Clinical and laboratory assessment of the effectiveness of early rehabilitation of patients with stroke using assistive robotic tools

Abstract

Background. Using external robotic tools in rehabilitation of patients after stroke could activate neuroplasticity mechanisms, thus reducing the ischemic area and improving the neurological outcome of the disease.Aim. To evaluate the effectiveness of early rehabilitation of stroke patients in Tomsk Regional Stroke Center using assistive robotic tools by correlational analysis of clinical and laboratory biomarkers of brain neuroplasticity.Materials and methods. The study included 68 patients who suffered from stroke of the middle cerebral artery. Early rehabilitation was carried out in Tomsk Regional Stroke Center using assistive robotic tools according to the protocol. Neurotrophic factors in blood serum were measured by the enzyme-linked immunosorbent assay. The severity of neurological disorders was characterized based on the Fugl – Meyer assessment scale (FMA).Results. The clinical effectiveness of early motor rehabilitation in Tomsk Regional Stroke Center is confirmed by the statistically significant increase on the FMA scale by 5.2 ± 2.4 points (p = 0.008). Positive association between neurotrophic factors in blood serum and FMA total score enables to consider the resulting data as an evidence of neuroplasticity activation associated with the use of robotic electromechanical technologies.

Serum BDNF’s Role as a Biomarker for Motor Training in the Context of AR-Based Rehabilitation after Ischemic Stroke

“…During the acute period of stroke, every patient received early rehabilitation within the Tomsk regional vascular center [ 65 ]. Motor rehabilitation was accomplished by using passive–active cyclic robotic electromechanical technologies (Armeo Power Hocoma robotic arm exoskeleton, MOTOmed Viva2 simulator) [ 66 ]. It is therefore probable that an activity-dependent increase in BDNF release occurred during this acute phase, augmenting the still-lowered serum BDNF levels.…”

“…Moreover, we only measured BDNF levels and only after the ischemic stroke incident had occurred. Lower levels of BDNF are correlated with an increased risk of stroke and a poorer prognosis [ 66 , 69 , 77 ], and hence, the premorbid BDNF levels in the patients may have been (somewhat) lower than the levels in the healthy controls.…”