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Winter LV, Panzer S, Konczak J. Dyad motor learning in a wrist-robotic environment: Learning together is better than learning alone. Hum Mov Sci 2024; 93:103172. [PMID: 38168644 DOI: 10.1016/j.humov.2023.103172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Dyad motor practice is characterized by two learners alternating between physical and observational practice, which can lead to better motor outcomes and reduce practice time compared to physical practice alone. Robot-assisted therapy has become an established neurorehabilitation tool but is limited by high therapy cost and access. Implementing dyad practice in robot-assisted rehabilitation has the potential to improve therapeutic outcomes and/or to achieve them faster. This study aims to determine the effects of dyad practice on motor performance in a wrist-robotic environment to evaluate its potential use in robotic rehabilitation settings. METHODS Forty-two healthy participants (18-35 years) were randomized into three groups (n = 14): Dyad practice, physical practice with rest and physical practice without rest. Participants practiced a 2 degree-of-freedom gamified wrist movement task for 20 trials using a custom-made wrist robotic device. A motor performance score (MPS) that captured temporal and spatial time-series kinematics was computed at baseline, the end of training and 24 h later to assess retention. RESULTS MPS did not differ between groups at baseline. All groups revealed significant performance gains by the end of training. However, dyads outperformed the other groups at the end of training (p < 0.001) and showed higher retention after 24-h (p = 0.02). Median MPS improved by 46.5% in dyads, 25.3% in physical practice-rest, and 33.6% in physical practice-no rest at the end of training compared to baseline. CONCLUSION Compared to physical practice alone, dyad practice leads to superior motor outcomes in a robot-assisted motor learning task. Dyads still outperformed their counterparts 24-h after practice. IMPACT STATEMENT Improving motor function in complex motor tasks without increasing required practice time, dyad practice can optimize therapeutic resources. This is particularly impactful in robot-assisted rehabilitation regimens as it would help to improve patients' outcomes and increase care efficiency.
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Affiliation(s)
- Leoni V Winter
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA; Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA.
| | - Stefan Panzer
- Universität des Saarlandes, Saarbrücken, Germany; Department of Health and Kinesiology, Texas A&M University, TX, USA
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA; Center for Clinical Movement Science, University of Minnesota, Minneapolis, MN, USA
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Elmas Bodur B, Erdoğanoğlu Y, Asena Sel S. Effects of robotic-assisted gait training on physical capacity, and quality of life among chronic stroke patients: A randomized controlled study. J Clin Neurosci 2024; 120:129-137. [PMID: 38241771 DOI: 10.1016/j.jocn.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/24/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Even though robotic therapy is becoming more commonly used in research protocols for lower limb stroke rehabilitation, there still is a significant gap between research evidence and its use in clinical practice. Therefore, the present study was designed assuming that the wearable mobile gait device training for chronic stroke patients might have different effects on functional independence when compared to training with a stationary gait device. The present study aims to examine the effects of gait training with ExoAthlet exoskeleton and Lokomat Free-D on functional independence, functional capacity, and quality of life in chronic stroke patients. METHODS The present study included 32 chronic stroke patients. Participants were randomly divided into two groups. Functional independence of patients was evaluated by using Functional Independence Measure (FIM), physical function was assessed by using the 30-second chair stand test (30-CST), functional capacity was measured by using the 6-Minute Walk Test (6MWT), and quality of life was assessed by using Short Form 36 (SF36). All participants underwent a conventional physiotherapy program for eight weeks, three sessions per week, and each session lasted 60 min. After the physiotherapy program, one group received gait training by using ExoAthlet exoskeleton (ExoAtlet 1 model/2019, Russia), while the other group received training by using Lokomat Free-D (Hocoma, Lokomat Pro Free-D model/2015, Switzerland). Participants were assessed at baseline and post-intervention. RESULTS Results achieved in this study revealed that there was a statistically significant difference between FIM, 30-CST, 6MWT, and SF36 scores before and after the treatment in both groups (p < 0.05).There was no difference in FIM, 30-CST, and 6MWT results between Exoskeleton ExoAthlet and Lokomat Free-D groups (p > 0.05). However, there was a statistically significant difference between Exoskeleton ExoAthlet and Lokomat Free-D groups in terms of SF-36 sub-parameters "vitality", "mental health", "bodily pain", and "general health perception" (p < 0.05). CONCLUSIONS This study demonstrated that the use of ExoAthlet exoskeleton and Lokomat Free-D in addition to conventional physiotherapy, was effective in improving functional independence, physical function, functional capacity, and quality of life among chronic stroke patients. Incorporation of robotic gait aids into rehabilitation for chronic stroke patients might offer significant advantages.
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Affiliation(s)
| | - Yıldız Erdoğanoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Antalya Bilim University, Antalya, Turkey.
| | - Sinem Asena Sel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Antalya Bilim University, Antalya, Turkey
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Jeon SY, Ki M, Shin JH. Resistive versus active assisted robotic training for the upper limb after a stroke: A randomized controlled study. Ann Phys Rehabil Med 2024; 67:101789. [PMID: 38118340 DOI: 10.1016/j.rehab.2023.101789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Selection of a suitable training modality according to the status of upper limb function can maximize the effects of robotic rehabilitation; therefore, it is necessary to identify the optimal training modality. OBJECTIVES This study aimed to compare robotic rehabilitation approaches incorporating either resistance training (RET) or active-assisted training (AAT) using the same rehabilitation robot in people with stroke and moderate impairment. METHODS In this randomized controlled trial, we randomly allocated 34 people with stroke who had moderate impairment to either the experimental group (RET, n = 18) or the control group (AAT, n = 16). Both groups performed robot-assisted therapy for 30 min, 5 days per week, for 4 weeks. The same rehabilitation robot provided resistance to the RET group and assistance to the AAT group. Body function and structure, activity, and participation outcomes were evaluated before, during, and after the intervention. RESULTS RET led to greater improvements than AAT in terms of smoothness (p = 0.006). The Fugl-Meyer Assessment (FMA)-upper extremity (p < 0.001), FMA-proximal (p < 0.001), Action Research Arm Test-gross movement (p = 0.011), and kinematic variables of joint independence (p = 0.017) and displacement (p = 0.011) also improved at the end of intervention more in the RET group. CONCLUSIONS Robotic RET was more effective than AAT in improving upper limb function, structure, and activity among participants with stroke who had moderate impairment.
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Affiliation(s)
- Sun Young Jeon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Myung Ki
- Department of Global Community Health, Graduate School of Public Health, Korea University, Republic of Korea; BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea.
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Miyazaki S, Yamako G, Arakawa H, Sakamoto T, Kawaguchi T, Ito K, Chosa E. Weight-shifting-based robot control system improves the weight-bearing rate and balance ability of the static standing position in hip osteoarthritis patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty. PeerJ 2023; 11:e15397. [PMID: 37214101 PMCID: PMC10199675 DOI: 10.7717/peerj.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Background After a total hip arthroplasty (THA), standing and walking balance are greatly affected in the early stages of recovery, so it is important to increase the weight-bearing amount (WBA) on the operated side. Sometimes, traditional treatments may not be enough to improve WBA and weight-bearing ratio (WBR) on the operated side in a satisfactory way. To solve this problem, we came up with a new weight-shifting-based robot control system called LOCOBOT. This system can control a spherical robot on a floor by changing the center of pressure (COP) on a force-sensing board in rehabilitation after THA. The goal of this study was to find out how rehabilitation with the LOCOBOT affects the WBR and balance in a static standing position in patients with unilateral hip osteoarthritis (OA) who had a primary uncemented THA. Methods This randomized controlled trial included 20 patients diagnosed with Kellgren-Lawrence (K-L) grade 3 or 4 hip OA on the operative side and K-L grade 0 normal hip on the nonoperative side. We used the minimization method for allocation and randomly assigned patients to either the LOCOBOT group or the control group. As a result, 10 patient seach were randomly assigned to the LOCOBOT and control groups. Both groups received 40 min of rehabilitation treatment. Out of the 40 min, the LOCOBOT group underwent treatment for 10 min with LOCOBOT. The control group performed COP-controlled exercises on a flat floor instead of using LOCOBOT for 10 of the 40 min. All theoutcome measures were performed pre-THA and 11.9 ± 1.6 days after THA (12 days after THA). The primary outcome measure included WBR in the static standing position. Results After12 days of THA, the LOCOBOT group exhibited significantly higher mean WBR and WBA (operated side) values than the control group. Furthermore, the LOCOBOT group exhibited significantly lower mean WBA (non-operated side) and outer diameter area (ODA) values than the control group. From pre-THA to 12 days after THA, the LOCOBOT group exhibited a significant improvement in mean WBR and WBA (operated side). Moreover, the mean WBA (non-operated side) and ODA significantly decreased. From pre-THA to 12 days after THA, the control group showed a significant increase in total trajectory length and ODA. Conclusions The most important finding of this study was that patients were able to perform the LOCOBOT exercise as early as the second day after THA, and that WBR and ODA significantly improved by the 12th day after THA. This result demonstrated that the LOCOBOT effectively improves WBR in a short period of time after THA and is a valuable system for enhancing balance ability. This expedites the acquisition of independence in activities of daily living after THA and may contribute to optimizing the effectiveness of medical care.
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Affiliation(s)
- Shigeaki Miyazaki
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Go Yamako
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Hideki Arakawa
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Takero Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsubasa Kawaguchi
- Rehabilitation Unit, University of Miyazaki Hospital, Miyazaki, Japan
| | - Kirari Ito
- Department of Mechanical Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Klinkwan P, Kongmareong C, Muengtaweepongsa S, Limtrakarn W. Prototype development of bilateral arm mirror-like- robotic rehabilitation device for acute stroke patients. Biomed Phys Eng Express 2023; 9. [PMID: 37116477 DOI: 10.1088/2057-1976/acd11d] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 04/30/2023]
Abstract
During the early six months after the onset of a stroke, patients usually remain disabled with limbs weakness and need intensive rehabilitation. An increased number of stroke patients is countered with a reduced number of physical therapists. The development of medical robots to substitute therapists' work should be helpful. We developed a prototype of bilateral arm mirror-like-robotic rehabilitation device covering the shoulder to the elbow as a 4-degrees of freedom (DOF). The device was operated by gripping the patient's arm or forearm. The motor for arm movement and point of force was calculated from static and dynamic. A developed microcontroller drove the assistive control system to regulate the movement of a robotic arm by getting the position of the normal arm's movement to control the weak arm's movement position. The prototype was built with operation control system and tested in the acute stroke patients. The effectiveness of rehabilitation using developed robot was assessed and compared with the conventional training group. Patients with either left or right arm paresis can practice with the device. They can safely train the weakened arm by using the normal arm as a working model. A bilateral robot was designed to be easy to use, lightweight, and compact size. Patients can use the device regularly for rehabilitation training, even at home.
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Affiliation(s)
- Phassakorn Klinkwan
- Thammasat University, Medical Engineering Program, Faculty of Engineering, Thammasat University, Pathum Thani, Thailand, Bangkok, 10200, THAILAND
| | - Chalunda Kongmareong
- Department of Blood Bank, Huachiew Chalermprakiet University, Department of Blood Bank, Faculty of Medical Technology, Huachiew Chalermprakiet University, Samutprakarn, Thailand, Samutprakarn, 10540, THAILAND
| | - Sombat Muengtaweepongsa
- Thammasat University Faculty of Medicine, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Thammasat University,Pathum Thani, Thailand, Pathumthani, 12120, THAILAND
| | - Wiroj Limtrakarn
- Department of Mechanical Engineering, Thammasat University, Thammasat University Center of Excellence in Computational Mechanics and Medical Engineering, Thammasat University, Pathum Thani, Thailand, Bangkok, 10200, THAILAND
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Şenocak E, Korkut E, Aktürk A, Ozer AY. Is the robotic rehabilitation that is added to intensive body rehabilitation effective for maximization of upper extremity motor recovery following a stroke? A randomized controlled study. Neurol Sci 2023:10.1007/s10072-023-06739-3. [PMID: 36897464 DOI: 10.1007/s10072-023-06739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Trunk stabilization, which is a factor that directly affects the performance of affected upper-limb movements in stroke patients, is of critical importance in the performance of selective motor control. AIMS This study aimed to investigate the effects on upper-limb motor function of the addition of robotic rehabilitation (RR) and conventional rehabilitation (CR) to intensive trunk rehabilitation (ITR). METHODS A total of 41 subacute stroke patients were randomly allocated to two groups: RR and CR. Both groups received the same ITR procedure. Following ITR, a robot-assisted rehabilitation program of 60 min, 5 days a week, for 6 weeks, was applied to the RR group, and an individualized upper-limb rehabilitation to the CR group. Assessments were made at baseline and after 6 weeks using the Trunk Impairment Scale (TIS), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FMA-UE), and Wolf Motor Function Test (WMFT). RESULTS Improvements were obtained in the TIS, FMA-UE, and WMFT scores for both groups (p < 0.001), with no superiority detected between the groups (p > 0.05). The RR group scores were relatively high, but not to a statistically significant. CONCLUSIONS When added to intensive trunk rehabilitation, the robot-assisted systems, which are recommended as a stand-alone therapy method, produced similar results to conventional therapies. This technology can be used as an alternative to conventional methods under appropriate conditions of clinical opportunity, access, time management, and staff limitations. However, when RR is combined with traditional interventions such as intensive trunk rehabilitation, it is essential to investigate if the real effect is due to the robotic rehabilitation or the accumulation of positive effects of excessive movement or force spread associated with trained muscles. REGISTRATION This trial was retrospectively registered in the ClinicalTrials.gov with NCT05559385 registration number (25/09/2022).
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Affiliation(s)
- Emre Şenocak
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey.
| | - Elif Korkut
- Clinic of Neurology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Adem Aktürk
- Department of Podology, Vocational School of Health Services, İstanbul Gelişim University, Istanbul, Turkey
| | - Aysel Yildiz Ozer
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Marmara University, Istanbul, Turkey
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Hazany S, Bagrodia N, Chu R, Shaw S. Results of a 2-week novel robotic rehabilitation program in 18 children with prior hemispherectomy. J Clin Neurosci 2023; 108:6-12. [PMID: 36549215 DOI: 10.1016/j.jocn.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Partial preservation of sensory and motor functions in the contralateral extremities after hemispherectomy is likely secondary to cortical reorganization of the remaining hemisphere and can be improved by rehabilitation. This study aims to investigate behavioral changes that may occur after a 2-week novel robotic rehabilitation program in 18 children with prior anatomic hemispherectomy. Other conventional rehabilitation methods were also reviewed and compared. METHODS This study examined the impact of a novel robotic rehabilitation 2-week program on 18 hemispherectomy patients (average age 14.3 ± 3.9 years; age at hemispherectomy 5.6 ± 4.5 years). RESULTS Statistically significant improvements were seen in the six-minute walk test (29 m, p < 0.001), Canadian Occupational Performance Measure performance (1.64 points, p = 0.002) and satisfaction (2.49 points, p = 0.001), and individual perceived performance on survey (1.72 points, p = 0.042). Fifteen patients showed improvement in the upper extremity Fugl-Meyer scores with an average increase of 3 points (p = 0.006). CONCLUSION This study demonstrates clinically meaningful and statistically significant improvements in motor function and behavior following a novel robotic rehabilitation two-week program.
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Affiliation(s)
- Saman Hazany
- Department of Neuroradiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Second Floor Imaging, Los Angeles, CA 90033, USA; Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA.
| | - Neelesh Bagrodia
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Remy Chu
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA
| | - Susan Shaw
- Rancho Los Amigos National Rehabilitation Center, 7601 Imperial Highway, Downey, CA 90242, USA; Department of Neurology, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, Suite 215, Los Angeles, CA 90089, USA
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Hazany S, Mann D, Bagrodia N, Krafnick AJ, Chu R Jr, Shaw S, Clark K. Cortical change after a 2-week novel robotic rehabilitation program in children with prior hemispherectomy: pilot imaging study. Childs Nerv Syst 2023; 39:443-9. [PMID: 36085526 DOI: 10.1007/s00381-022-05664-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Partial preservation of sensory and motor functions in the contralateral extremities after hemispherectomy is likely secondary to cortical reorganization of the remaining hemisphere and can be improved by rehabilitation. This study aims to investigate behavioral and structural cerebral cortical changes that may occur after a 2-week novel robotic rehabilitation program in children with prior anatomic hemispherectomy. METHODS Five patients with prior anatomic hemispherectomy (average age 10.8 years; all female) participated in a 2-week novel robotic rehabilitation program. Pre- and post-treatment (2 time points) high-resolution structural 3D FSPGR (fast spoiled gradient echo) magnetic resonance images were analyzed to measure cortical thickness and gray matter volume using a locally designed image processing pipeline. RESULTS Four of the five patients showed improvement in the Fugl-Meyer score (average increase 2.5 + 2.1 SD. Individual analyses identified small increases in gray matter volume near the hand knob area of the primary cortex in three of the five patients. Group analyses identified an increase in cortical thickness near the hand knob area of the primary motor cortex, in addition to other sensorimotor regions. CONCLUSION This small pilot study demonstrates that potentially rehabilitation-associated cortical changes can be identified with MRI in hemispherectomy patients.
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Meneses Castaño C, Penagos P, Yamile Jaramillo B. [Effectiveness of robotic technology and virtual reality for the rehabilitation of motor function in cerebral palsy. Systematic review]. Rehabilitacion (Madr) 2022:S0048-7120(22)00079-2. [PMID: 36344300 DOI: 10.1016/j.rh.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) is a health condition secondary to non-progressive damage that occurs during brain development in the fetal or infant stage. To evaluate the effectiveness of robotic technology and virtual reality on motor function in patients with CP compared to conventional rehabilitation strategies such as physical therapy, occupational therapy, neurodevelopmental intervention, and transcranial stimulation. A review of randomized controlled trials of the last 5 years was carried out. For the evaluation of the methodological quality of the included studies, the PEDro scale was used, with evaluation of the level of evidence and degree of recommendation according to the Oxford classification. RESULTS Seventeen articles met the eligibility criteria. Robotic technology and virtual reality proved to be effective in improving motor function, manual skills, and visual-perceptual skills in patients with CP, compared to the use of conventional rehabilitation strategies.
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Affiliation(s)
- C Meneses Castaño
- Escuela Colombiana de Rehabilitación, Bogotá, Cundinamarca, Colombia.
| | - P Penagos
- Escuela Colombiana de Rehabilitación, Bogotá, Cundinamarca, Colombia
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Koçak M, Gezgin E. PARS, low-cost portable rehabilitation system for upper arm. HardwareX 2022; 11:e00299. [PMID: 35509905 PMCID: PMC9058851 DOI: 10.1016/j.ohx.2022.e00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
This study introduces a compact low-cost single degree of freedom end-effector type upper arm rehabilitation system (PARS) along with its hardware and software elements. Proposed system is also suitable to be used in conjunction with a gaming environment. Throughout the study structural setup of the system was explained in detail along with its electronics, control system and gaming software. Introduced virtual gaming interface supports various game levels with different difficulties generated via interaction type control algorithms. Having simple structural design constructed by using basic available components, proposed system can be easily manufactured and utilized in physical rehabilitation procedures by using supplied open source codes. Introduced systems compactness and user friendly interface also allow its usage for individual home therapies for remote rehabilitation treatment procedures.
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Manuli A, Maggio MG, Stagnitti MC, Aliberti R, Cannavò A, Casella C, Milardi D, Bruschetta A, Naro A, Calabrò RS. Is intensive gait training feasible and effective at old age? A retrospective case-control study on the use of Lokomat Free-D in patients with chronic stroke. J Clin Neurosci 2021; 92:159-164. [PMID: 34509244 DOI: 10.1016/j.jocn.2021.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/17/2021] [Accepted: 08/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the last decade, the number of people over 60 has increased, leading to various healthcare problems. The aim of this retrospective study is to evaluate the effects of robotic rehabilitation in elderly patients as well as their perception of usability and adaptation to intensive robotic neurorehabilitation. METHODS This is a retrospective case-control study. Eighty elderly stroke patients were included in the analysis using an electronic data retrieval system. The enrolled patients were divided into two groups: the experimental group (EG) underwent rehabilitation training with Lokomat FreeD, equipped with a VR screen, while the control group (CG) performed traditional rehabilitation training. The two groups matched for age, sex, education, brain injury, stroke interval. The rehabilitation protocol included a total of 40 training sessions. RESULTS Both types of rehabilitation led to an improvement in the perceived level of disability (FIM) and in the performance in gait and balance (TT), highlighting a significant improvement especially in the EG. However, only in the EG, Lokomat training had induced an increase in the distance covered in 10 min (10 m walk test), and a significant improvement in mood (HRS-D). Moreover, Lokomat-FreeD was well tolerated by patients with high levels of usability. CONCLUSIONS Our results suggest that elderly patients may benefit from high-intensity robotic neurorehabilitation using the Lokomat-Pro FreeD.
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Affiliation(s)
| | - Maria Grazia Maggio
- University of Catania, Department of Biomedical and Biotechnological Science, Catania, Italy
| | - Maria Chiara Stagnitti
- Studio di Psicoterapia Relazionale e Riabilitazione Cognitiva, viale Europa, 107, Messina, Italy
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Albanese GA, Taglione E, Gasparini C, Grandi S, Pettinelli F, Sardelli C, Catitti P, Sandini G, Masia L, Zenzeri J. Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:130. [PMID: 34465356 PMCID: PMC8406564 DOI: 10.1186/s12984-021-00925-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation. Methods After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones. Results Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups’ performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015). Conclusions This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists’ effort, increase repeatability and accuracy of assessments, and promote subject’s engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644.
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Affiliation(s)
- Giulia Aurora Albanese
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy. .,Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genoa, Genoa, Italy.
| | - Elisa Taglione
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Cecilia Gasparini
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Sara Grandi
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Foebe Pettinelli
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Claudio Sardelli
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Paolo Catitti
- National Institute for Insurance against Accidents at Work (INAIL), Motor Rehabilitation Center, Volterra, Italy
| | - Giulio Sandini
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lorenzo Masia
- Institut für Technische Informatik (ZITI), Heidelberg University, Heidelberg, Germany
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences (RBCS) Unit, Istituto Italiano di Tecnologia, Genoa, Italy
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13
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Liakopoulou C, Mansourvar M, Bøglid A, Naemi A, Stengaard Sørensen A. Data Vizualization Dashboards in Robotic Rehabilitation. Stud Health Technol Inform 2021; 281:278-282. [PMID: 34042749 DOI: 10.3233/shti210164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Robotic rehabilitation can offer effective solutions, facilitating physiotherapist work, and helping patients regain their strength. Visualizing results of rehabilitative training could give a better insight into the factors that contribute to progress and measure the exact progress by every session. This paper aims to present a set of prototype dashboards to analyze and visualize data from robotic rehabilitation in order to help the patients measure their exerted force progress throughout the training period. The created visualization dashboards which proved helpful and essential to present achieved measurements, the progress of the patient, and the maximum force in a timeline presentation. The proposed prototypes could give a personalized overview to each patient, fed with the corresponding datasets.
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Affiliation(s)
- Christina Liakopoulou
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller, Institute, University of Southern Denmark, Odense, Denmark
| | - Marjan Mansourvar
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller, Institute, University of Southern Denmark, Odense, Denmark
| | - Anders Bøglid
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller, Institute, University of Southern Denmark, Odense, Denmark
| | - Amin Naemi
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller, Institute, University of Southern Denmark, Odense, Denmark
| | - Anders Stengaard Sørensen
- Centre of Health Informatics and Technology, The Maersk Mc-Kinney Moller, Institute, University of Southern Denmark, Odense, Denmark
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14
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Conti S, Spalletti C, Pasquini M, Giordano N, Barsotti N, Mainardi M, Lai S, Giorgi A, Pasqualetti M, Micera S, Caleo M. Combining robotics with enhanced serotonin-driven cortical plasticity improves post-stroke motor recovery. Prog Neurobiol 2021; 203:102073. [PMID: 33984455 DOI: 10.1016/j.pneurobio.2021.102073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
Despite recent progresses in robotic rehabilitation technologies, their efficacy for post-stroke motor recovery is still limited. Such limitations might stem from the insufficient enhancement of plasticity mechanisms, crucial for functional recovery. Here, we designed a clinically relevant strategy that combines robotic rehabilitation with chemogenetic stimulation of serotonin release to boost plasticity. These two approaches acted synergistically to enhance post-stroke motor performance. Indeed, mice treated with our combined therapy showed substantial functional gains that persisted beyond the treatment period and generalized to non-trained tasks. Motor recovery was associated with a reduction in electrophysiological and neuroanatomical markers of GABAergic neurotransmission, suggesting disinhibition in perilesional areas. To unveil the translational potentialities of our approach, we specifically targeted the serotonin 1A receptor by delivering Buspirone, a clinically approved drug, in stroke mice undergoing robotic rehabilitation. Administration of Buspirone restored motor impairments similarly to what observed with chemogenetic stimulation, showing the immediate translational potential of this combined approach to significantly improve motor recovery after stroke.
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Affiliation(s)
- S Conti
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - C Spalletti
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - M Pasquini
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - N Giordano
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - N Barsotti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Mainardi
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy
| | - S Lai
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - A Giorgi
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy
| | - M Pasqualetti
- Unit of Cell and Developmental Biology, Department of Biology, University of Pisa, Italy; Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - S Micera
- Translational Neural Engineering Area, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering Laboratory, École Polytechnique Fédérale de Lausanne (EPFL), Centre for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.
| | - M Caleo
- Institute of Neuroscience, National Research Council (CNR), Pisa, Italy; Department of Biomedical Sciences, University of Padova, Italy.
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15
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Ogul OE, Coskunsu DK, Akcay S, Akyol K, Hanoglu L, Ozturk N. The effect of Electromyography (EMG)-driven Robotic Treatment on the recovery of the hand Nine years after stroke. J Hand Ther 2021; 36:234-240. [PMID: 34253408 DOI: 10.1016/j.jht.2021.04.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/30/2021] [Accepted: 04/22/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years. CASE An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment. RESULTS The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4. DISCUSSION The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.
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Affiliation(s)
- Ozden Erkan Ogul
- Department of Ergotherapy, Medipol University Faculty of Health Sciences, Istanbul, Turkey
| | - Dilber Karagozoglu Coskunsu
- Department of Physiotherapy and Rehabilitation, Bahcesehir University Faculty of Health Sciences, Istanbul, Turkey; Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey.
| | - Sumeyye Akcay
- Department of Physiotherapy and Rehabilitation, Bahcesehir University Faculty of Health Sciences, Istanbul, Turkey
| | - Kubra Akyol
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul University-Cerrahpasa, Hadımkoy, Istanbul, Turkey
| | - Lutfu Hanoglu
- Deparment of Neurology, Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Necla Ozturk
- Department of Biophysics, Maltepe University Faculty of Medicine, Istanbul, Turkey
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16
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Erwin A, McDonald CG, Moser N, O'Malley MK. The SE-AssessWrist for robot-aided assessment of wrist stiffness and range of motion: Development and experimental validation. J Rehabil Assist Technol Eng 2021; 8:2055668320985774. [PMID: 33912353 PMCID: PMC8050761 DOI: 10.1177/2055668320985774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/15/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Physical human-robot interaction offers a compelling platform for assessing
recovery from neurological injury; however, robots currently used for
assessment have typically been designed for the requirements of
rehabilitation, not assessment. In this work, we present the design,
control, and experimental validation of the SE-AssessWrist, which extends
the capabilities of prior robotic devices to include complete wrist range of
motion assessment in addition to stiffness evaluation. Methods The SE-AssessWrist uses a Bowden cable-based transmission in conjunction with
series elastic actuation to increase device range of motion while not
sacrificing torque output. Experimental validation of robot-aided wrist
range of motion and stiffness assessment was carried out with five
able-bodied individuals. Results The SE-AssessWrist achieves the desired maximum wrist range of motion, while
having sufficient position and zero force control performance for wrist
biomechanical assessment. Measurements of two-degree-of-freedom wrist range
of motion and stiffness envelopes revealed that the axis of greatest range
of motion and least stiffness were oblique to the conventional anatomical
axes, and approximately parallel to each other. Conclusions Such an assessment could be beneficial in the clinic, where standard clinical
measures of recovery after neurological injury are subjective, labor
intensive, and graded on an ordinal scale.
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Affiliation(s)
- Andrew Erwin
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| | - Craig G McDonald
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| | - Nicholas Moser
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
| | - Marcia K O'Malley
- Department of Mechanical Engineering, Rice University, Houston, TX, USA
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17
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Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot enhanced stroke therapy optimizes rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil 2021; 18:10. [PMID: 33478563 PMCID: PMC7819212 DOI: 10.1186/s12984-021-00804-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
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Affiliation(s)
- Alexa B. Keeling
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Mark Piitz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Jennifer A. Semrau
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE USA
| | - Michael D. Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
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Corbianco S, Cavallini G, Dini M, Franzoni F, D'Avino C, Gerini A, Stampacchia G. Energy cost and psychological impact of robotic-assisted gait training in people with spinal cord injury: effect of two different types of devices. Neurol Sci 2021; 42:3357-66. [PMID: 33411195 DOI: 10.1007/s10072-020-04954-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the last years, there has been an intense technological development of robotic devices for gait rehabilitation in spinal cord injury (SCI) patients. The aim of the present study was to evaluate energy cost and psychological impact during a rehabilitation program with two different types of robotic rehabilitation systems (stationary system on a treadmill, Lokomat, and overground walking system, Ekso GT). METHODS Fifteen SCI patients with different injury levels underwent robot-assisted gait training sessions, divided into 2 phases: in the first phase, all subjects completed 3 sessions both Lokomat and Ekso GT. Afterwards, participants were randomly assigned to Lokomat or the Ekso for 17 sessions. A questionnaire, investigating the subjective psychological impact (SPI) during gait training, was administered. The functional outcome measures were oxygen consumption (VO2), carbon dioxide production (VCO2), metabolic equivalent of task (MET), walking economy, and heart rate (HR). RESULTS The metabolic responses (7.73 ± 1.02 mL/kg/min) and MET values (3.20 ± 1.01) during robotic overground walking resulted to be higher than those during robotic treadmill walking (3.91 ± 0.93 mL/kg/min and 1.58 ± 0.44; p < 0.01). Both devices showed high scores in emotion and satisfaction. Overground walking resulted in higher scores of fatigue, mental effort, and discomfort while walking with Lokomat showed a higher score in muscle relaxation. All patients showed improvements in walking economy due to a decrease in energy cost with increased speed and workload. CONCLUSIONS Overground robotic-assisted gait training in rehabilitation program needs higher cognitive and cardiovascular efforts than robot-assisted gait training on a treadmill.
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Maggio MG, Naro A, Calatozzo P, Rosa GL, Porcari B, Latella D, Marzullo P, Calabrò RS. Rehabilitation of somatoparaphrenia with misoplegia: insights from a single case-pilot study. J Integr Neurosci 2021; 20:439-447. [PMID: 34258945 DOI: 10.31083/j.jin2002046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 11/06/2022] Open
Abstract
Somatoparaphrenia lacka ownership of a paralyzed limb, i.e., the illusion that one's limbs belong to someone else. Somatoparaphrenia is one of the many forms of body misperceptions. We report a case of somatoparaphrenia with misoplegia, characterized by the absence of anosognosia for hemiplegia and personal neglect, following a surgical operation for left parietal meningioma. The patient received a novel multidisciplinary treatment, including motor rehabilitation training, traditional physiotherapy and robotic rehabilitation using the Hunova Movendo Technology and psychological counseling. At the end of the training, the patient improved in global cognitive functioning, mood, motor abilities, and the perception of herself and her body, reducing the sense of estrangement and repulsion in the lower right limb. Our result showed the importance of a specific neuropsychological assessment in patients with parietal brain lesions and the usefulness of an integrated psychological and motor approach in rehabilitating patients with somatoparaphrenia, primarily when associated with misoplegia.
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Affiliation(s)
- Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95124 Catania, Italy
| | | | - Patrizia Calatozzo
- Studio di Psicoterapia e Riabilitazione Cognitiva, Viale Europa, 00144 Roma, Italy
| | | | - Bruno Porcari
- Istituto di Ricerca e Cura a carattere Scientifico Centro Neurolesi "Bonino Pulejo", 98158 Messina, Italy
| | - Desiree Latella
- Studio di Psicoterapia e Riabilitazione Cognitiva, Viale Europa, 00144 Roma, Italy
| | - Pietro Marzullo
- Istituto di Ricerca e Cura a carattere Scientifico Centro Neurolesi "Bonino Pulejo", 98158 Messina, Italy
| | - Rocco Salvatore Calabrò
- Istituto di Ricerca e Cura a carattere Scientifico Centro Neurolesi "Bonino Pulejo", 98158 Messina, Italy
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Park JH, Park G, Kim HY, Lee JY, Ham Y, Hwang D, Kwon S, Shin JH. A comparison of the effects and usability of two exoskeletal robots with and without robotic actuation for upper extremity rehabilitation among patients with stroke: a single-blinded randomised controlled pilot study. J Neuroeng Rehabil 2020; 17:137. [PMID: 33076952 PMCID: PMC7574181 DOI: 10.1186/s12984-020-00763-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/20/2020] [Indexed: 12/05/2022] Open
Abstract
Background Robotic rehabilitation of stroke survivors with upper extremity dysfunction may yield different outcomes depending on the robot type. Considering that excessive dependence on assistive force by robotic actuators may interfere with the patient’s active learning and participation, we hypothesised that the use of an active-assistive robot with robotic actuators does not lead to a more meaningful difference with respect to upper extremity rehabilitation than the use of a passive robot without robotic actuators. Accordingly, we aimed to evaluate the differences in the clinical and kinematic outcomes between active-assistive and passive robotic rehabilitation among stroke survivors. Methods In this single-blinded randomised controlled pilot trial, we assigned 20 stroke survivors with upper extremity dysfunction (Medical Research Council scale score, 3 or 4) to the active-assistive robotic intervention (ACT) and passive robotic intervention (PSV) groups in a 1:1 ratio and administered 20 sessions of 30-min robotic intervention (5 days/week, 4 weeks). The primary (Wolf Motor Function Test [WMFT]-score and -time: measures activity), and secondary (Fugl-Meyer Assessment [FMA] and Stroke Impact Scale [SIS] scores: measure impairment and participation, respectively; kinematic outcomes) outcome measures were determined at baseline, after 2 and 4 weeks of the intervention, and 4 weeks after the end of the intervention. Furthermore, we evaluated the usability of the robots through interviews with patients, therapists, and physiatrists. Results In both the groups, the WMFT-score and -time improved over the course of the intervention. Time had a significant effect on the WMFT-score and -time, FMA-UE, FMA-prox, and SIS-strength; group × time interaction had a significant effect on SIS-function and SIS-social participation (all, p < 0.05). The PSV group showed better improvement in participation and smoothness than the ACT group. In contrast, the ACT group exhibited better improvement in mean speed. Conclusions There were no differences between the two groups regarding the impairment and activity domains. However, the PSV robots were more beneficial than ACT robots regarding participation and smoothness. Considering the high cost and complexity of ACT robots, PSV robots might be more suitable for rehabilitation in stroke survivors capable of voluntary movement. Trial registration The trial was registered retrospectively on 14 March 2018 at ClinicalTrials.gov (NCT03465267).
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Affiliation(s)
- Jin Ho Park
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Gyulee Park
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ha Yeon Kim
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Ji-Yeong Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Yeajin Ham
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea
| | - Donghwan Hwang
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Suncheol Kwon
- Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, 58, Samgaksan-ro, Gangbuk-gu, Seoul, Republic of Korea. .,Translational Research Program for Rehabilitation Robots, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Republic of Korea.
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21
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Nankaku M, Tanaka H, Ikeguchi R, Kikuchi T, Miyamoto S, Matsuda S. Effects of walking distance over robot-assisted training on walking ability in chronic stroke patients. J Clin Neurosci 2020; 81:279-283. [PMID: 33222930 DOI: 10.1016/j.jocn.2020.09.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
An understanding of the dose-response during training is important to identify the rehabilitation programs to obtain the improvement in chronic stroke patients. The purpose of this study was to determine whether distance-dose (distance walked across all sessions) during robot-assisted training affects the change of walking speed and distance in chronic stroke patients after intervention. Fifteen chronic stroke patients were enrolled in this study. The patients performed 8 gait training sessions using the Hybrid Assistive Limb (HAL) for 3 weeks. Gait speed, stride length, cadence, and 2-minute walk test (2MWT) were measured before and post-intervention. Total walking distance (distance walked across all sessions) in individual patients were also measured. Gait speed, stride length, cadence, and 2-minute walk test (2MWT) improved significantly after training. The average of walking distance for 8 sessions in individual patients was 3793.3 ± 2105.3 m. Moreover, the change of gait speed (r = 0.53) and 2MWT (r = 0.70) were positively correlated with the walking distance during 8 sessions. This study of finding demonstrated that greater total distance walked over all sessions of training using the HAL is directly associated with the better walking outcomes in patients with chronic stroke. Further researches with a larger number of patients and a control group are needed to quantify the study results more precisely.
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Affiliation(s)
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | | | - Takayuki Kikuchi
- Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Faculty of Medicine, Kyoto University, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthropedic Surgery, Faculty of Medicine, Kyoto University, Japan
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22
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Lambelet C, Temiraliuly D, Siegenthaler M, Wirth M, Woolley DG, Lambercy O, Gassert R, Wenderoth N. Characterization and wearability evaluation of a fully portable wrist exoskeleton for unsupervised training after stroke. J Neuroeng Rehabil 2020; 17:132. [PMID: 33028354 PMCID: PMC7541267 DOI: 10.1186/s12984-020-00749-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic hand and wrist impairment are frequently present following stroke and severely limit independence in everyday life. The wrist orientates and stabilizes the hand before and during grasping, and is therefore of critical importance in activities of daily living (ADL). To improve rehabilitation outcomes, classical therapy could be supplemented by novel therapies that can be applied in unsupervised settings. This would enable more distributed practice and could potentially increase overall training dose. Robotic technology offers new possibilities to address this challenge, but it is critical that devices for independent training are easy and appealing to use. Here, we present the development, characterization and wearability evaluation of a fully portable exoskeleton for active wrist extension/flexion support in stroke rehabilitation. METHODS First we defined the requirements, and based on these, constructed the exoskeleton. We then characterized the device with standardized haptic and human-robot interaction metrics. The exoskeleton is composed of two modules placed on the forearm/hand and the upper arm. These modules weigh 238 g and 224 g, respectively. The forearm module actively supports wrist extension and flexion with a torque up to 3.7 Nm and an angular velocity up to 530 deg/s over a range of 154∘. The upper arm module includes the control electronics and battery, which can power the device for about 125 min in normal use. Special emphasis was put on independent donning and doffing of the device, which was tested via a wearability evaluation in 15 healthy participants and 2 stroke survivors using both qualitative and quantitative methods. RESULTS All participants were able to independently don and doff the device after only 4 practice trials. For healthy participants the donning and doffing process took 61 ±15 s and 24 ±6 s, respectively. The two stroke survivors donned and doffed the exoskeleton in 54 s/22 s and 113 s/32 s, respectively. Usability questionnaires revealed that despite minor difficulties, all participants were positive regarding the device. CONCLUSIONS This study describes an actuated wrist exoskeleton which weighs less than 500 g, and which is easy and fast to don and doff with one hand. Our design has put special emphasis on the donning aspect of robotic devices which constitutes the first barrier a user will face in unsupervised settings. The proposed device is a first and intermediate step towards wearable rehabilitation technologies that can be used independently by the patient and in unsupervised settings.
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Affiliation(s)
- Charles Lambelet
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Damir Temiraliuly
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Marc Siegenthaler
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Marc Wirth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Daniel G. Woolley
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Nicole Wenderoth
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Baselizadeh A, Behjat A, Torabi A, Behzadipour S. Using robotic mechanical perturbations for enhanced balance assessment. Med Eng Phys 2020; 83:7-14. [PMID: 32807350 DOI: 10.1016/j.medengphy.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 05/17/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
Balance impairment is critical for many patient groups such as those with neural and musculoskeletal disorders and also the elderly. Accurate and objective assessment of balance performance has led to the development of several indices based on the measurement of the center of pressure. In this study, a robotic device was designed and fabricated to provide controlled and repeatable mechanical perturbations to the standing platform of the user. The device uses servo-controlled actuators and two parallel mechanisms to provide independent rotations in mediolateral and anterior-posterior directions. The device also provides visual feedback of the center of pressure position to the user. Functional tests were run and showed that the device is able to provide an appropriate dynamics (time constant of 0.19 s and bandwidth of 0.85 Hz) for the two motions. The efficacy of the device on the balance assessment was then evaluated experimentally. Ten healthy subjects performed a balance task with and without perturbations and seven center of pressure indices were measured. It was shown that the sensitivity of the indices to the user's performance was statistically increased in all indices particularly in anterior/posterior direction when the mechanical perturbations were present.
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Valdés BA, Khoshnam M, Neva JL, Menon C. Robotics-assisted visual-motor training influences arm position sense in three-dimensional space. J Neuroeng Rehabil 2020; 17:96. [PMID: 32664955 PMCID: PMC7362539 DOI: 10.1186/s12984-020-00727-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023] Open
Abstract
Background Performing activities of daily living depends, among other factors, on awareness of the position and movements of limbs. Neural injuries, such as stroke, might negatively affect such an awareness and, consequently, lead to degrading the quality of life and lengthening the motor recovery process. With the goal of improving the sense of hand position in three-dimensional (3D) space, we investigate the effects of integrating a pertinent training component within a robotic reaching task. Methods In the proof-of-concept study presented in this paper, 12 healthy participants, during a single session, used their dominant hand to attempt reaching without vision to two targets in 3D space, which were placed at locations that resembled the functional task of self-feeding. After each attempt, participants received visual and haptic feedback about their hand’s position to accurately locate the target. Performance was evaluated at the beginning and end of each session during an assessment in which participants reached without visual nor haptic feedback to three targets: the same two targets employed during the training phase and an additional one to evaluate the generalization of training. Results Collected data showed a statistically significant [39.81% (p=0.001)] reduction of end-position reaching error when results of reaching to all targets were combined. End-position error to the generalization target, although not statistically significant, was reduced by 15.47%. Conclusions These results provide support for the effectiveness of combining an arm position sense training component with functional motor tasks, which could be implemented in the design of future robot-assisted rehabilitation paradigms to potentially expedite the recovery process of individuals with neurological injuries.
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Affiliation(s)
- Bulmaro A Valdés
- Menrva Research Group, Schools of Mechatronic System and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Mahta Khoshnam
- Menrva Research Group, Schools of Mechatronic System and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Jason L Neva
- Université de Montréal, École de kinésiologie et des sciences de l'activité physique, Faculté de médecine, Montréal, QC, Canada.,Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic System and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada.
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Bevilacqua R, Maranesi E, Di Rosa M, Luzi R, Casoni E, Rinaldi N, Baldoni R, Lattanzio F, Di Donna V, Pelliccioni G, Riccardi GR. Rehabilitation of older people with Parkinson's disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies. BMC Neurol 2020; 20:186. [PMID: 32404132 PMCID: PMC7222584 DOI: 10.1186/s12883-020-01759-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background Parkinson’s disease is one of the most frequent causes of disability among the older adults. It is a chronic-progressive neuro-degenerative disease, characterized by several motor disorders. Balance disorders are a symptom that involves the body axis and do not respond to dopaminergic therapy used in Parkinson’s disease. Therefore, physiotherapy becomes an important intervention for the management of motor disorders. Originally, these rehabilitative approaches were based on empirical experiences, but several scientific evidences suggests that neuronal plasticity is exercise-dependent. In this context, robotic rehabilitation plays an important role because it allows to perform task-oriented exercises and to increase the number of repetitions and their intensity. This protocol study aims to evaluate the effectiveness of robotic-based intervention of the older adults with Parkinson’s disease, designed to improve the gait and to reduce the risk of falling. Methods This study is a single-blinded randomized controlled trial. The primary outcomes are: risk of falling, gait performance and fear of falling measured through Performance-Oriented Mobility Assessment (POMA), instrumental gait analysis and Short Falls Efficacy Scale – International (FES-I), respectively. One hundred ninety-five patients with PD will be recruited and randomly divided into three groups, to receive a traditional rehabilitation program or a robotic rehabilitation using Tymo system or Walker View in addition to the traditional therapy. Assessments will be performed at baseline, at the end of treatment and 6 months, 1 year and 2 years from the end of the treatment. A 10-treatment session will be conducted, divided into 2 training sessions per week, for 5 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. Discussion The final goals of the present study are to propose a new approach in the PD rehabilitation, focused on the use of robotic device, and to check the results not only at the end of the treatment but also in the long term. Trial registration NCT04087031, registration date September 12, 2019.
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Affiliation(s)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, Ancona, Italy.,Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, Ancona, Italy
| | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Fermo, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, Ancona, Italy
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Morone G, Cocchi I, Paolucci S, Iosa M. Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication. Expert Rev Med Devices 2020; 17:223-233. [PMID: 32107946 DOI: 10.1080/17434440.2020.1733408] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.Areas covered: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.Expert commentary: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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Affiliation(s)
- Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Ilaria Cocchi
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy
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Berger A, Horst F, Steinberg F, Thomas F, Müller-Eising C, Schöllhorn WI, Doppelmayr M. Increased gait variability during robot-assisted walking is accompanied by increased sensorimotor brain activity in healthy people. J Neuroeng Rehabil 2019; 16:161. [PMID: 31882008 PMCID: PMC6935063 DOI: 10.1186/s12984-019-0636-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gait disorders are major symptoms of neurological diseases affecting the quality of life. Interventions that restore walking and allow patients to maintain safe and independent mobility are essential. Robot-assisted gait training (RAGT) proved to be a promising treatment for restoring and improving the ability to walk. Due to heterogenuous study designs and fragmentary knowlegde about the neural correlates associated with RAGT and the relation to motor recovery, guidelines for an individually optimized therapy can hardly be derived. To optimize robotic rehabilitation, it is crucial to understand how robotic assistance affect locomotor control and its underlying brain activity. Thus, this study aimed to investigate the effects of robotic assistance (RA) during treadmill walking (TW) on cortical activity and the relationship between RA-related changes of cortical activity and biomechanical gait characteristics. METHODS Twelve healthy, right-handed volunteers (9 females; M = 25 ± 4 years) performed unassisted walking (UAW) and robot-assisted walking (RAW) trials on a treadmill, at 2.8 km/h, in a randomized, within-subject design. Ground reaction forces (GRFs) provided information regarding the individual gait patterns, while brain activity was examined by measuring cerebral hemodynamic changes in brain regions associated with the cortical locomotor network, including the sensorimotor cortex (SMC), premotor cortex (PMC) and supplementary motor area (SMA), using functional near-infrared spectroscopy (fNIRS). RESULTS A statistically significant increase in brain activity was observed in the SMC compared with the PMC and SMA (p < 0.05), and a classical double bump in the vertical GRF was observed during both UAW and RAW throughout the stance phase. However, intraindividual gait variability increased significantly with RA and was correlated with increased brain activity in the SMC (p = 0.05; r = 0.57). CONCLUSIONS On the one hand, robotic guidance could generate sensory feedback that promotes active participation, leading to increased gait variability and somatosensory brain activity. On the other hand, changes in brain activity and biomechanical gait characteristics may also be due to the sensory feedback of the robot, which disrupts the cortical network of automated walking in healthy individuals. More comprehensive neurophysiological studies both in laboratory and in clinical settings are necessary to investigate the entire brain network associated with RAW.
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Affiliation(s)
- Alisa Berger
- Department of Sport Psychology, Institute of Sport Science, Johannes Gutenberg-University Mainz, Albert Schweitzer Straße 22, 55128 Mainz, Germany
| | - Fabian Horst
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Fabian Steinberg
- Department of Sport Psychology, Institute of Sport Science, Johannes Gutenberg-University Mainz, Albert Schweitzer Straße 22, 55128 Mainz, Germany
- School of Kinesiology, Louisiana State University, Baton Rouge, USA
| | - Fabian Thomas
- Department of Sport Psychology, Institute of Sport Science, Johannes Gutenberg-University Mainz, Albert Schweitzer Straße 22, 55128 Mainz, Germany
| | | | - Wolfgang I. Schöllhorn
- Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Doppelmayr
- Department of Sport Psychology, Institute of Sport Science, Johannes Gutenberg-University Mainz, Albert Schweitzer Straße 22, 55128 Mainz, Germany
- Centre for Cognitive Neuroscience, Paris Lodron University of Salzburg, Salzburg, Austria
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Vukelić M, Belardinelli P, Guggenberger R, Royter V, Gharabaghi A. Different oscillatory entrainment of cortical networks during motor imagery and neurofeedback in right and left handers. Neuroimage 2019; 195:190-202. [PMID: 30951847 DOI: 10.1016/j.neuroimage.2019.03.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 03/02/2019] [Accepted: 03/27/2019] [Indexed: 01/08/2023] Open
Abstract
Volitional modulation and neurofeedback of sensorimotor oscillatory activity is currently being evaluated as a strategy to facilitate motor restoration following stroke. Knowledge on the interplay between this regional brain self-regulation, distributed network entrainment and handedness is, however, limited. In a randomized cross-over design, twenty-one healthy subjects (twelve right-handers [RH], nine left-handers [LH]) performed kinesthetic motor imagery of left (48 trials) and right finger extension (48 trials). A brain-machine interface turned event-related desynchronization in the beta frequency-band (16-22 Hz) during motor imagery into passive hand opening by a robotic orthosis. Thereby, every participant subsequently activated either the dominant (DH) or non-dominant hemisphere (NDH) to control contralateral hand opening. The task-related cortical networks were studied with electroencephalography. The magnitude of the induced oscillatory modulation range in the sensorimotor cortex was independent of both handedness (RH, LH) and hemispheric specialization (DH, NDH). However, the regional beta-band modulation was associated with different alpha-band networks in RH and LH: RH presented a stronger inter-hemispheric connectivity, while LH revealed a stronger intra-hemispheric interaction. Notably, these distinct network entrainments were independent of hemispheric specialization. In healthy subjects, sensorimotor beta-band activity can be robustly modulated by motor imagery and proprioceptive feedback in both hemispheres independent of handedness. However, right and left handers show different oscillatory entrainment of cortical alpha-band networks during neurofeedback. This finding may inform neurofeedback interventions in future to align them more precisely with the underlying physiology.
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Affiliation(s)
- Mathias Vukelić
- Division of Functional and Restorative Neurosurgery, Tuebingen Neuro Campus, Eberhard Karls University Tuebingen, Germany
| | - Paolo Belardinelli
- Division of Functional and Restorative Neurosurgery, Tuebingen Neuro Campus, Eberhard Karls University Tuebingen, Germany
| | - Robert Guggenberger
- Division of Functional and Restorative Neurosurgery, Tuebingen Neuro Campus, Eberhard Karls University Tuebingen, Germany
| | - Vladislav Royter
- Division of Functional and Restorative Neurosurgery, Tuebingen Neuro Campus, Eberhard Karls University Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Tuebingen Neuro Campus, Eberhard Karls University Tuebingen, Germany.
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Yazıcı M, Livanelioğlu A, Gücüyener K, Tekin L, Sümer E, Yakut Y. Effects of robotic rehabilitation on walking and balance in pediatric patients with hemiparetic cerebral palsy. Gait Posture 2019; 70:397-402. [PMID: 30974395 DOI: 10.1016/j.gaitpost.2019.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/26/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most prominent characteristics of hemiparetic cerebral palsy (hCP) children are structural and functional asymmetries. These children have low walking speeds, endurance and poor balance. The robotic walking devices repeat and experience symmetrical stepping at the corresponding speed and angles of the lower extremities. RESEARCH QUESTION 1: Are robotic walking devices effective in the development of walking in hCP children who can walk? RESEARCH QUESTION 2: How does the aerobic exercise experience with assisted and symmetrical movement affect the walking and local muscle, peripheral oxygenation of children with hCP? METHODS This prospective, controlled study included 24 children with hCP. All children attended to a standard physiotherapy rehabilitation (PTR) program (three days a week for 12 weeks); those in the study group (n=12) also attended to an Robotic Gait Training (RGT) program three times a week. Evaluations performed before treatment, after treatment, and at the 3rd month after treatment included assessment of balance, functionality walking and measurements for oxygenation of vastus lateralis muscle and peripheral oxygenation. RESULTS The evaluations were similar for both groups before treatment. After treatment, walking speed, endurance and peripheral O2 saturation were increased and balance abilities and functional performances improved in the RGT group as compared with the pre-treatment evaluations; these improvements in balance and functional performance were generally preserved after 3 months of treatment. An increase in 6-min walking distance and a partial increase in gross motor functions and functional muscle strength were observed in the control group; however, these abilities were not preserved after the treatment. SIGNIFICANCE RGT can provide a faster and higher effect on the development of functional muscle strength, balance, walking speed and endurance than the standard PTR program. It improves functional walking performance. RGT can be used for aerobic exercise training in children with walking hCP.
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Affiliation(s)
- Meltem Yazıcı
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey; Nuh Naci Yazgan University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kayseri, Turkey.
| | - Ayşe Livanelioğlu
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Kıvılcım Gücüyener
- Gazi University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Leman Tekin
- Gazi University Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey.
| | - Erkan Sümer
- Hacettepe University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| | - Yavuz Yakut
- Hasan Kalyoncu University Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey.
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Abstract
BACKGROUND Several neuromuscular disorders present muscle fatigue as a typical symptom. Therefore, a reliable method of fatigue assessment may be crucial for understanding how specific disease features evolve over time and for developing effective rehabilitation strategies. Unfortunately, despite its importance, a standardized, reliable and objective method for fatigue measurement is lacking in clinical practice and this work investigates a practical solution. METHODS 40 healthy young adults performed a haptic reaching task, while holding a robotic manipulandum. Subjects were required to perform wrist flexion and extension movements in a resistive visco-elastic force field, as many times as possible, until the measured muscles (mainly flexor and extensor carpi radialis) exhibited signs of fatigue. In order to analyze the behavior and the characteristics of the two muscles, subjects were divided into two groups: in the first group, the resistive force was applied by the robot only during flexion movements, whereas, in the second group, the force was applied only during extension movements. Surface electromyographic signals (sEMG) of both flexor and extensor carpi radialis were acquired. A novel indicator to define the Onset of Fatigue (OF) was proposed and evaluated from the Mean Frequency of the sEMG signal. Furthermore, as measure of the subjects' effort throughout the task, the energy consumption was estimated. RESULTS From the beginning to the end of the task, as expected, all the subjects showed a decrement in Mean Frequency of the muscle involved in movements resisting the force. For the OF indicator, subjects were consistent in terms of timing of fatigue; moreover, extensor and flexor muscles presented similar OF times. The metabolic analysis showed a very low level of energy consumption and, from the behavioral point of view, the test was well tolerated by the subjects. CONCLUSION The robot-aided assessment test proposed in this study, proved to be an easy to administer, fast and reliable method for objectively measuring muscular fatigue in a healthy population. This work developed a framework for an evaluation that can be deployed in a clinical practice with patients presenting neuromuscular disorders. Considering the low metabolic demand, the requested effort would likely be well tolerated by clinical populations.
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Affiliation(s)
- Maddalena Mugnosso
- Motor Learning, Assistive and Rehabilitation Robotics Lab, Robotics, Brain and Cognitive Sciences unit, Istituto Italiano di Tecnologia, Genoa, Italy.
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS),University of Genoa, Genoa, Italy.
| | - Francesca Marini
- Motor Learning, Assistive and Rehabilitation Robotics Lab, Robotics, Brain and Cognitive Sciences unit, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Michael Holmes
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Pietro Morasso
- Motor Learning, Assistive and Rehabilitation Robotics Lab, Robotics, Brain and Cognitive Sciences unit, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Jacopo Zenzeri
- Motor Learning, Assistive and Rehabilitation Robotics Lab, Robotics, Brain and Cognitive Sciences unit, Istituto Italiano di Tecnologia, Genoa, Italy
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Wallard L, Dietrich G, Kerlirzin Y, Bredin J. Effect of robotic-assisted gait rehabilitation on dynamic equilibrium control in the gait of children with cerebral palsy. Gait Posture 2018; 60:55-60. [PMID: 29156378 DOI: 10.1016/j.gaitpost.2017.11.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 04/12/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
Due to the intensity and repetition of movement, roboticassisted gait training therapy could have a beneficial effect on the recovery and improvement of postural and locomotor functions of the patient. This study sought to highlight the effects of robotic-assisted gait rehabilitation in gait of children with Cerebral Palsy (CP). We analyzed the different strategies before and after this rehabilitation which was used in order to generate forward motion while maintaining balance. Data were collected by a motion analysis system (Vicon® - Oxford Metrics, Oxford, UK). The children were divided into two groups in such a way as to obtain a randomized controlled population: i) a group of fourteen children (Treated Group) underwent 20 sessions of roboticassisted gait training therapy using the driven gait orthosis Lokomat®Pediatric (Hocoma AG, Volketswil, Switzerland) compared to ii) a group of sixteen children without sessions of Lokomat®Pediatric (Control Group). Significant differences are observed for the TG between the preand post-test values of the locomotor parameters and of the kinetic data of the propulsive forces of the Center of Mass (COM) and of the Center of Pressure (COP) dynamic trajectory. This first study, although performed on a limited number of patients, shows the usefulness of this robotic gait rehabilitation mainly in the balance control in gait. Indeed after this rehabilitation, these children improve their gait that is especially characterized by a more appropriate time lag between the time instant of COM-COP trajectory divergence and the time instant when the forward propulsive forces became apparent.
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Affiliation(s)
- L Wallard
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.
| | - G Dietrich
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - Y Kerlirzin
- Laboratoire Education Discours Apprentissages EA4071, Centre Universitaire des Saints-Pères, 45 rue des Saints-Pères, 75270 Paris Cedex 06, France
| | - J Bredin
- Centre de Santé-Institut Rossetti-PEP06, Unité Clinique d'Analyse du Mouvement, 400, Boulevard de la Madeleine, 06000 Nice, France; Université Côte d'Azur, LAMHESS, France
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Calabrò RS, Russo M, Naro A, De Luca R, Leo A, Tomasello P, Molonia F, Dattola V, Bramanti A, Bramanti P. Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial. J Neurol Sci 2017; 377:25-30. [PMID: 28477702 DOI: 10.1016/j.jns.2017.03.047] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/24/2017] [Accepted: 03/28/2017] [Indexed: 01/28/2023]
Abstract
Gait, coordination, and balance may be severely compromised in patients with multiple sclerosis (MS), with considerable consequences on the patient's daily living activities, psychological status and quality of life. For this reason, MS patients may benefit from robotic-rehabilitation and virtual reality training sessions. Aim of the present study was to assess the efficacy of robot-assisted gait training (RAGT) equipped with virtual reality (VR) system in MS patients with walking disabilities (EDSS 4.0 to 5.5) as compared to RAGT without VR. We enrolled 40 patients (randomized into two groups) undergoing forty RAGT±VR sessions over eight weeks. All the patients were assessed at baseline and at the end of the treatment by using specific scales. Effect sizes were very small and non-significant between the groups for Berg Balance Scale (-0.019, CI95% -2.403 to 2.365) and TUG (-0.064, 95%CI -0.408 to 0.536) favoring RAGT+VR. Effects were moderate-to-large and significant for positive attitude (-0.505, 95%CI -3.615 to 2.604) and problem-solving (-0.905, 95%CI -2.113 to 0.302) sub-items of Coping Orientation to Problem Experienced, thus largely favoring RAGT+VR. Our findings show that RAGT combined with VR is an effective therapeutic option in MS patients with walking disability as compared to RAGT without VR. We may hypothesize that VR may strengthen RAGT thanks to the entrainment of different brain areas involved in motor panning and learning.
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Affiliation(s)
| | - Margherita Russo
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Antonino Leo
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | | | - Francesco Molonia
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Vincenzo Dattola
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", C.da Casazza SS. 113, Messina, Italy
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Orihuela-Espina F, Roldán GF, Sánchez-Villavicencio I, Palafox L, Leder R, Sucar LE, Hernández-Franco J. Robot training for hand motor recovery in subacute stroke patients: A randomized controlled trial. J Hand Ther 2016; 29:51-7; quiz 57. [PMID: 26847320 DOI: 10.1016/j.jht.2015.11.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/17/2015] [Accepted: 11/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Evidence of superiority of robot training for the hand over classical therapies in stroke patients remains controversial. During the subacute stage, hand training is likely to be the most useful. AIM To establish whether robot active assisted therapies provides any additional motor recovery for the hand when administered during the subacute stage (<4 months from event) in a Mexican adult population diagnosed with stroke. HYPOTHESIS Compared to classical occupational therapy, robot based therapies for hand recovery will show significant differences at subacute stages. TRIAL DESIGN A randomized clinical trial. METHODS A between subjects randomized controlled trial was carried out on subacute stroke patients (n = 17) comparing robot active assisted therapy (RT) with a classical occupational therapy (OT). Both groups received 40 sessions ensuring at least 300 repetitions per session. Treatment duration was (mean ± std) 2.18 ± 1.25 months for the control group and 2.44 ± 0.88 months for the study group. The primary outcome was motor dexterity changes assessed with the Fugl-Meyer (FMA) and the Motricity Index (MI). RESULTS Both groups (OT: n = 8; RT: n = 9) exhibited significant improvements over time (Non-parametric Cliff's delta-within effect sizes: dwOT-FMA = 0.5, dwOT-MI = 0.5, dwRT-FMA = 1, dwRT-MI = 1). Regarding differences between the therapies; the Fugl-Meyer score indicated a significant advantage for the hand training with the robot (FMA hand: WRS: W = 8, p <0.01), whilst the Motricity index suggested a greater improvement (size effect) in hand prehension for RT with respect to OT but failed to reach significance (MI prehension: W = 17.5, p = 0.080). No harm occurred. CONCLUSIONS Robotic therapies may be useful during the subacute stages of stroke - both endpoints (FM hand and MI prehension) showed the expected trend with bigger effect size for the robotic intervention. Additional benefit of the robotic therapy over the control therapy was only significant when the difference was measured with FM, demanding further investigation with larger samples. Implications of this study are important for decision making during therapy administration and resource allocation.
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Affiliation(s)
| | | | | | - Lorena Palafox
- National Institute of Neurology and Neurosurgery (INNN), Mexico City, Mexico
| | - Ronald Leder
- National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Luis Enrique Sucar
- National Institute for Astrophysics, Optics and Electronics (INAOE), Puebla, Mexico
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Panarese A, Pirondini E, Tropea P, Cesqui B, Posteraro F, Micera S. Model-based variables for the kinematic assessment of upper-extremity impairments in post-stroke patients. J Neuroeng Rehabil 2016; 13:81. [PMID: 27609062 PMCID: PMC5016877 DOI: 10.1186/s12984-016-0187-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/26/2016] [Indexed: 11/22/2022] Open
Abstract
Background Common scales for clinical evaluation of post-stroke upper-limb motor recovery are often complemented with kinematic parameters extracted from movement trajectories. However, there is no a general consensus on which parameters to use. Moreover, the selected variables may be redundant and highly correlated or, conversely, may incompletely sample the kinematic information from the trajectories. Here we sought to identify a set of clinically useful variables for an exhaustive but yet economical kinematic characterization of upper limb movements performed by post-stroke hemiparetic subjects. Methods For this purpose, we pursued a top-down model-driven approach, seeking which kinematic parameters were pivotal for a computational model to generate trajectories of point-to-point planar movements similar to those made by post-stroke subjects at different levels of impairment. Results The set of kinematic variables used in the model allowed for the generation of trajectories significantly similar to those of either sub-acute or chronic post-stroke patients at different time points during the therapy. Simulated trajectories also correctly reproduced many kinematic features of real movements, as assessed by an extensive set of kinematic metrics computed on both real and simulated curves. When inspected for redundancy, we found that variations in the variables used in the model were explained by three different underlying and unobserved factors related to movement efficiency, speed, and accuracy, possibly revealing different working mechanisms of recovery. Conclusion This study identified a set of measures capable of extensively characterizing the kinematics of upper limb movements performed by post-stroke subjects and of tracking changes of different motor improvement aspects throughout the rehabilitation process. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0187-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessandro Panarese
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.
| | - Elvira Pirondini
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Peppino Tropea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy
| | - Benedetta Cesqui
- Centre of Space Bio-medicine, University of Rome Tor Vergata, Rome, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, AUSL 12, Viareggio, Italy.,Bioengineering Rehabilitation Laboratory, Auxilium Vitae Rehabilitation Centre, Volterra, Italy
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale R. Piaggio 34, 56025, Pontedera, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, School of Engineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Maggioni S, Melendez-Calderon A, van Asseldonk E, Klamroth-Marganska V, Lünenburger L, Riener R, van der Kooij H. Robot-aided assessment of lower extremity functions: a review. J Neuroeng Rehabil 2016; 13:72. [PMID: 27485106 PMCID: PMC4969661 DOI: 10.1186/s12984-016-0180-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/21/2016] [Indexed: 01/01/2023] Open
Abstract
The assessment of sensorimotor functions is extremely important to understand the health status of a patient and its change over time. Assessments are necessary to plan and adjust the therapy in order to maximize the chances of individual recovery. Nowadays, however, assessments are seldom used in clinical practice due to administrative constraints or to inadequate validity, reliability and responsiveness. In clinical trials, more sensitive and reliable measurement scales could unmask changes in physiological variables that would not be visible with existing clinical scores.In the last decades robotic devices have become available for neurorehabilitation training in clinical centers. Besides training, robotic devices can overcome some of the limitations in traditional clinical assessments by providing more objective, sensitive, reliable and time-efficient measurements. However, it is necessary to understand the clinical needs to be able to develop novel robot-aided assessment methods that can be integrated in clinical practice.This paper aims at providing researchers and developers in the field of robotic neurorehabilitation with a comprehensive review of assessment methods for the lower extremities. Among the ICF domains, we included those related to lower extremities sensorimotor functions and walking; for each chapter we present and discuss existing assessments used in routine clinical practice and contrast those to state-of-the-art instrumented and robot-aided technologies. Based on the shortcomings of current assessments, on the identified clinical needs and on the opportunities offered by robotic devices, we propose future directions for research in rehabilitation robotics. The review and recommendations provided in this paper aim to guide the design of the next generation of robot-aided functional assessments, their validation and their translation to clinical practice.
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Affiliation(s)
- Serena Maggioni
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland.
- Hocoma AG, Volketswil, Switzerland.
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland.
| | - Alejandro Melendez-Calderon
- Hocoma AG, Volketswil, Switzerland
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Edwin van Asseldonk
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Verena Klamroth-Marganska
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | | | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University Zürich, Zürich, Switzerland
| | - Herman van der Kooij
- Laboratory of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Bissolotti L, Villafañe JH, Gaffurini P, Orizio C, Valdes K, Negrini S. Changes in skeletal muscle perfusion and spasticity in patients with poststroke hemiparesis treated by robotic assistance (Gloreha) of the hand. J Phys Ther Sci 2016; 28:769-73. [PMID: 27134356 PMCID: PMC4842437 DOI: 10.1589/jpts.28.769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this case series was to determine the effects of robot-assisted
hand rehabilitation with a Gloreha device on skeletal muscle perfusion, spasticity, and
motor function in subjects with poststroke hemiparesis. [Subjects and Methods] Seven
patients, 2 women and 5 men (mean ± SD age: 60.5 ±6.3 years), with hemiparesis (>6
months poststroke), received passive mobilization of the hand with a Gloreha (Idrogenet,
Italy), device (30 min per day; 3 sessions a week for 3 weeks). The outcome measures were
the total hemoglobin profiles and tissue oxygenation index (TOI) in the muscle tissue
evaluated through near-infrared spectroscopy. The Motricity Index and modified Ashworth
Scale for upper limb muscles were used to assess mobility of the upper extremity.
[Results] Robotic assistance reduced spasticity after the intervention by 68.6% in the
upper limb. The Motricity Index was unchanged in these patients after treatment. Regarding
changes in muscle perfusion, significant improvements were found in total hemoglobin.
There were significant differences between the pre- and posttreatment modified Ashworth
scale. [Conclusion] The present work provides novel evidence that robotic assistance of
the hand induced changes in local muscle blood flow and oxygen supply, diminished
spasticity, and decreased subject-reported symptoms of heaviness and stiffness in subjects
with post-stroke hemiparesis.
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Affiliation(s)
- Luciano Bissolotti
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Paolo Gaffurini
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | - Claudio Orizio
- Laboratory of Neuromuscular Rehabilitation and Adapted Physical Activity, Italy
| | | | - Stefano Negrini
- IRCCS Don Gnocchi Foundation, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Hsieh YW, Liing RJ, Lin KC, Wu CY, Liou TH, Lin JC, Hung JW. Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke. J Neuroeng Rehabil 2016; 13:31. [PMID: 27000446 PMCID: PMC4802889 DOI: 10.1186/s12984-016-0138-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/11/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales. METHODS The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention. RESULTS RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT. CONCLUSION A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living. TRIAL REGISTRATION ClinicalTrials.gov. NCT01727648.
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Affiliation(s)
- Yu-wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan
| | - Rong-jiuan Liing
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan.
| | - Tsan-hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-chi Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jen-wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
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Calabrò RS, Cacciola A, Bertè F, Manuli A, Leo A, Bramanti A, Naro A, Milardi D, Bramanti P. Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci 2016; 37:503-14. [PMID: 26781943 DOI: 10.1007/s10072-016-2474-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/18/2022]
Abstract
Gait abnormalities following neurological disorders are often disabling, negatively affecting patients' quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one's ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson's disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.
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