Biomechanical Assessment of Reaching Movements in Post-Stroke Patients During a Robot-Aided Rehabilitation

Mazzoleni, Stefano; Posteraro, Federico; Filippi, Massimo; Forte, F.; Micera, S.; Dario, P.; Carrozza, M.C.

doi:10.1155/2011/298926

Cited by 23 publications

(18 citation statements)

References 20 publications

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“…In most studies only standard clinical instruments (e.g., Fugl-Meyer Assessment Scale, Ashworth Scale) were used as outcome measures and only few studies have analyzed the effects of robotic treatments using kinematic parameters (Colombo et al, 2010) (Mazzoleni et al, 2011). Indeed, improvement in motor impairment after stroke can also result from compensatory adaptations, which often occur adopting abnormal patterns of movement (Beer, Dewald, & Rymer, 2000) in order to accomplish a specific task.…”

Section: Introductionmentioning

confidence: 99%

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

Mazzoleni

Sale

Franceschini

et al. 2013

NRE

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OBJECTIVE:To evaluate the effects of add-on distal upper limb robot-assisted treatment on the outcome of proximal regions. DESIGN: 64 chronic stroke patients divided into two groups participated in the study. Group A was assigned to the proximal robot-assisted rehabilitation, Group B to the proximal and distal. Shoulder/elbow subsection of Fugl-Meyer Assessment scale was collected for Group A, whereas for Group B wrist subsection was also collected. Motricity Index was used and a set of kinematic parameters was computed for both groups. RESULTS: A decrease in impairment after the treatment in both groups of patients (Group A: Shoulder/elbow FM p < 0.001 and MI p < 0.001; Group B: Shoulder/elbow FM p < 0.001 and MI p < 0.001) was found. In the Group B wrist subsection of FM showed an improvement as well (p < 0.001). No difference between groups was found in changes of clinical scales. Movement velocity and accuracy increased after the robot-assisted treatment in both groups; group B showed a greater improvement in velocity. CONCLUSIONS: Robotic treatment is effective to reduce motor impairment in chronic stroke patients even if distal training added to proximal segments in the Group B does not provide any incremental benefit to the proximal segments. It remains unclear if the effectiveness of robot-assisted treatment is directly related to the upper limb segment specifically treated and which order may lead to better outcome.Our study suggests that kinematic parameters should be computed in order to better clarify the role of distal training (wrist) on proximal segments (shoulder/elbow) as well.

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Section: Introductionmentioning

confidence: 99%

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

Mazzoleni

Sale

Franceschini

et al. 2013

NRE

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“…The nPS is a metric used for assessing the smoothness of the movement in stroke patients [24]: low nPS values derive from few accelerations and decelerations, i.e., smooth movement. The nPS is defined as the number of peaks of the resultant velocity: vxyk=vxk2+vyk2.…”

Section: Methodsmentioning

confidence: 99%

“…A recent review by Tran et al [39] associated the kinematic parameters (KPs) to the International Classification of Functioning, Disability and Health (ICF) domains. The KPs have been moderately correlated to clinical outcome measures [15, 20, 24] and their validity and reliability have been established [40–42]. However, the majority of published studies employed KPs for assessing patient's status only at the beginning and at the end of the period of treatment [19–24, 26, 35–37].…”

Section: Introductionmentioning

confidence: 99%

“…The KPs have been moderately correlated to clinical outcome measures [15, 20, 24] and their validity and reliability have been established [40–42]. However, the majority of published studies employed KPs for assessing patient's status only at the beginning and at the end of the period of treatment [19–24, 26, 35–37]. However, robots for rehabilitation register data during each session of RT and thus allow day-to-day tracking of motor performance [16–18].…”

Section: Introductionmentioning

confidence: 99%

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Kinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects

Goffredo

Mazzoleni

Gison

et al. 2019

Applied Bionics and Biomechanics

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Background Upper limb robot-assisted therapy (RT) provides intensive, repetitive, and task-specific treatment, and its efficacy for stroke survivors is well established in literature. Biomechanical data from robotic devices has been widely employed for patient's assessment, but rarely it has been analysed for tracking patient progress during RT. The goal of this retrospective study is to analyse built-in kinematic data registered by a planar end-effector robot for assessing the time course of motor recovery and patient's workspace exploration skills. A comparison of subjects having mild and severe motor impairment has been also conducted. For that purpose, kinematic data recorded by a planar end-effector robot have been processed for investigating how motor performance in executing point-to-point trajectories with different directions changes during RT. Methods Observational retrospective study of 68 subacute stroke patients who conducted 20 daily sessions of upper limb RT with the InMotion 2.0 (Bionik Laboratories, USA): planar point-to-point reaching tasks with an “assist as needed” strategy. The following kinematic parameters (KPs) were computed for each subject and for each point-to-point trajectory executed during RT: movement accuracy, movement speed, number of peak speed, and task completion time. The Wilcoxon signed-rank tests were used with clinical outcomes. the Friedman test and post hoc Conover's test (Bonferroni's correction) were applied to KPs. A secondary data analysis has been conducted by comparing patients having different severities of motor impairment. The level of significance was set at p value < 0.05. Results At the RT onset, the movements were less accurate and smoothed, and showed higher times of execution than those executed at the end of treatment. The analysis of the time course of KPs highlighted that RT seems to improve the motor function mainly in the first sessions of treatment: most KPs show significant intersession differences during the first 5/10 sessions. Afterwards, no further significant variations occurred. The ability to perform movements away from the body and from the hemiparetic side remains more challenging. The results obtained from the data stratification show significant differences between subjects with mild and severe motor impairment. Conclusion Significant improvements in motor performance were registered during the time course of upper limb RT in subacute stroke patients. The outcomes depend on movement direction and motor impairment and pave the way to optimize healthcare resources and to design patient-tailored rehabilitative protocols.

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“…Many devices have been specifically developed for the neuro-rehabilitation of stroke patients, allowing patients to perform specific movements of the limbs. Extensive reviews of robotic devices for upper-limb neuro-rehabilitation have been carried out (Pizzi et al, 2005 ; Turchetti et al, 2014 ): many upper-limb robotic devices have been applied in stroke rehabilitation and their effectiveness has been evaluated at the start and end of treatment by means of widely used clinical assessment scales (Volpe et al, 2000 ; Masiero et al, 2007 ; Mazzoleni et al, 2013a , b ) and sometimes even by measurements performed using robotic systems (Colombo et al, 2005 ; Mazzoleni et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Phase-II Clinical Validation of a Powered Exoskeleton for the Treatment of Elbow Spasticity

et al. 2017

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Introduction: Spasticity is a typical motor disorder in patients affected by stroke. Typically post-stroke rehabilitation consists of repetition of mobilization exercises on impaired limbs, aimed to reduce muscle hypertonia and mitigate spastic reflexes. It is currently strongly debated if the treatment's effectiveness improves with the timeliness of its adoption; in particular, starting intensive rehabilitation as close as possible to the stroke event may counteract the growth and postpone the onset of spasticity. In this paper we present a phase-II clinical validation of a robotic exoskeleton in treating subacute post-stroke patients.Methods: Seventeen post-stroke patients participated in 10 daily rehabilitation sessions using the NEUROExos Elbow Module exoskeleton, each one lasting 45 min: the exercises consisted of isokinetic passive mobilization of the elbow, with torque threshold to detect excessive user's resistance to the movement. We investigated the safety by reporting possible adverse events, such as mechanical, electrical or software failures of the device or injuries or pain experienced by the patient. As regards the efficacy, the Modified Ashworth Scale, was identified as primary outcome measure and the NEEM metrics describing elbow joint resistance to passive extension (i.e., maximum extension torque and zero-torque angle) as secondary outcomes.Results: During the entire duration of the treatments no failures or adverse events for the patients were reported. No statistically significant differences were found in the Modified Ashworth Scale scores, between pre-treatment and post-treatment and between post-treatment and follow-up sessions, indicating the absence of spasticity increase throughout (14 days) and after (3–4 months follow-up) the treatment. Exoskeleton metrics confirmed the absence of significant difference in between pre- and post-treatment data, whereas intra-session data highlighted significant differences in the secondary outcomes, toward a decrease of the subject's joint resistance.Conclusions: The results show that our robotic exoskeleton can be safely used for prolonged sessions in post-stroke and suggest that intensive early rehabilitation treatment may prevent the occurrence of spasticity at a later stage. Moreover, the NEEM metrics were found to be reliable compared to the Modified Ashworth Scale and sensitive to revealing intra-session changes of elbow resistance to passive extension, in agreement with clinical evidences.

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Biomechanical Assessment of Reaching Movements in Post-Stroke Patients During a Robot-Aided Rehabilitation

Cited by 23 publications

References 20 publications

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

Kinematic Parameters for Tracking Patient Progress during Upper Limb Robot-Assisted Rehabilitation: An Observational Study on Subacute Stroke Subjects

Phase-II Clinical Validation of a Powered Exoskeleton for the Treatment of Elbow Spasticity

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