BACKGROUND: Robotic rehabilitation devices for upper limb function (ULF) provide global indicators of a patient's ability, but the temporal evolution of motion related to motor control is disregarded. OBJECTIVE: To determine normative values for indices of accuracy, speed and smoothness in the evaluation of upper limb function. METHODS: Twenty-five healthy individuals performed the Armeo ® Spring device "Vertical Capture" task. Custom stand-alone software was developed to provide the following indices: global Hand Path Ratio (HPR), local HPR in the target area (locHPR), vertical and horizontal overshoot (vertOS, horOS), maximum and mean velocity (maxVel, meanVel), mean/maximum velocity, number of peaks in velocity profiles (NVelPeaks) and normalized jerk (NormJerk). The dependence of indices on task characteristics was analyzed by an ANCOVA test. Indices inner relationships were assessed by a correlation and a factor analysis. Normative values were then provided. RESULTS: 4,268 single reaching movements were analyzed. Four indices were not affected by movement direction. Indices were minimally influenced by the difficulty level. Based upon correlation and factor analysis indices and can be grouped into three assessment fields, dealing with precision, velocity and smoothness. CONCLUSIONS: We have developed a tool to assess ULF in dynamic condition. Normative values were obtained to be used as references in assessing patients.

BackgroundRobotic exoskeletons are increasingly being used in objective and quantitative assessment of upper limb (UL) movements. A set of instrumental indices computed during robot-assisted reaching tasks with the Armeo®Spring has been proven to assess UL functionality. The aim of this study was to test the construct validity of this indices-based UL assessment when used with patients who have had a stroke.MethodsForty-four 45- to 79-year-old stroke patients with a Wolf Motor Function Test ability score (WMFT-FAS) ranging from 10 to 75 and a Motricity Index (MI) ranging from 14 to 33 at shoulder and elbow were enrolled, thus covering a wide range of impairments. Residual UL function was assessed by both the WMFT-FAS and the WMFT-TIME, as well as by a set of 9 numerical indices assessing movement accuracy, velocity and smoothness computed from a 3D endpoint trajectory obtained during the “Vertical Capture” task of the Armeo®Spring device. To explore which variables better represented motor control deficits, the Mann-Whitney U Test was used to compare patients’ indices to those obtained from 25 healthy individuals. To explore the inner relationships between indices and construct validity in assessing accuracy, velocity and smoothness, a factor analysis was carried out. To verify the indices concurrent validity, they were compared to both WMFT-FAS and WMFT-TIME by the Spearman’s correlation coefficient.ResultsSeven indices of stroke subjects were significantly different from those of healthy controls, with effect sizes in the range 0.35–0.74. Factor analysis confirmed that specific subsets of indices belonged to the domains of accuracy, velocity and smoothness (discriminant validity). One accuracy index, both velocity indices and two smoothness indices were significantly correlated with WMFT-FAS and WMFT-TIME (|rho| = 0.31–0.50) (concurrent validity). One index for each of the assessed movement domains was proven to have construct validity (discriminant and concurrent) and was selected. Moreover, the indices were able to detect differences in accuracy, velocity and/or smoothness in patients with the same WMFT level.ConclusionsThe proposed index-based UL assessment can be used to integrate and support clinical evaluation of UL function in stroke patients.

turchEtti 34 , donatella bonaiuti 35 on behalf of italian consensus conference on robotics in neurorehabilitation (cicEronE)1 irccs centro neurolesi bonino-pulejo, Messina, italy; 2 department of Medicine and rehabilitation, polyclinic of Monza, Monzabrianza, italy; 3 spinal cord unit and intensive rehabilitation Medicine, ausl piacenza, Villanova sull'arda and castel san Giovanni, piacenza, italy; 4 Gait and Motion analysis laboratory opa sol et salus, torre pedrera, rimini, italy; 5 department of Experimental and clinical Medicine università politecnica delle Marche (uniVpM), ancona, italy; 6 spinal cord unit, department of rehabilitation Medicine, Gervasutta hospital, udine, italy; 7 azienda sanitaria universitaria friuli centrale (asu-fc), udine, italy; 8 neuromotor and rehabilitation department, laM-Motion analysis laboratory, ausl-irccs reggio Emilia, reggio Emilia, italy; 9 rehabilitation therapeutic center, tramutola, potenza, italy; 10 irccs a. Gemelli university polyclinic foundation, rome, italy; 11 section of neurorehabilitation, department of translational research and new technologies in Medicine and surgery, university of pisa, pisa, italy; 12 Montecatone rehabilitation institute, imola, bologna, italy; 13 unit of neurophysiopathology, ics Maugeri, Montescano institute, pavia, italy; 14 centro protesi Vigorso di budrio, istituto nazionale assicurazione infortuni sul lavoro (inail),

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. as part of the cicEroNE italian consensus on robotic rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with Ms. EVidENcE acQuisitioN: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in Ms, between January 1 st , 2010 and december 31 st , 2020, in the following databases: cochrane library, pEdro, pubMed and Google scholar. the study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (aMstar 2) and the 10-item pEdro scale for the other research studies. EVidENcE syNthEsis: after an accurate screening, only 17 papers were included in the review, and most of them (13 rct) had a level ii evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. however, in more severe patients (Edss >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) Ms patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with Ms. future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.(Cite this article as: calabrò rs, cassio a, Mazzoli d, andrenelli E, bizzarini E, campanini i, et al.; italian consensus conference on robotics in Neurorehabilitation (cicEroNE). What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? a comprehensive systematic review on functional outcomes and clinical recommendations.

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Background Children with cerebral palsy (CP) and acquired brain injury (ABI) often exhibit upper limb impairment, with repercussions in their daily activities. Robotic rehabilitation may promote their functional recovery, but evidence of its effectiveness is often based on qualitative functional scales. The primary aim of the present work was to assess movement precision, velocity, and smoothness using numerical indices from the endpoint trajectory of Armeo®Spring. Secondly, an investigation of the effectiveness of robotic rehabilitation in CP and ABI children was performed. Methods Upper limb functional changes were evaluated in children with CP (N=21) or ABI (N=22) treated with Armeo®Spring (20 45-minute sessions over 4 weeks) using clinical scales and numerical indices computed from the exoskeleton trajectory. Results Functional scales (i.e., QUEST and Melbourne) were sensitive to changes produced by the treatment for the whole study group and for the two etiology-based subgroups (improvements above Minimal Clinically Importance Difference). Significant improvement was also observed in terms of velocity, fluidity, and precision of the movement through the numerical indices of kinematic performance. Differences in the temporal evolution of the motor outcome were highlighted between the ABI and CP subgroups, pointing toward adopting different rehabilitative protocols in these two populations. Conclusions Robot-assisted upper limb rehabilitation seems to be a promising tool to promote and assess rehabilitation in children affected by acquired and congenital brain diseases.

Historical, educational, and technical barriers have been reported to limit the use of surface electromyography (sEMG) in clinical neurorehabilitation settings. In an attempt to identify, review, rank, and interpret potential factors that may play a role in this scenario, we gathered information on ( 1 ) current use of sEMG and its clinical potential; ( 2 ) professional figures primarily dealing with sEMG; ( 3 ) educational aspects, and ( 4 ) possible barriers and reasons for its apparently limited use in neurorehabilitation. To this aim, an online 30-question survey was sent to 52 experts on sEMG from diverse standpoints, backgrounds, and countries. Participants were asked to respond to each question on a 5-point Likert scale or by ranking items. A cut-off of 75% agreement was chosen as the consensus threshold. Thirty-five invitees (67%) completed the electronic survey. Consensus was reached for 77% of the proposed questions encompassing current trends in sEMG use in neurorehabilitation, educational, technical, and methodological features as well as its translational utility for clinicians and patients. Data evidenced the clinical utility of sEMG for patient assessment, to define the intervention plan, and to complement/optimize other methods used to quantify muscle and physical function. The aggregate opinion of the interviewed experts confirmed that sEMG is more frequently employed in technical/methodological than clinical research. Moreover, the slow dissemination of research findings and the lack of education on sEMG seem to prevent prompt transfer into practice. The findings of the present survey may contribute to the ongoing debate on the appropriateness and value of sEMG for neurorehabilitation professionals and its potential translation into clinical settings.

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