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Agbemanyole KA, Agbohessou KG, Pons C, Lenca P, Rémy-Néris O, Goff-Pronost ML. Economic analysis of digital motor rehabilitation technologies: a systematic review. HEALTH ECONOMICS REVIEW 2024; 14:52. [PMID: 39014103 PMCID: PMC11253330 DOI: 10.1186/s13561-024-00523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
Rehabilitation technologies offer promising opportunities for interventions for patients with motor disabilities. However, their use in routine care remains limited due to their high cost and persistent doubts about their cost-effectiveness. Providing solid evidence of the economic efficiency of rehabilitation technologies would help dispel these doubts in order to better take advantage of these technologies. In this context, this systematic review aimed to examine the cost-effectiveness of rehabilitation interventions based on the use of digital technologies. In total, 660 articles published between 2011 and 2021 were identified, of which eleven studies met all the inclusion criteria. Of these eleven studies, seven proved to be cost-effective, while four were not. Four studies used cost-utility analyses (CUAs) and seven used cost-minimization analyses (CMAs). The majority (ten studies) focused on the rehabilitation of the upper and/or lower limbs after a stroke, while only one study examined the rehabilitation of the lower limbs after knee arthroplasty. Regarding the evaluated devices, seven studies analyzed the cost-effectiveness of robotic rehabilitation and four analyzed rehabilitation with virtual reality.The assessment of the quality of the included studies using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) suggested that the quality was related to the economic analysis method: all studies that adopted a cost-utility analysis obtained a high quality score (above 80%), while the quality scores of the cost-minimization analyses were average, with the highest score obtained by a CMA being 72%. The average quality score of all the articles was 75%, ranging between 52 and 100. Of the four studies with a considering score, two concluded that there was equivalence between the intervention and conventional care in terms of cost-effectiveness, one concluded that the intervention dominated, while the last one concluded that usual care dominated. This suggests that even considering the quality of the included studies, rehabilitation interventions based on digital technologies remain cost-effective, they improved health outcomes and quality of life for patients with motor disorders while also allowing cost savings.
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Affiliation(s)
- Koffi Adzinyo Agbemanyole
- IMT Atlantique, LaTIM, UMR INSERM 1101, F-29238, Brest, France.
- IMT Atlantique, Lab-STICC, UMR CNRS 6285, F-29238, Brest, France.
| | | | - Christelle Pons
- LaTIM (Laboratory of Medical Information Processing), INSERM UMR 1101 (Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche), 29238, Brest, France
- Physical Medicine and Rehabilitation Department, CHU de Brest, Hôpital Morvan, 29200, Brest, France
- UFR (Unité de Formation et de Recherche) Médecine, University of Western Brittany (UBO), 29238, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, 29200, Brest, France
| | - Philippe Lenca
- IMT Atlantique, Lab-STICC, UMR CNRS 6285, F-29238, Brest, France
| | - Olivier Rémy-Néris
- LaTIM (Laboratory of Medical Information Processing), INSERM UMR 1101 (Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche), 29238, Brest, France
- Physical Medicine and Rehabilitation Department, CHU de Brest, Hôpital Morvan, 29200, Brest, France
- UFR (Unité de Formation et de Recherche) Médecine, University of Western Brittany (UBO), 29238, Brest, France
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Bhattacharjee S, Barman A, Patel S, Sahoo J. The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:1041-1049. [PMID: 38367830 DOI: 10.1016/j.apmr.2024.01.027] [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: 10/17/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES To evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke. DESIGN A single-blind, 2-arm, parallel-group, open-level, randomized controlled trial. SETTING A tertiary care teaching hospital in India. PARTICIPANTS Forty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021 to July 2023. INTERVENTION Participants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5 days/week, 3 weeks). MAIN OUTCOME MEASURES Primary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). SECONDARY OUTCOMES the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks. RESULTS Persons who received RAT and ADL training reported significant improvement (P<.05) in UL motor function (mean difference [MD]=3.54;(95% confidence interval [CI]: 1.28 to 5.79]), UL passive joint motions (MD=2.54; [95% CI: 1.56 to 3.52]), SIS-HF (MD=6.37;[95% CI: 4.75 to 7.99]), SIS-ADL (MD=7.13 [95% CI: 3.52 to 8.74]), and in all domains of WHOQOL-BREF (except environmental domain) compared with persons who received CRT and ADL training at 12 weeks. CONCLUSIONS The findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, SIS-HF, SIS-ADL, and QOL at 12 weeks.
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Affiliation(s)
- Souvik Bhattacharjee
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Suman Patel
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagannatha Sahoo
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
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Cornec G, Lempereur M, Mensah-Gourmel J, Robertson J, Miramand L, Medee B, Bellaiche S, Gross R, Gracies JM, Remy-Neris O, Bayle N. Measurement properties of movement smoothness metrics for upper limb reaching movements in people with moderate to severe subacute stroke. J Neuroeng Rehabil 2024; 21:90. [PMID: 38812037 PMCID: PMC11134951 DOI: 10.1186/s12984-024-01382-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Movement smoothness is a potential kinematic biomarker of upper extremity (UE) movement quality and recovery after stroke; however, the measurement properties of available smoothness metrics have been poorly assessed in this group. We aimed to measure the reliability, responsiveness and construct validity of several smoothness metrics. METHODS This ancillary study of the REM-AVC trial included 31 participants with hemiparesis in the subacute phase of stroke (median time since stroke: 38 days). Assessments performed at inclusion (Day 0, D0) and at the end of a rehabilitation program (Day 30, D30) included the UE Fugl Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and 3D motion analysis of the UE during three reach-to-point movements at a self-selected speed to a target located in front at shoulder height and at 90% of arm length. Four smoothness metrics were computed: a frequency domain smoothness metric, spectral arc length metric (SPARC); and three temporal domain smoothness metrics (TDSM): log dimensionless jerk (LDLJ); number of submovements (nSUB); and normalized average rectified jerk (NARJ). RESULTS At D30, large clinical and kinematic improvements were observed. Only SPARC and LDLJ had an excellent reliability (intra-class correlation > 0.9) and a low measurement error (coefficient of variation < 10%). SPARC was responsive to changes in movement straightness (rSpearman=0.64) and to a lesser extent to changes in movement duration (rSpearman=0.51) while TDSM were very responsive to changes in movement duration (rSpearman>0.8) and not to changes in movement straightness (non-significant correlations). Most construct validity hypotheses tested were verified except for TDSM with low correlations with clinical metrics at D0 (rSpearman<0.5), ensuing low predictive validity with clinical metrics at D30 (non-significant correlations). CONCLUSIONS Responsiveness and construct validity of TDSM were hindered by movement duration and/or noise-sensitivity. Based on the present results and concordant literature, we recommend using SPARC rather than TDSM in reaching movements of uncontrolled duration in individuals with spastic paresis after stroke. TRIAL REGISTRATION NCT01383512, https://clinicaltrials.gov/ , June 27, 2011.
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Affiliation(s)
- Gwenaël Cornec
- Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France.
- UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France.
| | - Mathieu Lempereur
- Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France
- UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France
| | - Johanne Mensah-Gourmel
- Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France
- UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Rue Alain Colas, Brest, F-29200, France
| | - Johanna Robertson
- Physical Medicine and Rehabilitation Department, AP-HP, Raymond Poincaré Hospital, Université Paris-Saclay, Team INSERM 1179, UFR de Santé Simone Veil, Versailles Saint-Quentin university, Garches, France
| | - Ludovic Miramand
- UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Rue Alain Colas, Brest, F-29200, France
| | - Beatrice Medee
- Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France
| | - Soline Bellaiche
- Department of Neurological Physical Medicine and Rehabilitation, Henry-Gabrielle hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Raphael Gross
- Nantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, UR 4334, Nantes, F-44000, France
| | - Jean-Michel Gracies
- Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, F-94010, France
- Laboratoire Analyse et Restauration du Mouvement, UR 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France
| | - Olivier Remy-Neris
- Department of Physical and Rehabilitation Medicine, CHU Brest, Brest, F-29200, France
- UMR 1101 LaTIM, Univ Brest, INSERM, Brest, F-29200, France
| | - Nicolas Bayle
- Service de Rééducation Neurolocomotrice, Unité de Neurorééducation, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, F-94010, France
- Laboratoire Analyse et Restauration du Mouvement, UR 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France
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Li Y, Wang M, Wang L, Cao Y, Liu Y, Zhao Y, Yuan R, Yang M, Lu S, Sun Z, Zhou F, Qian Z, Kang H. Advances in the Application of AI Robots in Critical Care: Scoping Review. J Med Internet Res 2024; 26:e54095. [PMID: 38801765 PMCID: PMC11165292 DOI: 10.2196/54095] [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: 10/29/2023] [Revised: 03/07/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In recent epochs, the field of critical medicine has experienced significant advancements due to the integration of artificial intelligence (AI). Specifically, AI robots have evolved from theoretical concepts to being actively implemented in clinical trials and applications. The intensive care unit (ICU), known for its reliance on a vast amount of medical information, presents a promising avenue for the deployment of robotic AI, anticipated to bring substantial improvements to patient care. OBJECTIVE This review aims to comprehensively summarize the current state of AI robots in the field of critical care by searching for previous studies, developments, and applications of AI robots related to ICU wards. In addition, it seeks to address the ethical challenges arising from their use, including concerns related to safety, patient privacy, responsibility delineation, and cost-benefit analysis. METHODS Following the scoping review framework proposed by Arksey and O'Malley and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a scoping review to delineate the breadth of research in this field of AI robots in ICU and reported the findings. The literature search was carried out on May 1, 2023, across 3 databases: PubMed, Embase, and the IEEE Xplore Digital Library. Eligible publications were initially screened based on their titles and abstracts. Publications that passed the preliminary screening underwent a comprehensive review. Various research characteristics were extracted, summarized, and analyzed from the final publications. RESULTS Of the 5908 publications screened, 77 (1.3%) underwent a full review. These studies collectively spanned 21 ICU robotics projects, encompassing their system development and testing, clinical trials, and approval processes. Upon an expert-reviewed classification framework, these were categorized into 5 main types: therapeutic assistance robots, nursing assistance robots, rehabilitation assistance robots, telepresence robots, and logistics and disinfection robots. Most of these are already widely deployed and commercialized in ICUs, although a select few remain under testing. All robotic systems and tools are engineered to deliver more personalized, convenient, and intelligent medical services to patients in the ICU, concurrently aiming to reduce the substantial workload on ICU medical staff and promote therapeutic and care procedures. This review further explored the prevailing challenges, particularly focusing on ethical and safety concerns, proposing viable solutions or methodologies, and illustrating the prospective capabilities and potential of AI-driven robotic technologies in the ICU environment. Ultimately, we foresee a pivotal role for robots in a future scenario of a fully automated continuum from admission to discharge within the ICU. CONCLUSIONS This review highlights the potential of AI robots to transform ICU care by improving patient treatment, support, and rehabilitation processes. However, it also recognizes the ethical complexities and operational challenges that come with their implementation, offering possible solutions for future development and optimization.
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Affiliation(s)
- Yun Li
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Min Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuan Cao
- The Second Hospital, Hebei Medical University, Hebei, China
| | - Yuyan Liu
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhao
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Rui Yuan
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mengmeng Yang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Siqian Lu
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Zhichao Sun
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Feihu Zhou
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhirong Qian
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian, China
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hongjun Kang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Lülsdorff K, Junker FB, Studer B, Wittenberg H, Pickenbrock H, Schmidt-Wilcke T. Neurorehabilitation of the upper extremity - immersive virtual reality vs. electromechanically assisted training. A comparative study. Front Neurol 2023; 14:1290637. [PMID: 38187150 PMCID: PMC10768030 DOI: 10.3389/fneur.2023.1290637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Severe paresis of the contralesional upper extremity is one of the most common and debilitating post-stroke impairments. The need for cost-effective high-intensity training is driving the development of new technologies, which can complement and extent conventional therapies. Apart from established methods using electromechanical devices, immersive virtual reality (iVR) systems hold promise to provide cost-efficient high-intensity arm training. Objective We investigated whether iVR-based arm training yields at least equivalent effects on upper extremity function as compared to an electromechanically assisted training in stroke patients with severe arm paresis. Methods 52 stroke patients with severe arm paresis received a total of ten daily group therapy sessions over a period of three weeks, which consisted of 20 min of conventional therapy and 20 min of either electromechanically assisted (ARMEOSpring®) or iVR-based (CUREO®) arm training. Changes in upper extremity function was assessed using the Action Research Arm Test (ARAT) and user acceptance was measured with the User Experience Questionnaire (UEQ). Results iVR-based training was not inferior to electromechanically assisted training. We found that 84% of patients treated with iVR and 50% of patients treated with electromechanically assisted arm training showed a clinically relevant improvement of upper extremity function. This difference could neither be attributed to differences between the groups regarding age, gender, duration after stroke, affected body side or ARAT scores at baseline, nor to differences in the total amount of therapy provided. Conclusion The present study results show that iVR-based arm training seems to be a promising addition to conventional therapy. Potential mechanisms by which iVR unfolds its effects are discussed.
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Affiliation(s)
- Kira Lülsdorff
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Frederick Benjamin Junker
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Bettina Studer
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Heike Wittenberg
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Heidrun Pickenbrock
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
| | - Tobias Schmidt-Wilcke
- Mauritius Hospital and Neurorehabilitation Center Meerbusch, Meerbusch, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
- Center of Neurology, District Hospital Mainkofen, Deggendorf, Germany
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He YZ, Huang ZM, Deng HY, Huang J, Wu JH, Wu JS. Feasibility, safety, and efficacy of task-oriented mirrored robotic training on upper-limb functions and activities of daily living in subacute poststroke patients: a pilot study. Eur J Phys Rehabil Med 2023; 59:660-668. [PMID: 37869761 PMCID: PMC10795073 DOI: 10.23736/s1973-9087.23.08018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Robotic training with high repetitions facilitates upper-limb movements but provides fewer benefits for activities of daily living. Integrating activities of daily living training tasks and mirror therapy into a robot may enhance the functional gains of robotic training. AIM The aim of this study was to investigate the feasibility, safety, and efficacy of the task-oriented mirrored upper-limb robotic training on the upper-limb functions and activities of daily living of subacute poststroke patients. DESIGN This study is a single-blinded, active-controlled pilot study. SETTING The study was carried out at rehabilitation outpatient clinic and ward. POPULATION A total of 32 subacute poststroke patients were enrolled in the study. METHODS The enrolled patients were allocated into two groups in a ratio of 1:1. The experimental group received 4 weeks of task-oriented mirrored upper-limb robotic training, consisting of five sessions of 30-minute duration, along with 30 minutes of conventional training. The control group only received 60 minutes of conventional training. The outcome measures were the Fugl-Meyer Assessment Scale for Upper Extremity, Modified Barthel Index, Stroke Self-Efficacy Scale, System Usability Scale, and Quebec User Evaluation with Assistive Technology. RESULTS All patients completed the full training sessions without significant adverse events related to robotic training. The task-oriented mirrored upper-limb robotic training led to increased Fugl-Meyer Assessment Scale for Upper Extremity (difference: 10.38 points, P<0.001) and Modified Barthel Index (difference: 18.38 points, P<0.001) scores, both of which exceeded the minimal clinically important difference. Intergroup analysis showed significantly higher improvements in the Fugl-Meyer Assessment Scale for Upper Extremity total scores, shoulder, wrist, and hand scores; and Modified Barthel Index scores in the experimental group than in conventional training (all P<0.05). Both groups showed significant improvements in Stroke Self-Efficacy Scale scores after the intervention (both P<0.001), but without a statistically significant intergroup difference (P>0.05). Participants in the experimental group scored an average usability perception score of 74.74 (good) and an average satisfaction score of four or more out of five. CONCLUSIONS In general, task-oriented mirrored upper-limb robotic training appears feasible and safe for subacute poststroke rehabilitation, facilitating the recovery of upper-limb functions and activities of daily living. CLINICAL REHABILITATION IMPACT Task-oriented mirrored upper-limb robotic training shows promise for future clinical rehabilitation and clinical trials involving subacute poststroke patients.
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Affiliation(s)
- You-Ze He
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Zhen-Ming Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hai-Yin Deng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
| | - Jian-Huang Wu
- Shenzhen Wisemen Medical Technologies Co., Ltd, Shenzhen, China
| | - Jing-Song Wu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China -
- Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China
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Yoo SD, Lee HH. The Effect of Robot-Assisted Training on Arm Function, Walking, Balance, and Activities of Daily Living After Stroke: A Systematic Review and Meta-Analysis. BRAIN & NEUROREHABILITATION 2023; 16:e24. [PMID: 38047093 PMCID: PMC10689857 DOI: 10.12786/bn.2023.16.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 12/05/2023] Open
Abstract
This meta-analysis aimed to compare the effects of robot-assisted training (RAT) with those of conventional therapy (CT), considering the potential sources of heterogeneity in the previous studies. We searched three international electronic databases (MEDLINE, Embase, and the Cochrane Library) to identify relevant studies. Risk of bias assessment was performed using the Cochrane's Risk of Bias 1.0 tool. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations method. The meta-analyses for each outcome of the respective domains were performed using 24 randomized controlled trials (RCTs) on robot-assisted arm training (RAAT) for arm function, 7 RCTs on RAAT for activities of daily living (ADL), 12 RCTs on robot-assisted gait training (RAGT) for balance, 6 RCTs on RAGT for walking, and 7 RCTs on RAGT for ADL. The random-effects model for the meta-analysis revealed that RAAT has significant superiority over CT in improving arm function, and ADL. We also showed that RAGT has significant superiority over CT in improving balance. Our study provides high-level evidence for the superiority of RAT over CT in terms of functional recovery after stroke. Therefore, physicians should consider RAT as a therapeutic option for facilitating functional recovery after stroke.
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Affiliation(s)
- Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University College of Medicine, Seoul, Korea
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Takebayashi T, Uchiyama Y, Okita Y, Domen K. Development of a program to determine optimal settings for robot-assisted rehabilitation of the post-stroke paretic upper extremity: a simulation study. Sci Rep 2023; 13:9217. [PMID: 37280304 DOI: 10.1038/s41598-023-34556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Robot-assisted therapy can effectively treat upper extremity (UE) paralysis in patients who experience a stroke. Presently, UE, as a training item, is selected according to the severity of the paralysis based on a clinician's experience. The possibility of objectively selecting robot-assisted training items based on the severity of paralysis was simulated using the two-parameter logistic model item response theory (2PLM-IRT). Sample data were generated using the Monte Carlo method with 300 random cases. This simulation analyzed sample data (categorical data with three difficulty values of 0, 1, and 2 [0: too easy, 1: adequate, and 2: too difficult]) with 71 items per case. First, the most appropriate method was selected to ensure the local independence of the sample data necessary to use 2PLM-IRT. The method was to exclude items with low response probability (maximum response probability) within a pair in the Quality of Compensatory Movement Score (QCM) 1-point item difficulty curve, items with low item information content within a pair in the QCM 1-point item difficulty curve, and items with low item discrimination. Second, 300 cases were analyzed to determine the most appropriate model (one-parameter or two-parameter item response therapy) to be used and the most favored method to establish local independence. We also examined whether robotic training items could be selected according to the severity of paralysis based on the ability of a person (θ) in the sample data as calculated by 2PLM-IRT. Excluding items with low response probability (maximum response probability) in a pair in the categorical data 1-point item difficulty curve was effective in ensuring local independence. Additionally, to ensure local independence, the number of items should be reduced to 61 from 71, indicating that the 2PLM-IRT was an appropriate model. The ability of a person (θ) calculated by 2PLM-IRT suggested that seven training items could be estimated from 300 cases according to severity. This simulation made it possible to objectively estimate the training items according to the severity of paralysis in a sample of approximately 300 cases using this model.
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Affiliation(s)
- Takashi Takebayashi
- Department of Rehabilitation Science, School of Medicine, Osaka Metropolitan University, 3-7-30, Habikino, Osaka, 583-8555, Japan.
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yuho Okita
- School of Health Science, Swinburne University of Technology, Melbourne, Australia
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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O'Dell MW. Stroke Rehabilitation and Motor Recovery. Continuum (Minneap Minn) 2023; 29:605-627. [PMID: 37039412 DOI: 10.1212/con.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Up to 50% of the nearly 800,000 patients who experience a new or recurrent stroke each year in the United States fail to achieve full independence afterward. More effective approaches to enhance motor recovery following stroke are needed. This article reviews the rehabilitative principles and strategies that can be used to maximize post-stroke recovery. LATEST DEVELOPMENTS Evidence dictates that mobilization should not begin prior to 24 hours following stroke, but detailed guidelines beyond this are lacking. Specific classes of potentially detrimental medications should be avoided in the early days poststroke. Patients with stroke who are unable to return home should be referred for evaluation to an inpatient rehabilitation facility. Research suggests that a substantial increase in both the dose and intensity of upper and lower extremity exercise is beneficial. A clinical trial supports vagus nerve stimulation as an adjunct to occupational therapy for motor recovery in the upper extremity. The data remain somewhat mixed as to whether robotics, transcranial magnetic stimulation, functional electrical stimulation, and transcranial direct current stimulation are better than dose-matched traditional exercise. No current drug therapy has been proven to augment exercise poststroke to enhance motor recovery. ESSENTIAL POINTS Neurologists will collaborate with rehabilitation professionals for several months following a patient's stroke. Many questions still remain about the ideal exercise regimen to maximize motor recovery in patients poststroke. The next several years will likely bring a host of new research studies exploring the latest strategies to enhance motor recovery using poststroke exercise.
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Abstract
Stroke recovery therapeutics include many classes of intervention and numerous treatment targets. Stroke is a very heterogeneous disease. As such, stroke recovery therapeutics benefit from a personalized medicine approach that considers intersubject differences, such as in infarct location or stroke severity, when assigning treatment. Prediction of treatment responders can be improved by incorporating biological measures, such as neural injury and neural function, as the bedside behavioral phenotype has an incomplete relationship with the biological events underlying stroke recovery. Another ramification of high variability between patients is the need to examine effects of restorative therapies in relation to dose, time poststroke, and stroke severity in clinical trials. For example, enrollment across a wide time interval poststroke or in a population with a very broad range of deficits means high variance across patients in the biological state of the brain. The doses of rehabilitation therapy being studied are often low; it takes substantial practice to acquire a skill in the healthy brain; this is more, not less, pronounced after a stroke. Recognition and treatment of poststroke depression represents a major unmet need. These points are considered in the context of a review of recent advances in stroke recovery therapeutics.
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Affiliation(s)
- Lorie G Richards
- Department of Occupational and Recreational Therapies, University of Utah, Salt Lake City (L.G.R.)
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles (S.C.C.).,California Rehabilitation Institute, Los Angeles (S.C.C.)
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Takebayashi T, Takahashi K, Okita Y, Kubo H, Hachisuka K, Domen K. Impact of the robotic-assistance level on upper extremity function in stroke patients receiving adjunct robotic rehabilitation: sub-analysis of a randomized clinical trial. J Neuroeng Rehabil 2022; 19:25. [PMID: 35216603 PMCID: PMC8881821 DOI: 10.1186/s12984-022-00986-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background Robotic therapy has been demonstrated to be effective in treating upper extremity (UE) paresis in stroke survivors. However, it remains unclear whether the level of assistance provided by robotics in UE training could affect the improvement in UE function in stroke survivors. We aimed to exploratorily investigate the impact of robotic assistance level and modes of adjustment on functional improvement in a stroke-affected UE. Methods We analyzed the data of 30 subacute stroke survivors with mild-to-severe UE hemiplegia who were randomly assigned to the robotic therapy (using ReoGo System) group in our previous randomized clinical trial. A cluster analysis based on the training results (the percentage of each stroke patient’s five assistance modes of robotics used during the training) was performed. The patients were divided into two groups: high and low robotic assistance groups. Additionally, the two groups were sub-categorized into the following classes based on the severity of UE functional impairment: moderate-to-mild [Fugl-Meyer Assessment (FMA) score ≥ 30] and severe-to-moderate class (FMA < 30). The outcomes were assessed using FMA, FMA-proximal, performance-time in the Wolf motor function test (WMFT), and functional assessment scale (FAS) in WMFT. The outcomes of each class in the two groups were analyzed. A two-way analysis of variance (ANOVA) was conducted with robot assistance level and severity of UE function as explanatory factors and the change in each outcome pre- and post-intervention as the objective factor. Results Overall, significant differences of the group × severity interaction were found in most of the outcomes, including FMA-proximal (p = 0.038, η2 = 0.13), WMFT-PT (p = 0.021, η2 = 0.17), and WMFT-FAS (p = 0.045, η2 = 0.14). However, only the FMA score appeared not to be significantly different in each group (p = 0.103, η2 = 0.09). Conclusion An optimal amount of robotic assistance is a key to maximize improvement in post-stroke UE paralysis. Furthermore, severity of UE paralysis is an important consideration when deciding the amount of assistance in robotic therapy. Trial registration Trial enrollment was done at UMIN (UMIN 000001619, registration date was January 1, 2009)
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Affiliation(s)
- Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, College of Health and Human Sciences, Osaka Prefecture University, 3-7-30, Habikino, Osaka, 583-8555, Japan.
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Science, Kitasato University, Kanagawa, Japan
| | - Yuho Okita
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Hironobu Kubo
- Department of Medical Science, Teijin Parma Limited, Tokyo, Japan
| | | | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Hyogo, Japan
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Broderick M, Almedom L, Burdet E, Burridge J, Bentley P. Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care. Neurorehabil Neural Repair 2021; 35:974-985. [PMID: 34449290 PMCID: PMC8593287 DOI: 10.1177/15459683211041313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.
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Affiliation(s)
- Michelle Broderick
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Leeza Almedom
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
| | - Etienne Burdet
- Department. of Bioengineering, Human Robotics Group, Imperial College, South Kensington Campus, London, UK
| | - Jane Burridge
- Department of Restorative Neuroscience, University of Southampton, Southampton, UK
| | - Paul Bentley
- Department of Brain Sciences, 4615Imperial College London, Charing Cross Hospital Campus, London, UK
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Nibras N, Liu C, Mottet D, Wang C, Reinkensmeyer D, Remy-Neris O, Laffont I, Schweighofer N. Dissociating Sensorimotor Recovery and Compensation During Exoskeleton Training Following Stroke. Front Hum Neurosci 2021; 15:645021. [PMID: 33994981 PMCID: PMC8120113 DOI: 10.3389/fnhum.2021.645021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/30/2021] [Indexed: 01/23/2023] Open
Abstract
The quality of arm movements typically improves in the sub-acute phase of stroke affecting the upper extremity. Here, we used whole arm kinematic analysis during reaching movements to distinguish whether these improvements are due to true recovery or to compensation. Fifty-three participants with post-acute stroke performed ∼80 reaching movement tests during 4 weeks of training with the ArmeoSpring exoskeleton. All participants showed improvements in end-effector performance, as measured by movement smoothness. Four ArmeoSpring angles, shoulder horizontal (SH) rotation, shoulder elevation (SE), elbow rotation, and forearm rotation, were recorded and analyzed. We first characterized healthy joint coordination patterns by performing a sparse principal component analysis on these four joint velocities recorded during reaching tests performed by young control participants. We found that two dominant joint correlations [SH with elbow rotation and SE with forearm rotation] explained over 95% of variance of joint velocity data. We identified two clusters of stroke participants by comparing the evolution of these two correlations in all tests. In the "Recoverer" cluster (N = 19), both joint correlations converged toward the respective correlations for control participants. Thus, Recoverers relearned how to generate smooth end-effector movements while developing joint movement patterns similar to those of control participants. In the "Compensator" cluster (N = 34), at least one of the two joint correlations diverged from the corresponding correlation of control participants. Compensators relearned how to generate smooth end-effector movements by discovering various new compensatory movement patterns dissimilar to those of control participants. New compensatory patterns included atypical decoupling of the SE and forearm joints, and atypical coupling of the SH rotation and elbow joints. There was no difference in clinical impairment level between the two groups either at the onset or at the end of training as assessed with the Upper Extremity Fugl-Meyer scale. However, at the start of training, the Recoverers showed significantly faster improvements in end-effector movement smoothness than the Compensators. Our analysis can be used to inform neurorehabilitation clinicians on how to provide movement feedback during practice and suggest avenues for refining exoskeleton robot therapy to reduce compensatory patterns.
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Affiliation(s)
- Nadir Nibras
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Chang Liu
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Denis Mottet
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Alès, Montpellier, France
| | - Chunji Wang
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - David Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, Anatomy and Neurobiology, University of California, Irvine, Irvine, CA, United States
| | - Olivier Remy-Neris
- Université de Brest, Centre Hospitalier Universitaire, LaTIM-INSERM UMR 1101, Brest, France
| | - Isabelle Laffont
- Euromov Digital Health in Motion, University of Montpellier, IMT Mines Alès, Montpellier, France.,Montpellier University Hospital, Euromov Digital Health in Motion, Montpellier University, Montpellier, France
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
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Bernhardt J, Hayward KS. What Is Next After This Well-Conducted, but Neutral, Multisite Trial Testing Self-Rehabilitation Approaches? Stroke 2021; 52:1948-1950. [PMID: 33910368 DOI: 10.1161/strokeaha.121.034533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health and NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, Australia (J.B., K.S.H.)
| | - Kathryn S Hayward
- Florey Institute of Neuroscience and Mental Health and NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, Australia (J.B., K.S.H.).,Melbourne School of Health Sciences & Melbourne Medical School, University of Melbourne, Parkville, Australia (K.S.H.)
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