Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke

Abstract

This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients' group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 0-66 points), Modified Ashworth scale (MA, 0-60 pts) and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion) and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA) parameters, as a result of the increased active ranges of motion and improved cocontraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement) and position of target to be reached (ipsilateral, central and contralateral peripersonal space). These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow and shoulder joints.

Tongue-controlled robotic rehabilitation: A feasibility study in people with stroke

“…Thus, capturing this objective motor improvement gives insight into the return of UL functioning that was previously lost. Improvements in AROM and PROM were also observed for participants 2 and 3, consistent with previous findings of a positive effect in movement execution and increases in AROM [49] with the addition of RT to stroke rehabilitation. Our data suggest that the magnitude of improvements in AROM and PROM following the TDS-HM intervention may be greatest for people with stroke with the least AROM and PROM at baseline.…”

Robot-Assisted Reach Training for Improving Upper Extremity Function of Chronic Stroke

“…improve motor function and arm activity of stroke patients, and Frisoli et al (2012) demonstrated that robotic-assisted rehabilitation training including reaching and spatial antigravity movements induced decrement of movement time and improvement of motor recovery and functional movement. Findings from the current study are consistent with previous studies; we believe that the specific and repetitive tasks implemented during robot-assisted reach training led to an improvement of functional movement of the upper extremity in stroke patients.…”

“…Inclusion criteria were 1) hemiparesis from a single stroke occurring at least six months prior, 2) sufficient cognition to follow simple instructions and understand the purpose of the study (Mini-Mental State Examination [MMSE] score > 18 points) (Masiero et al 2011), 3) absence of a musculoskeletal condition that could affect the ability to sit safely, and 4) absence of hemispatial neglect. Exclusion criteria were 1) participation in other studies or rehabilitation programs, 2) shoulder subluxation or pain in the upper limbs, or 3) spasticity (Modified Ashworth Scale score > 2) (Frisoli et al 2012). Two of the 12 potential subjects were excluded because they failed to meet the inclusion criteria.…”

“…With these features, robotic devices allow users to participate in interactive training and motor relearning via high-intensity, repetitive, and frequent tasks (Peter et al 2011;Basteris et al 2014). Frisoli et al (2012) reported that robotic-assisted training with a focus on point-to-point reaching movements was effective in rehabilitating the functional movement of the upper limbs of a group of nine chronic stroke patients. In addition, Staubli et al (2009) investigated the effect of intensive arm training with rehabilitation robots and found that three of four stroke patients showed significant improvements on motor performance.…”

Design Of Smart Robot For Wrist Rehabilitation

“…In particular, the development of upper-limb [13], hand exoskeleton [14] and wrist [17] [48] rehabilitation robotic system was oriented to stroked patients.…”