protocol of motor rehabilitation through spectral and symbolic analyses of short-term heart rate variability in a group of 20 healthy subjects (11 men, mean age 25+/-3.8 years). The protocol included the following phases: (1) sitting position; (2) standing position; (3) suspension during subject instrumentation; (4 and 5) robotic-assisted treadmill locomotion at 1.5km/h and 2.5km/h respectively with partial body weight support; (6) standing recovery after exercise. Results showed a significant tachycardia associated with the reduction in variance during the suspended phase of the protocol compared to the sitting position. Spectral analysis did not demonstrate any significant autonomic response during the entire protocol, while symbolic analysis detected an increase in sympathetic modulation during body suspension and an increase of vagal modulation during walking. These results could be used to improve understanding of the cardiovascular effects of rehabilitation in subjects undergoing robotic driven gait orthosis treadmill training.
[Show abstract][Hide abstract] ABSTRACT: We present a preliminary study that combines functional electrical stimulation and time-domain near infrared spectroscopy for a quantitative measurement of the local muscular metabolism during rehabilitation of post-acute stroke patients. Seven healthy subjects and nine post-acute stroke patients underwent a protocol of knee flex-extension of the quadriceps induced by functional electrical stimulation. During the protocol time-domain near infrared spectroscopy measurement were performed on both left and right muscle. Hemodynamic parameters (concentration of oxy- and deoxy-genated hemoglobin) during baseline did not show any significant differences between healthy subject and patients, while functional performances (knee angle amplitude) were distinctly different. Nevertheless, even if their clinical histories were noticeably different, there was no differentiation among functional performances of patients. On the basis of the hemodynamic parameters measured during the recovery phase, instead, it was possible to identify two classes of patients showing a metabolic trend similar or very different to the one obtained by healthy subjects. The presented results suggest that the combination of functional and metabolic information can give an additional tool to the clinicians in the evaluation of the rehabilitation in post-acute stroke patients.