Posts Tagged Amadeo
[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.
The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.
50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.
The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).
These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.
These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.
[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial
- Robotic hand training can be helpful in improving hand motor recovery.
- Amadeo™ induces large modulations of sensorimotor rhythms and connectivity.
- Robotic training yields improvement of hand motor performance by restoring hand motor control.
[Abstract] The effect of robot therapy assisted by surface EMG on hand recovery in post-stroke patients. A pilot study
Neurorehabilitation of patients with upper limb motor dysfunction due to central nervous system damage still lacks adequate standardization. During the last decade, robot- and device-assisted rehabilitation has become more feasible for the treatment of functional disorders of the upper limb after stroke. Here we present an overview of technological aspects and differential use of devices for upper limb rehabilitation as well as a review of relevant clinical studies. We also discuss the potential for standardized evaluation in the context of limited health care resources. The effectiveness of device-assisted therapy, in comparison to conventional approaches, remains a matter of debate, largely due to the heterogeneous design of the available clinical studies. However, we believe that a better understanding of the timing, intensity, and quality of upper limb rehabilitation, as well as technological progress, will lead to the establishment of a central role for robot- and device-assisted rehabilitation in the next decade.
Improvement of the functionality of the upper limb after an injury to the central nervous system (CNS) is one of the most important tasks of neurorehabilitation. Stroke is the leading cause of upper limb disability, with a range of complex functional upper limb impairments occurring in approximately 50 to 70 percent of cases . In addition, these patients commonly exhibit sensory-motor deficits of the lower extremity, speech impairment, visual defects, and cognitive deficits during the acute phase. Even limited dysfunction of the upper extremity can result in significant limitations of daily activities and quality of life . The probability of regaining sufficient hand function, i. e., grasping adequate for performance of everyday activities, in the presence of a pronounced functional disorder due to a distal paresis or hand paralysis, is at most 20 percent . Effective therapy of the upper limb is therefore a crucial component of neurorehabilitation.
In recent years, neurorehabilitative therapy for motor deficits has focused on task-specific training, comprising repetitive, context-specific exercises. In addition, introduction of “shaping” exercises at the individual patient’s limits of motion, as well as active or passive repetitive activities to reinforce motor learning, should be considered essential foundations of rehabilitative therapy.
A uniform standard of therapy for upper extremity sensorimotor deficits is not currently in place, and individual variation in deficits renders such a standardization unlikely. Based on 109 publications, the guidelines of the German Society for Neurorehabilitation (Deutsche Gesellschaft für Neurorehabilitation), “Rehabilitative Therapy of Arm Paresis after Stroke” published in 2009  provide recommendations regarding the timing, duration, and intensity of therapy. The highest levels (A and B) of recommended therapy contain subgroups of repetitive exercises for gripping and releasing to treat paresis of the hand with partially retained proximal motor function. These include damage-oriented training for arm capacity, basic arm training, constraint-induced movement therapy, mirror therapy, and mental training, as well as neuromuscular electrostimulation (NMES). Robotics-supported upper limb therapy provides a potential adjunct, particularly for those unable to perform the therapeutic motions independently, and is classified as recommendation level B (therapy that should be carried out), i. e., offering average efficacy with a medium to high degree of supporting evidence, based on studies of device-supported therapy focusing on stereotypical movements, without specific task-oriented exercises.
Despite considerable growth in recent years in the number of studies investigating the efficacy of robot-assisted interventions in improving arm function and daily activity performance, the methodological heterogeneity of the studies has led to the conclusion in recent Cochrane meta-analyses that the evidence remains limited  . Nonetheless, a systematic review and meta-analysis this year suggested there may be improvement in motor control and muscle strength .
In the next sections, we provide an overview of the current state of technological developments as well as clinical applications. […]
The AMADEO is the latest in a long row of clinically tried and tested robotic- and computer-assisted therapy devices for fingers and hands. The new design and the specially developed tyroS software make the AMADEO more flexible and offer an expanded spectrum of therapy options.