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Soleimani M, Ghazisaeedi M, Heydari S. The efficacy of virtual reality for upper limb rehabilitation in stroke patients: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2024; 24:135. [PMID: 38790042 PMCID: PMC11127427 DOI: 10.1186/s12911-024-02534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Stroke frequently gives rise to incapacitating motor impairments in the upper limb. Virtual reality (VR) rehabilitation has exhibited potential for augmenting upper extremity recovery; nonetheless, the optimal techniques for such interventions remain a topic of uncertainty. The present systematic review and meta-analysis were undertaken to comprehensively compare VR-based rehabilitation with conventional occupational therapy across a spectrum of immersion levels and outcome domains. METHODS A systematic search was conducted in PubMed, IEEE, Scopus, Web of Science, and PsycNET databases to identify randomized controlled trials about upper limb rehabilitation in stroke patients utilizing VR interventions. The search encompassed studies published in the English language up to March 2023. The identified studies were stratified into different categories based on the degree of immersion employed: non-immersive, semi-immersive, and fully-immersive settings. Subsequent meta-analyses were executed to assess the impact of VR interventions on various outcome measures. RESULTS Of the 11,834 studies screened, 55 studies with 2142 patients met the predefined inclusion criteria. VR conferred benefits over conventional therapy for upper limb motor function, functional independence, Quality of life, Spasticity, and dexterity. Fully immersive VR showed the greatest gains in gross motor function, while non-immersive approaches enhanced fine dexterity. Interventions exceeding six weeks elicited superior results, and initiating VR within six months post-stroke optimized outcomes. CONCLUSIONS This systematic review and meta-analysis demonstrates that adjunctive VR-based rehabilitation enhances upper limb motor recovery across multiple functional domains compared to conventional occupational therapy alone after stroke. Optimal paradigms likely integrate VR's immersive capacity with conventional techniques. TRIAL REGISTRATION This systematic review and meta-analysis retrospectively registered in the OSF registry under the identifier [ https://doi.org/10.17605/OSF.IO/YK2RJ ].
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Affiliation(s)
- Mohsen Soleimani
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Soroush Heydari
- Department of Health Information Management and Medical Informatics, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Liu Q, Liu Z, Cheng H, Xu Y, Wang F, Liu L, Hu X. The impact of reminiscent music therapy and robot-assisted rehabilitation on older stroke patients: a protocol for a randomized controlled trial. Front Neurol 2024; 15:1345629. [PMID: 38651105 PMCID: PMC11033498 DOI: 10.3389/fneur.2024.1345629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Background Stroke is the main disease that causes the burden of neurological disease, leading to upper limb dysfunction and affecting their self-care abilities. Robot-assisted rehabilitation therapy has been gradually used in the rehabilitation of upper limb function after stroke. However, it would be beneficial to explore auxiliary interventions such as reminiscent music therapy, a combination of music and reminiscent, to relieve negative emotions and post-stroke fatigue and improve rehabilitation outcomes. This protocol aims to evaluate the effectiveness of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. Methods This trial is a single-blind, three-arm randomized controlled trial. Older stroke patients with upper limb dysfunction will be recruited. Participants will be randomly assigned to receive usual rehabilitation treatment and care, usual rehabilitation treatment and care plus robot-assisted rehabilitation and reminiscent music therapy, or usual rehabilitation treatment and care plus robot-assisted rehabilitation. Robot-assisted rehabilitation will be conducted by rehabilitation doctors five times per week for 3 weeks. In experimental group 1, a reminiscent song list will be played for patients. The primary outcome is activities of daily living. All outcomes will be evaluated at baseline and in the week immediately post-intervention. Discussion We are conducting the first randomized controlled trial on the effects of reminiscent music therapy combined with robot-assisted rehabilitation in older stroke patients. It is expected that this study, if proven effective in improving the activities of daily living in older stroke patients with upper limb dysfunction, will provide evidence-based rehabilitation strategies for medical staff.Clinical Trial Registration: ChiCTR2200063738.
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Affiliation(s)
- Qian Liu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, and West China School of Nursing, Sichuan University, Chengdu, China
| | - Zuoyan Liu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Hong Cheng
- School of Automation Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Yang Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Fang Wang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, and West China School of Nursing, Sichuan University, Chengdu, China
| | - Li Liu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, and West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiuying Hu
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, and West China School of Nursing, Sichuan University, Chengdu, China
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Potcovaru CG, Salmen T, Bîgu D, Săndulescu MI, Filip PV, Diaconu LS, Pop C, Ciobanu I, Cinteză D, Berteanu M. Assessing the Effectiveness of Rehabilitation Interventions through the World Health Organization Disability Assessment Schedule 2.0 on Disability-A Systematic Review. J Clin Med 2024; 13:1252. [PMID: 38592067 PMCID: PMC10931950 DOI: 10.3390/jcm13051252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a tool designed to measure disability in accordance with the International Classification of Functioning, Disability and Health. Measuring disability is becoming increasingly important due to its high prevalence, which continues to rise. Rehabilitation interventions can reduce disability and enhance functioning. (2) Objective: The present study aims to assess the impact of rehabilitation interventions on reducing disability, as measured by the WHODAS 2.0 questionnaire. It also seeks to identify which specific rehabilitation interventions are more effective and to explore other disability assessment questionnaires. (3) Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a systematic review, with the protocol registered with the identifier CRD42023495309, focused on "WHODAS" and "rehabilitation" using PubMed and Web of Science electronic databases. (4) Results: We identified 18 articles from various regions encompassing patients with various health conditions, related to stroke, the cardiovascular system (cardiovascular disease, chronic heart failure), the pulmonary system (chronic obstructive pulmonary disease), the neurologic system (Parkinson's disease, cerebral palsy, neurodegenerative disease), the musculoskeletal system (orthopaedic surgery), cancer, and chronic pain, and among frail elderly. These patients have received a wide range of rehabilitation interventions: from conventional therapy to virtual reality, robot-assisted arm training, exergaming, and telerehabilitation. (5) Discussion and Conclusions: A wide range of rehabilitation techniques can effectively improve disability with various comorbidities, offering numerous benefits. The WHODAS 2.0 questionnaire proves to be an efficient and reliable tool for measuring disability, and scores have a tendency to decrease after rehabilitation.
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Affiliation(s)
- Claudia-Gabriela Potcovaru
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (C.-G.P.); (T.S.); (M.I.S.)
| | - Teodor Salmen
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (C.-G.P.); (T.S.); (M.I.S.)
| | - Dragoș Bîgu
- Department of Philosophy and Social and Human Sciences, Bucharest University of Economic Studies, Piata Romana. No. 6, District 1, 010374 Bucharest, Romania;
| | - Miruna Ioana Săndulescu
- Doctoral School, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (C.-G.P.); (T.S.); (M.I.S.)
| | - Petruța Violeta Filip
- Department of Gastroenterology and Internal Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (P.V.F.); (L.S.D.); (C.P.)
| | - Laura Sorina Diaconu
- Department of Gastroenterology and Internal Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (P.V.F.); (L.S.D.); (C.P.)
| | - Corina Pop
- Department of Gastroenterology and Internal Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (P.V.F.); (L.S.D.); (C.P.)
| | - Ileana Ciobanu
- Physical and Rehabilitation Medicine Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Delia Cinteză
- Physical Medicine and Rehabilitation Department 9, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Mihai Berteanu
- Physical Medicine and Rehabilitation Department 9, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
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Hong R, Li B, Bao Y, Liu L, Jin L. Therapeutic robots for post-stroke rehabilitation. MEDICAL REVIEW (2021) 2024; 4:55-67. [PMID: 38515779 PMCID: PMC10954296 DOI: 10.1515/mr-2023-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
Stroke is a prevalent, severe, and disabling health-care issue on a global scale, inevitably leading to motor and cognitive deficits. It has become one of the most significant challenges in China, resulting in substantial social and economic burdens. In addition to the medication and surgical interventions during the acute phase, rehabilitation treatment plays a crucial role in stroke care. Robotic technology takes distinct advantages over traditional physical therapy, occupational therapy, and speech therapy, and is increasingly gaining popularity in post-stroke rehabilitation. The use of rehabilitation robots not only alleviates the workload of healthcare professionals but also enhances the prognosis for specific stroke patients. This review presents a concise overview of the application of therapeutic robots in post-stroke rehabilitation, with particular emphasis on the recovery of motor and cognitive function.
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Affiliation(s)
- Ronghua Hong
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Yunjun Bao
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingyu Liu
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Lingjing Jin
- Department of Neurology and Neurological Rehabilitation, Shanghai Disabled Persons’ Federation Key Laboratory of Intelligent Rehabilitation Assistive Devices and Technologies, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
- Neurotoxin Research Center, Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Collaborative Innovation Center for Brain Science, Tongji University, Shanghai, China
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Ti CHE, Hu C, Yuan K, Chu WCW, Tong RKY. Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1-11. [PMID: 38051622 DOI: 10.1109/tnsre.2023.3339756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( β =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( β =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.
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Dai L, Zhang W, Zhang H, Fang L, Chen J, Li X, Yu H, Song J, Chen S, Zheng B, Zhang Y, Li Z. Effects of robot-assisted upper limb training combined with intermittent theta burst stimulation (iTBS) on cortical activation in stroke patients: A functional near-infrared spectroscopy study. NeuroRehabilitation 2024; 54:421-434. [PMID: 38640179 DOI: 10.3233/nre-230355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND The therapeutic effect and mechanism of robot-assisted upper limb training (RT) combined with intermittent theta burst stimulation (iTBS) for stroke patients are unclear. OBJECTIVE The purpose of this study was to evaluate changes in brain activation after combination therapy and RT alone using functional near-infrared spectroscopy (fNIRS). METHODS Patients were randomly assigned to two groups (iTBS + RT Group, n = 18, and RT Group, n = 18). Training was conducted five times a week for four weeks. fNIRS was used to measure changes in oxyhemoglobin in both the primary motor cortex (M1) and pre-motor and supplementary motor area (pSMA) during affected limb movement. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was employed for evaluating the function of upper limbs. RESULTS Thirty-two patients with subacute stroke completed the study. The cortex of both hemispheres was extensively activated prior to treatment in the RT group. After training, overactivation decreased. The brain activation of the combined treatment group transferred to the affected side after the treatment. There was a notable enhancement in the FMA-UE scores for both groups, with the combined group's progress significantly surpassing that of the RT group. CONCLUSION RT combined with iTBS can improve the motor function of stroke patients and promote the balance between cerebral hemispheres.
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Affiliation(s)
- Lei Dai
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huihuang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Linjie Fang
- Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Xiang Li
- Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Hong Yu
- Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Jianfei Song
- Zhejiang Rehabilitation Medical Center, Hangzhou, China
| | - Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujia Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhongyi Li
- Hangzhou Innovation Institute, Beihang University, Hangzhou, China
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Tang C, Zhou T, Zhang Y, Yuan R, Zhao X, Yin R, Song P, Liu B, Song R, Chen W, Wang H. Bilateral upper limb robot-assisted rehabilitation improves upper limb motor function in stroke patients: a study based on quantitative EEG. Eur J Med Res 2023; 28:603. [PMID: 38115157 PMCID: PMC10729331 DOI: 10.1186/s40001-023-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Upper limb dysfunction after stroke seriously affects quality of life. Bilateral training has proven helpful in recovery of upper limb motor function in these patients. However, studies evaluating the effectiveness of bilateral upper limb robot-assisted training on improving motor function and quality of life in stroke patients are lacking. Quantitative electroencephalography (EEG) is non-invasive, simple, and monitors cerebral cortical activity, which can be used to evaluate the effectiveness of interventions. In this study, EEG was used to evaluate the effect of end-drive bilateral upper extremity robot-assisted training on upper extremity functional recovery in stroke patients. METHODS 24 stroke patients with hemiplegia were randomly divided into a conventional training (CT, n = 12) group or a bilateral upper limb robot-assisted training (BRT, n = 12) group. All patients received 60 min of routine rehabilitation treatment including rolling, transferring, sitting, standing, walking, etc., per day, 6 days a week, for three consecutive weeks. The BRT group added 30 min of bilateral upper limb robot-assisted training per day, while the CT group added 30 min of upper limb training (routine occupational therapy) per day, 6 days a week, for 3 weeks. The primary outcome index to evaluate upper limb motor function was the Fugl-Meyer functional score upper limb component (FMA-UE), with the secondary outcome of activities of daily living (ADL), assessed by the modified Barthel index (MBI) score. Quantitative EEG was used to evaluate functional brain connectivity as well as alpha and beta power current source densities of the brain. RESULTS Significant (p < 0.05) within-group differences were found in FMA-UE and MBI scores for both groups after treatment. A between-group comparison indicated the MBI score of the BRT group was significantly different from that of the CT group, whereas the FMA-UE score was not significantly different from that of the CT group after treatment. The differences of FMA-UE and MBI scores before and after treatment in the BRT group were significantly different as compared to the CT group. In addition, beta rhythm power spectrum energy was higher in the BRT group than in the CT group after treatment. Functional connectivity in the BRT group, under alpha and beta rhythms, was significantly increased in both the bilateral frontal and limbic lobes as compared to the CT group. CONCLUSIONS BRT outperformed CT in improving ADL in stroke patients within three months, and BRT facilitates the recovery of upper limb function by enhancing functional connectivity of the bilateral cerebral hemispheres.
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Affiliation(s)
- Congzhi Tang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ting Zhou
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Yun Zhang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Runping Yuan
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Xianghu Zhao
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ruian Yin
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Pengfei Song
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Bo Liu
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Ruyan Song
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China
| | - Wenli Chen
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China.
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, 210009, China.
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He YZ, Huang ZM, Deng HY, Huang J, Wu JH, Wu JS. Feasibility, safety, and efficacy of task-oriented mirrored robotic training on upper-limb functions and activities of daily living in subacute poststroke patients: a pilot study. Eur J Phys Rehabil Med 2023; 59:660-668. [PMID: 37869761 PMCID: PMC10795073 DOI: 10.23736/s1973-9087.23.08018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Robotic training with high repetitions facilitates upper-limb movements but provides fewer benefits for activities of daily living. Integrating activities of daily living training tasks and mirror therapy into a robot may enhance the functional gains of robotic training. AIM The aim of this study was to investigate the feasibility, safety, and efficacy of the task-oriented mirrored upper-limb robotic training on the upper-limb functions and activities of daily living of subacute poststroke patients. DESIGN This study is a single-blinded, active-controlled pilot study. SETTING The study was carried out at rehabilitation outpatient clinic and ward. POPULATION A total of 32 subacute poststroke patients were enrolled in the study. METHODS The enrolled patients were allocated into two groups in a ratio of 1:1. The experimental group received 4 weeks of task-oriented mirrored upper-limb robotic training, consisting of five sessions of 30-minute duration, along with 30 minutes of conventional training. The control group only received 60 minutes of conventional training. The outcome measures were the Fugl-Meyer Assessment Scale for Upper Extremity, Modified Barthel Index, Stroke Self-Efficacy Scale, System Usability Scale, and Quebec User Evaluation with Assistive Technology. RESULTS All patients completed the full training sessions without significant adverse events related to robotic training. The task-oriented mirrored upper-limb robotic training led to increased Fugl-Meyer Assessment Scale for Upper Extremity (difference: 10.38 points, P<0.001) and Modified Barthel Index (difference: 18.38 points, P<0.001) scores, both of which exceeded the minimal clinically important difference. Intergroup analysis showed significantly higher improvements in the Fugl-Meyer Assessment Scale for Upper Extremity total scores, shoulder, wrist, and hand scores; and Modified Barthel Index scores in the experimental group than in conventional training (all P<0.05). Both groups showed significant improvements in Stroke Self-Efficacy Scale scores after the intervention (both P<0.001), but without a statistically significant intergroup difference (P>0.05). Participants in the experimental group scored an average usability perception score of 74.74 (good) and an average satisfaction score of four or more out of five. CONCLUSIONS In general, task-oriented mirrored upper-limb robotic training appears feasible and safe for subacute poststroke rehabilitation, facilitating the recovery of upper-limb functions and activities of daily living. CLINICAL REHABILITATION IMPACT Task-oriented mirrored upper-limb robotic training shows promise for future clinical rehabilitation and clinical trials involving subacute poststroke patients.
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Affiliation(s)
- You-Ze He
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Zhen-Ming Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hai-Yin Deng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Jian-Huang Wu
- Shenzhen Wisemen Medical Technologies Co., Ltd, Shenzhen, China
| | - Jing-Song Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China -
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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Yoo SD, Lee HH. The Effect of Robot-Assisted Training on Arm Function, Walking, Balance, and Activities of Daily Living After Stroke: A Systematic Review and Meta-Analysis. BRAIN & NEUROREHABILITATION 2023; 16:e24. [PMID: 38047093 PMCID: PMC10689857 DOI: 10.12786/bn.2023.16.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023] Open
Abstract
This meta-analysis aimed to compare the effects of robot-assisted training (RAT) with those of conventional therapy (CT), considering the potential sources of heterogeneity in the previous studies. We searched three international electronic databases (MEDLINE, Embase, and the Cochrane Library) to identify relevant studies. Risk of bias assessment was performed using the Cochrane's Risk of Bias 1.0 tool. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations method. The meta-analyses for each outcome of the respective domains were performed using 24 randomized controlled trials (RCTs) on robot-assisted arm training (RAAT) for arm function, 7 RCTs on RAAT for activities of daily living (ADL), 12 RCTs on robot-assisted gait training (RAGT) for balance, 6 RCTs on RAGT for walking, and 7 RCTs on RAGT for ADL. The random-effects model for the meta-analysis revealed that RAAT has significant superiority over CT in improving arm function, and ADL. We also showed that RAGT has significant superiority over CT in improving balance. Our study provides high-level evidence for the superiority of RAT over CT in terms of functional recovery after stroke. Therefore, physicians should consider RAT as a therapeutic option for facilitating functional recovery after stroke.
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Affiliation(s)
- Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University College of Medicine, Seoul, Korea
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Chen YW, Li KY, Lin CH, Hung PH, Lai HT, Wu CY. The effect of sequential combination of mirror therapy and robot-assisted therapy on motor function, daily function, and self-efficacy after stroke. Sci Rep 2023; 13:16841. [PMID: 37803096 PMCID: PMC10558527 DOI: 10.1038/s41598-023-43981-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/01/2023] [Indexed: 10/08/2023] Open
Abstract
Robot-assisted therapy and mirror therapy are both effective in promoting upper limb function after stroke and combining these two interventions might yield greater therapeutic effects. We aimed to examine whether using mirror therapy as a priming strategy would augment therapeutic effects of robot-assisted therapy. Thirty-seven chronic stroke survivors (24 male/13 female; age = 49.8 ± 13.7 years) were randomized to receive mirror therapy or sham mirror therapy prior to robot-assisted therapy. All participants received 18 intervention sessions (60 min/session, 3 sessions/week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using Fugl-Meyer Assessment and Wolf Motor Function Test. Daily function was assessed using Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance. Both groups demonstrated statistically significant improvements in measures of motor function and daily function, but no significant between-group differences were found. Participants who received mirror therapy prior to robot-assisted therapy showed greater improvements in measures of self-efficacy, compared with those who received sham mirror therapy. Our findings suggest that sequentially combined mirror therapy with robot-assisted therapy could be advantageous for enhancing self-efficacy post-stroke.Trial registration: ClinicalTrials.gov Identifier: NCT03917511. Registered on 17/04/2019, https://clinicaltrials.gov/ct2/show/ NCT03917511.
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Affiliation(s)
- Yen-Wei Chen
- Department of Physical Therapy, College of Medical and Health Science, Asia University, NO.500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan
| | - Kuan-Yi Li
- Department of Occupational Therapy and Graduate Institute of Behavioral Science, College of Medicine, Chang Gung University, No.259, Wenhua 1St Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, No.8, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 61363, Taiwan
| | - Pei-Hsuan Hung
- Department of Physical Medicine and Rehabilitation, Jiannren Hospital, No. 136, Nanyang Rd., Nanzi Dist., Kaohsiung City, 811504, Taiwan
| | - Hui-Tzu Lai
- Department of Physical Medicine and Rehabilitation, LO-Sheng Hospital Ministry of Health and Welfare, No.794, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24257, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Science, College of Medicine, Chang Gung University, No.259, Wenhua 1St Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Yu Z, Yang X, Qin F, Ma T, Zhang J, Leng X, Bi H, Liu X. Effects of acupuncture synchronized rehabilitation therapy on upper limb motor and sensory function after stroke: a study protocol for a single-center, 2 × 2 factorial design, randomized controlled trial. Front Neurol 2023; 14:1162168. [PMID: 37840941 PMCID: PMC10569312 DOI: 10.3389/fneur.2023.1162168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Upper limb function reconstruction has been an important issue in the field of stroke rehabilitation. Due to the complexity of upper extremity dysfunction in stroke patients, the clinical efficacy produced by central or peripheral stimulation alone is limited. For this reason, our group has proposed acupuncture synchronized rehabilitation therapy (ASRT), i.e., simultaneous scalp acupuncture and intradermal acupuncture during rehabilitation. Pre-experiments results showed that this therapy can effectively improve the motor and sensory functions of upper limbs in post-stroke patients, but the clinical efficacy and safety of ASRT need to be further verified, and whether there is a synergistic effect between scalp acupuncture and intradermal acupuncture also needs to be studied in depth. Therefore, we designed a randomized controlled trial to compare the efficacy and safety of different therapies to explore a more scientific "synchronous treatment model." Methods This is a single-center, randomized controlled trial using a 2 × 2 factorial design. We will recruit 136 stroke survivors with upper extremity dysfunction and randomize them into four groups (n = 34). All subjects will undergo routine treatment, based on which the Experimental Group 1: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb; Experimental Group 2: rehabilitation training of the affected upper limb synchronized with focal-side scalp acupuncture treatment, and Experimental Group 3: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb synchronized with focal-side scalp acupuncture treatment; Control Group: rehabilitation training of the affected upper limb only. The intervention will last for 4 weeks, 5 times a week. Both acupuncture treatments will be performed according to the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcome indicators for this trial are Fugl-Meyer Assessment-Upper Extremity and Somatosensory Evoked Potential. Secondary outcome indicators include Wolf Motor Function Test, Upper Extremity Function Test, revised Nottingham Sensory Assessment Scale, Diffusion Tensor Imaging, and Modified Barthel Index. The incidence of adverse events will be used as the indicator of safety. Discussion The study will provide high-quality clinical evidence on whether ASRT improves upper limb motor and sensory function and activities of daily living (ADL) in stroke patients, and determine whether scalp acupuncture and intradermal acupuncture have synergistic effects. Clinical trial registration https://www.chictr.org.cn/, Chinese Clinical Trial Registry [ChiCTR2200066646].
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Affiliation(s)
- Zifu Yu
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxia Yang
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Fang Qin
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Tiantian Ma
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Zhang
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaoxuan Leng
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongyan Bi
- Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xihua Liu
- Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Trzmiel T, Marchewka R, Pieczyńska A, Zasadzka E, Zubrycki I, Kozak D, Mikulski M, Poświata A, Tobis S, Hojan K. The Effect of Using a Rehabilitation Robot for Patients with Post-Coronavirus Disease (COVID-19) Fatigue Syndrome. SENSORS (BASEL, SWITZERLAND) 2023; 23:8120. [PMID: 37836950 PMCID: PMC10575211 DOI: 10.3390/s23198120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023]
Abstract
The aim of this study was to compare the effectiveness of traditional neurological rehabilitation and neurological rehabilitation combined with a rehabilitation robot for patients with post-COVID-19 fatigue syndrome. Eighty-six participants transferred from intensive care units due to post-viral fatigue after COVID-19 were randomly divided into two groups: the intervention group and the control group. The control group received standard neurological rehabilitation for 120 min a day, while the intervention group received the same neurological rehabilitation for 75 min a day, complemented by 45 min of exercises on the rehabilitation robot. The Berg scale, Tinetti scale, six-minute walking test, isokinetic muscle force test, hand grip strength, Barthel Index, and Functional Independence Measure were used to measure the outcomes. Both groups improved similarly during the rehabilitation. Between groups, a comparison of before/after changes revealed that the intervention group improved better in terms of Functional Independence Measure (p = 0.015) and mean extensor strength (p = 0.023). The use of EMG-driven robots in the rehabilitation of post-COVID-19 fatigue syndrome patients was shown to be effective.
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Affiliation(s)
- Tomasz Trzmiel
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Renata Marchewka
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
| | - Anna Pieczyńska
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Ewa Zasadzka
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Igor Zubrycki
- Institute of Automatic Control, Lodz University of Technology, 90-537 Łódź, Poland;
| | - Dominika Kozak
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
- Department of Physiotherapy, University of Health Science, 85-067 Bydgoszcz, Poland
| | - Michał Mikulski
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
| | - Anna Poświata
- Egzotech sp. z o.o., 44-100 Gliwice, Poland; (D.K.); (M.M.); (A.P.)
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland (S.T.); (K.H.)
- Neurorehabilitation Ward, Greater Poland Provincial Hospital, 60-480 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 61-866 Poznan, Poland
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14
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Urrutia R, Miren Gutiérrez-Muto A, Sanz-Morère CB, Gómez A, Politi AM, Lunardini F, Baccini M, Cecchi F, León N, Oliviero A, Tornero J. Spasticity evaluation with the Amadeo Tyromotion device in patients with hemispheric stroke. Front Neurorobot 2023; 17:1172770. [PMID: 37483539 PMCID: PMC10356585 DOI: 10.3389/fnbot.2023.1172770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Objective The objective of this study is to verify the reliability and the concurrent and discriminant validity of the measurements of spasticity offered by the robotic device, quantifying the (1) test-retest reliability, (2) correlation with the clinical evaluation using the Modified Ashworth Scale (MAS), (3) inter-rater reliability between the two physiotherapists, and (4) ability to discriminate between healthy and stroke patients. Methods A total of 20 stroke patients and 20 healthy volunteers participated in the study. Two physical therapists (PT1 and PT2) independently evaluated the hand spasticity of stroke subjects using the MAS. Spasticity was assessed, both in healthy and stroke patients, with the Amadeo device at three increasing velocities of passive movement for three consecutive repeated assessments, while raw data of force and position were collected through an external program. Data analysis The intraclass correlation coefficient (ICC) and the weighted kappa were computed to estimate the reliability of the Amadeo device measurements, the inter-rater reliability of MAS, and the correlation between the MAS and Amadeo device measurements. The discriminant ability of the Amadeo device was assessed by comparing the stroke and healthy subjects' spasticity measurements with the percentage of agreements with 0 in MAS for healthy subjects. Results The test-retest reliability of the Amadeo device was high with ICC at all three velocities (ICC = 0.908, 0.958, and 0.964, respectively) but lower if analyzed with weighted kappa correlation (0.584, 0.748, and 0.749, respectively) as mean values for each velocity. The correlation between Amadeo and the clinical scale for stroke patients with weighted kappa correlation was poor (0.280 ± 0.212 for PT1 and 0.290 ± 0.155 for PT2). The inter-rater reliability of the clinical MAS was high (ICC = 0.911). Conclusion Both MAS and Amadeo spasticity scores showed good reliability. The Amadeo scores did not show a strong clinical correlation with the MAS in stroke patients. Hitherto, Amadeo evaluation shows trends that are consistent with the characteristics of spasticity, such as an increase in spasticity as the speed of muscle stretching increases. The ability of the device to discriminate between stroke patients and healthy controls is low. Future studies adopting an instrumental gold standard for spasticity may provide further insight into the validity of these measurements.
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Affiliation(s)
- Rocío Urrutia
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
- Joint PhD Program in Neuroscience, University of Castilla La Mancha, Albacete, Spain
| | | | - Clara B. Sanz-Morère
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Arantxa Gómez
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
| | - Angela M. Politi
- Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy
| | | | - Marco Baccini
- Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy
| | - Francesca Cecchi
- Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Natacha León
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
| | - Antonio Oliviero
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
| | - Jesús Tornero
- Center for Clinical Neuroscience, Hospital Los Madroños, Madrid, Spain
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Moulaei K, Bahaadinbeigy K, Haghdoostd AA, Nezhad MS, Sheikhtaheri A. Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review. Arch Public Health 2023; 81:84. [PMID: 37158979 PMCID: PMC10169358 DOI: 10.1186/s13690-023-01100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation. METHODS This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data. RESULTS We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively. CONCLUSIONS Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.
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Affiliation(s)
- Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoostd
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Shahabi Nezhad
- Department of Physical Therapy, Faculty of Allied Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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16
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Huo Y, Wang X, Zhao W, Hu H, Li L. Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis. Front Physiol 2023; 14:1172958. [PMID: 37256069 PMCID: PMC10226272 DOI: 10.3389/fphys.2023.1172958] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
Objective: A growing body of research shows the promise and efficacy of EMG-based robot interventions in improving the motor function in stroke survivors. However, it is still controversial whether the effect of EMG-based robot is more effective than conventional therapies. This study focused on the effects of EMG-based robot on upper limb motor control, spasticity and activity limitation in stroke survivors compared with conventional rehabilitation techniques. Methods: We searched electronic databases for relevant randomized controlled trials. Outcomes included Fugl-Meyer assessment scale (FMA), Modified Ashworth Scale (MAS), and activity level. Result: Thirteen studies with 330 subjects were included. The results showed that the outcomes post intervention was significantly improved in the EMG-based robot group. Results from subgroup analyses further revealed that the efficacy of the treatment was better in patients in the subacute stage, those who received a total treatment time of less than 1000 min, and those who received EMG-based robotic therapy combined with electrical stimulation (ES). Conclusion: The effect of EMG-based robot is superior to conventional therapies in terms of improving upper extremity motor control, spasticity and activity limitation. Further research should explore optimal parameters of EMG-based robot therapy and its long-term effects on upper limb function in post-stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: 387070.
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Affiliation(s)
- Yunxia Huo
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Xiaohan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Weihua Zhao
- Northwestern Polytechnical University Hospital, Xi’an, China
| | - Huijing Hu
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
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Yuan R, Qiao X, Tang C, Zhou T, Chen W, Song R, Jiang Y, Reinhardt JD, Wang H. Effects of Uni- vs. Bilateral Upper Limb Robot-Assisted Rehabilitation on Motor Function, Activities of Daily Living, and Electromyography in Hemiplegic Stroke: A Single-Blinded Three-Arm Randomized Controlled Trial. J Clin Med 2023; 12:jcm12082950. [PMID: 37109287 PMCID: PMC10143606 DOI: 10.3390/jcm12082950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE To evaluate if bilateral or unilateral upper limb robot-assisted rehabilitation training using a new three-dimensional end-effector robot that targets shoulder and elbow flexion and abduction is superior to conventional therapy with regard to upper extremity motor function recovery and neuromuscular improvement in stroke patients. DESIGN Randomized, controlled, parallel, assessor-blinded, three-arm clinical trial. SETTING Southeast University Zhongda Hospital Nanjing, Jiangsu, China. METHODS Seventy patients with hemiplegic stroke were randomly assigned to conventional training (Control, n = 23) or unilateral (URT, n = 23), or bilateral robotic training (BRT, n = 24). The conventional group received routine rehabilitation, 60 min/day, 6 days/week, for 3 weeks. For URT and BRT upper limb robot-assisted rehabilitation training was added. This was 60 min/day, 6 days/week, for 3 weeks. The primary outcome was upper limb motor function assessed with Fugl-Meyer-Upper Extremity Scale (FMA-UE). Secondary outcomes were activities of daily living (ADL) assessed with the Modified Barthel Index (MBI), Motor Evoked Potential (MEP) to assess corticospinal tract connectivity, Root Mean Square (RMS) value, and integrate Electromyography (iEMG) value recorded by surface electromyography to evaluate muscle contraction function. RESULTS The primary outcome indicator FMA-UE (least square mean (LSMEAN): 31.40, 95% confidence interval (95% CI): 27.74-35.07) and the secondary outcome indicator MBI (LSMEAN: 69.95, 95% CI: 66.69-73.21) were significantly improved in BRT as opposed to control (FMA-UE, LSMEAN: 24.79, 95% CI: 22.23-27.35; MBI, LSMEAN: 62.75, 95% CI: 59.42-66.09); and unilateral (FMA-UE, LSMEAN: 25.97, 95% CI: 23.57-28.36; MBI, LSMEAN: 64.34, 95% CI: 61.01-67.68). BRT also showed greater improvement in the anterior deltoid bundle with regard to muscle contraction function indicated by RMS (LSMEAN: 257.79, 95% CI: 211.45-304.12) and iEMG (LSMEAN: 202.01, 95% CI: 167.09-236.94), as compared to the controls (RMS, LSMEAN: 170.77, 95% CI: 148.97-192.58; iEMG, LSMEAN: 132.09, 95% CI: 114.51-149.68), and URT (RMS, LSMEAN: 179.05, 95% CI: 156.03-202.07; iEMG, LSMEAN: 130.38, 95% CI: 107.50-153.26). There was no statistically significant difference between URT and conventional training for any outcome. There was no significant difference in MEP extraction rate after treatment between groups (p = 0.54 for URT, p = 0.08 for BRT). CONCLUSIONS A 60 min daily training for upper extremities using a three-dimensional end-effector targeting elbow and shoulder adding conventional rehabilitation appears to promote upper limb function and ADL in stroke patients only if delivered bilaterally. URT does not seem to result in better outcomes than conventional rehabilitation. Electrophysiological results suggest that training using a bilateral upper limb robot increases the recruitment of motor neurons rather than improving the conduction function of the corticospinal tract.
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Affiliation(s)
- Runping Yuan
- Graduate School of Bengbu Medical College, Bengbu 233030, China
- Southeast University Zhongda Hospital, Nanjing 210003, China
| | - Xu Qiao
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu 610041, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - Congzhi Tang
- Southeast University Zhongda Hospital, Nanjing 210003, China
| | - Ting Zhou
- Southeast University Zhongda Hospital, Nanjing 210003, China
| | - Wenli Chen
- Southeast University Zhongda Hospital, Nanjing 210003, China
| | - Ruyan Song
- Southeast University Zhongda Hospital, Nanjing 210003, China
| | - Yong Jiang
- The First Affiliated Hospital of Bengbu Medical College, Bengbu 233099, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Sichuan University, Chengdu 610041, China
- Swiss Paraplegic Research, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Center for Rehabilitation Medicine, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hongxing Wang
- Southeast University Zhongda Hospital, Nanjing 210003, China
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18
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Wang T, Liu Z, Gu J, Tan J, Hu T. Effectiveness of soft robotic glove versus repetitive transcranial magnetic stimulation in post-stroke patients with severe upper limb dysfunction: A randomised controlled trial. Front Neurol 2023; 13:887205. [PMID: 36712422 PMCID: PMC9874667 DOI: 10.3389/fneur.2022.887205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To explore the difference in rehabilitation effect between soft robot gloves and repetitive transcranial magnetic stimulation (rTMS) in patients with severe upper limb motor dysfunction after a stroke. Methods A total of 69 post-stroke patients with severe upper limb dysfunction were randomly assigned to a repetitive transcranial magnetic group, a soft robotic glove group, and a conventional treatment group. The primary outcomes were the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Modified Barthel Index (MBI). The secondary endpoints were the amplitude surface electromyogram of the extensor wrist muscle (sEMG) and the cerebral hemispheric resting motor threshold (RMT). Results The change of FMA-UE score in the soft robotic glove group was significantly better than that in the conventional treatment group (median difference: 2 points; 95% confidence interval [1, 3]; P < 0.05), but there was no significant difference compared with the repetitive transcranial magnetic stimulation group (median difference: 0 points; 95% confidence interval [-1, 2]; P [0.547] > 0.05). There was no significant difference in the change of MBI score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [F = 2.458, P [0.093] > 0.05]. There was no significant difference in the change of sEMG score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [H = 0.042, P [0.980] > 0.05]. Additionally, the change of RMT score in the soft robotic glove group was significantly inferior to that in the repetitive transcranial magnetic treatment group [difference: -1.09; 95% confidence interval [-2.048, 0.048]; P < 0.05], but there was no significant difference compared with the conventional treatment group [difference: 0.31 points; 95% confidence interval [-0.879, 0.358]; P [0.495] > 0.05]. Conclusion For patients with severe dyskinesia after a stroke, soft robotic gloves are as effective as repetitive transcranial magnetic stimulation and may be a good choice for home rehabilitation. In addition, conventional treatment combined with repetitive transcranial magnetic stimulation (rTMS) or a soft robotic glove produced better rehabilitation outcomes than conventional treatment alone.
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Affiliation(s)
- Taotao Wang
- Zhongshan People's Hospital, Zhongshan, China,*Correspondence: Taotao Wang ✉
| | | | - Jianxiong Gu
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China,Jianxiong Gu ✉
| | - Jizhi Tan
- Guangdong Medical University, Zhanjiang, China
| | - Tian Hu
- Guangdong Medical University, Zhanjiang, China
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Tohanean N, Tucan P, Vanta OM, Abrudan C, Pintea S, Gherman B, Burz A, Banica A, Vaida C, Neguran DA, Ordog A, Tarnita D, Pisla D. The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study. J Clin Med 2023; 12:jcm12020425. [PMID: 36675354 PMCID: PMC9866490 DOI: 10.3390/jcm12020425] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.
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Affiliation(s)
- Nicoleta Tohanean
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Oana-Maria Vanta
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Cristian Abrudan
- Neurology Department, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400012 Cluj-Napoca, Romania
- Neurosurgery Department, Cluj-Napoca Emergency Clinical County Hospital, 400349 Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babes-Bolyai University, 400029 Cluj-Napoca, Romania
| | - Bogdan Gherman
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Alin Burz
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Alexandru Banica
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
- Correspondence: (O.-M.V.); (A.B.); (A.B.)
| | - Calin Vaida
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
| | - Deborah Alice Neguran
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Andreea Ordog
- Neurology I Department, Cluj-Napoca Emergency Clinical County Hospital, 400012 Cluj-Napoca, Romania
| | - Daniela Tarnita
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Doina Pisla
- CESTER, Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, 400641 Cluj-Napoca, Romania
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Loro A, Borg MB, Battaglia M, Amico AP, Antenucci R, Benanti P, Bertoni M, Bissolotti L, Boldrini P, Bonaiuti D, Bowman T, Capecci M, Castelli E, Cavalli L, Cinone N, Cosenza L, Di Censo R, Di Stefano G, Draicchio F, Falabella V, Filippetti M, Galeri S, Gimigliano F, Grigioni M, Invernizzi M, Jonsdottir J, Lentino C, Massai P, Mazzoleni S, Mazzon S, Molteni F, Morelli S, Morone G, Nardone A, Panzeri D, Petrarca M, Posteraro F, Santamato A, Scotti L, Senatore M, Spina S, Taglione E, Turchetti G, Varalta V, Picelli A, Baricich A. Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:brainsci13010092. [PMID: 36672074 PMCID: PMC9856764 DOI: 10.3390/brainsci13010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors. METHODS PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used. RESULTS A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of -0.62 (95%CI - 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = -1.019, 95% CI - 1.827; -0.210, p-value = 0.0135). CONCLUSIONS RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy.
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Affiliation(s)
- Alberto Loro
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
- Correspondence: or
| | - Margherita Beatrice Borg
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Marco Battaglia
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Angelo Paolo Amico
- Physical Medicine and Rehabilitation Unit, Polyclinic of Bari, 70124 Bari, Italy
| | - Roberto Antenucci
- Rehabilitation Unit, Castel San Giovanni Hospital, 29015 Piacenza, Italy
| | - Paolo Benanti
- Theology Department, Pontifical Gregorian University, 00187 Rome, Italy
| | - Michele Bertoni
- Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy
| | - Luciano Bissolotti
- Casa di Cura Domus Salutis, Fondazione Teresa Camplani, 25100 Brescia, Italy
| | - Paolo Boldrini
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Donatella Bonaiuti
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Thomas Bowman
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Marianna Capecci
- Experimental and Clinic Medicine Department, Università Politecnica delle Marche (UNIVPM), 60126 Ancona, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Loredana Cavalli
- Physical Medicine and Rehabilitation Unit, Centro Giusti, 50125 Florence, Italy
| | - Nicoletta Cinone
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Lucia Cosenza
- Rehabilitation Unit, Department of Rehabilitation, “Santi Antonio e Biagio e Cesare Arrigo” National Hospital, 15122 Alessandria, Italy
| | - Rita Di Censo
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Giuseppina Di Stefano
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Francesco Draicchio
- Dipartimento Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), 00192 Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FISH), 00197 Rome, Italy
| | - Mirko Filippetti
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Silvia Galeri
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Prevention Medicine, Luigi Vanvitelli University of Campania, 81100 Naples, Italy
| | - Mauro Grigioni
- Department of New Technologies in Public Healthcare, Italian National Institute of Health (ISS), 00161 Rome, Italy
| | - Marco Invernizzi
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, 15122 Alessandria, Italy
| | - Johanna Jonsdottir
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Carmelo Lentino
- Rehabilitation Unit, Santa Corona Hospital, 17027 Pietra Ligure, Italy
| | - Perla Massai
- Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy
| | - Stefano Mazzoleni
- Department of Electrical Engineering and Information Technology, Polytechnic University of Bari, 70126 Bari, Italy
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
| | - Stefano Mazzon
- Azienda Unità Locale Socio Sanitaria Euganea (AULSS 6), 35100 Padua, Italy
| | - Franco Molteni
- Rehabilitation Department, Valduce Villa Beretta Hospital, 23845 Costa Masnaga, Italy
| | - Sandra Morelli
- Department of New Technologies in Public Healthcare, Italian National Institute of Health (ISS), 00161 Rome, Italy
| | - Giovanni Morone
- Neurorehabilitation Unit, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| | - Antonio Nardone
- Pediatric, Diagnostical and Clinical-Surgical Sciences Department, University of Pavia, 27100 Pavia, Italy
- Neurorehabilitation Unit, Istituto Clinico-Scientifico Maugeri SPA IRCCS, 27100 Pavia, Italy
| | - Daniele Panzeri
- Pediatric Rehabilitation Unit, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Maurizio Petrarca
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | | | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
| | - Michele Senatore
- Italian Association of Occupational Therapists (AITO), 00136 Rome, Italy
| | - Stefania Spina
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Elisa Taglione
- Rehabilitation Unit, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), 56048 Volterra, Italy
| | | | - Valentina Varalta
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Alessandro Picelli
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Alessio Baricich
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
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21
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Zhu Y, Wang C, Li J, Zeng L, Zhang P. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke-A network meta-analysis of randomized controlled trials. Front Neurol 2023; 14:1125172. [PMID: 37139055 PMCID: PMC10150552 DOI: 10.3389/fneur.2023.1125172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background This study aimed to observe the effects of six different types of AI rehabilitation techniques (RR, IR, RT, RT + VR, VR and BCI) on upper limb shoulder-elbow and wrist motor function, overall upper limb function (grip, grasp, pinch and gross motor) and daily living ability in subjects with stroke. Direct and indirect comparisons were drawn to conclude which AI rehabilitation techniques were most effective in improving the above functions. Methods From establishment to 5 September 2022, we systematically searched PubMed, EMBASE, the Cochrane Library, Web of Science, CNKI, VIP and Wanfang. Only randomized controlled trials (RCTs) that met the inclusion criteria were included. The risk of bias in studies was evaluated using the Cochrane Collaborative Risk of Bias Assessment Tool. A cumulative ranking analysis by SUCRA was performed to compare the effectiveness of different AI rehabilitation techniques for patients with stroke and upper limb dysfunction. Results We included 101 publications involving 4,702 subjects. According to the results of the SUCRA curves, RT + VR (SUCRA = 84.8%, 74.1%, 99.6%) was most effective in improving FMA-UE-Distal, FMA-UE-Proximal and ARAT function for subjects with upper limb dysfunction and stroke, respectively. IR (SUCRA = 70.5%) ranked highest in improving FMA-UE-Total with upper limb motor function amongst subjects with stroke. The BCI (SUCRA = 73.6%) also had the most significant advantage in improving their MBI daily living ability. Conclusions The network meta-analysis (NMA) results and SUCRA rankings suggest RT + VR appears to have a greater advantage compared with other interventions in improving upper limb motor function amongst subjects with stroke in FMA-UE-Proximal and FMA-UE-Distal and ARAT. Similarly, IR had shown the most significant advantage over other interventions in improving the FMA-UE-Total upper limb motor function score of subjects with stroke. The BCI also had the most significant advantage in improving their MBI daily living ability. Future studies should consider and report on key patient characteristics, such as stroke severity, degree of upper limb impairment, and treatment intensity/frequency and duration. Systematic review registration www.crd.york.ac.uk/prospero/#recordDetail, identifier: CRD42022337776.
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Affiliation(s)
- Yu Zhu
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- Linfen Central Hospital, Linfen, Shanxi, China
| | - Chen Wang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jin Li
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- *Correspondence: Peizhen Zhang
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22
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Proffitt R, Boone A, Hunter EG, Schaffer O, Strickland M, Wood L, Wolf TJ. Interventions to Improve Social Participation, Work, and Leisure Among Adults Poststroke: A Systematic Review. Am J Occup Ther 2022; 76:23881. [PMID: 35943845 DOI: 10.5014/ajot.2022.049305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Sustaining a stroke frequently leads to difficulties in returning to work, leisure, and social participation. These outcomes are important for occupational therapy practitioners to address. OBJECTIVE To determine the current evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve social participation, work, and leisure among adults poststroke. DATA SOURCES MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. STUDY SELECTION AND DATA COLLECTION Primary inclusion criteria were peer-reviewed journal articles published between January 1, 2009, and December 31, 2019, within the scope of occupational therapy that evaluated an intervention to address work, leisure, or social participation poststroke (levels of evidence ranged from Level 1b to Level 2b). Reviewers assessed records for inclusion, quality, and validity following Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS Forty-seven articles met the inclusion criteria. Forty-four articles related to social participation were categorized as follows: occupation-based approaches, metacognitive strategy training, education and training approaches, impairment-based approaches, and enriched environment approaches. Three articles related to work and 3 articles related to leisure were not further categorized (2 articles were each included in two categories). Seventeen Level 1b and 30 Level 2b articles were included. The strength of evidence to support occupational therapy interventions for social participation, work, and leisure outcomes is predominantly low. CONCLUSIONS AND RELEVANCE Occupational therapy interventions may improve work, leisure, and social participation outcomes poststroke, with the strongest evidence existing for client education, upper extremity training, and cognitive training for improving social participation. What This Article Adds: Occupational therapy practitioners may use the available literature along with clinical reasoning to improve work, leisure, and social participation outcomes among clients poststroke. Additional research is required to build stronger evidence to support clinical decision making in stroke rehabilitation in these areas.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Anna Boone
- Anna Boone, PhD, MOT, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Elizabeth G Hunter
- Elizabeth G. Hunter, PhD, OTR/L, is Assistant Professor, Graduate Center for Gerontology, University of Kentucky, Lexington
| | - Olivia Schaffer
- Olivia Schaffer, BHS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Madison Strickland
- Madison Strickland, BHS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Lea Wood
- Lea Wood, BS, is Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Timothy J Wolf
- Timothy J. Wolf, PhD, OTD, MSCI, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, University of Missouri, Columbia
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Coskunsu DK, Akcay S, Ogul OE, Akyol DK, Ozturk N, Zileli F, Tuzun BB, Krespi Y. Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study. Acta Neurol Scand 2022; 146:499-511. [PMID: 35855628 DOI: 10.1111/ane.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. MATERIALS & METHOD A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke (<1 month after cerebrovascular accident) and randomly allocated to experimental group (EG) and control group (CG). Neurophysiological rehabilitation program was performed to both EG and CG for 5 days a week and totally 15 sessions. The EG also received robotic rehabilitation with the EMG-driven exoskeleton hand robot (Hand of Hope®, Rehab-Robotics Company) 15 sessions over 3 weeks. Hand motor functions (Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT)), activities of daily living (Motor Activity Log (MAL)), force and EMG activities of extensor and flexor muscles for the cup test were evaluated before treatment (pretreatment) and after the 15th session (posttreatment). RESULTS Eleven patients (59.91 ± 14.20 yr) in the EG and 9 patients (70 ± 14.06 yr) in the CG completed the study. EG did not provide a significant advantage compared with the CG in FMA-UE, ARAT and MAL scores and cup-force and EMG activities (p > .05 for all). CONCLUSION In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.
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Affiliation(s)
- Dilber Karagozoglu Coskunsu
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey.,Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Fenerbahce University, Istanbul, Turkey
| | - Sumeyye Akcay
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Bahcesehir University, Istanbul, Turkey
| | - Ozden Erkan Ogul
- Faculty of Health Sciences, Department of Ergotherapy, Medipol University, Istanbul, Turkey
| | - D Kubra Akyol
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul-Cerrahpasa University, Istanbul, Turkey
| | - Necla Ozturk
- Faculty of Medicine, Department of Biophysics, Maltepe University, Istanbul, Turkey
| | - Füsun Zileli
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Birgul Baştan Tuzun
- Neurology Department, İstanbul Haseki Research and Education Hospital, Istanbul, Turkey
| | - Yakup Krespi
- Faculty of Medicine, Department of Neurology, Istinye University, Istanbul, Turkey
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25
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Zuccon G, Lenzo B, Bottin M, Rosati G. Rehabilitation robotics after stroke: a bibliometric literature review. Expert Rev Med Devices 2022; 19:405-421. [PMID: 35786139 DOI: 10.1080/17434440.2022.2096438] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is the leading cause of long-term disability in developed countries. Due to population aging, the number of people requiring rehabilitation after stroke is going to rise in the coming decades. Robot-mediated neurorehabilitation has the potential to improve clinical outcomes of rehabilitation treatments. A statistical analysis of the literature aims to focus on the main trend of this topic. AREAS COVERED A bibliometric survey on post-stroke robotic rehabilitation was performed through a database collection of scientific publications in the field of rehabilitation robotics. By covering the last 20 years, 17429 sources were collected. Relevant patterns and statistics concerning the main research areas were analyzed. Leading journals and conferences which publish and disseminate knowledge in the field were identified. A detailed nomenclature study was carried out. The time trends of the research field were captured. Opinions and predictions of future trends that are expected to shape the near future of the field were discussed. EXPERT OPINION Data analysis reveals the continuous expansion of the research field over the last two decades, which is expected to rise considerably in near future. More attention will be paid to the lower limbs rehabilitation and disease/design specific applications in early-stage patients.
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Affiliation(s)
- Giacomo Zuccon
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Basilio Lenzo
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Matteo Bottin
- Department of Industrial Engineering, University of Padua, Padua, Italy
| | - Giulio Rosati
- Department of Industrial Engineering, University of Padua, Padua, Italy
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26
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Proffitt R, Boone A, Schaffer O, Strickland M, Wood L, Wolf TJ. Impairment-Based Interventions to Improve Social Participation Outcomes for Adults Poststroke (January 1, 2009-December 31, 2019). Am J Occup Ther 2022; 76:23321. [PMID: 35789360 DOI: 10.5014/ajot.2022.050090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on stroke and impairment-based interventions to improve social participation for adults poststroke.
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Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Anna Boone
- Anna Boone, PhD, MOT, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia
| | - Olivia Schaffer
- Olivia Schaffer, BHS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Madison Strickland
- Madison Strickland, BHS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Lea Wood
- Lea Wood, BS, is Occupational Therapy Student, Department of Occupational Therapy, University of Missouri, Columbia
| | - Timothy J Wolf
- Timothy J. Wolf, PhD, OTD, MSCI, OTR/L, FAOTA, is Associate Dean for Research and Department Chair, Department of Occupational Therapy, University of Missouri, Columbia
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27
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Jamin P, Duret C, Hutin E, Bayle N, Koeppel T, Gracies JM, Pila O. Using Robot-Based Variables during Upper Limb Robot-Assisted Training in Subacute Stroke Patients to Quantify Treatment Dose. SENSORS 2022; 22:s22082989. [PMID: 35458975 PMCID: PMC9026756 DOI: 10.3390/s22082989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022]
Abstract
In post-stroke motor rehabilitation, treatment dose description is estimated approximately. The aim of this retrospective study was to quantify the treatment dose using robot-measured variables during robot-assisted training in patients with subacute stroke. Thirty-six patients performed fifteen 60 min sessions (Session 1−Session 15) of planar, target-directed movements in addition to occupational therapy over 4 (SD 2) weeks. Fugl−Meyer Assessment (FMA) was carried out pre- and post-treatment. The actual time practiced (percentage of a 60 min session), the number of repeated movements, and the total distance traveled were analyzed across sessions for each training modality: assist as needed, unassisted, and against resistance. The FMA score improved post-treatment by 11 (10) points (Session 1 vs. Session 15, p < 0.001). In Session 6, all modalities pooled, the number of repeated movements increased by 129 (252) (vs. Session 1, p = 0.043), the total distance traveled increased by 1743 (3345) cm (vs. Session 1, p = 0.045), and the actual time practiced remained unchanged. In Session 15, the actual time practiced showed changes only in the assist-as-needed modality: −13 (23) % (vs. Session 1, p = 0.013). This description of changes in quantitative-practice-related variables when using different robotic training modalities provides comprehensive information related to the treatment dose in rehabilitation. The treatment dose intensity may be enhanced by increasing both the number of movements and the motor difficulty of performing each movement.
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Affiliation(s)
- Pascal Jamin
- Institut Robert Merle d’Aubigné, Rééducation et Appareillage, 94460 Valenton, France;
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Emilie Hutin
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Nicolas Bayle
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est, 94000 Créteil, France; (E.H.); (N.B.); (J.-M.G.)
- Bioingénierie, Tissus et Neuroplasticité (BIOTN), Université Paris-Est Créteil, 94000 Créteil, France
| | - Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France; (C.D.); (T.K.)
- Correspondence:
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28
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Gerardin E, Bontemps D, Babuin NT, Herman B, Denis A, Bihin B, Regnier M, Leeuwerck M, Deltombe T, Riga A, Vandermeeren Y. Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients, and healthy individuals. J Neuroeng Rehabil 2022; 19:28. [PMID: 35300709 PMCID: PMC8928664 DOI: 10.1186/s12984-022-01009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs). Methods Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions. Results Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28–55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale. Conclusions Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke. Trial registration: ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019. https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01009-3.
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Affiliation(s)
- Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium. .,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium. .,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium.
| | - Damien Bontemps
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Nicolas-Thomas Babuin
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Adrien Denis
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Audrey Riga
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
| | - Yves Vandermeeren
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
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29
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Langton-Frost N, Brodsky MB. Speech-language pathology approaches to neurorehabilitation in acute care during COVID-19: Capitalizing on neuroplasticity. PM R 2021; 14:217-226. [PMID: 34595841 PMCID: PMC8661644 DOI: 10.1002/pmrj.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/03/2021] [Accepted: 09/24/2021] [Indexed: 11/11/2022]
Abstract
Neurologic manifestations associated with a coronavirus disease 2019 (COVID‐19) diagnosis are common and often occur in severe and critically ill patients. In these patients, the neurologic symptoms are confounded by critical care conditions, such as acute respiratory distress syndrome (ARDS). Patients with dual diagnoses of COVID‐19 and neurologic changes such as myopathy, polyneuropathy, and stroke are likely at a higher risk of experiencing deficits with swallowing, communication, and/or cognition. Speech‐language pathologists are an integral part of both the critical care and neurologic disorders multi‐disciplinary teams, offering valuable contributions in the evaluation, treatment, and management of these areas. Patients in intensive care units (ICUs) who require mechanical ventilation often experience difficulty with communication and benefit from early speech‐language pathology intervention to identify the most efficient communication methods with the medical team and caregivers. Moreover, patients with neurologic manifestations may present with cognitive‐linguistic impairments such as aphasia, thereby increasing the need for communication‐based interventions. Difficulties with voice and swallowing after extubation are common, often requiring frequent treatment sessions, possibly persisting beyond ICU discharge. After leaving the ICU, patients with COVID‐19 often experience physical, cognitive, and mental health impairments collectively called post‐intensive care syndrome. This is often a lengthy road as they progress toward full recovery, requiring continued speech‐language pathology treatment after hospital discharge, capitalizing on the principles of neuroplasticity.
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Affiliation(s)
- Nicole Langton-Frost
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, USA
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30
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Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations. Occup Ther Int 2021; 2021:6649549. [PMID: 34393681 PMCID: PMC8349462 DOI: 10.1155/2021/6649549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/18/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals' participation. Objective To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.
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31
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Budhota A, Chua KSG, Hussain A, Kager S, Cherpin A, Contu S, Vishwanath D, Kuah CWK, Ng CY, Yam LHL, Loh YJ, Rajeswaran DK, Xiang L, Burdet E, Campolo D. Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands. Front Neurol 2021; 12:622014. [PMID: 34149587 PMCID: PMC8206540 DOI: 10.3389/fneur.2021.622014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/23/2021] [Indexed: 01/31/2023] Open
Abstract
Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0); p < 0.01]. FMA gains were retained 18 weeks post-training [week 24; RT: Δ5.38 (4.67) and week 24 CT: Δ4.50 (5.35); p < 0.01]. The RT group clinical scores improved similarly when compared to CT group with no significant inter-group at all time points although the conventional therapy time was reduced to one third in RT group. There were no training-related adverse side effects. In conclusion, time matched combinatory training incorporating H-Man RAT produced similar outcomes compared to conventional therapy alone. Hence, this study supports a combinatory approach to improve motor function in post-stroke arm paresis. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02188628.
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Affiliation(s)
- Aamani Budhota
- Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.,Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Karen S G Chua
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Asif Hussain
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - Adèle Cherpin
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sara Contu
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Deshmukh Vishwanath
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christopher W K Kuah
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Chwee Yin Ng
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Lester H L Yam
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Yong Joo Loh
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Deshan Kumar Rajeswaran
- Centre for Advanced Rehabilitation Therapeutics, Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Liming Xiang
- School of Physical and Mathematical Sciences, Nanyang Technological University, Singapore, Singapore
| | - Etienne Burdet
- Department of Bioengineering, Imperial College of Science, Technology and Medicine, London, United Kingdom
| | - Domenico Campolo
- Robotic Research Center, Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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32
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Marotta N, Demeco A, Moggio L, Ammendolia A. The adjunct of transcranial direct current stimulation to Robot-assisted therapy in upper limb post-stroke treatment. J Med Eng Technol 2021; 45:494-501. [PMID: 34038313 DOI: 10.1080/03091902.2021.1922527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Transcranial direct current stimulation (TDCS) and robot-assisted therapy (RAT) proved to be promising interventions in post-stroke rehabilitation. However, the effects of combining the two treatments are not significantly clear. To determine the effects of combined therapy using transcranial direct current stimulation (tDCS) with robot-assisted therapy (RAT) in the impairment of the upper limb in stroke rehabilitation. The Cochrane Library, MEDLINE, Embase, Google Scholar, and Trial Registries were systematically searched for randomised controlled trials in May 2020. As the outcome, the Fugl-Meyer Assessment score (FMS) was used. A pairwise and a network meta-analysis were performed. 5 RCTs with RAT versus RAT + tDCS groups and 21 RCTs with RAT versus the control group with 892 people were analysed. Of these studies, 10 RCTs evaluated acute-subacute (<8 weeks) people, while 16 chronic people. By analysing the FMS with a pair-wise meta-analysis, we demonstrate significant improvements only in the RAT alone compared to the control (acute-subacute, SMD:4.09 (1.31, 6.87) and chronic, SMD:2.22 (0.99, 3.45)). Instead, performing a network meta-analysis, through an analysis of the surface under the cumulative ranking curve (SUCRA) we report a ranking of the effectiveness of the interventions. We assess SUCRA in acute-subacute stroke: Control:0.23, RAT + tDCS:0.31, RAT:0.96 and in chronic stroke: Control:0.06, RAT + tDCS:0.62, RAT:0.82. RAT is, respectively, 96% and 82% likely to be the best-ranked treatment. Despite the limitations, this network meta-analysis appears to demonstrate through the rank of interventions that adding tDCS to RAT is not useful in upper-limb stroke rehabilitation.
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Affiliation(s)
- Nicola Marotta
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Andrea Demeco
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Lucrezia Moggio
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Antonio Ammendolia
- Department of Surgical and Medical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Rémy-Néris O, Le Jeannic A, Dion A, Médée B, Nowak E, Poiroux É, Durand-Zaleski I. Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke: The REM-AVC Randomized Trial. Stroke 2021; 52:1938-1947. [PMID: 33910364 DOI: 10.1161/strokeaha.120.032545] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Olivier Rémy-Néris
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France.,University of Brest, France (O.R.-N.).,Laboratory of Medical Information Processing, INSERM UMR 1101, Brest, France (O.R.-N., B.M.)
| | - Anaïs Le Jeannic
- Health Economics Clinical Research Unit (URC Eco), APHP, Paris, France (A.L.J., I.D.-Z.)
| | - Angelina Dion
- INSERM, CIC 1412 (A.D., E.N.), Brest University Hospital, France
| | - Béatrice Médée
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France.,Laboratory of Medical Information Processing, INSERM UMR 1101, Brest, France (O.R.-N., B.M.)
| | - Emmanuel Nowak
- INSERM, CIC 1412 (A.D., E.N.), Brest University Hospital, France
| | - Élodie Poiroux
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France
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Paolucci T, Agostini F, Mangone M, Bernetti A, Pezzi L, Liotti V, Recubini E, Cantarella C, Bellomo RG, D'Aurizio C, Saggini R. Robotic rehabilitation for end-effector device and botulinum toxin in upper limb rehabilitation in chronic post-stroke patients: an integrated rehabilitative approach. Neurol Sci 2021; 42:5219-5229. [PMID: 33826010 PMCID: PMC8642375 DOI: 10.1007/s10072-021-05185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determine the effects of an integrated rehabilitation protocol, including botulinum toxin and conventional rehabilitation exercise plus end-effector (EE) robotic training for functional recovery of the upper limb (UL) compared to training with the robot alone in post-chronic stroke patients with mild to severe spasticity, compared to training with the robot alone. METHODS In this prospective, observational case-control study, stroke patients were allocated into 2 groups: robot group (RG, patients who underwent robotic treatment with EE) and robot-toxin group (RTG, patients who in addition have carried out the injection of botulinum toxin for UL recovery). All patients were assessed by Fugl-Meyer Assessment (FMA), Motricity Index (MI), modified Ashworth scale (MAS), numeric rating scale (NRS), Box and Block Test (BBT), Frenchay Arm Test (FAT), and Barthel Index (BI) at baseline (T0), T1 (end of treatment), and T2 (3 months of follow-up). RESULTS Forty-four patients were included and analyzed (21RG; 23RTG). From the analysis between groups, the results suggested how there was a statistically significant difference in favor of RTG, specifically ΔT0-T1 and ΔT0-T2 for B&B p = 0.009 and p = 0.035; ΔT0-T1 and ΔT0-T2 for FAT with p = 0.016 and p = 0.031; ΔT0-T1 for MAS shoulder p = 0.016; ΔT0-T1 and ΔT0-T2 with p = 0.010 and p = 0.005 for MAS elbow; and ΔT0-T1 and ΔT0-T2 with p = 0.001 and p = 0.013 for MAS wrist. CONCLUSION Our results suggest, in line with the literature, a good efficacy in the reduction of spasticity and in the improvement of the function of the UL, with the reduction of pain, adopting a rehabilitation protocol integrated with BoTN, robot-assisted training, and traditional physiotherapy.
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Affiliation(s)
- Teresa Paolucci
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Agostini
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Massimiliano Mangone
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
| | - Andrea Bernetti
- Physical Medicine and Rehabilitation Unit, Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Letizia Pezzi
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Vitalma Liotti
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Elena Recubini
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Cristina Cantarella
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Sciences, University of Study of Urbino Carlo Bo, Urbino, Italy
| | - Carlo D'Aurizio
- U.O.C. Physical Medicine and Rehabilitation, Hospital of Popoli, Pescara, Italy
| | - Raoul Saggini
- Unit of Physical Medicine and Rehabilitation, Department of Oral Medical Science and Biotechnology (DSMOB), G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,IRCSS Centro Neurolesi "Bonino Pulejo", Messina, Italy
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Wu J, Cheng H, Zhang J, Yang S, Cai S. Robot-Assisted Therapy for Upper Extremity Motor Impairment After Stroke: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6103015. [PMID: 33454787 DOI: 10.1093/ptj/pzab010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/31/2020] [Accepted: 12/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. METHODS The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. RESULTS Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%). CONCLUSION RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
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Affiliation(s)
- Jingyi Wu
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Hao Cheng
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shanli Yang
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
| | - Sufang Cai
- Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.,Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China
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Yeganeh Doost M, Herman B, Denis A, Sapin J, Galinski D, Riga A, Laloux P, Bihin B, Vandermeeren Y. Bimanual motor skill learning and robotic assistance for chronic hemiparetic stroke: a randomized controlled trial. Neural Regen Res 2021; 16:1566-1573. [PMID: 33433485 PMCID: PMC8323667 DOI: 10.4103/1673-5374.301030] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Using robotic devices might improve recovery post-stroke, but the optimal way to apply robotic assistance has yet to be determined. The current study aimed to investigate whether training under the robotic active-assisted mode improves bimanual motor skill learning (biMSkL) more than training under the active mode in stroke patients. Twenty-six healthy individuals (HI) and 23 chronic hemiparetic stroke patients with a detectable lesion on MRI or CT scan, who demonstrated motor deficits in the upper limb, were randomly allocated to two parallel groups. The protocol included a two-day training on a new bimanual cooperative task, LIFT-THE-TRAY, under either the active or active-assisted modes (where assistance decreased in a pre-determined stepwise fashion) with the bimanual version of the REAplan® robotic device. The hypothesis was that the active-assisted mode would result in greater biMSkL than the active mode. The biMSkL was quantified by a speed-accuracy trade-off (SAT) before (T1) and immediately after (T2) training on days 1 and 2 (T3 and T4). The change in SAT after 2 days of training (T4/T1) indicated that both HI and stroke patients learned and retained the bimanual cooperative task. After 2 days of training, the active-assisted mode did not improve biMSkL more than the active mode (T4/T1) in HI nor stroke patients. Whereas HI generalized the learned bimanual skill to different execution speeds in both the active and active-assisted subgroups, the stroke patients generalized the learned skill only in the active subgroup. Taken together, the active-assisted mode, applied in a pre-determined stepwise decreasing fashion, did not improve biMSkL more than the active mode in HI and stroke subjects. Stroke subjects might benefit more from robotic assistance when applied “as-needed.” This study was approved by the local ethical committee (Comité d’éthique médicale, CHU UCL Namur, Mont-Godinne, Yvoir, Belgium; Internal number: 54/2010, EudraCT number: NUB B039201317382) on July 14, 2016 and was registered with ClinicalTrials.gov (Identifier: NCT03974750) on June 5, 2019.
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Affiliation(s)
- Maral Yeganeh Doost
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Herman
- UCLouvain, Louvain Bionics; UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Adrien Denis
- UCLouvain, Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | | | | | - Audrey Riga
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Patrice Laloux
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur - site Mont-Godinne, Yvoir, Belgium
| | - Yves Vandermeeren
- UCLouvain, CHU UCL Namur - site Mont-Godinne, Department of Neurology, Stroke Unit, Yvoir; UCLouvain, Institute of NeuroScience (IoNS), Clinical neuroscience division (NEUR) division, Brussels; UCLouvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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Carswell C, Rea PM. What the Tech? The Management of Neurological Dysfunction Through the Use of Digital Technology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1317:131-145. [PMID: 33945135 DOI: 10.1007/978-3-030-61125-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Worldwide, it is estimated that millions of individuals suffer from a neurological disorder which can be the result of head injuries, ischaemic events such as a stroke, or neurodegenerative disorders such as Parkinson's disease (PD) and multiple sclerosis (MS). Problems with mobility and hemiparesis are common for these patients, making daily life, social factors and independence heavily affected. Current therapies aimed at improving such conditions are often tedious in nature, with patients often losing vital motivation and positive outlook towards their rehabilitation. The interest in the use of digital technology in neuro-rehabilitation has skyrocketed in the past decade. To gain insight, a systematic review of the literature in the field was conducting following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for three categories: stroke, Parkinson's disease and multiple sclerosis. It was found that the majority of the literature (84%) was in favour of the use of digital technologies in the management of neurological dysfunction; with some papers taking a "neutral" or "against" standpoint. It was found that the use of technologies such as virtual reality (VR), robotics, wearable sensors and telehealth was highly accepted by patients, helped to improve function, reduced anxiety and make therapy more accessible to patients living in more remote areas. The most successful therapies were those that used a combination of conventional therapies and new digital technologies.
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Affiliation(s)
- Caitlin Carswell
- Anatomy Facility, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul M Rea
- School of Life Sciences, University of Glasgow, Glasgow, UK.
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Merians AS, Fluet GG, Qiu Q, Yarossi M, Patel J, Mont AJ, Saleh S, Nolan KJ, Barrett AM, Tunik E, Adamovich SV. Hand Focused Upper Extremity Rehabilitation in the Subacute Phase Post-stroke Using Interactive Virtual Environments. Front Neurol 2020; 11:573642. [PMID: 33324323 PMCID: PMC7726202 DOI: 10.3389/fneur.2020.573642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/14/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction: Innovative motor therapies have attempted to reduce upper extremity impairment after stroke but have not made substantial improvement as over 50% of people post-stroke continue to have sensorimotor deficits affecting their self-care and participation in daily activities. Intervention studies have focused on the role of increased dosing, however recent studies have indicated that timing of rehabilitation interventions may be as important as dosing and importantly, that dosing and timing interact in mediating effectiveness. This study is designed to empirically test dosing and timing. Methods and Analysis: In this single-blinded, interventional study, subjects will be stratified on two dimensions, impairment level (Fugl-Meyer Upper Extremity Assessment (FM) and presence or absence of Motor Evoked Potentials (MEPs) as follows; (1) Severe, FM score 10–19, MEP+, (2) Severe, FM score 10–19, MEP–, (3) Moderate, FM score 20–49, MEP+, (4) Moderate, FM score 20–49, MEP–. Subjects not eligible for TMS will be assigned to either group 2 (if severe) or group 3 (if moderate). Stratified block randomization will then be used to achieve a balanced assignment. Early Robotic/VR Therapy (EVR) experimental group will receive in-patient usual care therapy plus an extra 10 h of intensive upper extremity therapy focusing on the hand using robotically facilitated rehabilitation interventions presented in virtual environments and initiated 5–30 days post-stroke. Delayed Robotic/VR Therapy (DVR) experimental group will receive the same intervention but initiated 30–60 days post-stroke. Dose-matched usual care group (DMUC) will receive an extra 10 h of usual care initiated 5–30 days post-stroke. Usual Care Group (UC) will receive the usual amount of physical/occupational therapy. Outcomes: There are clinical, neurophysiological, and kinematic/kinetic measures, plus measures of daily arm use and quality of life. Primary outcome is the Action Research Arm Test (ARAT) measured at 4 months post-stroke. Discussion: Outcome measures will be assessed to determine whether there is an early time period in which rehabilitation will be most effective, and whether there is a difference in the recapture of premorbid patterns of movement vs. the development of an efficient, but compensatory movement strategy. Ethical Considerations: The IRBs of New Jersey Institute of Technology, Rutgers University, Northeastern University, and Kessler Foundation reviewed and approved all study protocols. Study was registered in https://ClinicalTrials.gov (NCT03569059) prior to recruitment. Dissemination will include submission to peer-reviewed journals and professional presentations.
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Affiliation(s)
- Alma S Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Gerard G Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Ashley J Mont
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Soha Saleh
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Karen J Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - A M Barrett
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.,Center for Stroke Rehabilitation Research, Kessler Foundation, West Orange, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Sergei V Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
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Chien WT, Chong YY, Tse MK, Chien CW, Cheng HY. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis. Brain Behav 2020; 10:e01742. [PMID: 32592282 PMCID: PMC7428503 DOI: 10.1002/brb3.1742] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stroke survivors often experience upper-limb motor deficits and achieve limited motor recovery within six months after the onset of stroke. We aimed to systematically review the effects of robot-assisted therapy (RT) in comparison to usual care on the functional and health outcomes of subacute stroke survivors. METHODS Randomized controlled trials (RCTs) published between January 1, 2000 and December 31, 2019 were identified from six electronic databases. Pooled estimates of standardized mean differences for five outcomes, including motor control (primary outcome), functional independence, upper extremity performance, muscle tone, and quality of life were derived by random effects meta-analyses. Assessments of risk of bias in the included RCTs and the quality of evidence for every individual outcomes were conducted following the guidelines of the Cochrane Collaboration. RESULTS Eleven RCTs involving 493 participants were included for review. At post-treatment, the effects of RT when compared to usual care on motor control, functional independence, upper extremity performance, muscle tone, and quality of life were nonsignificant (all ps ranged .16 to .86). The quality of this evidence was generally rated as low-to-moderate. Less than three RCTs assessed the treatment effects beyond post-treatment and the results remained nonsignificant. CONCLUSION Robot-assisted therapy produced benefits similar, but not significantly superior, to those from usual care for improving functioning and disability in patients diagnosed with stroke within six months. Apart from using head-to-head comparison to determine the effects of RT in subacute stroke survivors, future studies may explore the possibility of conducting noninferiority or equivalence trials, given that the less labor-intensive RT may offer important advantages over currently available standard care, in terms of improved convenience, better adherence, and lower manpower cost.
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Affiliation(s)
- Wai-Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Man-Kei Tse
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | | | - Ho-Yu Cheng
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
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