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Garlet AB, Righi NC, Schardong J, Della Méa Plentz R. Effects of robotic rehabilitation using the Erigo ® device on patients with neurological injury: a systematic review and meta-analysis of randomized clinical trials. Disabil Rehabil Assist Technol 2024; 19:1135-1144. [PMID: 36469933 DOI: 10.1080/17483107.2022.2151656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/12/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically review the effects of robotic rehabilitation with the Erigo® device on patients with neurological injury on safety, spasticity, muscle strength, functionality, gait/balance, and changes in the level of consciousness. METHODS MEDLINE, SciELO, EMBASE, The Cochrane Library - CENTRAL and PEDro databases were consulted without the restriction of date and language. Randomized controlled trials that evaluated the robotic rehabilitation and compared it to conventional or placebo therapy, isolated or in association with other therapy, were selected. Studies in which the treatment time was less than 10 sessions were excluded. The risk of bias was assessed with the use of the RoB 2.0 tool. RESULTS Nine studies were included, totaling 347 patients. The robotic rehabilitation performed by the Erigo® device proved to be safe for neurological patients. The meta-analysis showed an improvement for spasticity (MD = 0.29; 95% CI = -0.49 to -0.08; I2 = 0%), but there was no significant increase in muscle strength in patients with stroke (MD = 0.25; CI 95% = -0.22 to -0,71; I2 = 0%). Erigo® showed inconclusive effects on functionality, gait/balance and level of consciousness in patients with severe acquired brain injury and vegetative or minimally conscious state. All studies present some concerns for the risk of bias. CONCLUSION Erigo® as a robotic rehabilitation strategy is safe for patients with acquired brain injury and appears to reduce spasticity in patients with stroke. The effects on muscle strength, functionality, gait and balance and level of consciousness remain uncertain and the methodological quality of the clinical trials included in this review is limited.
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Affiliation(s)
- Andrieli Barbieri Garlet
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Natiele Camponogara Righi
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Jociane Schardong
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rodrigo Della Méa Plentz
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
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Shiggins C, Ryan B, Dewan F, Bernhardt J, O'Halloran R, Power E, Lindley RI, McGurk G, Rose ML. Inclusion of People With Aphasia in Stroke Trials: A Systematic Search and Review. Arch Phys Med Rehabil 2024; 105:580-592. [PMID: 37394026 DOI: 10.1016/j.apmr.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 05/23/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Although people with aphasia (PwA) represent 30% of stroke survivors, they are frequently excluded from stroke research, or their inclusion is unclear. Such practice significantly limits the generalizability of stroke research, increases the need to duplicate research in aphasia-specific populations, and raises important ethical and human rights issues. OBJECTIVE To detail the extent and nature of inclusion of PwA in contemporary stroke randomized controlled trials (RCTs). METHODS We conducted a systematic search to identify completed stroke RCTs and RCT protocols published in 2019. Web of Science was searched using terms "stroke" and "randomized controlled trial". These articles were reviewed by extracting rates of PwA inclusion/exclusion, whether "aphasia" or related terms were referred to in the article or supplemental files, eligibility criteria, consent procedures, adaptations made to support the inclusion of PwA, and attrition rates of PwA. Data were summarized, and descriptive statistics applied when appropriate. RESULTS 271 studies comprising 215 completed RCTs and 56 protocols were included. 36.2% of included studies referred to aphasia/dysphasia. Of completed RCTs, only 6.5% explicitly included PwA, 4.7% explicitly excluded PwA, and inclusion was unclear in the remaining 88.8%. Among RCT protocols, 28.6% of studies intended inclusion, 10.7% intended excluding PwA, and in 60.7%, inclusion was unclear. In 45.8% of included studies, sub-groups of PwA were excluded, either explicitly (ie, particular types/severities of aphasia, eg, global aphasia) or implicitly, by way of ambiguous eligibility criteria which could potentially relate to a sub-group of PwA. Little rationale for exclusion was provided. 71.2% of completed RCTs did not report any adaptations that could support the inclusion of PwA, and minimal information was provided about consent procedures. Where it could be determined, attrition of PwA averaged 10% (range 0%-20%). CONCLUSION This paper details the extent of inclusion of PwA in stroke research and highlights opportunities for improvement.
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Affiliation(s)
- Ciara Shiggins
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia; Queensland Aphasia Research Centre, the University of Queensland, Brisbane, Australia; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia; School of Health Sciences, University of East Anglia, Norwich, UK.
| | - Brooke Ryan
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; University of Technology Sydney, Graduate School of Health, Clinical Psychology, Ultimo, Australia; Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Farhana Dewan
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
| | - Julie Bernhardt
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; National Health and Medical Research Council Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Robyn O'Halloran
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
| | - Emma Power
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; University of Technology Sydney, Graduate School of Health, Speech Pathology, Ultimo, Australia
| | - Richard I Lindley
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gordon McGurk
- Human Research Ethics Committee, Royal Brisbane and Women's Hospital, Brisbane, Australia; Human Research Ethics Committee A, University of Queensland, Brisbane, Australia; Human Research Ethics Committee, Townsville Hospital and Health Service, Townsville, Australia; OmniAdvisory Consulting
| | - Miranda L Rose
- National Health and Medical Research Council Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia; School of Allied Health, Human Services and Sport, La Trobe University, Bundoora Campus, Melbourne, Australia
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Rosenfelder MJ, Helmschrott VC, Willacker L, Einhäupl B, Raiser TM, Bender A. Effect of robotic tilt table verticalization on recovery in patients with disorders of consciousness: a randomized controlled trial. J Neurol 2023; 270:1721-1734. [PMID: 36536249 PMCID: PMC9971146 DOI: 10.1007/s00415-022-11508-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Verticalization is a common therapeutic intervention during rehabilitation of patients with disorders of consciousness (DoC). The Erigo®Pro is a robotic tilt-table (RTT) with built-in stepping unit for the lower extremities to prevent orthostatic hypotension during verticalization. In addition, the system also provides functional electrical stimulation (FES) of muscles of the lower extremities. In this randomized controlled clinical trial (RCT), 47 patients with subacute DoC received a 4-week verticalization regime (16 verticalization sessions) and were allocated to one of three experimental groups: (1) verticalization by means of RTT with FES, (2) by means of RTT without FES, or (3) by conventional physiotherapy (CPT). Level of consciousness (LoC), spasticity, functional independence in daily activities, and functional brain connectivity measured by means of high-density quantitative EEG were assessed at baseline, directly after the verticalization program and after 6 months. There was a similar clinical improvement in all three experimental groups. RTT was not associated with an effect on any of the clinical outcomes. Verticalization or mobilization time during the study period was significantly positively correlated with recovery of consciousness (rho = 0.494, p < 0.001) in the short term and showed a statistical trend at the 6 months follow-up (rho = 0.244, p = 0.078). In conclusion, RTT treatment is not more effective in promoting recovery of consciousness than CPT in subacute DoC patients. Yet, our data suggest, that verticalization may be an important and feasible rehabilitation intervention in this group of patients. ClinicalTrials.gov NCT Number NCT02639481, registered on December 24, 2015.
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Affiliation(s)
- M J Rosenfelder
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany.
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069, Ulm, Germany.
| | - V C Helmschrott
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany
| | - L Willacker
- Department of Neurology, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - B Einhäupl
- Department of Neurology, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T M Raiser
- Department of Neurology, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - A Bender
- Therapiezentrum Burgau, Kapuzinerstraße 34, 89331, Burgau, Germany
- Department of Neurology, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377, Munich, Germany
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De Luca R, Bonanno M, Vermiglio G, Trombetta G, Andidero E, Caminiti A, Pollicino P, Rifici C, Calabrò RS. Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study. Brain Sci 2022; 12:brainsci12081045. [PMID: 36009107 PMCID: PMC9405818 DOI: 10.3390/brainsci12081045] [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: 07/06/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized music stimulation in people with DoC. Methods: Sixteen subjects affected by minimally conscious state due to traumatic brain lesions who attended our Intensive Neuro-Rehabilitation Unit were enrolled in this randomized trial. They received either music robotic verticalization (MRV) using the Erigo device plus a personalized music playlist or only RVT without music stimuli. Each treatment was performed 2 times a week for 8 consecutive weeks in addition to standard neurorehabilitation. Results: We found significant improvements in all patients’ outcomes in the experimental group (who received MRV): Coma Recovery Scale-Revised (CRS-R) (p < 0.01), Level of Cognitive Functioning (LCF) (p < 0.02), Functional Independence Measure (FIM) (p < 0.03), Functional Communication Scale (FCS) (p < 0.007), Trunk Control Test (TCT) (p = 0.05). Significant differences between the two groups were also found in the main outcome measure CRS-R (p < 0.01) but not for TCT and FIM. Conclusions: Our study supports the safety and effectiveness of RVT with the Erigo device in chronic MCS, and the achievement of better outcomes when RVT is combined with music stimulation.
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Peper KK, Zardykhan D, Egger M, Steinbock M, Muller F, Hildenbrand X, Koenig A, Jensen ER, Haddadin S. Testing robot-based assist-as-needed therapy for improving active participation of a patient during early neurorehabilitation: a case study. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176105 DOI: 10.1109/icorr55369.2022.9896495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this study, a patient in the Intensive Care-Unit received robot-based mobilization therapy with an assist-as-needed (AAN) function over the course of three weeks. Therapists were able to adapt the hip range of motion $\beta$, the bed verticalization angle $\alpha$ and the leg load force FLoad for each therapy, based on the current condition of the patient. To evaluate the patient active participation, surface electromyography (sEMG) of the M. rectus femoris (RF) and M. biceps femoris (BF) were measured and analyzed. It was observed that the patient active participation, measured through sEMG, increased along with increased hip range of motion $\beta$, bed verticalization angle $\alpha$ and leg load force FLoad set by the therapists. The patient muscle activation pattern followed the pattern of healthy controls, in part. To the authors' best knowledge, this study is the first of its kind to be performed with an ICU patient.
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