A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES

Abstract

BackgroundTo date, the limited degrees of freedom (DOF) of most robotic training devices hinders them from providing functional training following stroke. We developed a 6-DOF exoskeleton (“BONES”) that allows movement of the upper limb to assist in rehabilitation. The objectives of this pilot study were to evaluate the impact of training with BONES on function of the affected upper limb, and to assess whether multijoint functional robotic training would translate into greater gains in arm function than single joint robotic training also conducted with BONES.MethodsTwenty subjects with mild to moderate chronic stroke participated in this crossover study. Each subject experienced multijoint functional training and single joint training three sessions per week, for four weeks, with the order of presentation randomized. The primary outcome measure was the change in Box and Block Test (BBT). The secondary outcome measures were the changes in Fugl-Meyer Arm Motor Scale (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and quantitative measures of strength and speed of reaching. These measures were assessed at baseline, after each training period, and at a 3-month follow-up evaluation session.ResultsTraining with the robotic exoskeleton resulted in significant improvements in the BBT, FMA, WMFT, MAL, shoulder and elbow strength, and reaching speed (p < 0.05); these improvements were sustained at the 3 month follow-up. When comparing the effect of type of training on the gains obtained, no significant difference was noted between multijoint functional and single joint robotic training programs. However, for the BBT, WMFT and MAL, inequality of carryover effects were noted; subsequent analysis on the change in score between the baseline and first period of training again revealed no difference in the gains obtained between the types of training.ConclusionsTraining with the 6 DOF arm exoskeleton improved motor function after chronic stroke, challenging the idea that robotic therapy is only useful for impairment reduction. The pilot results presented here also suggest that multijoint functional robotic training is not decisively superior to single joint robotic training. This challenges the idea that functionally-oriented games during training is a key element for improving behavioral outcomes.Trial registrationNCT01050231.

Rehabilitation of post stroke patients using a bioengineering system "brain-computer interface + exoskeleton"

“…M. Milot и соавт. [23] считают, что для увеличения эффективности роботизированной терапии необхо-димо одновременное использование виртуальной реальности. Нами роботизированное устройство было использовано в комплексе «ИМК + экзоске-лет», т.е.…”

Restoration of the complicated locomotor functions of the upper extremities in the patients surviving ischemic stroke

“…В наши дни у специалистов отсутствует единое мнение об эффективности роботизированных мето-дик в восстановлении постинсультных двигатель-ных нарушений верхней конечности в сравнении с традиционными [4,14,19,25,26]. Так, V. KlamrothMarganska и соавт.…”

“…[14] и M. Milot и соавт. [26] у больных с постинсультным гемипаре-зом верхней конечности значимых статистических различий по шкале функциональной активности между роботизированными и традиционными заня-тиями не отмечено.…”

The Use of Robotics in Stroke Rehabilitation

“…Thus, the results of my past and current works in rehabilitation robotics of stroke survivors will be presented. For examples, from a previous study with the arm exoqueleton BONES [4], it was shown that a sophisticated multijoint robotic training was not a critical variable of improvement in motor function of the trained limb. It was also suggested that robots, designed to allow training of the full range of motion of the trained limb, could allow a better transfer of training gains to improvement in performance of daily task by stroke survivors.…”