Comparison of active-assisted and active-unassisted robot-mediated upper limb therapy in subacute stroke

2020 ◽  
pp. 1-7
Author(s):  
Ophélie Pila ◽  
Typhaine Koeppel ◽  
Anne-Gaëlle Grosmaire ◽  
Christophe DURET
Keyword(s):  
Upper Limb ◽  
Motor Recovery ◽  
Post Treatment ◽  
Group Differences ◽  
Robotic Therapy ◽  
Well Design ◽  
Subacute Stroke ◽  
The Mean ◽  
Working Distance ◽  
Assistive Robotic

Background: Upper-limb robot-mediated therapy is usually carried out in active-assisted mode because it enables performance of many movements. However, assistance may reduce the patient’s own efforts which could limit motor recovery. Objective: The aim of this study was to compare the effects of active-assisted and active-unassisted robotic interactions on motor recovery in subacute stroke patients with moderate hemiparesis. Methods: Fourteen patients underwent a 6-week combined upper limb program of usual therapy and robotic therapy using either the active-unassisted (n = 8) or active-assisted (n = 6) modes. In the active-assisted group, assistance was only provided for the first 3 weeks (1st period) and was then switched off for the remaining 3 weeks (2nd period). The Fugl-Meyer Assessment (FMA) was carried out pre- and post-treatment. The mean number of movements performed and the mean working distance during the 1st and 2nd periods were compared between groups. Results: FMA score improved post-treatment in both groups with no between-group differences: active-assisted group: +8±6 pts vs active-unassisted group: +10±6 pts (ns). Between the 1st and 2nd periods, there was a statistical trend towards an improvement in the number of movements performed (p = 0.06) in the active-unassisted group (526±253 to 783±434, p = 0.06) but not in the active-assisted group (882±211 to 880±297, ns). Another trend of improvement was found for the working distance in the active-unassisted group (8.7±4.5 to 9.9±4.7, p = 0.09) but not in the active-assisted group (14.0±0 to 13.5±1.1, ns). Conclusions: The superiority of the non-assistive over assistive robotic modes has not been demonstrated. However, the non-assistive mode did not appear to reduce motor recovery in this population, despite the performance of fewer movements on shorter working distance compared with the group who had assistance. It seems that the requirement of effort could be a determinant factor for recovery in neurorehabilitation however further well-design studies are needed to fully understand this phenomenon.

scholarly journals Retrospective Robot-Measured Upper Limb Kinematic Data From Stroke Patients Are Novel Biomarkers

2021 ◽  
Vol 12 ◽  
Author(s):  
Michela Goffredo ◽  
Sanaz Pournajaf ◽  
Stefania Proietti ◽  
Annalisa Gison ◽  
Federico Posteraro ◽  
...  
Keyword(s):  
Upper Limb ◽  
External Rotation ◽  
Predictive Biomarkers ◽  
Motor Recovery ◽  
Post Treatment ◽  
Kinematic Parameters ◽  
Kinematic Data ◽  
Subacute Stroke ◽  
Flexion Extension ◽  
Pre Treatment

Background: The efficacy of upper-limb Robot-assisted Therapy (ulRT) in stroke subjects is well-established. The robot-measured kinematic data can assess the biomechanical changes induced by ulRT and the progress of patient over time. However, literature on the analysis of pre-treatment kinematic parameters as predictive biomarkers of upper limb recovery is limited.Objective: The aim of this study was to calculate pre-treatment kinematic parameters from point-to-point reaching movements in different directions and to identify biomarkers of upper-limb motor recovery in subacute stroke subjects after ulRT.Methods: An observational retrospective study was conducted on 66 subacute stroke subjects who underwent ulRT with an end-effector robot. Kinematic parameters were calculated from the robot-measured trajectories during movements in different directions. A Generalized Linear Model (GLM) was applied considering the post-treatment Upper Limb Motricity Index and the kinematic parameters (from demanding directions of movement) as dependent variables, and the pre-treatment kinematic parameters as independent variables.Results: A subset of kinematic parameters significantly predicted the motor impairment after ulRT: the accuracy in adduction and internal rotation movements of the shoulder was the major predictor of post-treatment Upper Limb Motricity Index. The post-treatment kinematic parameters of the most demanding directions of movement significantly depended on the ability to execute elbow flexion-extension and abduction and external rotation movements of the shoulder at baseline.Conclusions: The multidirectional analysis of robot-measured kinematic data predicts motor recovery in subacute stroke survivors and paves the way in identifying subjects who may benefit more from ulRT.

Motor Recovery of the Ipsilesional Upper Limb in Subacute Stroke

2013 ◽  
Vol 94 (11) ◽  
pp. 2283-2290 ◽  
Author(s):  
Julien Metrot ◽  
Jerome Froger ◽  
Isabelle Hauret ◽  
Denis Mottet ◽  
Liesjet van Dokkum ◽  
...  
Keyword(s):  
Upper Limb ◽  
Motor Recovery ◽  
Subacute Stroke

scholarly journals Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study

2021 ◽  
Vol 11 (3) ◽  
pp. 290
Author(s):  
Mauro Mancuso ◽  
Serena Di Tondo ◽  
Enza Costantini ◽  
Alessio Damora ◽  
Patrizio Sale ◽  
...  
Keyword(s):  
Upper Limb ◽  
Action Observation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Recovery ◽  
Control Group ◽  
Stroke Patients ◽  
Rehabilitative Treatment ◽  
Subacute Stroke ◽  
The Moment

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T0) and at the end of treatment (T1). No statistical differences were found at T0 for inclusion criteria between the CG and EG, whereas both groups improved significantly at T1. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients.

scholarly journals Influence of Cognitive Impairment on the Recovery of Subjects with Subacute Stroke Undergoing Upper Limb Robotic Rehabilitation

2021 ◽  
Vol 11 (5) ◽  
pp. 587
Author(s):  
Irene Aprile ◽  
Giulia Guardati ◽  
Valeria Cipollini ◽  
Dionysia Papadopoulou ◽  
Serena Monteleone ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Spatial Attention ◽  
Upper Limb ◽  
Motor Recovery ◽  
Robotic Rehabilitation ◽  
Upper Limb Rehabilitation ◽  
Rehabilitation Intervention ◽  
Subacute Stroke ◽  
Cognitive Screen ◽  
Limb Rehabilitation

Cognitive decline is often present in stroke survivors, with a significant impact on motor recovery. However, how specific cognitive domains could impact motor recovery after robotic rehabilitation in patients with stroke is still not well understood. In this study, we analyzed the relationship between cognitive impairment and the outcome of a robot-mediated upper limb rehabilitation intervention in a sample of 51 subacute stroke patients. Participants were enrolled and treated with a set of robotic and sensor-based devices. Before the intervention, patients underwent a cognitive assessment by means of the Oxford Cognitive Screen. To assess the effect of the 30-session rehabilitation intervention, patients were assessed twice with the following outcome measures: the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), to evaluate motor function; the Upper limb Motricity Index (MI), to evaluate upper limb muscle strength; the Modified Barthel Index (mBI), to evaluate activities of daily living and mobility. We found that deficits in spatial attention and executive functions impacted the mBI improvement, while language, number processing, and spatial attention deficits reduced the gains in the FMA-UE. These results suggest the importance to evaluate the cognitive functions using an adequate tool in patients with stroke undergoing a robotic rehabilitation intervention.

scholarly journals Use of a Robotic Device for the Rehabilitation of Severe Upper Limb Paresis in Subacute Stroke: Exploration of Patient/Robot Interactions and the Motor Recovery Process

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Christophe Duret ◽  
Ophélie Courtial ◽  
Anne-Gaëlle Grosmaire ◽  
Emilie Hutin
Keyword(s):  
Upper Limb ◽  
Recovery Process ◽  
Motor Recovery ◽  
Interaction Parameters ◽  
Robotic Device ◽  
Robot Interaction ◽  
Movement Velocity ◽  
Subacute Stroke ◽  
Novel Approach ◽  
Upper Limb Paresis

This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age55±17years; time since stroke,52±21days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8(P=0.003), while Guidance decreased at S12(P=0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%,P=0.002). Changes in FMA score were correlated with the Stiffness parameter (R=0.4,P=0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process.

scholarly journals Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5544 ◽  
Author(s):  
Eduardo Palermo ◽  
Darren Richard Hayes ◽  
Emanuele Francesco Russo ◽  
Rocco Salvatore Calabrò ◽  
Alessandra Pacilli ◽  
...  
Keyword(s):  
Upper Limb ◽  
Effective Means ◽  
Post Treatment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Optoelectronic System ◽  
Clinical Scales ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Kinematic Assessment

Robot-mediated therapies enhance the recovery of post-stroke patients with motor deficits. Repetitive and repeatable exercises are essential for rehabilitation following brain damage or other disorders that impact the central nervous system, as plasticity permits to reorganize its neural structure, fostering motor relearning. Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots. In this paper, we report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients’ 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment. Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment.

Sign in / Sign up

Export Citation Format

Share Document