Posts Tagged robotic-assisted therapy
[Abstract] Effectiveness of a single session of dual-transcranial direct current stimulation in combination with upper limb robotic-assisted rehabilitation in chronic stroke patients: a randomized, double-blind, cross-over study
The impact of transcranial direct current stimulation (tDCS) is controversial in the neurorehabilitation literature. It has been suggested that tDCS should be combined with other therapy to improve their efficacy.
To assess the effectiveness of a single session of upper limb robotic-assisted therapy (RAT) combined with real or sham-tDCS in chronic stroke patients. Twenty-one hemiparetic chronic stroke patients were included in a randomized, controlled, cross-over double-blind study.
Each patient underwent two sessions 7 days apart in a randomized order: (a) 20 min of real dual-tDCS associated with RAT (REAL+RAT) and (b) 20 min of sham dual-tDCS associated with RAT (SHAM+RAT). Patient dexterity (Box and Block and Purdue Pegboard tests) and upper limb kinematics were evaluated before and just after each intervention. The assistance provided by the robot during the intervention was also recorded. Gross manual dexterity (1.8±0.7 blocks, P=0.008) and straightness of movement (0.01±0.03, P<0.05) improved slightly after REAL+RAT compared with before the intervention. There was no improvement after SHAM+RAT. The post-hoc analyses did not indicate any difference between interventions: REAL+RAT and SHAM+RAT (P>0.05). The assistance provided by the robot was similar during both interventions (P>0.05).
The results showed a slight improvement in hand dexterity and arm movement after the REAL+RAT tDCS intervention. The observed effect after a single session was small and not clinically relevant. Repetitive sessions could increase the benefits of this combined approach.
[Conference paper] Robotic Upper Limb Rehabilitation Using Armeo®Spring for Chronic Stroke Patients at University Malaya Medical Centre (UMMC) – Abstract+References
This is a retrospective study of patients with chronic partial arm paresis post stroke who attended neurorehabilitation at University Malaya Medical Centre, Malaysia. In this study we aimed to analyze the clinical and practical outcome of robotic-assisted upper limb rehabilitation. Specifically, we analyzed the impact of therapy on motor and function of chronic stroke arm paresis through structured therapy protocol. We extended our analysis towards user acceptance in robotic-assisted rehabilitation. We applied our Armeo®Spring Therapy Protocol on stroke patients with unilateral partial upper limb paresis of more than six months duration. The outcome measures were muscle strength, spasticity and hand dexterity. Thirty three patients who fulfilled the criteria of treatment protocol attended outpatient therapy session. Fourteen patients completed the treatment protocol in which ten participants were stroke patients. This study reported statistically significant improvement in multiple joint range of motions following therapy. Although there was non progressing arm spasticity, and improved paretic hand dexterity, both latter outcomes were not statistically significant at the end of therapy.
4.Colombo, R., Sterpi, I., Mazzone, A., Delconte, C., Pisano, F.: Robot aided neurorehabilitation in sub-acute and chronic stroke: does spontaneous recovery have limited impact on outcome? NeuroRehabilitation 33, 621–629 (2013)Google Scholar
7.Desrosiers, J., Bravo, G., Hébert, R., Dutil, E., Mercier, L.: Validation of the box and block test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch. Phys. Med. Rehabil. 75, 751–755 (1994)Google Scholar
8.Hocoma Armeo®Therapy Concept: http://www.stargen-eu.cz/wp-content/uploads/2015/04/Hocoma_Armeo_BRO_Armeo_Therapy_Concept_120420_en.pdf
[Conference Paper Abstract] Effectiveness of dual-tDCS in combination with upper limb robotic-assisted rehabilitation: a randomised, double-blind, cross-over study
Background: The impact of transcranial Direct Current Stimulation (tDCS) is controversial in the neurorehabilitation literature. It has been suggested that tDCS should be combined with other therapy to improve their efficacy.
Aim: To assess the effectiveness of upper limb robotic-assisted therapy (RAT) combined with real or sham-tDCS in chronic stroke patients.
Methods: Twenty-one hemiparetic stroke patients were included in a randomised, controlled, double-blind, cross-over study. Each patient underwent two therapy sessions seven days apart in a randomised order: (1) 20 minutes of real dual-tDCS associated with RAT (REAL+RAT) and (2) 20 minutes of sham dual-tDCS associated with RAT (SHAM+RAT). Patient dexterity (Box & Block and Purdue Pegboard tests) and upper limb kinematics were evaluated before and just after each intervention. The assistance provided by the robot during the intervention was also recorded.
Results: Gross manual dexterity (1.8 +/- 0.7 blocks, p=0.008) and straightness of movement (0.01 +/- 0.03, p<0.05) improved slightly after REAL+RAT compare to before the intervention. There was no improvement after SHAM+RAT. The post-hoc analyses did not objectify difference between interventions: REAL+RAT and SHAM+RAT (p>0.05). The assistance provided by the robot was similar during the two interventions (p>0.05).
Conclusion: The results demonstrated a slight improvement in hand dexterity and arm movement after the REAL+RAT tDCS intervention. The observed effect after one session was small and not clinically relevant, but repetitive sessions could increase the benefits of this combined approach.
[ARTICLE] Incorporating Robotic-Assisted Telerehabilitation in a Home Program to Improve Arm Function Following Stroke – Full Text HTML
Background and Purpose: After stroke, many individuals lack resources to receive the intensive rehabilitation that is thought to improve upper extremity motor function. This case study describes the application of a telerehabilitation intervention using a portable robotic device combined with a home exercise program (HEP) designed to improve upper extremity function.
Case Description: The participant was a 54-year-old man, 22 weeks following right medullary pyramidal ischemic infarct. At baseline, he exhibited residual paresis of the left upper extremity, resulting in impaired motor control consistent with a flexion synergistic pattern, scoring 22 of 66 on the Fugl-Meyer Assessment.
Intervention: The participant completed 85 total hours of training (38 hours of robotic device and 47 hours of HEP) over the 8-week intervention period.
Outcomes: The participant demonstrated an improvement of 26 points on the Action Research Arm Test, 5 points on the Functional Ability Scale portion of the Wolf Motor Function Test, and 20 points on the Fugl-Meyer Assessment, all of which surpassed the minimal clinically important difference. Of the 17 tasks of the Wolf Motor Function Test, he demonstrated improvement on 11 of the 15 time-based tasks and both strength measures. The participant reported an overall improvement in his recovery from stroke on the Stroke Impact Scale quality-of-life questionnaire from 40 of 100 to 65 of 100. His score on the Center for Epidemiologic Studies Depression Scale improved by 19 points.
Discussion: This case demonstrates that robotic-assisted therapy paired with an HEP can be successfully delivered within a home environment to a person with stroke. Robotic-assisted therapy may be a feasible and efficacious adjunct to an HEP program to elicit substantial improvements in upper extremity motor function, especially in those persons with stroke who lack access to stroke rehabilitation centers.
Video Abstract available (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A52) for more insights from the authors.