Is Passive Mobilization Robot-Assisted Therapy Effective in Upper Limb Motor Recovery in Patients with Acquired Brain Injury? A Randomized Crossover Trial

Objective: The aim of this study is to determine inter-rater, test–retest and intra-rater reproducibility and responsiveness of subjective assessment of upper limb associated reactions in people with acquired brain injury using (1) the ‘Qualifiers Scale’ of the International Classification of Functioning, Disability and Health Framework, and (2) visually estimated elbow flexion angle during walking. Design: Observational study. Setting: A brain injury rehabilitation centre, Melbourne, Australia. Subjects: People with acquired brain injury and upper limb associated reactions and experienced neurological physiotherapists. Main measures: The Qualifiers Scale applied to individual upper limb joints and global associated reaction on a 5-point scale (0–4), a summed upper limb severity score and visually estimated elbow flexion angle. Results: A total of 42 people with acquired brain injury (mean age: 48.4 ± 16.5 years) were videoed walking at self-selected and fast speeds. A subset of 30 chronic brain injury participants (mean time post injury: 8.2 ± 9.3 years) were reassessed one week later for retest reproducibility. Three experienced neurological physiotherapists (mean experience: 22.7 ± 9.1 years) viewed these videos and subjectively rated the upper limb associated reactions. Strong-to-very strong test–retest, intra- and inter-rater reproducibility was found for elbow flexion angle (ICC > 0.86) and the Qualifiers Scale applied to global and individual upper limb joints (ICC > 0.60). Responsiveness of change from self-selected to fast walking speed (mean increase 0.46 m/s) was highest for elbow flexion angle (effect size = 0.83) and low-to-moderate for the Qualifiers Scale. Conclusion: Subjectively rated associated reactions during walking demonstrated strong reproducibility and moderate responsiveness to speed change. The Qualifiers Scale and elbow flexion angle can both subjectively quantify associated reactions during walking in a clinical setting.

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Upper limb robotic assessment: Pilot study comparing velocity dependent resistance in individuals with acquired brain injury to healthy controls

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/2055668320929535 ◽

2020 ◽

Vol 7 ◽

pp. 205566832092953

Author(s):

Nitin Seth ◽

Denise Johnson ◽

Brian Allen ◽

Hussein A Abdullah

Keyword(s):

Brain Injury ◽

Upper Limb ◽

Sagittal Plane ◽

Acquired Brain Injury ◽

Rehabilitation Robotics ◽

Healthy Controls ◽

Clinical Scales ◽

The Relationship ◽

Further Development ◽

Flexion And Extension

Introduction Assessment of velocity dependent resistance (VDR) can provide insights into spasticity in individuals with upper motor neuron syndrome. This study investigates the relationship between Modified Ashworth scores and a biomechanical based representation of VDR using a rehabilitation robot. Comparisons in VDR are made for the upper limb (UL) between individuals with acquired brain injury and healthy controls for the para-sagittal plane. Methods The system manipulates the individual’s limb through five flexion and extension motions at increasing speeds to obtain force profiles at different velocities. An approximation of VDR is calculated and analyzed statistically against clinical scales and tested for interactions. Results All individuals (aged 18–65), including healthy controls exhibited VDR greater than 0 (P < 0.05). MAS scores were found to be related to VDR (P < 0.05) with an interaction found between MAS Bicep and Tricep scores (P < 0.01). Considering this interaction, evidence of differences in VDR were found between several neighboring assessment score combinations. Conclusion The robot can detect and quantify VDR that captures information relevant to UL spasticity. Results suggests a better categorization of VDR is possible and supports further development of rehabilitation robotics for assisting spasticity assessment.

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