Search Results (13)

Background: The present study aimed to determine whether the protocolized use of pneumatic splints within neurodevelopmental therapeutic approaches produces a positive effect on sensorimotor impairments of the hemiplegic upper extremity in patients. Methods: A randomized clinical single-blind trial was conducted. Stroke patients were recruited and randomized into an experimental group, which completed a treatment protocol of splinting plus physiotherapy for 45 min per session, two sessions per week for four weeks; or a control group, which received the same type of conventional physiotherapy treatment for the same period of time. The patients were evaluated by Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and the Trunk Control Scale. Secondary variables were Mini-BEStest, the modified Ashworth scale for ankle flexors, and computerized measurements of upper limb functional parameters performed by Armeo Spring^® robotic systems and Amadeo^®. All variables were measured pre- and post-treatment. Results: Twenty stroke patients with subacute and chronic stroke completed the protocol. Mann–Whitney U tests showed statistically significant differences between groups for the FM sensation variable (Z = −2.19; p = 0.03). The rest of the variables studied in the comparison between the two study groups did not present statistically significant differences (p > 0.05). Conclusions: The use of air splints in combination with physiotherapy treatment produced improvements in exteroceptive and proprioceptive sensitivity in post-stroke adult patients in the subacute and chronic phases. Full article

(1) Background: The influence of robotic therapy on patients with sub-acute cervical spinal cord injury (SCI) for improving their activities of daily living (ADL) performance is unclear; (2) Methods: 31 subjects with cervical SCI completed the training randomly assigned to an intervention or control group during 40 sessions. All the subjects received, in each session, 30 min of upper-extremity conventional therapy. In addition, the subjects within the control group received another 30 min of conventional therapy, whereas subjects within the intervention group received 30 min of robotic therapy with Armeo Spring (Hocoma AG, Volketswil, Switzerland). Therefore, the ADL of drinking was trained by using the exoskeleton. Feasibility and efficacy measurements as clinical scales and kinematic indices, and usability questionnaires, were used as assessment at baseline and at the ending of the study (week 10); (3) Results: The intervention group significantly improved with regards to the feeding and grooming items of the Spinal Cord Independence Measure scale. The improvement in the movement smoothness related to the activity of drinking was greater in the intervention group than in the control (p = 0.034); (4) Conclusions: The findings of this study reveal that patients with cervical SCI improve their performance in ADL with robotic therapy. Full article

In the neurorehabilitation field, robot-aided motion analysis (R-AMA) could be helpful for two main reasons: (1) it allows the registration and monitoring of patients’ motion parameters in a more accurate way than clinical scales (clinical purpose), and (2) the multitude of data produced using R-AMA can be used to build machine learning algorithms, detecting prognostic and predictive factors for better motor outcomes (research purpose). Despite their potential in clinical settings, robotic assessment tools have not gained widespread clinical acceptance. Some barriers remain to their clinical adoption, such as their reliability and validity compared to the existing standardized scales. In this narrative review, we sought to investigate the usefulness of R-AMA systems in patients affected by neurological disorders. We found that the most used R-AMA tools are the Lokomat (an exoskeleton device used for gait and balance rehabilitation) and the Armeo (both Power and Spring, used for the rehabilitation of upper limb impairment). The motion analysis provided by these robotic devices was used to tailor rehabilitation sessions based on the objective quantification of patients’ functional abilities. Spinal cord injury and stroke patients were the most investigated individuals with these common exoskeletons. Research on the use of robotics as an assessment tool should be fostered, taking into account the biomechanical parameters able to predict the accuracy of movements. Full article

(1) Improving upper limb function is essential for people with tetraplegia. Although promising, technology-assisted upper limb training is understudied in this population. This article describes its implementation in a Swiss spinal cord injury rehabilitation centre and reports on the observed changes. (2) A retrospective evaluation of clinical data from January 2018 to June 2020 examined patient characteristics, training parameters, goal-setting practices, goal achievement, and changes in muscle strength over the course of technology-assisted upper limb training. (3) Data analysis included 61 individuals, 68.9% of whom had a spinal cord injury. The ArmeoSpring was the most frequently used device. The typical treatment regimen was three 25 min sessions per week, with evaluations approximately every six weeks. The 1:1 sessions, delivered by specialised staff, focused primarily on improving shoulder movement and the ability to eat and drink. Functional goals were set using a grid. Performance on selected goals in the areas of ‘body functions’ and ‘activities & participation’ as well as muscle strength, increased over the course of training. (4) The ArmeoSpring has broad applicability. Despite the observed improvements, the isolated effect of technology-assisted upper limb training cannot be concluded due to the lack of a control group and various concurrent interventions. Full article

The use of robotics in rehabilitating motor functions has increased exponentially in recent decades. One of the most used robotic tools is undoubtedly the Armeo^® Power, which has proved to have excellent qualities as a rehabilitation tool. However, none of these studies has investigated the ability of Armeo^® Power to assess the upper limb by correlating the data resulting from the software with patient-reported outcome measures (PROMs). The present study aims to evaluate the variability between the standardized PROMs, Stroke Upper Limb Capacity Scale (SULCS), Fugl–Meyer upper limb assessment (FMA-UL), and the Armeo^® Power measurements. To evaluate the correlation between SULCS and FMA-UL and the strength and joint assessments obtained with the Armeo^® Power, Pearson’s correlation coefficient was used. A total of 102 stroke survivors were included in this cross-sectional study, and all participants finished the study. The results showed many statistically significant correlations between PROM items and Armeo^® Power data. In conclusion, from this study, it can be stated that Armeo^® Power, based on the analysis of the data collected, can be an objective evaluation tool, which can be combined with the operator-employee traditional evaluation techniques, especially when compared to a patient-reported outcome measures (PROMs). Full article

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients’ characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo^®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368. Full article

Background: Rehabilitation robotics is a field of study which aims to understand and augment rehabilitation through the use of robotics devices. Objective: This proof of concept study aimed to test the safety (no. adverse events, incidence of infection), feasibility (program demand, adherence, participant satisfaction) and efficacy (Peak Oxygen uptake (VO_2peak), 6-min walk test, gait speeds, Canadian Occupational Performance Measure, quality of life) of Lokomat^® and Armeo^®Spring training in children and adolescents and young adults (AYAs) during or soon after cancer treatment. Method: This was a 6-week single arm pre-post study. Cancer patients with significant musculoskeletal, neurological, gait and/or upper limb deficiency aged 5 to 25 years were recruited. The rehabilitation program included access to two robotic orthoses: the Lokomat^® and/or Armeo^®Spring. Robotic devices utilised real-time biofeedback and computer games to engage and guide participants through a repetitive functional range of movement aimed at improving functional deficiencies. Progressive increases in exercise intensity and duration were encouraged. Results: Twentey-eight participants were approached for study; twenty-one consented. Seventy-six percent completed the six-week intervention with an overall adherence of 83%. The mean participant satisfaction score was 8.8/10. Forty-nine adverse events were recorded throughout the course of the study, forty-five grade 1, three grade 2 and one grade 3. No adverse events led to withdrawal from the study. Preliminary efficacy results indicate large beneficial effects on VO_2peak (r = 0.63), 10 m comfortable pace walk (r = 0.51) and maximal pace walk (r = 0.60), 6-min walk test (r = 0.60), maximal back and leg strength (r = 0.71), trunk flexibility (r = 0.60), The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30) (r = 0.61), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT F) r = 0.53 and the Canadian Occupational Performance Measure, satisfaction (r = 0.88) and performance scores (r = 0.83), and moderate beneficial effects on Leisure Score Index (LSI) (r = 0.30). Conclusion: Our results suggest that Lokomat^® and Armeo^®Spring training is safe and feasible for use in children and AYAs who are currently undergoing or have recently completed cancer therapy. A larger controlled trial investigating the efficacy of robotics rehabilitation in this cohort is warranted. Full article

The study’s aim is to analyze the improved hand function and bimanual performance with unilateral cerebral palsy (CP) from repeat doses of an augmented, group-based pediatric constraint-induced movement therapy (pCIMT) camp. Fifteen children with unilateral CP (ages 5–15 years, 9 male, 6 female, Manual Abilities Classification System (MACS) I = 3, MACS II = 11, and MACS III = 1) participated in two sessions of an annual pCIMT camp. Participants attended 10 days of camp where they received group-based training wearing a constraint for a total of 50 h, received bilateral, occupation-based activities for 10 h (60 h total) including 30 min each day on the Hocoma Armeo^®Spring. The Assisting Hand Assessment (AHA) was administered pre-intervention and post-intervention. Our results discovered a mean interval dose 1 and 2 was 511 days. Dose 1 mean AHA score at baseline was 55.93 ± 12.78 and 63.07 ± 12.85 at post. Dose 2 mean AHA score as 58.13 ± 14.83 and post 66.53 ± 12.82. In conclusion, there was an overall significant bimanual functional improvement based on AHA scores that indicate, regardless of which camp session, scores improved from pre-intervention to post-intervention. There was a generalized upward trend in improved hand function of a group-based pCIMT, and diminished effects between doses were reversed with repeat doses. Full article

Almost half of stroke patients report impaired function of the upper limb and hand. Stability of the trunk is required for the proper movement of the body, including the legs and arms. The aim of the study was to analyze the effect of trunk stabilization exercises on coordinated movement of the affected upper limb in patients after stroke, using an Armoe^®Spring device and the “wall” and “abacus” functional tests. Materials and methods: This is a randomized, double-blinded study. The research was carried out in the Rehabilitation Clinic on a group of 60 stroke patients who were randomly assigned to groups differing in the rehabilitation program. The study group had physiotherapy based on the NDT Bobath concept and the control group used classic exercises. The importance of the trunk for upper limb coordination was assessed on the Armeo^®Spring device using three evaluation programs, “perpendicular fishing”; “horizontal fishing”; “reaction time”, and two proprietary tests, “wall” and “abacus”. Results: The post-treatment analysis showed significantly better results in the study group for the abacus (p < 0.001), wall (p = 0.003) tests, and a significantly higher percentage of task completion in the vertical fishing (p = 0.036) and reaction time (p = 0.009) tests. Conclusions: Physiotherapy including exercises to stabilize the trunk had a significant effect on increasing the functional efficiency of the affected upper limb and on improving the handgrip strength. The Armeo^®Spring device is a good device for the functional assessment of the upper limb before and after therapy. Full article

Hand movements are particularly impaired in patients with Parkinson’s Disease (PD), contributing to functional disability and difficulties in activities of daily living. Growing evidence has shown that robot-assisted therapy may be considered an effective and reliable method for the delivery of the highly repetitive training that is needed to trigger neuroplasticity, as intensive, repetitive and task-oriented training could be an ideal strategy to facilitate the relearning of motor function and to minimize motor deficit. The purpose of this study is to evaluate the improvement of hand function with semi-autonomous exercises using an upper extremity exoskeleton in patients with PD. A multicenter, parallel-group, randomized clinical trial was then carried out at the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy). Thirty subjects with a diagnosis of PD and a Hoehn–Yahr score between 2 and 3 were enrolled in the study. Patients were 1:1 randomized into either the experimental group (ERT), receiving 45 min training daily, 6 days weekly, for 8 weeks with Armeo^®Spring (Volketswil, Switzerland) (a gravity-supporting device), or the control group (CPT), which was subjected to the same amount of conventional physical therapy. Motor abilities were assessed before and after the end of the training. The main outcomes measures were the Nine-hole peg test and the motor section of the UPDRS. All patients belonging to ERT and 9 out of 15 patients belonging to the CPT completed the trial. ERT showed a greater improvement in the primary outcome measure (nine-hole peg test) than CPT. Moreover, a statistically significant improvement was found in ERT concerning upper limb mobility, and disease burden as compared to CPT. Using an upper extremity exoskeleton (i.e., the Armeo^®Spring) for semi-autonomous training in an inpatient setting is a new perspective to train patients with PD to improve their dexterity, executive function and, potentially, quality of life. Full article

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. Full article

Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level. Full article