scholarly journals Clinical Interpretation of Working Volume and Weight Support in Upper Limb Robotic Neurorehabilitation after Stroke

2021 ◽  
Vol 11 (24) ◽  
pp. 12123
Author(s):  
Marco Iosa ◽  
Alex Martino Cinnera ◽  
Fioravante Capone ◽  
Alessandro Cruciani ◽  
Matteo Paolucci ◽  
...  
Keyword(s):  
Upper Limb ◽  
Chronic Phase ◽  
Neurological Deficits ◽  
Robotic Rehabilitation ◽  
Robotic Therapy ◽  
Clinical Scores ◽  
Weight Support ◽  
Working Volume ◽  
Complex Relationships ◽  
Two Parameters

In the past two decades, many studies reported the efficacy of upper limb robotic rehabilitation in patients after stroke, also in its chronic phase. Among the possible advantages of robotic therapy over conventional therapy are the objective measurements of kinematic and kinetic parameters during therapy, such as the spatial volume covered by the patient’s upper limb and the weight support provided by the robot. However, the clinical meaning and the usability of this information is still questioned. Forty patients with chronic stroke were enrolled in this study and assessed at the beginning of upper limb robotic therapy (Armeo® Power) and after two weeks (ten sessions) of therapy by recording the working volume and weight support provided by the robot and by administering six clinical scales to assess upper limb mobility, strength, spasticity, pain, neurological deficits, and independency. At baseline, the working volume significantly correlated with spasticity, whereas weight support significantly correlated with upper limb strength, pain, spasticity, and neurological deficits. After two weeks of robotic rehabilitation, all the clinical scores as well as the two parameters improved. However, the percentage changes in the working volume and weight support did not significantly correlate with any of the changes in clinical scores. These results suggest caution in using the robotic parameters as outcome measures because they could follow the general improvement of the patient, but complex relationships with clinical features are possible. Robotic parameters should be analyzed in combination with the clinical scores or other objective measures because they may be informative about therapy progression, and there is a need to combine their clinical, neuroscientific, and biomechanical results to avoid misleading interpretations.

scholarly journals Effects of Home-Based Robotic Therapy Involving the Single-Joint Hybrid Assistive Limb Robotic Suit in the Chronic Phase of Stroke: A Pilot Study

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Koichi Hyakutake ◽  
Takashi Morishita ◽  
Kazuya Saita ◽  
Hiroyuki Fukuda ◽  
Etsuji Shiota ◽  
...  
Keyword(s):  
Upper Limb ◽  
Chronic Phase ◽  
Stroke Patients ◽  
Limb Function ◽  
Robotic Therapy ◽  
Upper Limb Function ◽  
Home Based ◽  
And Function ◽  
Home Based Therapy ◽  
Hybrid Assistive Limb

Introduction. Robotic therapy has drawn attention in the rehabilitation field including home-based rehabilitation. A previous study has reported that home-based therapy could be more effective for increasing upper limb activity than facility-based therapy. The single-joint hybrid assistive limb (HAL-SJ) is an exoskeleton robot developed according to the interactive biofeedback theory, and several studies have shown its effectiveness for upper limb function in stroke patients. A study of home-based robotic therapy has shown to enhance rehabilitation effectiveness for stroke patient with a paretic upper limb. However, home-based therapy involving a HAL-SJ in stroke patients with paretic upper limbs has not been investigated. The present study aimed to investigate paretic upper limb activity and function with home-based robotic therapy involving a HAL-SJ in stroke patients. Materials and Methods. A home-based robotic therapy program involving a HAL-SJ was performed for 30 min per session followed by standard therapy for 30 min per session, 2 times a week, for 4 weeks (i.e., completion of all 8 sessions involved 8 h of rehabilitation), at home. After the intervention, patients were followed up by telephone and home visits for 8 weeks. The paretic upper limb activity and function were assessed using the Motor Activity Log (MAL; amount of use (AOU)), arm triaxial accelerometry (laterality index (LI)), the Fugl–Meyer assessment (FMA), and the action research arm test (ARAT), at baseline and week 4 and week 12 after the start of training. Results. The study included 10 stroke patients (5 men; mean age, 61.1 ± 7.1 years). The AOU scores and LI significantly improved at week 4 after the start of training (p<0.05). However, no significant changes were observed in the LI at week 12 (p=0.161) and the FMA scores at both week 4 and week 12 (p=0.059 and p=0.083, respectively). The ARAT scores significantly improved at both week 4 and week 12 (p<0.05). Conclusion. Home-based robotic therapy combined with conventional therapy could be a valuable approach for increasing paretic upper limb activity and maintaining paretic upper limb function in the chronic phase of stroke.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study

2020 ◽  
pp. 1-11
Author(s):  
Gloria Perini ◽  
Rita Bertoni ◽  
Rune Thorsen ◽  
Ilaria Carpinella ◽  
Tiziana Lencioni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Experimental Treatment ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Arm Rehabilitation ◽  
Point Increase ◽  
Task Oriented

BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upperextremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10 point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.

scholarly journals A comprehensive assessment of cerebellar damage in multiple sclerosis using diffusion tractography and volumetric analysis

2011 ◽  
Vol 17 (9) ◽  
pp. 1079-1087 ◽  
Author(s):  
VM Anderson ◽  
CAM Wheeler-Kingshott ◽  
K Abdel-Aziz ◽  
DH Miller ◽  
A Toosy ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Limb ◽  
Mean Diffusivity ◽  
Volumetric Analysis ◽  
Motor Deficit ◽  
Superior Cerebellar Peduncle ◽  
Radial Diffusivity ◽  
Linear Regression Models ◽  
Clinical Scores ◽  
Cerebellar Peduncle

Background: White matter (WM) and grey matter (GM) brain damage in multiple sclerosis (MS) is widespread, but the extent of cerebellar involvement and impact on disability needs to be clarified. Objective: This study aimed to assess cerebellar WM and GM atrophy and the degree of fibre coherence in the main cerebellar connections, and their contribution to disability in relapsing–remitting MS (RRMS) and primary progressive MS (PPMS). Methods: Fourteen patients with RRMS, 12 patients with PPMS and 16 healthy controls were recruited. Cerebellar WM and GM volumes and tractography-derived measures from the middle and superior cerebellar peduncles, including fractional anisotropy (FA), mean diffusivity (MD), and directional diffusivities, were quantified from magnetic resonance imaging (MRI). Patients were assessed on clinical scores, including the MS Functional Composite score subtests. Linear regression models were used to compare imaging measures between 12 RRMS, 11 PPMS and 16 controls, and investigate their association with clinical scores. Results: Patients with PPMS showed reduced FA and increased radial diffusivity in the middle cerebellar peduncle compared with controls and patients with RRMS. In PPMS, lower cerebellar WM volume was associated with worse performance on the upper limb test. In the same patient group, we found significant relationships between superior cerebellar peduncle FA and upper limb function, and between superior cerebellar peduncle FA, MD and radial diffusivity and speed of walking. Conclusion: These findings indicate reduced fibre coherence in the main cerebellar connections, and link damage in the whole cerebellar WM, and, in particular, in the superior cerebellar peduncle, to motor deficit in PPMS.

scholarly journals Technology for monitoring everyday prosthesis use: a systematic review

2020 ◽  
Author(s):  
Alix Chadwell ◽  
Laura Diment ◽  
Encarna Micó Amigo ◽  
Dafne Zuleima Morgado Ramirez ◽  
Alexander Dickinson ◽  
...  
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Battery Life ◽  
Activity Levels ◽  
Everyday Activity ◽  
Prosthetic Devices ◽  
Clinical Scores ◽  
Standard Clinical Practice ◽  
The Cost

BackgroundUnderstanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring.MethodsA systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis-users during daily-living.Results60 lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm.ConclusionsActivity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user’s requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke

2021 ◽  
Vol 57 (2) ◽  
Author(s):  
Giovanni MORONE ◽  
Angela PALOMBA ◽  
Alex MARTINO CINNERA ◽  
Michela AGOSTINI ◽  
Irene APRILE ◽  
...  
Keyword(s):  
Systematic Review ◽  
Upper Limb ◽  
Robotic Rehabilitation
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