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[Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews]. Z Gerontol Geriatr 2020; 54:54-60. [PMID: 33044620 PMCID: PMC7835300 DOI: 10.1007/s00391-020-01796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Abstract
Hintergrund Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor. Ziel der Arbeit Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland. Methoden Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein. Ergebnisse Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme. Schlussfolgerungen Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Thakkar HK, Liao WW, Wu CY, Hsieh YW, Lee TH. Predicting clinically significant motor function improvement after contemporary task-oriented interventions using machine learning approaches. J Neuroeng Rehabil 2020; 17:131. [PMID: 32993692 PMCID: PMC7523081 DOI: 10.1186/s12984-020-00758-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Accurate prediction of motor recovery after stroke is critical for treatment decisions and planning. Machine learning has been proposed to be a promising technique for outcome prediction because of its high accuracy and ability to process large volumes of data. It has been used to predict acute stroke recovery; however, whether machine learning would be effective for predicting rehabilitation outcomes in chronic stroke patients for common contemporary task-oriented interventions remains largely unexplored. This study aimed to determine the accuracy and performance of machine learning to predict clinically significant motor function improvements after contemporary task-oriented intervention in chronic stroke patients and identify important predictors for building machine learning prediction models. METHODS This study was a secondary analysis of data using two common machine learning approaches, which were the k-nearest neighbor (KNN) and artificial neural network (ANN). Chronic stroke patients (N = 239) that received 30 h of task-oriented training including the constraint-induced movement therapy, bilateral arm training, robot-assisted therapy and mirror therapy were included. The Fugl-Meyer assessment scale (FMA) was the main outcome. Potential predictors include age, gender, side of lesion, time since stroke, baseline functional status, motor function and quality of life. We divided the data set into a training set and a test set and used the cross-validation procedure to construct machine learning models based on the training set. After the models were built, we used the test data set to evaluate the accuracy and prediction performance of the models. RESULTS Three important predictors were identified, which were time since stroke, baseline functional independence measure (FIM) and baseline FMA scores. Models for predicting motor function improvements were accurate. The prediction accuracy of the KNN model was 85.42% and area under the receiver operating characteristic curve (AUC-ROC) was 0.89. The prediction accuracy of the ANN model was 81.25% and the AUC-ROC was 0.77. CONCLUSIONS Incorporating machine learning into clinical outcome prediction using three key predictors including time since stroke, baseline functional and motor ability may help clinicians/therapists to identify patients that are most likely to benefit from contemporary task-oriented interventions. The KNN and ANN models may be potentially useful for predicting clinically significant motor recovery in chronic stroke.
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Affiliation(s)
- Hiren Kumar Thakkar
- Department of Computer Science Engineering and School of Engineering and Applied Sciences, Bennett University, Plot Nos 8-11, TechZone II, Greater Noida, 201310 Uttar Pradesh India
| | - Wan-wen Liao
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan, Taiwan
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial. J Neurol 2020; 268:474-483. [PMID: 32844309 DOI: 10.1007/s00415-020-10143-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is consistent evidence that robotic rehabilitation is at least as effective as conventional physiotherapy for upper extremity (UE) recovery after stroke, suggesting to focus research on which subgroups of patients may better respond to either intervention. In this study, we evaluated which baseline variables are associated with the response after the two approaches. METHODS This is a secondary analysis of a randomized-controlled trial comparing robotic and conventional treatment for the UE. After the assigned intervention, changes of the Fugl-Meyer Assessment UE score by ≥ 5 points classified patients as responders to treatment. Variables associated with the response were identified in a univariate analysis. Then, variables independently associated with recovery were investigated, in the whole group, and the two groups separately. RESULTS A sample of 190 patients was evaluated after the treatment; 121 were responders. Age, baseline impairment, and neglect were significantly associated with worse response to the treatment. Age was the only independently associated variable (OR 0.967, p = 0.023). Considering separately the two interventions, age remained negatively associated with recovery (OR 0.948, p = 0.013) in the conventional group, while none of the variables previously identified were significantly associated with the response to treatment in the robotic group. CONCLUSIONS We found that, in our sample, age is significantly associated with the outcome after conventional but not robotic UE rehabilitation. Possible explanations may include an enhanced positive attitude of the older patients towards technological training and reduced age-associated fatigue provided by robotic-assisted exercise. The possibly higher challenge proposed by robotic training, unbiased by the negative stereotypes concerning very old patients' expectations and chances to recover, may also explain our findings. TRIAL REGISTRATION NUMBER NCT02879279.
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105
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Cho KH, Song WK. Effects of two different robot-assisted arm training on upper limb motor function and kinematics in chronic stroke survivors: A randomized controlled trial. Top Stroke Rehabil 2020; 28:241-250. [PMID: 32791945 DOI: 10.1080/10749357.2020.1804699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient's functional level. OBJECTIVES This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients. METHODS In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl-Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance. RESULTS The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05). CONCLUSIONS Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Chungbuk, Republic of Korea
| | - Won-Kyung Song
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, Republic of Korea
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106
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Chien WT, Chong YY, Tse MK, Chien CW, Cheng HY. Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis. Brain Behav 2020; 10:e01742. [PMID: 32592282 PMCID: PMC7428503 DOI: 10.1002/brb3.1742] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stroke survivors often experience upper-limb motor deficits and achieve limited motor recovery within six months after the onset of stroke. We aimed to systematically review the effects of robot-assisted therapy (RT) in comparison to usual care on the functional and health outcomes of subacute stroke survivors. METHODS Randomized controlled trials (RCTs) published between January 1, 2000 and December 31, 2019 were identified from six electronic databases. Pooled estimates of standardized mean differences for five outcomes, including motor control (primary outcome), functional independence, upper extremity performance, muscle tone, and quality of life were derived by random effects meta-analyses. Assessments of risk of bias in the included RCTs and the quality of evidence for every individual outcomes were conducted following the guidelines of the Cochrane Collaboration. RESULTS Eleven RCTs involving 493 participants were included for review. At post-treatment, the effects of RT when compared to usual care on motor control, functional independence, upper extremity performance, muscle tone, and quality of life were nonsignificant (all ps ranged .16 to .86). The quality of this evidence was generally rated as low-to-moderate. Less than three RCTs assessed the treatment effects beyond post-treatment and the results remained nonsignificant. CONCLUSION Robot-assisted therapy produced benefits similar, but not significantly superior, to those from usual care for improving functioning and disability in patients diagnosed with stroke within six months. Apart from using head-to-head comparison to determine the effects of RT in subacute stroke survivors, future studies may explore the possibility of conducting noninferiority or equivalence trials, given that the less labor-intensive RT may offer important advantages over currently available standard care, in terms of improved convenience, better adherence, and lower manpower cost.
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Affiliation(s)
- Wai-Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | - Man-Kei Tse
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
| | | | - Ho-Yu Cheng
- The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong
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Mehrholz J, Pollock A, Pohl M, Kugler J, Elsner B. Systematic review with network meta-analysis of randomized controlled trials of robotic-assisted arm training for improving activities of daily living and upper limb function after stroke. J Neuroeng Rehabil 2020; 17:83. [PMID: 32605587 PMCID: PMC7325016 DOI: 10.1186/s12984-020-00715-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/25/2020] [Indexed: 12/21/2022] Open
Abstract
Background The aim of the present study was to to assess the relative effectiveness of the various types of electromechanical-assisted arm devices and approaches after stroke. Method This is a systematic review of randomized controlled trials with network meta-analysis. Our primary endpoints were activities of daily living (measured e.g. with Barthel-Index) and hand-arm function (measured e.g. with the Fugl-Meyer Scale for the upper limb), our secondary endpoints were hand-arm strength (measured e.g. with the Motricity Index) and safety. We used conventional arm training as our reference category and compared it with different intervention categories of electromechanical-assisted arm training depending on the therapy approach. We did indirect comparisons between the type of robotic device. We considered the heterogeneity of the studies by means of confidence and prediction intervals. Results Fifty five randomized controlled trials, including 2654 patients with stroke, met our inclusion criteria. For the primary endpoints activities of daily living and hand-arm function and the secondary endpoint hand-arm strength, none of the interventions achieved statistically significant improvements, taking into account the heterogeneity of the studies. Safety did not differ with regard to the individual interventions of arm rehabilitation after stroke. Conclusion The outcomes of robotic-assisted arm training were comparable with conventional therapy. Indirect comparisons suggest that no one type of robotic device is any better or worse than any other device, providing no clear evidence to support the selection of specific types of robotic device to promote hand-arm recovery. Trial registration PROSPERO 2017 CRD42017075411
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Affiliation(s)
- Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany.
| | - Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Marcus Pohl
- Vamed Klinik Schloss Pulsnitz, Pulsnitz, Germany
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
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Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev 2020; 5:CD005950. [PMID: 32449959 PMCID: PMC7387111 DOI: 10.1002/14651858.cd005950.pub5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to changes in perception, cognition, mood, speech, health-related quality of life, and function, such as difficulty walking and using the arm. Activity limitations (decreased function) of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities. OBJECTIVES To determine whether MP improves outcomes of upper extremity rehabilitation for individuals living with the effects of stroke. In particular, we sought to (1) determine the effects of MP on upper extremity activity, upper extremity impairment, activities of daily living, health-related quality of life, economic costs, and adverse effects; and (2) explore whether effects differed according to (a) the time post stroke at which MP was delivered, (b) the dose of MP provided, or (c) the type of comparison performed. SEARCH METHODS We last searched the Cochrane Stroke Group Trials Register on September 17, 2019. On September 3, 2019, we searched the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, the Physiotherapy Evidence Database (PEDro), and REHABDATA. On October 2, 2019, we searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We reviewed the reference lists of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) of adult participants with stroke who had deficits in upper extremity function (called upper extremity activity). DATA COLLECTION AND ANALYSIS Two review authors screened titles and abstracts of the citations produced by the literature search and excluded obviously irrelevant studies. We obtained the full text of all remaining studies, and both review authors then independently selected trials for inclusion. We combined studies when the review produced a minimum of two trials employing a particular intervention strategy and a common outcome. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks, called upper extremity activity. Secondary outcomes included upper extremity impairment (such as quality of movement, range of motion, tone, presence of synergistic movement), activities of daily living (ADLs), health-related quality of life (HRQL), economic costs, and adverse events. We assessed risk of bias in the included studies and applied GRADE to assess the certainty of the evidence. We completed subgroup analyses for time since stroke, dosage of MP, type of comparison, and type of arm activity outcome measure. MAIN RESULTS We included 25 studies involving 676 participants from nine countries. For the comparison of MP in addition to other treatment versus the other treatment, MP in combination with other treatment appears more effective in improving upper extremity activity than the other treatment without MP (standardized mean difference [SMD] 0.66, 95% confidence interval [CI] 0.39 to 0.94; I² = 39%; 15 studies; 397 participants); the GRADE certainty of evidence score was moderate based on risk of bias for the upper extremity activity outcome. For upper extremity impairment, results were as follows: SMD 0.59, 95% CI 0.30 to 0.87; I² = 43%; 15 studies; 397 participants, with a GRADE score of moderate, based on risk of bias. For ADLs, results were as follows: SMD 0.08, 95% CI -0.24 to 0.39; I² = 0%; 4 studies; 157 participants; the GRADE score was low due to risk of bias and small sample size. For the comparison of MP versus conventional treatment, the only outcome with available data to combine (3 studies; 50 participants) was upper extremity impairment (SMD 0.34, 95% CI -0.33 to 1.00; I² = 21%); GRADE for the impairment outcome in this comparison was low due to risk of bias and small sample size. Subgroup analyses of time post stroke, dosage of MP, or comparison type for the MP in combination with other rehabilitation treatment versus the other treatment comparison showed no differences. The secondary outcome of health-related quality of life was reported in only one study, and no study noted the outcomes of economic costs and adverse events. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is required to evaluate effects of MP on time post stroke, the volume of MP required to affect outcomes, and whether improvement is maintained over the long term.
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Affiliation(s)
- Ruth E Barclay
- Department of Physical Therapy, College of Rehabilitation Science, University of Manitoba, Winnipeg, Canada
| | - Ted J Stevenson
- Rehabilitation Services, St Boniface General Hospital, Winnipeg, Canada
| | - William Poluha
- Sciences and Technology Library, University of Manitoba, Winnipeg, Canada
| | - Brenda Semenko
- Occupational Therapy Department, Health Sciences Centre, Winnipeg, Canada
| | - Julie Schubert
- Steelcity Physiotherapy & Wellness Centre, Selkirk, Canada
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Platz T, Sandrini G. Specialty Grand Challenge for NeuroRehabilitation Research. Front Neurol 2020; 11:349. [PMID: 32528395 PMCID: PMC7257490 DOI: 10.3389/fneur.2020.00349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/08/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Thomas Platz
- BDH-Klinik Greifswald, Centre for Neurorehabilitation, Intensive and Ventilation Care, Spinal Cord Injury Unit, University of Greifswald, Greifswald, Germany.,Neurorehabilitation Research Group, University Medical Centre, Greifswald, Germany.,Special Interest Group Clinical Pathways, World Federation for NeuroRehabilitation, North Shields, United Kingdom
| | - Giorgio Sandrini
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Wuennemann MJ, Mackenzie SW, Lane HP, Peltz AR, Ma X, Gerber LM, Edwards DJ, Kitago T. Dose and staffing comparison study of upper limb device-assisted therapy. NeuroRehabilitation 2020; 46:287-297. [DOI: 10.3233/nre-192993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marissa J. Wuennemann
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Stuart W. Mackenzie
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Heather Pepper Lane
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Avrielle R. Peltz
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Linda M. Gerber
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Edith Cown University, Joondalup, Australia
| | - Tomoko Kitago
- Human Motor Recovery Laboratory, Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
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111
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Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery. Curr Neuropharmacol 2020; 18:51-64. [PMID: 31362657 PMCID: PMC7327936 DOI: 10.2174/1570159x17666190726104139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Neuroplasticity is a natural process occurring in the brain for the entire life. Stroke is the leading cause of long term disability and a huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies target the chronic stage. Recovery after stroke depends on the ability of our brain to reestablish the structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of the compounds such as citicoline, fluoxetine, niacin, levodopa, etc. are already in clinical use or are being trialed in clinical issues. Many studies are also testing cell therapies; in our review, we focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section, we selected methods of cognitive, behavioral, and physical rehabilitation as well as adjuvant interventions for neuroprotection including noninvasive brain stimulation and extremely low-frequency electromagnetic field. The modern rehabilitation represents a new model of physical interventions with the limited therapeutic window up to six months after stroke. However, previous studies suggest that the time window for stroke recovery is much longer than previously thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post-stroke patients.
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Affiliation(s)
- Rafał Szelenberger
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Kostka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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Amano Y, Noma T, Etoh S, Miyata R, Kawamura K, Shimodozono M. Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial. Biomed Eng Online 2020; 19:28. [PMID: 32375788 PMCID: PMC7203976 DOI: 10.1186/s12938-020-00774-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398
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Affiliation(s)
- Yumeko Amano
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Tomokazu Noma
- Kagoshima University Hospital Kirishima Rehabilitation Center, Kagoshima, Japan.,Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Higashi-nukumi-cho 26-2, Handa, Aichi, 475-0012, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ryuji Miyata
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
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113
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Bai Z, Fong KNK, Zhang JJ, Chan J, Ting KH. Immediate and long-term effects of BCI-based rehabilitation of the upper extremity after stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2020; 17:57. [PMID: 32334608 PMCID: PMC7183617 DOI: 10.1186/s12984-020-00686-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial number of clinical studies have demonstrated the functional recovery induced by the use of brain-computer interface (BCI) technology in patients after stroke. The objective of this review is to evaluate the effect sizes of clinical studies investigating the use of BCIs in restoring upper extremity function after stroke and the potentiating effect of transcranial direct current stimulation (tDCS) on BCI training for motor recovery. METHODS The databases (PubMed, Medline, EMBASE, CINAHL, CENTRAL, PsycINFO, and PEDro) were systematically searched for eligible single-group or clinical controlled studies regarding the effects of BCIs in hemiparetic upper extremity recovery after stroke. Single-group studies were qualitatively described, but only controlled-trial studies were included in the meta-analysis. The PEDro scale was used to assess the methodological quality of the controlled studies. A meta-analysis of upper extremity function was performed by pooling the standardized mean difference (SMD). Subgroup meta-analyses regarding the use of external devices in combination with the application of BCIs were also carried out. We summarized the neural mechanism of the use of BCIs on stroke. RESULTS A total of 1015 records were screened. Eighteen single-group studies and 15 controlled studies were included. The studies showed that BCIs seem to be safe for patients with stroke. The single-group studies consistently showed a trend that suggested BCIs were effective in improving upper extremity function. The meta-analysis (of 12 studies) showed a medium effect size favoring BCIs for improving upper extremity function after intervention (SMD = 0.42; 95% CI = 0.18-0.66; I2 = 48%; P < 0.001; fixed-effects model), while the long-term effect (five studies) was not significant (SMD = 0.12; 95% CI = - 0.28 - 0.52; I2 = 0%; P = 0.540; fixed-effects model). A subgroup meta-analysis indicated that using functional electrical stimulation as the external device in BCI training was more effective than using other devices (P = 0.010). Using movement attempts as the trigger task in BCI training appears to be more effective than using motor imagery (P = 0.070). The use of tDCS (two studies) could not further facilitate the effects of BCI training to restore upper extremity motor function (SMD = - 0.30; 95% CI = - 0.96 - 0.36; I2 = 0%; P = 0.370; fixed-effects model). CONCLUSION The use of BCIs has significant immediate effects on the improvement of hemiparetic upper extremity function in patients after stroke, but the limited number of studies does not support its long-term effects. BCIs combined with functional electrical stimulation may be a better combination for functional recovery than other kinds of neural feedback. The mechanism for functional recovery may be attributed to the activation of the ipsilesional premotor and sensorimotor cortical network.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.,Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China.,Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR.
| | - Jack Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Josephine Chan
- School of Occupational Therapy, Institute of Health Sciences, Texas Woman's University, Houston Center, USA
| | - K H Ting
- University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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Saita K, Morishita T, Hyakutake K, Ogata T, Fukuda H, Kamada S, Inoue T. Feasibility of Robot-assisted Rehabilitation in Poststroke Recovery of Upper Limb Function Depending on the Severity. Neurol Med Chir (Tokyo) 2020; 60:217-222. [PMID: 32173715 PMCID: PMC7174245 DOI: 10.2176/nmc.oa.2019-0268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The single-joint Hybrid Assistive Limb (HAL-SJ) robot is an exoskeleton-type suit developed for the neurorehabilitation of upper limb function. Several studies have addressed the usefulness of the robot; however, the appropriate patient selection remains unclear. In this study, we evaluated the effectiveness of the HAL-SJ exoskeleton in improving upper limb function in the subacute phase after a stroke, as a function of the severity of arm paralysis. Our analysis was based on a retrospective review of 35 patients, treated using the HAL-SJ exoskeleton in the subacute phase after their stroke, between October 2014 and December 2018. The severity of upper limb impairment was quantified using the Brunnstrom recovery stage (BRS) as follows: severe, BRS score 1–2, n = 10; moderate, BRS 3–4, n = 12; and mild, BRS 5–6, n = 13. The primary endpoint was the improvement in upper limb function, from baseline to post-intervention, measured using the Fugl-Meyer assessment upper limb motor score (ΔFMA-UE; range 0–66). The ΔFMA-UE score was significant for all three severity groups (P <0.05). The magnitude of improvement was greater in the moderate group than in the mild group (P <0.05). The greatest improvement was attained for patients with a moderate level of upper limb impairment at baseline. Our findings support the feasibility of the HAL-SJ to improve upper limb function in the subacute phase after a stroke with appropriate patient selection. This study is the first report showing the effect of robot-assisted rehabilitation using the HAL-SJ, according to the severity of paralysis in acute stroke patients with upper extremity motor deficits.
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Affiliation(s)
- Kazuya Saita
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Koichi Hyakutake
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Hiroyuki Fukuda
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | - Satoshi Kamada
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital
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115
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Takebayashi T, Takahashi K, Domen K, Hachisuka K. Impact of initial flexor synergy pattern scores on improving upper extremity function in stroke patients treated with adjunct robotic rehabilitation: A randomized clinical trial. Top Stroke Rehabil 2020; 27:516-524. [PMID: 32151236 DOI: 10.1080/10749357.2020.1738660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Robot-assisted rehabilitation is an appealing strategy for patients after stroke, as it generates repetitive movements in a consistent, precise, and automated manner. Objective: To identify patients who will benefit most from robotic rehabilitation for upper extremity (UE) hemiparesis. Methods:We used data from our previous randomized clinical trial comparing 6 weeks of robotic therapy (ReoGeo system) plus standard therapy (n=30) with self-guided therapy plus standard therapy (n=26) for sub-acute phase rehabilitation in adults with mild to moderate UE hemiparesis. The outcome measures were three Fugl-Meyer (FMA) motor scores: total UE score, proximal UE score, and UE flexor synergy score. Based on pre-therapy UE flexor synergy scores, participants were categorized into mild (10-12 points), moderate (6-9 points), and severe (0-5 points) impairment classes. Results: In the robotic group, all outcome measures improved after therapy in patients with moderate or severe impairment. In the self-guided therapy, most outcomes did not improve, regardless of the impairment class. When changes from pre- to post-therapy were compared between robotic and self-guided groups, most outcomes were similar in all impairment classes. However, robotic therapy was associated with greater improvement in UE flexor synergy than self-guided therapy in patients with moderate impairment (2.3±1.3 vs. -0.1±2.8, P=0.027). Conclusions: Post-strokerobot-assisted rehabilitation, as an adjunct to standard rehabilitation therapy, improved UE function in patients with moderate or severe pre-therapy UE flexor synergy impairment. Adjunct robotic therapy produced greater improvement in UE flexor synergy motor function than adjunct self-guided rehabilitation in patients with moderate pre-therapy impairment.
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Affiliation(s)
- Takashi Takebayashi
- School of Comprehensive Rehabilitation, College of Health and Human Science, Osaka Prefecture University , Osaka, Japan.,Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University , Osaka, Japan
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Science, Kitasato University , Kanagawa, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Science, Hyogo College of Medicine , Hyogo, Japan
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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] [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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117
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Yurkewich A, Kozak IJ, Hebert D, Wang RH, Mihailidis A. Hand Extension Robot Orthosis (HERO) Grip Glove: enabling independence amongst persons with severe hand impairments after stroke. J Neuroeng Rehabil 2020; 17:33. [PMID: 32102668 PMCID: PMC7045638 DOI: 10.1186/s12984-020-00659-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/13/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Hand Extension Robot Orthosis (HERO) Grip Glove was iteratively designed to meet requests from therapists and persons after a stroke who have severe hand impairment to create a device that extends all five fingers, enhances grip strength and is portable, lightweight, easy to put on, comfortable and affordable. METHODS Eleven persons who have minimal or no active finger extension (Chedoke McMaster Stage of Hand 1-4) post-stroke were recruited to evaluate how well they could perform activities of daily living and finger function assessments with and without wearing the HERO Grip Glove. RESULTS The 11 participants showed statistically significant improvements (p < 0.01), while wearing the HERO Grip Glove, in the water bottle grasp and manipulation task (increase of 2.3 points, SD 1.2, scored using the Chedoke Hand and Arm Inventory scale from 1 to 7) and in index finger extension (increase of 147o, SD 44) and range of motion (increase of 145o, SD 36). The HERO Grip Glove provided 12.7 N (SD 8.9 N) of grip force and 11.0 N (SD 4.8) of pinch force to their affected hands, which enabled those without grip strength to grasp and manipulate blocks, a fork and a water bottle, as well as write with a pen. The participants were 'more or less satisfied' with the HERO Grip Glove as an assistive device (average of 3.3 out of 5 on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale). The highest satisfaction scores were given for safety and security (4.6) and ease of use (3.8) and the lowest satisfaction scores were given for ease of donning (2.3), which required under 5 min with assistance. The most common requests were for greater grip strength and a smaller glove size for small hands. CONCLUSIONS The HERO Grip Glove is a safe and effective tool for enabling persons with a stroke that have severe hand impairment to incorporate their affected hand into activities of daily living, which may motivate greater use of the affected upper extremity in daily life to stimulate neuromuscular recovery.
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Affiliation(s)
- Aaron Yurkewich
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada.
- Bioengineering, Imperial College London, London, UK.
| | - Illya J Kozak
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
| | - Debbie Hebert
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- University Health Network - Toronto Rehabilitation Institute - KITE, Toronto, Canada
- Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Picelli A, Munari D, Modenese A, Filippetti M, Saggioro G, Gandolfi M, Corain M, Smania N. Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study. Eur J Phys Rehabil Med 2020; 56:444-450. [PMID: 32096616 DOI: 10.23736/s1973-9087.20.06112-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. AIM To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. DESIGN Proof-of-concept, pilot, randomized controlled trial. SETTING University hospital. POPULATION Twenty adult outpatients with distal radius fracture due to wrist injury. METHODS All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. RESULTS No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. CONCLUSIONS Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. CLINICAL REHABILITATION IMPACT The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.
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Affiliation(s)
- Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy - .,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy -
| | - Daniele Munari
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Angela Modenese
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Mirko Filippetti
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gabriele Saggioro
- Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Marialuisa Gandolfi
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
| | - Massimo Corain
- Unit of Hand Surgery, Department of Surgery and Odontology, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Unit of Neurorehabilitation, Department of Neurosciences, University Hospital of Verona, Verona, Italy
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119
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Evaluation of Commercial Ropes Applied as Artificial Tendons in Robotic Rehabilitation Orthoses. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10030920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to present the design, selection and testing of commercial ropes (artificial tendons) used on robotic orthosis to perform the hand movements for stroke individuals over upper limb rehabilitation. It was determined the load applied in the rope would through direct measurements performed on four individuals after stroke using a bulb dynamometer. A tensile strength test was performed using eight commercial ropes in order to evaluate the maximum breaking force and select the most suitable to be used in this application. Finally, a pilot test was performed with a user of the device to ratify the effectiveness of the rope. The load on the cable was 12.38 kgf (121.4 N) in the stroke-affected hand, which is the maximum tensile force that the rope must to supports. Paragliding rope (DuPont™ Kevlar ® ) supporting a load of 250 N at a strain of 37 mm was selected. The clinical test proved the effectiveness of the rope, supporting the requested efforts, without presenting permanent deformation, effectively performing the participant’s finger opening.
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120
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Carpinella I, Lencioni T, Bowman T, Bertoni R, Turolla A, Ferrarin M, Jonsdottir J. Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial. J Neuroeng Rehabil 2020; 17:10. [PMID: 32000790 PMCID: PMC6990497 DOI: 10.1186/s12984-020-0646-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Robot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales. METHODS Forty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM). RESULTS R_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen's d = - 0.81, p = 0.019), elbow extension (Cohen's d = - 0.71, p = 0.038), and trunk movement (Cohen's d = - 1.12, p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen's d = - 0.83, p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen's d = 1.16, p = 0.019). CONCLUSIONS Robot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings. TRIAL REGISTRATION www.ClinicalTrials.gov NCT03530358. Registered 21 May 2018. Retrospectively registered.
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Affiliation(s)
- Ilaria Carpinella
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Tiziana Lencioni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy.
| | - Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Rita Bertoni
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Andrea Turolla
- Movement Neuroscience Research Group, IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venezia, Lido, Italy
| | - Maurizio Ferrarin
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
| | - Johanna Jonsdottir
- IRCCS Fondazione Don Carlo Gnocchi, via Capecelatro 66, 20148, Milan, Italy
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121
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Raghavan P, Bilaloglu S, Ali SZ, Jin X, Aluru V, Buckley MC, Tang A, Yousefi A, Stone J, Agrawal SK, Lu Y. The Role of Robotic Path Assistance and Weight Support in Facilitating 3D Movements in Individuals With Poststroke Hemiparesis. Neurorehabil Neural Repair 2020; 34:134-147. [PMID: 31959040 DOI: 10.1177/1545968319887685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background. High-intensity repetitive training is challenging to provide poststroke. Robotic approaches can facilitate such training by unweighting the limb and/or by improving trajectory control, but the extent to which these types of assistance are necessary is not known. Objective. The purpose of this study was to examine the extent to which robotic path assistance and/or weight support facilitate repetitive 3D movements in high functioning and low functioning subjects with poststroke arm motor impairment relative to healthy controls. Methods. Seven healthy controls and 18 subjects with chronic poststroke right-sided hemiparesis performed 300 repetitions of a 3D circle-drawing task using a 3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100 repetitions each with path assistance alone, weight support alone, and path assistance plus weight support in a random order over a single session. Kinematic data from the task were used to compute the normalized error and speed as well as the speed-error relationship. Results. Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5) showed the lowest error with path assistance plus weight support, whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ± 6.8) moved faster with path assistance alone. When both speed and error were considered together, low functioning subjects significantly reduced their error and increased their speed but showed no difference across the robotic conditions. Conclusions. Robotic assistance can facilitate repetitive task performance in individuals with severe arm motor impairment, but path assistance provides little advantage over weight support alone. Future studies focusing on antigravity arm movement control are warranted poststroke.
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Affiliation(s)
- Preeti Raghavan
- New York University, New York, NY, USA.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Syed Zain Ali
- New York University, New York, NY, USA.,NYIT College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Xin Jin
- Columbia University, New York, NY, USA
| | | | - Megan C Buckley
- New York University, New York, NY, USA.,NYIT College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | | | | | | | - Ying Lu
- New York University, New York, NY, USA
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122
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Germanotta M, Gower V, Papadopoulou D, Cruciani A, Pecchioli C, Mosca R, Speranza G, Falsini C, Cecchi F, Vannetti F, Montesano A, Galeri S, Gramatica F, Aprile I. Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke. J Neuroeng Rehabil 2020; 17:1. [PMID: 31900169 PMCID: PMC6942416 DOI: 10.1186/s12984-019-0634-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 12/12/2019] [Indexed: 02/14/2023] Open
Abstract
Background The majority of stroke survivors experiences significant hand impairments, as weakness and spasticity, with a severe impact on the activity of daily living. To objectively evaluate hand deficits, quantitative measures are needed. The aim of this study is to assess the reliability, the validity and the discriminant ability of the instrumental measures provided by a robotic device for hand rehabilitation, in a sample of patients with subacute stroke. Material and methods In this study, 120 patients with stroke and 40 controls were enrolled. Clinical evaluation included finger flexion and extension strength (using the Medical Research Council, MRC), finger spasticity (using the Modified Ashworth Scale, MAS) and motor control and dexterity during ADL performance (by means of the Frenchay Arm Test, FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the Intraclass Correlation Coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using the Spearman’s Correlation Coefficient (r). Finally, we investigated the ability of the robotic measures to distinguish between patients with stroke and healthy subjects, by means of Mann-Whitney U tests. Results All the investigated measures were able to discriminate patients with stroke from healthy subjects (p < 0.001). Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone. Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT). Discussion Finger strength (in both flexion and extension) and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales. Changes higher than the obtained MDC in these robotic measures could be considered as clinically relevant and used to assess the effect of a rehabilitation treatment in patients with subacute stroke.
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Affiliation(s)
- Marco Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy.
| | - Valerio Gower
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Arianna Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | | | - Rita Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Gabriele Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Catuscia Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Federica Vannetti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci, 269, 50143, Florence, Italy
| | - Angelo Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Furio Gramatica
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
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123
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Schladen MM, Koumpouros Y, Sandison M, Casas R, Lum P. Conceptualization of Hand-TaPS to measure the subjective experience of dynamic hand orthoses in promoting functional recovery at home after stroke. ACTA ACUST UNITED AC 2020; 32:285-294. [PMID: 34421288 DOI: 10.3233/tad-200289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dynamic exoskeleton orthoses provide assistance needed to complete movements that would otherwise be impossible after stroke. Beyond the demonstration of their effectiveness, the subjective experience of dynamic orthoses also needs to be considered. OBJECTIVE To support functional recovery after stroke through the development of Hand-TaPS (Task Practice after Stroke), an instrument to evaluate dynamic hand orthoses in home therapy. METHODS Dynamic hand orthosis subject matter experts (N = 14), professionals and consumers, considered the items of PYTHEIA, a valid and reliable instrument merging well-tested, assistive technology (AT) assessment items with those tuned to the greater complexity of emerging technologies. Experts reflected on how each item aligned with their personal experience of dynamic orthosis use. Interpretative Phenomenological Analysis guided identification of themes. RESULTS Four themes (5/20 items) appraised highly relevant for Hand-TaPS. The remaining eight themes (15/20 items) were deemed in need of modification. CONCLUSIONS Dynamic hand orthoses constitute a special case of AT; the assistance they provide targets therapy, not ADLs. Our work to develop Hand-TaPS provides a clear example of the theoretical difference between rehabilitative and assistive technology and underscores the importance of consideration of how a device is used in its assessment.
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Affiliation(s)
- Manon M Schladen
- MedStar Health Research Institute, Hyattsville, MD, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Yiannis Koumpouros
- Department of Informatics and Computer Engineering, University of West Attica, Aigaleio, Greece
| | - Melissa Sandison
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - Rafael Casas
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - Peter Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
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124
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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: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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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125
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Clark WE, Sivan M, O'Connor RJ. Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. J Rehabil Assist Technol Eng 2019; 6:2055668319863557. [PMID: 31763052 PMCID: PMC6854750 DOI: 10.1177/2055668319863557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
This review evaluates the effectiveness of robotic and virtual reality technologies used for neurological rehabilitation in stroke survivors. It examines each rehabilitation technology in turn before considering combinations of these technologies and the complexities of rehabilitation outcome assessment. There is high-quality evidence that upper-limb robotic rehabilitation technologies improve movement, strength and activities of daily living, whilst the evidence for robotic lower-limb rehabilitation is currently not as convincing. Virtual reality technologies also improve activities of daily living. Whilst the benefit of these technologies over dose-controlled conventional rehabilitation is likely to be small, there is a role for both technologies as part of a broader rehabilitation programme, where they may help to increase the intensity and amount of therapy delivered. Combining robotic and virtual reality technologies in a rehabilitation programme may further improve rehabilitation outcomes and we would advocate randomised controlled trials of these technologies in combination.
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Affiliation(s)
- William E Clark
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Manoj Sivan
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rory J O'Connor
- Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.,National Demonstration Centre for Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,National Institute of Health Research Devices for Dignity MedTech Co-operative, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
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126
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Upper Limb Robotics in Rehabilitation: An Approach to Select the Devices, Based on Rehabilitation Aims, and Their Evaluation in a Feasibility Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9183920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Robot-mediated therapy is a viable approach for upper limb rehabilitation. The upper limb is a highly complex segment and the identification of the appropriate devices capable of rehabilitating it globally (from the shoulder to the hand) in clinical practice is crucial. In this work, we aimed: (i) to describe an approach used in identifying a set of technological and robotic devices to globally treat the upper limb, and (ii) to evaluate the feasibility of the identified set in clinical practice. Using an ad-hoc form, a multidisciplinary team identified a set of four robotic and sensor-based devices to treat globally the upper limb. Then, 30 stroke patients were enrolled and assigned to two groups: the robotic group (RG), where patients were treated with the robotic set, or the conventional group (CG). All patients were evaluated before and after the treatment. In the RG the patients used all the devices (one in each rehabilitation session); the treatment was well accepted, without drop-outs or adverse events. Using a multidisciplinary approach, we identified a set of technological and robotic devices to treat the upper limb globally, and then we experimented to ascertain its feasibility, in a pilot study. Robotics offers a considerable number of devices for rehabilitation that should be selected according to rehabilitation aims and feasibility in clinical practice.
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127
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Abstract
People with hemiparesis after stroke appear to recover 70% to 80% of the difference between their baseline and the maximum upper extremity Fugl-Meyer (UEFM) score, a phenomenon called proportional recovery (PR). Two recent commentaries explained that PR should be expected because of mathematical coupling between the baseline and change score. Here we ask, If mathematical coupling encourages PR, why do a fraction of stroke patients (the "nonfitters") not exhibit PR? At the neuroanatomical level of analysis, this question was answered by Byblow et al-nonfitters lack corticospinal tract (CST) integrity at baseline-but here we address the mathematical and behavioral causes. We first derive a new interpretation of the slope of PR: It is the average probability of scoring across remaining scale items at follow-up. PR therefore breaks when enough test items are discretely more difficult for a patient at follow-up, flattening the slope of recovery. For the UEFM, we show that nonfitters are most unlikely to recover the ability to score on the test items related to wrist/hand dexterity, shoulder flexion without bending the elbow, and finger-to-nose movement, supporting the finding that nonfitters lack CST integrity. However, we also show that a subset of nonfitters respond better to robotic movement training in the chronic phase of stroke. These persons are just able to move the arm out of the flexion synergy and pick up small blocks, both markers of CST integrity. Nonfitters therefore raise interesting questions about CST function and the basis for response to intensive movement training.
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128
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Fong J, Crocher V, Tan Y, Oetomo D. Indirect Robotic Movement Shaping through Motor Cost Influence. IEEE Int Conf Rehabil Robot 2019; 2019:977-982. [PMID: 31374756 DOI: 10.1109/icorr.2019.8779430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Movement patterns are commonly disrupted after a neurological incident. The correction and recovery of these movement patterns is part of therapeutic practice, and should be considered in the development of robotic device control strategies. This is an area which has limited exploration in rehabilitation robotics literature. This work presents a new strategy aiming at influencing the cost associated with a movement, based on the principle of optimal motor control. This approach is unique, in that it does not directly modify the movement pattern, but instead encourages this altered movement. This 'Indirect Shaping Control' is applied in a preliminary experiment using an end-effector based device with 5 healthy subjects. The study concludes that such an approach may encourage changes in movement patterns which do persist to out-of-robot reaching actions, but this was not consistent over all subjects and further experiments are required.
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129
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Aird L, Alvarado N, Andole S, Cohen DL, Dawson J, Fernandez-Garcia C, Finch T, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Ternent L, Turner DL, Vale L, Wilkes S, Shaw L. Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial. Lancet 2019; 394:51-62. [PMID: 31128926 PMCID: PMC6620612 DOI: 10.1016/s0140-6736(19)31055-4] [Citation(s) in RCA: 213] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Loss of arm function is a common problem after stroke. Robot-assisted training might improve arm function and activities of daily living. We compared the clinical effectiveness of robot-assisted training using the MIT-Manus robotic gym with an enhanced upper limb therapy (EULT) programme based on repetitive functional task practice and with usual care. METHODS RATULS was a pragmatic, multicentre, randomised controlled trial done at four UK centres. Stroke patients aged at least 18 years with moderate or severe upper limb functional limitation, between 1 week and 5 years after their first stroke, were randomly assigned (1:1:1) to receive robot-assisted training, EULT, or usual care. Robot-assisted training and EULT were provided for 45 min, three times per week for 12 weeks. Randomisation was internet-based using permuted block sequences. Treatment allocation was masked from outcome assessors but not from participants or therapists. The primary outcome was upper limb function success (defined using the Action Research Arm Test [ARAT]) at 3 months. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN69371850. FINDINGS Between April 14, 2014, and April 30, 2018, 770 participants were enrolled and randomly assigned to either robot-assisted training (n=257), EULT (n=259), or usual care (n=254). The primary outcome of ARAT success was achieved by 103 (44%) of 232 patients in the robot-assisted training group, 118 (50%) of 234 in the EULT group, and 85 (42%) of 203 in the usual care group. Compared with usual care, robot-assisted training (adjusted odds ratio [aOR] 1·17 [98·3% CI 0·70-1·96]) and EULT (aOR 1·51 [0·90-2·51]) did not improve upper limb function; the effects of robot-assisted training did not differ from EULT (aOR 0·78 [0·48-1·27]). More participants in the robot-assisted training group (39 [15%] of 257) and EULT group (33 [13%] of 259) had serious adverse events than in the usual care group (20 [8%] of 254), but none were attributable to the intervention. INTERPRETATION Robot-assisted training and EULT did not improve upper limb function after stroke compared with usual care for patients with moderate or severe upper limb functional limitation. These results do not support the use of robot-assisted training as provided in this trial in routine clinical practice. FUNDING National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK; Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Helen Bosomworth
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | | | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West Healthcare NHS Trust, Northwick Park Hospital, Harrow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Gary A Ford
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Medical Sciences Division, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christopher I Price
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Laura Ternent
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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130
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Mane R, Chew E, Phua KS, Ang KK, Robinson N, Vinod AP, Guan C. Prognostic and Monitory EEG-Biomarkers for BCI Upper-Limb Stroke Rehabilitation. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1654-1664. [PMID: 31247558 DOI: 10.1109/tnsre.2019.2924742] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the availability of multiple rehabilitative interventions, identifying the one that elicits the best motor outcome based on the unique neuro-clinical profile of the stroke survivor is a challenging task. Predicting the potential of recovery using biomarkers specific to an intervention hence becomes important. To address this, we investigate intervention-specific prognostic and monitory biomarkers of motor function improvements using quantitative electroencephalography (QEEG) features in 19 chronic stroke patients following two different upper extremity rehabilitative interventions viz. Brain-computer interface (BCI) and transcranial direct current stimulation coupled BCI (tDCS-BCI). Brain symmetry index was found to be the best prognostic QEEG for clinical gains following BCI intervention ( r = -0.80 , p = 0.02 ), whereas power ratio index (PRI) was observed to be the best predictor for tDCS-BCI ( r = -0.96 , p = 0.004 ) intervention. Importantly, statistically significant between-intervention differences observed in the predictive capabilities of these features suggest that intervention-specific biomarkers can be identified. This approach can be further pursued to distinctly predict the expected response of a patient to available interventions. The intervention with the highest predicted gains may then be recommended to the patient, thereby enabling a personalized rehabilitation regime.
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131
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Duret C, Grosmaire AG, Krebs HI. Robot-Assisted Therapy in Upper Extremity Hemiparesis: Overview of an Evidence-Based Approach. Front Neurol 2019; 10:412. [PMID: 31068898 PMCID: PMC6491567 DOI: 10.3389/fneur.2019.00412] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/04/2019] [Indexed: 01/15/2023] Open
Abstract
Robot-mediated therapy is an innovative form of rehabilitation that enables highly repetitive, intensive, adaptive, and quantifiable physical training. It has been increasingly used to restore loss of motor function, mainly in stroke survivors suffering from an upper limb paresis. Multiple studies collated in a growing number of review articles showed the positive effects on motor impairment, less clearly on functional limitations. After describing the current status of robotic therapy after upper limb paresis due to stroke, this overview addresses basic principles related to robotic therapy applied to upper limb paresis. We demonstrate how this innovation is an evidence-based approach in that it meets both the improved clinical and more fundamental knowledge-base about regaining effective motor function after stroke and the need of more objective, flexible and controlled therapeutic paradigms.
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Affiliation(s)
- Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France.,Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Anne-Gaëlle Grosmaire
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, Boissise-Le-Roi, France
| | - Hermano Igo Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Neurology, University of Maryland, Baltimore, MD, United States.,Department of Physical Medicine and Rehabilitation, Fujita Health University, Nagoya, Japan.,Institute of Neuroscience, University of Newcastle, Newcastle upon Tyne, United Kingdom.,Department of Mechanical Sciences and Bioengineering, Osaka University, Osaka, Japan.,Wolfson School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom
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132
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Platz T. Evidence-Based Guidelines and Clinical Pathways in Stroke Rehabilitation-An International Perspective. Front Neurol 2019; 10:200. [PMID: 30930832 PMCID: PMC6423914 DOI: 10.3389/fneur.2019.00200] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
A high societal burden and a considerable increase in stroke-related disability was globally observed over the last 3 decades, and is expected to continue implying a major challenge for societies around the word. Structured multidisciplinary stroke rehabilitation reduces stroke-related disability both in older and younger stroke survivors of either sex and independent of stroke severity. In addition, there is rapidly increasing evidence to support the clinical effectiveness of specific stroke rehabilitation interventions. Evidence-based guidelines help to promote best possible clinical practice. Inherent difficulty for their provision is that it takes enormous efforts to systematically appraise the evidence for guidelines and their regular updates, if they should not be at risk of bias by incomplete evidence selection. A systematic review of the pertaining literature indicates that the currently published stroke rehabilitation guidelines have a national background and focus and represent the health care situations in high-income countries. Societies around the globe would benefit from central evidence sources that systematically appraise the available evidence and make explicit links to practice recommendations. Such knowledge could facilitate a more wide-spread development of valid comprehensive up-to-date evidence-based national guidelines. In addition, the development of genuine international evidence-based stroke rehabilitation guidelines that focus on therapeutic approaches rather than organizational issues, could be used by many to structure regional or local stroke rehabilitation pathways and to develop their resources in a way that will eventually achieve effective stroke rehabilitation. Such international practice recommendations for stroke rehabilitation are currently under development by the World Federation for NeuroRehabilitation (WFNR).
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Affiliation(s)
- Thomas Platz
- Spinal Cord Injury Unit, Centre for Neurorehabilitation, Intensive and Ventilation Care, BDH-Klinik Greifswald, University of Greifswald, Greifswald, Germany
- Special Interest Group Clinical Pathways, World Federation for NeuroRehabilitation, North Shields, United Kingdom
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Gandolfi M, Valè N, Dimitrova EK, Mazzoleni S, Battini E, Filippetti M, Picelli A, Santamato A, Gravina M, Saltuari L, Smania N. Effectiveness of Robot-Assisted Upper Limb Training on Spasticity, Function and Muscle Activity in Chronic Stroke Patients Treated With Botulinum Toxin: A Randomized Single-Blinded Controlled Trial. Front Neurol 2019; 10:41. [PMID: 30766508 PMCID: PMC6365972 DOI: 10.3389/fneur.2019.00041] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The combined use of Robot-assisted UL training and Botulinum toxin (BoNT) appear to be a promising therapeutic synergism to improve UL function in chronic stroke patients. Objective: To evaluate the effects of Robot-assisted UL training on UL spasticity, function, muscle strength and the electromyographic UL muscles activity in chronic stroke patients treated with Botulinum toxin. Methods: This single-blind, randomized, controlled trial involved 32 chronic stroke outpatients with UL spastic hemiparesis. The experimental group (n = 16) received robot-assisted UL training and BoNT treatment. The control group (n = 16) received conventional treatment combined with BoNT treatment. Training protocols lasted for 5 weeks (45 min/session, two sessions/week). Before and after rehabilitation, a blinded rater evaluated patients. The primary outcome was the Modified Ashworth Scale (MAS). Secondary outcomes were the Fugl-Meyer Assessment Scale (FMA) and the Medical Research Council Scale (MRC). The electromyographic activity of 5 UL muscles during the “hand-to-mouth” task was explored only in the experimental group and 14 healthy age-matched controls using a surface Electromyography (EMGs). Results: No significant between-group differences on the MAS and FMA were measured. The experimental group reported significantly greater improvements on UL muscle strength (p = 0.004; Cohen's d = 0.49), shoulder abduction (p = 0.039; Cohen's d = 0.42), external rotation (p = 0.019; Cohen's d = 0.72), and elbow flexion (p = 0.043; Cohen's d = 1.15) than the control group. Preliminary observation of muscular activity showed a different enhancement of the biceps brachii activation after the robot-assisted training. Conclusions: Robot-assisted training is as effective as conventional training on muscle tone reduction when combined with Botulinum toxin in chronic stroke patients with UL spasticity. However, only the robot-assisted UL training contributed to improving muscle strength. The single-group analysis and the qualitative inspection of sEMG data performed in the experimental group showed improvement in the agonist muscles activity during the hand-to-mouth task. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03590314
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Nicola Valè
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Eleonora Kirilova Dimitrova
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Stefano Mazzoleni
- Polo Sant' Anna Valdera, Scuola Superiore Sant' Anna, The BioRobotics Institute, Pontedera, Italy
| | - Elena Battini
- Polo Sant' Anna Valdera, Scuola Superiore Sant' Anna, The BioRobotics Institute, Pontedera, Italy
| | - Mirko Filippetti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, Foggia, Italy
| | - Michele Gravina
- Physical Medicine and Rehabilitation Section, OORR Hospital, University of Foggia, Foggia, Italy
| | - Leopold Saltuari
- Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.,Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Nicola Smania
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,UOC Neurorehabilitation, AOUI Verona, Verona, Italy
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