Exercises for paretic upper limb after stroke: A combined virtual-reality and telemedicine approach (original) (raw)
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Applied Sciences, 2019
Robot-aided systems to support the physical rehabilitation of individuals with neurological impairment is one of the fields that has been widely developed in the last few decades. However, the adoption of these systems in clinical practice remains limited. In order to better understanding the causes of this limitation, a systematic review of robot-based systems focused on upper extremity rehabilitation is presented in this paper. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the type of device, the data analysis capability, the therapy method, the human–robot interaction, the safety strategies, and the focus of treatment. As a conclusion, self-adaptation for personalizing the treatments, safeguarding and enhancing of patient–robot interaction towards training essential factors of movement generation into the same paradigm, or the use of lifelike environments in fully-immersive virtual reality for incr...
Robotic-assisted rehabilitation of the upper limb after acute stroke
Archives of physical medicine …, 2007
Objective: To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb. Design: A single-blind randomized controlled trial, with an 8-month follow-up. Setting: Neurologic department and rehabilitation hospital. Participants: Thirty-five patients with acute (Յ1wk of onset), unilateral, ischemic embolic, or thrombotic stroke. Interventions: Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (nϭ17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (nϭ18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli. Main Outcome Measures: The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS). Results: Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (PՅ.05) and biceps (PϽ.05) scores, the FMA for the proximal upper arm (PϽ.05), the FIM instrument (PϽ.05), and the FIM motor score (PϽ.01); these gains were also sustained at the 3-and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted. Conclusions: Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb.
The Journal of Rehabilitation Research and Development, 2011
This randomized, controlled, multisite Department of Veterans Affairs clinical trial assessed robot-assisted (RA) upper-limb therapy with the Mirror Image Movement Enabler (MIME) in the acute stroke rehabilitation setting. Hemiparetic subjects (n = 54) received RA therapy using MIME for either up to 15 hours (low-dose) or 30 hours (high-dose) or received up to 15 hours of additional conventional therapy in addition to usual care (control). The primary outcome measure was the Fugl-Meyer Assessment (FMA). The secondary outcome measures were the Functional Independence Measure (FIM), Wolf Motor Function Test, Motor Power, and Ashworth scores at intake, discharge, and 6-month follow-up. Mean duration of study treatment was 8.6, 15.8, and 9.4 hours for the low-dose, high-dose, and control groups, respectively. Gains in the primary outcome measure were not significantly different between groups at follow-up. Significant correlations were found at discharge between FMA gains and the dose and intensity of RA. Intensity also correlated with FMA gain at 6 months. The high-dose group had greater FIM gains than controls at discharge and greater tone but no difference in FIM changes compared with low-dose subjects at 6 months. As used during acute rehabilitation, motor-control changes at follow-up were no less with MIME than with additional conventional therapy. Intensity of training with MIME was positively correlated with motor-control gains.
Robotic therapy for chronic motor impairments after stroke: follow-up results
Archives of Physical Medicine and Rehabilitation, 2004
Objectives: To study the effects of robotic rehabilitation in persons with chronic motor impairments after stroke and to examine whether improvements in motor abilities were sustained 4 months after the end of therapy. Design: Pretest-posttest design. Setting: Rehabilitation hospital, outpatient care. Participants: Volunteer sample of 42 persons with persistent hemiparesis from a single, unilateral stroke within the past 1 to 5 years. Intervention: Robotic therapy for the paretic upper limb consisted of either sensorimotor active-assistive exercise, or progressive-resistive training during repetitive, planar reaching tasks, 3 times a week for 6 weeks. Main Outcome Measures: Modified Ashworth Scale, Fugl-Meyer Assessment (FMA), Motor Status Scale (MSS) score, and Medical Research Council motor power score. Results: No significant differences were found among pretreatment clinical evaluations. Statistically significant gains from admission to discharge and from admission to follow-up (PϽ.05) were found on the FMA, MSS score for shoulder and elbow, and motor power score. Conclusions: Short-term, goal-directed robotic therapy can significantly improve motor abilities of the exercised limb segments in persons with chronic stroke that are sustained 4 months after discharge. This suggests that motor recovery can be enhanced by repetitive exercise training more than 1 year after stroke.