Robot-Assisted Arm Training in Stroke Individuals With Unilateral Spatial Neglect: A Pilot Study

Assessing the Effectiveness of Rehabilitation Interventions through the World Health Organization Disability Assessment Schedule 2.0 on Disability-A Systematic Review

(1) Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a tool designed to measure disability in accordance with the International Classification of Functioning, Disability and Health. Measuring disability is becoming increasingly important due to its high prevalence, which continues to rise. Rehabilitation interventions can reduce disability and enhance functioning. (2) Objective: The present study aims to assess the impact of rehabilitation interventions on reducing disability, as measured by the WHODAS 2.0 questionnaire. It also seeks to identify which specific rehabilitation interventions are more effective and to explore other disability assessment questionnaires. (3) Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a systematic review, with the protocol registered with the identifier CRD42023495309, focused on "WHODAS" and "rehabilitation" using PubMed and Web of Science electronic databases. (4) Results: We identified 18 articles from various regions encompassing patients with various health conditions, related to stroke, the cardiovascular system (cardiovascular disease, chronic heart failure), the pulmonary system (chronic obstructive pulmonary disease), the neurologic system (Parkinson's disease, cerebral palsy, neurodegenerative disease), the musculoskeletal system (orthopaedic surgery), cancer, and chronic pain, and among frail elderly. These patients have received a wide range of rehabilitation interventions: from conventional therapy to virtual reality, robot-assisted arm training, exergaming, and telerehabilitation. (5) Discussion and Conclusions: A wide range of rehabilitation techniques can effectively improve disability with various comorbidities, offering numerous benefits. The WHODAS 2.0 questionnaire proves to be an efficient and reliable tool for measuring disability, and scores have a tendency to decrease after rehabilitation.

Overview of the role of robots in upper limb disabilities rehabilitation: a scoping review

BACKGROUND

Neuromotor rehabilitation and improvement of upper limb functions are necessary to improve the life quality of patients who have experienced injuries or have pathological outcomes. Modern approaches, such as robotic-assisted rehabilitation can help to improve rehabilitation processes and thus improve upper limb functions. Therefore, the aim of this study was to investigate the role of robots in upper limb disability improvement and rehabilitation.

METHODS

This scoping review was conducted by search in PubMed, Web of Science, Scopus, and IEEE (January 2012- February 2022). Articles related to upper limb rehabilitation robots were selected. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). We used an 18-field data extraction form to extract data from articles and extracted the information such as study year, country, type of study, purpose, illness or accident leading to disability, level of disability, assistive technologies, number of participants in the study, sex, age, rehabilitated part of the upper limb using a robot, duration and frequency of treatment, methods of performing rehabilitation exercises, type of evaluation, number of participants in the evaluation process, duration of intervention, study outcomes, and study conclusions. The selection of articles and data extraction was made by three authors based on inclusion and exclusion criteria. Disagreements were resolved through consultation with the fifth author. Inclusion criteria were articles involving upper limb rehabilitation robots, articles about upper limb disability caused by any illness or injury, and articles published in English. Also, articles involving other than upper limb rehabilitation robots, robots related to rehabilitation of diseases other than upper limb, systematic reviews, reviews, and meta-analyses, books, book chapters, letters to the editor, and conference papers were also excluded. Descriptive statistics methods (frequency and percentage) were used to analyses the data.

RESULTS

We finally included 55 relevant articles. Most of the studies were done in Italy (33.82%). Most robots were used to rehabilitate stroke patients (80%). About 60.52% of the studies used games and virtual reality rehabilitate the upper limb disabilities using robots. Among the 14 types of applied evaluation methods, "evaluation and measurement of upper limb function and dexterity" was the most applied evaluation method. "Improvement in musculoskeletal functions", "no adverse effect on patients", and "Safe and reliable treatment" were the most cited outcomes, respectively.

CONCLUSIONS

Our findings show that robots can improve musculoskeletal functions (musculoskeletal strength, sensation, perception, vibration, muscle coordination, less spasticity, flexibility, and range of motion) and empower people by providing a variety of rehabilitation capabilities.

Advances in the Rehabilitation of Hemispatial Inattention

PURPOSE OF REVIEW

There continue to be a plethora of approaches to the rehabilitation of hemispatial inattention, from different forms of sensory stimulation (visual, auditory and somatosensory feedback), through all major modes of non-invasive brain stimulation to drug therapies. Here we summarise trials published in the years 2017-2022 and tabulate their effect sizes, with the aim of drawing on common themes that may serve to inform future rehabilitative studies.

RECENT FINDINGS

Immersive virtual reality approaches to visual stimulation seem well tolerated, although they have yet to yield any clinically relevant improvements. Dynamic auditory stimulation looks very promising and has high potential for implementation. Robotic interventions are limited by their cost and are perhaps best suited to patients with a co-occurring hemiparesis. Regarding brain stimulation, rTMS continues to demonstrate moderate effects but tDCS studies have yielded disappointing results so far. Drugs, primarily aimed at the dopaminergic system, often demonstrate beneficial effects of a medium size, but as with many of the approaches, it seems difficult to predict responders and non-responders. Our main recommendation is that researchers consider incorporating single-case experimental designs into their studies as rehabilitation trials are likely to remain small in terms of patient numbers, and this is the best way to deal with all the factors that cause large between-subject heterogeneity.

The Efficacity of the NeuroAssist Robotic System for Motor Rehabilitation of the Upper Limb-Promising Results from a Pilot Study

The research aimed to evaluate the efficacy of the NeuroAssist, a parallel robotic system comprised of three robotic modules equipped with human-robot interaction capabilities, an internal sensor system for torque monitoring, and an external sensor system for real-time patient monitoring for the motor rehabilitation of the shoulder, elbow, and wrist. The study enrolled 10 consecutive patients with right upper limb paresis caused by stroke, traumatic spinal cord disease, or multiple sclerosis admitted to the Neurology I Department of Cluj-Napoca Emergency County Hospital. The patients were evaluated clinically and electrophysiologically before (T1) and after the intervention (T2). The intervention consisted of five consecutive daily sessions of 30-45 min each of 30 passive repetitive movements performed with the robot. There were significant differences (Wilcoxon signed-rank test) between baseline and end-point clinical parameters, specifically for the Barthel Index (53.00 ± 37.72 vs. 60.50 ± 36.39, p = 0.016) and Activities of Daily Living Index (4.70 ± 3.43 vs. 5.50 ± 3.80, p = 0.038). The goniometric parameters improved: shoulder flexion (70.00 ± 56.61 vs. 80.00 ± 63.59, p = 0.026); wrist flexion/extension (34.00 ± 28.75 vs. 42.50 ± 33.7, p = 0.042)/(30.00 ± 22.97 vs. 41.00 ± 30.62, p = 0.042); ulnar deviation (23.50 ± 19.44 vs. 33.50 ± 24.15, p = 0.027); and radial deviation (17.50 ± 18.14 vs. 27.00 ± 24.85, p = 0.027). There was a difference in muscle activation of the extensor digitorum communis muscle (1.00 ± 0.94 vs. 1.40 ± 1.17, p = 0.046). The optimized and dependable NeuroAssist Robotic System improved shoulder and wrist range of motion and functional scores, regardless of the cause of the motor deficit. However, further investigations are necessary to establish its definite role in motor recovery.

Unilateral Spatial Neglect Recovery Poststroke

Unilateral spatial neglect (USN) is a common and disabling cognitive consequence of stroke wherein individuals demonstrate decreased response to contralesional information. Here, we provide an updated narrative review of studies that shed light on the neural mechanisms and predictors of recovery of USN. Additionally, we report a rapid review of randomized controlled trials focusing on USN intervention, both nonpharmacological and pharmacological, published in the last 5 years. Randomized controlled trials are reviewed within the context of systematic reviews and meta-analyses of USN interventions published within the same time frame. The quality of randomized controlled trials of treatment is higher compared to quality reported in previous reviews and meta-analyses. However, remaining weaknesses in participant demographic reporting, as well as small, heterogenous samples, render generalizability and cross-study interpretation a challenge. Nevertheless, evidence regarding neural mechanisms underlying USN recovery and regarding the effectiveness of targeted USN interventions is accumulating and strengthening, setting the foundation for future investigations into patient-specific factors that may influence treatment response. We identify gaps and provide suggestions for future USN intervention research.

Effect of Robot-Assisted Training on Unilateral Spatial Neglect After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Several studies have shown that robotic devices can effectively improve motor function in stroke patients through limb activation. However, the effects of robot-assisted therapy on perceptual deficits after stroke is unclear.

OBJECTIVE

This review aimed to evaluate the effectiveness of robotic limb activation in patients with unilateral spatial neglect (USN) after stroke.

METHODS

In this systematic review, a literature search was performed using MEDLINE, EMBASE, CENTRAL, CINAHL, and LILACS databases without language restrictions. Randomized controlled trials (RCTs) and quasi-RCTs of robot-assisted therapy for USN after stroke were selected. Two reviewers independently assessed the risk of bias and certainty of the evidence of the included studies.

RESULTS

A total of 630 studies were identified, including five studies for qualitative synthesis and four meta-analyses. The results of RCTs comparing robotic limb activation with a control group suggested an improvement in the degree of USN measured by the line bisection test (standardized mean difference [SMD], -0.64; 95% confidence interval [CI], -1.13 to -0.15; P = .01). There were no differences between the groups in the motor-free visual perception test 3rd edition (SMD, 0.27; 95% CI, -0.25-0.79; P = .31), star cancellation test (SMD, 0.26; 95% CI, -0.42-0.94; P = .54), Albert's test (SMD, -0.67; 95% CI, -2.01-0.66; P = .32), and Catherine Bergego Scale (SMD, -0.81; 95% CI, -2.07-0.45; P = .21).

CONCLUSION

The study demonstrated that limb activation through robotic therapy can improve midline perception. However, there was no impact on tasks assessing visual scanning, functionality, or activities of daily living.